WOkLD HEALTH ORGANISATION MONDIALE 7 ORGANIZAT'ON 1 JE LA SANTÉ
SEVENTEENTH WORLD HEALTH ASSEMBLY A17/цR/5 Corr.1 10 March 1964 DIX- ЗЕРTIEME ASSEMBТ Е MONDIALE DE LA SANTÉ 10 mars 1964
Compte rendu in extenso Provisional Verbatim Record provisoire
FIFTH PLENARY MEETING CINQUIEME SEANCE PLENIERE
Thursday, 5 March 1964 Jeudi 5 mars 1964 at 9.30 a.m. à9 h.30
Palais des Nations Palais des Nations Geneva Genève
CORRIGENDA
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insérer: Le Professeur HÉLIOS (Grèce): Monsieur le Vice- Président, Messieurs les délégués, au nom de la délégation de mon pays, je tiens, à mon tour, à féliciter chaleureusement notre Président, le Dr Afridi, et vous -même, à l'occasion de votre élection. Qu'il me soit aussi permis d'adresser mes félicitations bien sincères au Directeur général, qui nous a présenté un rapport en tous points remarquable. WORLD HEALTH ORGANISATION MONDIALE ORGANIZATION DE LA SANTÉ
SEVENTEENTH WORT?: HEALTH ASSEMBLY A17 /VR/5 5 March 1964 Da- SEPTIEME ASSEMBLEE MONПIATR DE LA SANTE 5 mars 1964
Compte rendu in extenso Provisional Verbatim Record provisoire
FIFTH PLENARY MEETING CINQUIEME SEANCE PTFNIERE
Thursday, 5 March 1964 Jeudi, 5 mars 1964 at 9.30 a.m. à 9 h.30
Palais des Nations Palais des Nations Geneva Genève
Acting President Mr J. ALVAREZ AMEZQUITA (Mexico) Président par intérim: (Mexique)
later President: Dr M. K. AFRIDI (Pakistan) puis Président:
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CONTENTS
Page
1. General discussion on the reports of the Executive Board and the Report of the Director -General on the Work of WHO in 1963 (continued) 3
2. Award of the Léon Bernard Foundation Prize 65
SOMMAIRE
1. Discussion générale des rapports du Conseil exécutif et du Rapport du Directeur général sur l'activité de l'OMS en 1963 (suite) 3
2. Attribution du Prix de la Fondation Léon Bernard 65 А17/цн/5 page 3
© 1. GENERAL DISCUSSION ON THE REPORTS. OF THE EXECUTIVE BOARD AND THE REPORT OF THE DIRECTOR- GENERAL ON THE WORK OF WHO IN 1963 (continued) DISCUSSION GÉNERAT,F DES RAPPORTS DU CONSEIL EXECUTIF ET DU RAPPORT DU DIRECTEUR GENERAL SUR L'ACTTE DE L'OMS EN 1963 (suite)
Le PRESIDENT PAR.INTERIM (traduction de l'espagnol) : Nous reprenons la dis-
cussion générale sur les points suivants de l'ordre du jour : 1.9, Etude et appro-
bation des rapports du Conseil exécutif sur ses trente -deuxième et trente- troisième
sessions; 1.10, Examen du Rapport annuel du Directeur général sur l'activité de
l'Organisation mondiale de la Santé en 1963.
Avant que ne commencent les interventions, je dois rappeler à Messieurs les
délégués, comme l'a déjà fait observer hier le Président, que le temps dont nous
disposons pour ce débat est limité. J'espère que chacun m'aidera pour que le
nombre maximum d'orateurs puisse prendre la parole.
Le premier orateur inscrit est de le délégué de la République fédérale
d'Allemagne. Le délégué de la RépuЫique fédérale д'Allémagne a la parole.
Le Dr STRALAU (RépuЫique fédérale d'Allemagne) : Monsieur le Président,
Mesdames et Messieurs, je voudrais tout d'abord, Monsieur le Président, vous féli-
citer de votre élection à ces hautes fonctions qui fait honneur à vos activités. А17/VА/5. page 4
Honorables délégués, un des moyens de lutte les plus efficaces contre la maladie
et la mort qui frappent chaque annéе plusieurs millions d'êtres humains est l'amé-
lioration de l'hygiène du milieu. Au nombre des tâches générales les plus importantes
dans ce domaine, on peut ranger les soins à apporter à l'eau. En 1959, déjà,dans
son rapport à la Douzième Assemblée mondiale de la Santé, le Directeur général avait
souligné l'importance de l'eau dans le cadre des efforts déployés en vue d'améliorer
l'hygiène du milieu, et c'est avec satisfaction que nous enregistrons le fait qu'au
cours des cinq dernières années le programme d'approvisionnement public en eau, dont
la réalisation avait été décidée à l'époque, a été abordé sérieusement. Nous sommes disposés à fournir, au cours des années à venir aussi, des contributions volontaires pour encourager ces efforts.
La République fédérale d'Allemagne se rallie sans réserve à l'opinion de l'OМS selon laquelle il faut attacher une importance particul�re au problème de la pro- tection contre les radiations. C'est la raison pour laquelle nous avons porté une attention toute spéciale, au cours de l'аnnéе écoulée, à ce рrоЫèте d'actualité.
Dans le cadre de notre législation, des règlements sont en préparation, qui sont destinés à garantir une protection lors de la production et de l'application des rayons X. La formation des médecins dans le domaine de 'la protection contre les radiations va être intensifiée. Nous nous efforçons constamment d'approfondir nos connaissances relatives aux dangers des radiations ionisantes et aux mesures de protection contre ces dangers. ¢ 17/VR/5 Page 5
Le Gouvernement de la République fédérale est tout particulièrement satisfait
de ce que l'OMS s'active avec tant d'insistance dans le domaine de la détection et
de l'étude des effets nocifs survenant lors de l'application de produits pharmaceu-
tiques et de ce qu'elle s'efforce de retransmettre par les voies les plus rapides
à tous les Etats Membres des renseignements sur ces effets nocifs.
Enfin, je voudrais faire quelques remarques à propos du financement des taches
incombant à l'Organisation. On ne peut pas justifier le fait qu'une augmentation
constc..nte du budget devient =une charge qui ne peut plus; à la longue; être supportée
par les Etats Membres. Il conviendrait donc d'envisager une limitation de l'augmenta-
tion du budget pour l'année 1965 à la proportion déterminée par l'accroissement du
revenu national des pays Membres, déterminée par l'accroissement du niveau des
salaires et des prix, et de maintenir également dans ce cadre, pour autant que cela est possible, les augmentations futures.
Je vous prie de ne pas interpréter ces dernières observations comme une critique de l'activité de l'OMS mais, au contraire, comme l'expression du souci de ne pas dépasser nos propres forces et les forces et possibilités de l'Organisation.
Pour terminer mes remarques, je ne voudrais pas manquer de remercier M. le
DiYrecteur général et ses collaborateurs du travail qu'ils ont accompli dans le courant de l'année qui vient de s'écouler.
Le PRESIDENT PAR INTERIM (traduction de l'espagnol) : Je vous remercie,
Dr Stralau. Le délégué de la RépuЫique du Viet -Nam a la parole. А17/vR/5 page, ½
'Le Dr LE CUU ТRUONG (République du Viet -Nam) : Monsieur le Président,
Messieurs "lés délégués, je voudrais tout d'abord me joindre aux orateurs qui m'ont précédé polir vous adresser, Monsieur le Président, toutes mes félicitations pour votre élection á cette haute fonction. Je voudrais également féliciter M. le Directeur général de l'excellente présentation de son rapport sur les activités de l'0MS en
1963, dont les réalisations et les résultats acquis montrent encore une fois toute l'efficacité des travaux de l'Organisation.
C'est avec satisfaction que je constate l'effort toujours soutenu de TOMS, particulièrement dans les programmes d'éradication du paludisme et des maladies transmissibles en général.. Cet effort est essentiel pour préserver la santé et
élever le niveau de vie des peuples, particulièrement ceux des pays en voie de développement où les fléaux et les maladies existent encore en nombre non négligeable.
C'est le but même de l'OMS, mais qui est encore loin d'être atteint. Aussi cet effort devrait -il être soutenu d'une façón continue, et même, dans l'avenir, il devrait être accru, en particulier dans l'élaboration du prochain programme de travail de l'OMS. La variole, le choléra, la peste, le paludisme, la tuberculose, la lèрrе, etc., sont des maladies qui existent encore, non pas dans tous les pays, bien sûr, mais il est certain que leur éradication comporte de nombreux prob èmes h résoudre, aussi bien sur le plan national qu'international, notamment dans les pays en voie de développement, où les facteurs locaux sont autant de particularités dont nous devrions tenir oompte si nous voulons obtenir de bons résultats. A17/VR/5 page 7
Selon mon opinion, un point important auquel nous devrions accorder une
attention particulière est la surveillance et la consolidation des programmes
d'éradication des maladies transmissibles, afin d'éviter une réapparitión possible
de telle ou telle maladie qu'on croyait disparue définitivement. Les maladies ont
encore leur mystère, mais nous devrions prendre nos mesures pour ne pas être pris
au dépourvu, ce qui, je le reconnais, n "est pas souvent possible.
Ainsi, par exemple, dans mon pays, nous n'avons pas eu de cas de choléra depuis
1953. Avant cette date, le choléra existait à l'état épidémique ou endémique.
Nous avons eu des poussées épidémiques en 1926 -1927; pour tout le pays, durant ces
deux années, on enregistrait 41 874 cas dont 32 580 mortels. En 1937 -1938, nous
avons eu 20 632 cas, dont 15 407 mortels. En 1947 -1948, dans le sud seulement, on
enregistrait 1018 cas, dont 647 mortels. Malgré les mesures préventives que nous
avons prises chaque année dans le cadre de campagnes de vaccination anticholérique
poussées, nous voyons quand même réapparaître une épidémie. de choléra El Tor assez
sévère au début de cette année, faisant un certain nombre de victimes. Immédiate-
ment, les moyens curatifs ont été mis en oeuvre et les mesures préventives prises.
Une équipe d'experts américains conduits par le capitaine Philipps, du Centre de
Recherche Namru II basé à Taiwan, a offert son assistance technique assez tôt pour
que le taux de mortalité baisse d'une manière très appréciab e. Grâce à cette méthode, les malades, si gravement atteints soient -ils, ont beaucoup de chances d'être sauvés s'ils arrivent à temps à l'hôpital. L'apparition du choléra El Tir
(sérotype Ogawa) au Viet -Nam a permis aux experts d'avoir des idées plus précises А17 /VR /5 page 8
sur cette maladie, particulièrement sur une technique thérapeutique par voie orale, qui serait très utile pour les malades des zones rurales se trouvant loin des centres médicaux. Les recherches sont en cours, mais il semble que jusqu'à présent elles ne donnent pas encore de résultats probants au Viet -Nam.
Quant aux mesures préventives, une campagne de masse de vaccination anticho- lérique a couvert tout le pays. Pour mener cette campagne aussi rapidement que possible, les 250 000 centicubes de vaccin fournis quotidiennement par l'Institut
Pasteur de Saigon se trouvent insuffisants. Aussi un certain nombre de pays amis
- les Etats -Unis d'Amérique, l'Angleterre, les Philippines, la Malaisie, la
République de Chine - ont -ils apporté aussitôt leur aide en vaccin et en sérum salé еt bicarbonaté. Au nom de mon gouvernement, je leur adresse ici mes sincères remerciements. Qu'ils sachent que leur aide et leurs dons ont sauvé beaucoup de malades et nous ont permis d'une manière très efficace d'empécher que l'épidémie ne s'étende.
Je voudrais aussi vous parler en quelques mots, Monsieur le Président, de quelques-unes de nos activités sanitaires au cours de l'année 1963. Elles ont porté en général sur nos programmes de santé publique, mais se sont étendues particulière- ment aux régions rurales. Les programmes d'éradication du paludisme, de lutte contre la tuberculose, de protection maternelle et infantile, d'assainissement, d'immunisation, de lutte contre la lèpre, de santé mentale, de nutrition, d'ensei- gnement et de formation professionnelle, de statistiques sanitaires se développent A17/VR /5 page 9
régulièrement. Pour donner à tous ces programmes toute l'efficacité voulue, nous avons renforcé nos services de santé et formé un personnel sanitaire qualifié et en nombre suffisant. Un séminaire de soins infirmiers a réuni en septembre 1963 tous les responsables de l'enseignement et de la formation du personnel infirmier de toutes catégories.
Je voudrais, avant de terminer, vous parler en quelques mots de notre nouveau projet d'approvisionnement en eau de la ville de Saigon. L'ancien système d'appro- visionnement au moyen des puits (Layne), prévu pour une ville de 400 000 habitants, est devenu insuffisant pour satisfaire les besoins en eau d'une population de près de 2 millions d'habitants. Telle est la situation de notre capitale, la ville de
Saigon. Nous avons élaboré un projet d'adduction d'eau du fleuve de Douai situé
à une trentaine de kilomètres de Saigon. Les travaux, d'un coût total de k3 millions de dollars environ, ont commencé il y a plus d'un an et vont être terminés à la fin de 1964 ou au début de 1965. Les habitants de la ville de Saigon, qui recevaient
150 000 mètres cubes par jour avec l'ancien système de puits, auront la possibilité d'utiliser 450 000 mètres cubes jusqu'à un maximum de 800 000 mètres cubes par jour.
Je m'excuse, Monsieur le Président, de m'être étendu sur les activités sanitaires de mon pays, mais j'aurais voulu vous montrer, malgré toutes les difficultés ren- contrées, l'effort de mon gouvernement pour la lutte contre les maladies et pour l'amélioration du niveau de vie de la population. А17/V1/5 ¹¸´ 10
Le PR.ESIDENТ PAR INTERIM (traduction de l'espagnol): Merci,
Dr Le Cuu Truing. Le délégué du Royaume -Uni de Grande- Bretagne et d'Irlande du Nord a la parole.
Sir George GODBвh (United Kingdom of Great Britain and Northern Ireland):
Mr Vice -President, the United Kingdom delegation shares in the evident pleasure of this Assembly in the election of Dr Afridi and in your own presence in the Chair this morning. The President asked speakers to be brief, and I will try to keep my comments on the Director -General's admirable report within the five minutes which I hope is a reasonable interpretation of his wish.
The report records two encouraging developments in the control of
smallpox - the wider availability of freeze -dried vaccine and the first field
trial of the new British anti -viral drug, methylisatin thiosemicarbasone. It
is to be hoped that further field trials of this drug can be pressed on in
endemic areas, for it might provide that rapid reduction of spread of
infection among those known to have been exposed which is so badly needed to
supplement the primary prevention obtainable from adequate vaccination. We
can already prevent infection, but we can only rely on isolation to contain it,
once it has been acquired, and that isolation is rarely complete. А17fVR/5 page 11
My delegation, though temporarily without a Scot, takes pleasure in the
reported success of the link between the Edinburgh and Banda Schools of
Medicine. This seems an admirable method of mutual assistance - for it is mutual - and one we earnestly hope to be able to repeat elsewhere.
We are to discuss later the control of toxic effects of drugs. A beginning has been made in the interchange of information on such effects, but it will obviously require much improvement both in countries' own methods of reporting and appraisal of such findings, and in the review and dissemination of such information by WHO. We have had examples of chance association of congenital abnormalities with the use, in pregnancy, of anti -emetic drugs, leading to needless alarm and restriction of use of drugs subsequently shown to be innocuous. It is obvious that each country must look first to its own reporting service, and that Britain has done. A new expert body now reviews the scientific information -on all new drugs both before release for clinical trial and before release for general use. It is also developing a reporting system on all late toxic effects of drugs already in use. A system of reporting all congenital defects apparent at birth has been introduced; and we gladly acknowledge the help we have had from other Member
States and from the Organization, and also the ready participation of the pharmaceutical industry and the medical profession in a general but voluntary scheme in our own country. A17М/5 page 1?
Finally, I must refer to one matter in which, with great regret, I find myself at variance with the Director -General - and I have so great a respect for Dr Candau that I do not do that lightly. We have an admirable report on research activities which so far follow the proper pattern of research developments in WHO. Much valuable co- ordination of national effort has been achieved and many special studies have been initiated, and even sponsored, where expert advice indicated a need; there is obviously opportunity for further development here. But I cannot support the idea of a WHO centre for fundamental research in medical and allied biological fields. This is not simply because of costs but because the scientific concept seems wrong.
Research activities of this kind ought to be related to the national health services from which they spring. There is room for a difference of opinion here, of course, but the best scientific advice I have been able to obtain - including the views of some of those whose names appear among those consulted about the new project - is that such a project is not only unjustified at this time but might even affect adversely the work of the scientists concerned, withdrawn as they would be from the national centres in which they now work.
It is of course premature to discuss this at the Assembly now, because it is only before us for information pending further study by the Executive Board and we must wait upon the outcome of that. I mention this only because of the
Director -General's concluding remarks. It would be quite unfair to him not to sound this warning note. Thank you, Mr President. A 17/VR /5 page 13
Le РRESIDENТ PAR INTERIM (traduction de l'espagnol): Je vous remercie,
Sir George. Le délégué de l'Union des Républiques socialistes soviétiques a la
parole.
Dr SERENКO (Union of Soviet Socialist Republics) (translation from the Russian):
Mr President, allow me on behalf of the Soviet delegation to congratulate you on your
election to the august and responsible post of President of the Seventeenth World
Health Assembly. Allow me also to thank Mr Majekodunmi for his excellent work as
President of the Sixteenth World Health Assembly.
Mr President, fellow delegates, ladies and gentlemen, the Seventeenth World
Health Assembly is starting its work at an auspicious moment, when we are all witnessing an important event which inspires the people of the world with fresh hope. The
conclusion of the Moscow Treaty on the partial discontinuation of nuclear weapon tests gives us grounds to believe that governments will continue these peace - loving moves and that mankind may be secure in the expectation of a peaceful existence, friendly co- operation and increased prosperity. The hope is strengthened that our organization's work will find a more favourable soil and will promote to a greater degree the fulfil- ment of the provisions of the WHO Constitution regarding the attainment by all peoples
of the highest possible level of health.
After hearing the Director -General's interesting report, we are all aware of the need to make a general evaluation of the health situation and of the main health problems in the world against a background of economic, social and cultural progress. A 17/VR/5 page 11•
Such an analysis of world health problems will undoubtedly help to define and make more precise the aims, trends and methods of WHO activities.
It is clear to anyone that we are living at a time when the pattern of disease in most countries has changed sharply. We are often told that in the developed countries neuropsychiatrie diseases and the prevalence of malignant neoplasms, cardio- vascular disorders and the so- called degenerative diseases constitute the most impor- tant health problems. Indeed, investigations by epidemiologists, demographers, statisticians and other specialists show that 70 per cent. of all mortality in these countries can be laid to the account of cardiovascular diseases and malignant tumours.
A large percentage of persons are suffering from neuropsychiatrie disorders of one sort or another. Accidents, particularly in the home and on the roads, are responsible for over a half the deaths among children and adolescents. Endocrine disorders and disturbances of the metabolism constitute a problem which is causing more and more anxiety in the developed countries.
At the same time, there are extensive areas of the world, particularly in Asia,
Africa and South America that remain, as it were, "disease reserves ", in which plague, 4 in many instances cholera, and also smallpox are still widespread and in which malaria, bilharziasis, yaws and trachoma and other infections have, so to speak, made comfortable nests for themselves.
The pattern of disease therefore presents two aspects, outwardly very unlike because of the sharp differences still existing in social, economic, material and cultural conditions in the life of the peoples. However, reports have recently been coming in to the effect that there is a tendency for the disease patterns in various A17/VR/5 page 15
countries and various parts of the world to become more alike. We can now speak of the prospect of a more or less identical pattern of disease appearing in the various countries. Already today there are indications of this in such facts as the compara- tively wide distribution of cardiovascular diseases, malignant tumours and certain degenerative diseases, as well as of other specific disorders, in a number of areas of Africa and Asia. The trend towards a universal epidemiological pattern does not of course put an end to those differences in pathological processes that arise as a result of differences of a climatic, economic and medico -geographical nature. Never- theless, the main health problems mentioned above will obviously become general problems for the majority of states and parts of the world. That is the trend of historical, socio- economic and cultural progress. Accordingly the main task of our
World Organization, the main bias of its activities, should be to promote the develop- ment of that trend.
Seen in this light, the work of our organization in attacking the weakest and the most easily broken links in the chain of diseases is particularly important. As has repeatedly been pointed out in debates in WHO, infectious and parasitic diseases in developing countries, which still remain the most important problem of those countries.` health services, form one such vulnerable point.
First and foremost in importance are WHO's activities for the eradication of smallpox in the world. As was demonstrated as long ago as 1958, when WHO adopted its programme for the eradication of this disease, we possess all the necessary ¢ 17/VR/5 page 16
conditions and means for eradicating it: vaccination, and if necessary revaccination, in endemic areas, with thermostable smallpox vaccine - that is a practical and perfectly feasible programme. Yet in 1964, when we expected to be able to celebrate the conclusion of the campaign and to congratulate one another on the complete eradication of smallpox from the world, we are obliged once again to turn our attention to the statistics of new victims of the disease: not just individual cases, but tens of thousands of cases of infection and death are occurring, as they did before.
Obviously, we cannot and must not calmly fall back on the usual phrases and explanatiotis as to why the world smallpox eradication campaign should have lost its impetus like this, explanations that generally have to do with lack of resources. The problem of sma.11pox eradication must now, at long last, be given its rightful place in WHO's work.
The paramount role of socio- economic and cultural factors in the development of the health services and in the changing pattern of disease, is being particularly clearly demonstrated now in WHO's malaria eradication work. Most instructive and striking figures and considerations were brought forward at the last session of the
Executive Board: it appears that, after the malaria eradication campaign has been in progress for nearly ten years, not less but considerably more efforts and resources are required to secure its complete success than were envisaged in 1955. According to the conservative estimate of the Secretariat, the campaign still needs some 1800 mi1'_!.on dollars, whereas the estimated figure in 1955 was 1600 million dollars. _t is becoming abundantly clear to everyone that only a concerted effort to raise the А7.7/VR/5 page 17
population's material standard of living, the setting up of extensive, widely
diversified well -run health services, the use of mechanical and chemical control
methods, land improvement, and new methods of therapy, can ensure the success of the
malaria eradication campaign. It is not only methods and tactics that require
revision, but also the whole orientation, the strategy, of WHO's malaria eradication
work. Thus, fellow delegates, WHO can actively contribute to progress in the
changing pattern of disease, in eliminating the differences in the pattern of pathologi-
cal processes in different States and areas, primarily through its scientific advisory
and expert work, directed first and foremost towards working out the most rational
methods or, if you prefer, methodology to employ in the struggle for the health of
the peoples.
Nevertheless one frequently hears somewhat different concepts of the way in
which WHO should work. One such concept is that disease control and health protection
are the decisive factors in the social, cultural and economic progress of society.
And while it is quite obvious that a connexion exists between the state of a population's 0 health and the health services on the one hand, and the development of production and
the level of prosperity on the other, we are all realists and cannot but be aware
that the best cure for disease, and the main cure, is not drugs but social, cultural
and economic progress. The saying that a poor economy is the enemy of health, is
therefore profoundly true.
Adopting this, the only correct view, one can hardly expect to see any substantial
results from the activities of WHO as a body providing material assistance, as an A 1.7/x/5 page 18 organization that endeavours to supplement national expenditures and resources devoted to health. Substantial results could not seriously be anticipated even if our organization's budget were to increase at an even faster rate than it is doing at present - and the present rate of increase is already excessively high. Activities of this kind on the part of WHO can only remain a drop in the ocean of the countries' and nations' growing needs for the protection and improvement of their peoples' health. In saying that, I am not pointing out anything new. The only rational lines along which our organization should mainly work must be those that are clearly and unambiguously laid down in its Constitution: the concentration of collective efforts on advisory, experimental and methodological activities. A recommendation should be made that the dispersal of our slender resources on secondary and less important programmes and projects must cease. Encouraging in this connexion are the proposals of the Executive Board, mentioned in the Director -General's Report, concerning the need to review our organization's methods of work with a view to economy of resources and concentration of effort on the most important types of work.
This point is assuming special importance now that, parallel with the tendency, already referred to, for the disease pattern to become more nearly similar in differsn'..�. countries, new problems are arising as a result of the progress of modern technology, science and administration. Mankind is now being confronted with a number of new tasks in connexion with the control of cardiovascular diseases, accidents, neuropsychia rie disorders and other factors endangering health. WHO is clearly, therefore, adopting the right course in setting up study groups and expert committees with the specific task of studying these new kinds of danger to human health - which include А17/VR/5 page 19 automation, the effects of atomic energy, and the like. Thus the significance of
WHO's intensified research programme is becoming most important in the Organization's work. And although a number of Member States of our organization have not yet been confronted with these problems, it must not be forgotten that, in those countries too, they are lying in wait for the public health services. These problems are, moreover, so numerous arid complex, and study of them requires such immense expenditures, that all the projects for the setting up of a WHO scientific centre or a group of centres operating under the World Organization's auspices, with their large budgets, do not amount to even an infinitesimal fraction of the real material and financial resources required to solve these problems. Only jointly planned, co- ordinated work on the part of large numbers of scientific institutes in all the countries of the world is capable of solving these new problems that confront mankind. Tempting and inspiring though it is, the plan for the setting up of WHO research centres can accordingly do nothing whatever to solve these new problems. What is required is that WHO concentrate to a still greater degree, within the limits of its budget, on the development of international scientific co- operation and on encouraging the scientific research already being carried out in different countries. We feel that the World Health
Organization would not be taking the right course in having its own scientific institutes and centres and other material possessions. In order to extend its field of influence and the limits of its action to any considerable degree, and become a mighty centre A 17/'ТR/5 page 20
for research and for providing countries with practical assistance, including
financial assistance, WHO would have to increase its expenditure tenfold, nay, a
hundredfold. Obviously, that is imposciblе at present. WHO's programme of work
can be extended by one means only, namely by general and complete disarmament, which
would release for mankind's use immense material resources that could secure ideal
conditions for the work of the World Health Organization. Accordingly one of the
main directions of WHO's activities, making it possible to improve human health and
to preserve human life, should be towards promoting general and complete disarmament.
Another worthy type of health activity in our time is the fight which is being
fought by medical workers against the pessimism, despondency and despair in which
many people are sunk today. It is no accident that certain trends in contemporary
philosophical thought, beginning with personalism and ending with new varieties of
finalism, are proclaiming that civilization and progress will perish. The work of.
WHO and national health bodies to promote general physical and mental health, the
health of the individual and of nations, is the cure for such gloomy thoughts. This
is a great and humane activity. The World Health Organization must not remain aloof
from it. The World Health Organization must make its contribution to the strengthening
of peace throughout the world, and call upon the health workers of all countries to
strive together for a further strengthening of friendship between the nations and an
intensification of international co- operation.
Le PRÉSIDENT PAR INTERIM (traduction de l'espagnol): Je vous remercie,
Dr Serenko. Le délégué des Etats -Unis d'Amérique a la parole. A17/VR /5 page 21
Dr TERRY (United States of America): Mr Vice -President, friends and
distinguished colleagues, I am deeply privileged to bring the greetings of my
Government to the nations represented at this the Seventeenth Assembly of the
World Health Organization.
On behalf of my delegation and myself, I wish to congratulate our new President,
Dr Afridi, on his election to this position. I should also, at this time, like
to congratulate our three Vice -Presidents and indicate that we are particularly
1 happy at this time to have presiding in the Chair our good neighbour and distinguished
colleague, the Minister of Health of Mexico. I also wish to extend our congratu-
lations to our immediate past -President, Dr Majekodunmi, on the smooth and successful
completion of the duties of his office.
The Director -General in his excellent annual report points out that, and I
quote, "WHO must constantly strike a balance between three main objectives:
(1) to provide assistance to countries anxious to deal with their immediate health
problems; (2) to help them in their long -term efforts to strengthen their local
and national health services; and (3) to serve as an effective channel of
communication on technical and scientific information
While congratulating the Director- General on his brilliant record of progress,
let us make just a few selected remarks on each of these broad objectives. A17 /\ТR/5 page 22
First - immediate health problems. We are again encouraged by the progress which has been made in the world -wide malaria eradication campaign. Despite formidable obstacles, we are moving ahead against this ancient and stubborn scourge of mankind. More and more areas are moving into the consolidation phase and many nations have been declared free of the disease. As you know,
Mr Vice -President, my Government has for many years supported the world -wide eradication programme. Less than a month ago, President Johnson renewed our support in a special health message to the Congress. He pledged the United
States of America to continued, vigorous effort. We are fully committed to the objectives of this programme and to the leadership of WHO. Under no circumstances can we permit any relaxation, nor can we delay this programme pending the development of supporting health services. Community health services are of course essential in every country of the world, but development of local health services can progress hand in hand with malaria eradication. Never before in history have the nations of the world attempted by co- operative action to eradicate a disease from the face of the earth. his is an enormous task, certainly one of the most difficult ever undertaken in the health field and surely one of the most rewarding to humanity.
Of the second broad WHO mission - the longer range health problems of Member countries and the relationship between those problems and the great goals of economic development - let me single out the problem of community water supply. А17/VR/5 page 25
It takes skills and money to eradicate malaria, but it takes an even greater variety of skills, and often a great deal of money, to solve the problems of water
supply such as were so graphically illustrated in Dr Candau's report. In the past year some notable progress has been made in the achievement of greater international co- operation to oversome the major water problems of the world:
(1) the Inter- American Development Bank has undertaken some comprehensive urban water programmes; (2) the United Nations Special Fund has adopted a new and encouraging policy of seeking out pre -investment and pilot projects in rural and urban water supplies. The Special Fund has also shown itself willing to finance the training of water supply technicians and middle -level health technicians whose skills are needed, particularly in the rural areas, where water is a major development problem. As these financial institutions and others become more interested in using the skills of health engineers to serve the general goal of economic and social development, the tasks of and opportunities open to WHO and to the regional organizations are going to be much greater. We are going to have to think bigger about this subject in WHO. When I say "think bigger" I mean something quite practical. It is not only enough to dig a well in a rural area to provide a ready water supply to a needy village. We have to think in terms of water tables, and of industrial, commercial and the agricultural users of water since we know that these will be the big consumers of water in the future. We are going to have to think bigger in terms of establishing appropriate organizations and in terms of training engineers, chemists, biologists and others to staff these organizations. А17 /vR/5 page 2�F
If we are going to make good use of the money available from financial
institutions, we are going to have to first develop well -engineered projects
and sound programmes of management at the national level.
In some parts of the world, we know enough now to say categorically that
the water problem will not yield without concentrating more skills and a great deal of capital. What better example than the city of Calcutta? The water problems of that city have been studied by a host of organizations, national and
international, yet they remain today stubborn obstacles to health and development
in that part of India. Calcutta with its environs, according to the Minister of Health of India, is an endemic focus of cholera. From the city, the disease
spreads to other parts of India from time to time, and there is danger of it
spreading to other countries as well. Here is an immediate health danger which
is intimately wrapped up in a major long -range development problem. It is beyond our ingenuity to combine talents and money from national and international sources
to solve both of these inter -related problems, is it? Can we not offer to the
Government of India a partnership made up of WHO and, say, the World Bank - with
further finance provided by bilateral aid programmes if necessary - a partnership which could bring to bear the resources needed to break through the water problem
in Calcutta? Can we not start now to "think big" about Calcutta?
Health of course is the first requirement for economic and social development.
For human energy, the product of health, is the great common denominator of economic and social progress. This is so obvious that I am continually amazed А17 /Vа/5 page 25
that in some quarters, even today, we hear economists and financiers saying that health really does not deserve a top priority in the development plans and programmes of the developing countries. We are told that education or agriculture must come first. We are told that the "engineers" of health programmes, doctors and technicians, have been too successful; that they have released too much human energy in relation to the productive work and opportunities for progress open to the peoples of the developing countries. I reject this pessimistic note.
No branch of science or technology has contributed more solid hope, more real opportunity for economic and social progress than medicine and public health.
That is why WHO must accept the role of a leader - and be accepted as a leader - among international development organizations in this Decade of Development.
Finally let me say a word about WHO's third major objective - to act as "an
14 effective channel of communication on technical and scientific information . .
I think it is safe to say that we are entering on a new and exciting chapter on international co- operation in the field of research. There are in train two great initiatives: the one spoken by the late President Kennedy at the United
Nations, last fall, and the other by President de Gaulle shortly afterwards. I would venture the prediction that both these initiatives will come together here in WHO, where Dr Сandаu has already prepared the ground. Ten years from now, I am confident that we will look back on our current deliberations here in WHO as the starting point of a great adventure in research. А17 /./.5 page 26
.My Government welëomes wholeheartedly the leadership which the Government of
France has taken in suggesting that there be created an affiliate of WHO, a research
fund and an advisory group concerned with cancer. research., We believe that President
Kennedy's call fora world health communication centre, under the direction.,of WHO,
is in every way compatible with and complementary to this initiative. In fact the
deliberations which have been going on recently. in Paris suggest to me that,the
features common to these two great ideas give us a way, to begin.. .
There is nothing more frustratingto a research scientist than to, find that he has "rediscovered" a known fact. Imperfect communication of scientific knowledge
is wasteful in many ways. Most important of all, communication failures slow down
our progress against disease and can result from more than simply failures to
communicate, rapidly, known knowledge. Failures can also result from haphazard reporting practices and diagnostic techniques which do not allow for.swift and efficient communication. Thus. to mount a world campaign against cancer we must._
seek to make this organization something more than the communication centre it already is. It must have at its disposal those tools of modern technology, which will permit the scientists to work at their tasks secure in the knowledge that :they know clearly, and at all times, the place where the known ends and the unknown begins. ,There. must be. uniform reporting practices and recognized diagnostic techniques. These would be among, the new services WHO would, seek to supply, as a world health communication centre. A17 /VR /5 page 27
We would hope, and expect too, that eventually WHO and its research affiliates would also give considerable attention to demonstration projects. For example, the technical developments of jet injectors and their uses in the United States and elsewhere for giving mass vaccinations suggests that this is a most important new tool for helping the control of communicable diseases throughout the world.
Training and demonstrations of this method of immunization have recently been conducted by several African countries, using a new vaccine against measles, under a programme
jointly sponsored by the United States National Institutes of Health and Agency for
International Development. Studies now show that it is entirely feasible to use a jet injector for smallpox vaccination. The vaccine is effective in the jet injector when diluted ten -fold, giving results at least equal to those obtained by the best present methods. Studies in progress give us reason to believe that even a 1 to 50 dilution of the vaccine may well provide the required protection when given by this method. The significance of this finding to the problem of vaccine shortages is quite evident.
The opportunities before us for increased international co- operation in biomedical research are very great indeed. The task immediately ahead is to decide how and where to start. This task can be put into a simple question: how best can a new departure in international co- operation make more effective existing national research efforts and help to build a national research capacity in those tropical areas of the world where disease is so much a barrier to national development? By A17 /VR/5 page 28
next year, at this Assembly, it is my profound hope that here, in WHO, we will together have fashioned an exciting answer to this question.
The three missions of WHO - disease control, long -range health problems and their relations to the broad goals of economic development and co- operative ventures in biomedical research - all must proceed together. This means very hard choices ahead for this Assembly - choices forced on us by the always scarce resources available, in terms of human talent quite as much as in terms of money. With this thought in mind, may I leave you with a final plea? Let us preserve WHO as an island of hope and progress in this divided world, a place where we can make hard technical choices without having, at the same time, to bear the burdens of political dispute. There is so much to do, so much opportunity, so much challenge, that we cannot afford to attempt to treat the diseases of the body politic of the world without sacrificing priceless opportunities to treat the diseases of human beings. Let us, however hard it may be, leave behind the trappings of nationalism when we enter the doors of this Assembly in order that we may be able to serve those people behind all governments who look to us, not for political solutions but for medical solutions.
Î Le PRESIDENT PAR INTERIM (traduction de l'espagnol): je vous remercie,
Dr Terry. Le délégué du Cameroun a la parole. A17/VR/5 page 29
Le Dr TCHOUNGUI (Сamеrоun) : Monsieur le Président, honorables délégués, puisque l'occasion m'est offerte de prendre la parole à l'occasion de la discus- sion du rapport de M. le Directeur général, je voudrais avant toute chose, au nom de la délégation camerounaise et en mon nom personnel, féliciter le colonel Afridi de sa brillante élection au fauteuil présidentiel.
Si j'ai tenu, mes chers collègues, à appeler le colonel Afridi par son grade, c'est pour mieux souligner la brillante carrière qu'il fit dans l'armée. Bacté- riologue et parasitologue éminent, il fut choisi dès 1933 par le Département indien de la Recherche médicale et nommé à l'Institut de Paludologie de l'Inde.
Pendant la guerre, il a servi en Afrique, en Irak, en Iran, en Birmanie, en
Malaisie et en Thaïlande comme consultant en paludologie de. l'armée. Bt lorsqu'en
1955 le colonel Afridi prend sa retraite, il n'en continue pas moins d'exercer son activité au profit de son pays, puisque de 1958 á 1962, i1 remplit les fonc- tions de vice-chancelier de l'Université de Peshawar et de conseiller au Ministère de la Santé du Gouvernement du Pakistan. Ses connaissances étendues de l'adminis- tration de la santé publique ont incité l'Organisation mondiale de la Santé à s'assurer sa collaboration, non pas seulement en qualité de consultant, mais comme
Directeur régional adjoint. Représentant du Pakistan au Conseil exécutif de l'OMS, il en fut élu Président en 1962. Je connais personnellement cet homme courtois et affable qu'est le colonel Afridi. J'ai eu l'occasion de le rencontrer depuis plusieurs années aux sessions de l'Assemblée mondiale de la Santé et je me réjouis de le voir occuper la lourde charge de Président de l'Assemblée. A17/á/5 page 30
Mes félicitations vont également à Madame et à Messieurs les Vice- Présidents
de l'Assemblée ainsi qu'aux personnalités qui auront la tache de diriger les dé-
bats des commissions. Qu'il me soit permis également de souhaiter la bienvenue
dans cette assemblée a deux Etats frères africains qui viennent d'accéder à l'in-
dépendance, le Kenya et Zanzibar. Le Cameroun désire vivement que d'autres
viennent rapidement se joindre à nous, car nous ne serons jamais assez nombreux
et assez forts pour lutter contre la maladie. Je voudrais enfin féliciter et
remercier.le Dr Majekodunmi de la manière si éloquente dont il a su assumer les
lourdes taches qui lui incombaient en tant que Président de la Seizième Assemblée.
La lutte contre la maladie, l'Organisation mondiale de la Santé depuis sa
création l'a, entreprise sur une vaste échelle, et je n'en veux pour preuve que
le remarquable exposé qui nous a été fait par le Dr Candau, Directeur général
de l'Organisation. Ne nous a -t -il pas dit que la lutte contre le paludisme était
la. plus prodigieuse entreprise sanitaire de l'histoire, mise en oeuvre par l'0MS
à l'échelle mondiale. Cette lutte commence, et si nous pouvons le féliciter des
progrès réalisés depuis huit ans, force nous est de constater les échecs que nous
avons enregistrés. Ceux -ci ne constituent cependant pas un barrage infranchis-
sable, ils ont contribué seulement à nous montrer les failles du système que nous
avions mis en place.
Depuis prés de sept ans, la lutte contre le paludisme a été entreprise au
Cameroun avec l'aide de l'Organisation mondiale de la Santé par la création de
zones pilotes en région forestière et en savane. Malgré tous les efforts déployés,
nous nous sommes aperçus que nous n'étions pas parvenus à l'interruption de la А17 /VR /5 page 31
transmission dans ces zones. A cet échec, de nombreuses explications ont été
fournies : mobilité de la population, exophilie du vecteur, résistance aux insec-
ticides, etc. En fait, nous pensons avec le Dr Candau qu'il importe en premier
lieu d'améliorer la santé publique en général, c'est -à -dire de mettre en place
une infrastructure solide avec un personnel qualifié, sur laquelle pourra s'appuyer un service d'éradication du paludisme. L'infrastructure sanitaire est une affaire
de gouvernement et le Cameroun s'y consacre entièrement puisque le budget de la
santé atteindra cette année deux milliards de francs CFA, soit près de 12 de
son budget. La formation du personnel qualifié a été prise en charge par 1'OMS,
et nous devons remercier l'Organisation d'avoir créé au Togo un centre de palu-
dologie, dont l'inauguration vient d'avoir lieu ces jours derniers à Lomé. Ce
centre formera le personnel supérieur et subalterne qui sera engagé dans les cam- pagnes de lutte contre le paludisme en Afrique.
Un dernier point capital pour la lutte contre le paludisme est la coordina- tion des activités entre les pays intéressés, car il est bien évident que toute campagne conduite dans un territoire est vouée à l'échec si une campagne analogue n'est pas menée concurremment dans les pays limitrophes. De cette nécessité de
collaboration, le Cameroun est conscient, pour la lutte non seulement contre le paludisme, mais aussi contre les épidémies et endémies qui déciment encore nos populations; tous les Etats équatoriaux le sont également, et c'est pourquoi en
1963 nous nous sommes réunis pour créer une organisation de coordination et de coopération pour la lutte contre les grandes endémies en Afrique centrale, à А17/vR/5 page 32
l'image de l'organisation existant déjà pour l'Afrique de l'Ouest et dont l'acti-
vité et l'efficacité ne peuvent étrе discutées. Nous pensons ainsi collaborer
avec l'Organisation mondiale de la Santé et mener à bien une lutte coordonnée
contre les moustiques et les multiples affections auxquelles est exposée notre population équatoriale.
Monsieur le Président, je ne désirerais pas abuser du temps de parole qui m'est accordé; aussi n'est -il pas dans mes intentions d'analyser les multiples sujets remarquablement traités dans le rapport de M. le Directeur général, me réservant d'en traiter quelques -uns lors de la discussion du programme et du budget. I1 n'est pas davantage dans mes intentions d'imposer à mes collègues le détail des activités sanitaires dans la Répub ique fédérale du Cameroun. Deux
problèmes cepвndant méritent à mon avis une attention particulière : la forma- tion du personnel et la recherche médicale.
Pour nous, pays africains en voie de développement, la formation d'un per- sonnel médical et paramédical qualifié est capitale. Lui seul conditionnera la bonne marche de nos services sanitaires et spéciaux et, je l'ai déjà dit à la tribune de cette assemblée, la formation de ce personnel, à quelque échelon qu'il appartienne, doit se faire en Afrique. Le Gouvernement du Cameroun a sol- licité et obtenu l'assistance de TOMS pour l'aider à créer une faculté mixte de médecine et de pharmacie et pour le conseiller dans l'enseignement des soins infirmiers. Cette obligation nous est apparue comme une nécessité car si l'en - seignement dispensé en Europe est indiscutable sur le plan scientifique, il pré- sente cependant de nombreux écueils. L'étudiant qui l'a suivi ne peut l'adapter A17/)R/5 page 33
à son pays : i1 est resté lui -même trop longtemps éloigné pour pouvoir se réadapter au milieu des siens. C'est pourquoi il hésite à rentrer, et même lorsqu'il le fait, il se trouve alors dans des conditions de travail bien différentes de celles qu'il a connues en Europe (personnel subalterne peu compétent, crédits limités, diffi- cultés d'existence, etc.), toutes conditions qui lui étaient totalement inconnues, auxquelles il a du mal à s'adapter et qui le laissent déçu et désorienté. D'autre part, il est peu au courant des diverses affections tropicales, de leur incidence sur la morbidité générale; il pense et agit en médecin praticien mais pas en mé- decin de la santé publique.
L'Organisation mondiale de la Santé a entendu notre appel, et nous exprimons tous nos remerciements aux éminents professeurs européens membres de l'équipe consultative de l'OMS, qui pendant un mois ont visité notre pays, étudié nos pro - b èmes sanitaires et jugé nécessaire la création d'une école de médecine en
Afrique centrale. Ils nous ont laissé de remarquables directives de planification qu'il ne reste plus qu'à suivre et à réaliser sans tarder.
Le problème de la recherche médicale est encore plus vaste et il ne m'est pas permis de porter un jugement sur cette question après l'excellent travail fourni par les experts hautement qualifiés qui eurent á l'étudier. Toutefois, je puis dire que le Cameroun collaborera dans une faible mesure au programme de ces recherches médicales. Un laboratoire de virologie vient d'être ouvert à l'Institut
Pasteur du Cameroun ayant à sa tête un chef de service diplômé de l'Institut Pasteur de Paris qui pendant un an a suivi l'enseignement du Professeur Lépine. Deux médecins A17 /VR/5 page 3�+
camerounais, actuellement en stage à l'Institut Pasteur de Paris, compléteront très rapidement cette équipe de chercheurs et je suis heureux d'annoncer que l'étude des arbovirus et entérovirus sur cultures cellulaires a déjà permis d'isoler plusieurs virus poliomyélitiques autochtones. C'est cette recherche médicale ap- pliquée qui présente pour nos pays africains un caractère d'urgence pour le plus grand bénéfice de notre population. Je pense, pour ma part, qu'elle doit cependant
être adaptée avec le plus grand soin aux autres activités de l'Organisation mondiale de la Santé, et le Cameroun s'efforcera quant à lui d'apporter sa modeste contribu- tion à cette grande oeuvre humanitaire.
Voilà, Monsieur le Président, les quelques réflexions que m'a suggérées la lecture du rapport annuel de M. le Directeur général. Je vous remercie, ainsi que l'Assemblée, de m'avoir accordé votre attention.
Le PRESIDENT PAR INTERIM (traduction de l'espagnol) : Je vous remercie,
Dr Tchoungui..Le дélеguе de la Norvège a la parole.
Dr EVANG (Norway): Mr Vice -President, in commenting upon the excellent reports before us, I will limit myself to a few aspects which to me seem to be of great, indeed fundamental importance in evaluating the work of this organization, in the year l963. Of course, in discussing retrospectively the work of our organization in the single given year we also to some extent are setting a pattern for the future, which is of course the intention, an aim, of the general discussion. A17 /vн /5 page 35
Now what sort of an organization are these two reports telling us about?
Let us, dear fellow delegates, for one moment try to detach ourselves from what we know about the development of the World Health Organization over the fifteen years of its existence. Let us forget about our prides and prejudices in relation to this organization. Let us try to feel that we come back from lunar existence for fifteen years and are reading these two reports to get a picture of the World
Health Organization. We meet then an international organization, governmental, part of the United Nations machinery but economically independent, and, to a remarkably high degree as far as its technical work is concerned, a non -political organization, which has obviously won the trust, the confidence, the respect, indeed in many cases the love of its Member States. It participated in this very year, 1963, in more than 800 different health projects in 1k) countries: health projects covering a wide variety in the fields of promotion of health, prevention of disease, curative medicine, rehabilitation, research and education. The exchange of scientific insight, the practical experience of administrative and educational patterns, took place through the good offices of this organization at breath -taking speed and over a very broad front. Under fellowships programmes and exchange programmes for scientific research workers, hundreds, indeed thousands, of young, middle -aged, and old people were crossing borders with the intent of gathering knowledge, of improving health services, alleviating pain and suffering and making more effective health services. And in spite of all these far -flung А17 /vR /5 page 36
activities calling also for very complex and complicated co- operation with national governments in countries in different stages of development, with non -governmental organizations, etc., through regional offices of this organi- zation strategically located, you could in fact read of no scandals, of no flagrant failures, of no serious discontent or severe, justified and concrete criticism.
This does not mean, of course, that everything went according to plan, that we succeeded everywhere, that the Organization did not on some occasions put money on the wrong horse. What it means, as far as I can see, from the reports and also from the comments coming from big and small, developed and developing countries is that Member States and WHO as an organization have found one another in constructive down -to -earth health work on a surprisingly broad front of attack, that governments are no longer afraid of asking WHO for services, and that WHO has gradually been able to develop methods for international health work of remarkable quality and flexibility. Now, this of course may sound like a sunny Sunday afternoon lazy picnic story. It is not. It is the story of very hard work, painstaking planning, intense efforts on behalf of a large number of devoted people in the Secretariat, in the health administrations of the countries concerned, at the local levels where the operations are taking place. It is also the story of the well -known and universal human inadequacies, weaknesses - the story of corruption, delays., disappointments, frustrations, but А17/vR/5 page 37
also the story of how to handle these ever existing peculiarities of human beings.
It.is, in short, the story of an organization working on the whole successfully
in an extremely complicated field where no real precedent existed. Also the
Organization proved in 1963 that it can meet emergencies - and it did all this,
Mr Vice-President, at a remarkably low cost. We take all this for granted.
Eighteen years ago - or fifteen years ago, if you like - certainly we did not
.do that.. Most of the money, the personnel and the efforts we rightly spend
in the developing countries, in the fight against malaria, tuberculosis,
venereal diseases, and other communicable diseases, in maternal and child health,
in improving environmental sanitation, and in strengthening medical education
and administration. I mention these facts, Mr Vice- President, because we are
perhaps apt to forget that this is the permanent basis of our organization and
that no one has suggested that we change these basic patterns.
And now some of our problems. The world is moving faster today than
only fifteen years ago -.not to speak of fifty years ago. In the field of
medicine, this holds true for all the main factors which enter into the picture
of promoting health services. Scientific knowledge, the spelling out of
knowledge in techniques, the understanding of the people and the politicians,
the increased purchasing power. As a matter of fact, both developing as well
as developed countries, without exception, find themselves at the present time
in the situation where the demand for health services is much higher than the
supply. If, therefore, WHO is not going to find itself lagging behind it A17 /VR /5 Page 38
certainly cannot rest on its laurels. It must be on the alert, finding its way always to the front line of attack on disease. We may, in my opinion,
be proud of having had foresight in several fields: I mention malaria,
tuberculosis, partly venereal diseases and treponematoses, poliomyelitis,
trachoma, maternal and child health, medical education, environmental sanitation -
only to mention a few. In other fields, we may have had foresight but we have
not so far accomplished much - smallpox, schistosomiasis, filariasis, leprosy,
certain enteric infections including cholera, animal disease, rehabilitation,
mental health, dental health. And again, there are other fields in which I
feel that we have been very slow in taking up the matter for a realistic
approach. The chemical environment around us - food additives, drugs,
insecticides, other health hazards. The medical care problem, various nuisances which are now changing into health hazards - air pollution from radioactive
fall -out, from vehicles and from industries, water pollution, from industries
and from many other sources, and noise and vibration. I also mention the health aspects of human reproduction, where we have been very slow.
Also, in strengthening the health services of the various Member States we have been rather reluctant to enter the picture. Of course the central health administration of any given country is a key to the whole solution of
the health problems of that country, and also a key to fruitful co- operation with WHO. Nevertheless, there seems at present to exist in several countries А17 /VR /5 page 39
a trend towards weakening fundamentally the central health administration by
removing the scientists in public health, the health administrators, and
replacing them by lay administrators. I will not prolong this part of my
statement, Mr President. Sometimes one has had perhaps the feeling that the
Organization in its early days was a little careful not to touch a problem because it was controversial. This may be true and correct for a youngster,
but for a grown -up person like WHO is now, it is of course a suicidal attitude.
Most important problems as a matter of nature are controversial, at least as
long as they are new and important, and WHO cannot afford to stay outside.
The outgoing President, Dr Majekodunmi, in his most remarkable statement at
the opening of this Assembly, if I did not misunderstand him, seemed to feel
the need for a, what he called, "concentration" of the efforts of WHO. If I
understood him correctly again - you must forgive me if I did not - he feels
that we should perhaps try to limit the area of our activities. This seems very reasonable to all of us, especially as long as we view the question from
our own point of view. We are all interested in WHO doing more in the specific
fields which are important problems to us and to our regions. We all need
WHO - and more of WHO. The World Health Assemblies, however, in fixing
priorities and deciding upon the policy of this organization, have had to take
a broader view, namely the interest of all Member States. We are, as has been
stated on several occasions, dependent upon the goodwill of all Member States A17 /vR /5 page 40
to get the money necessary for our activities. Therefore the World Health
Assembly has always found - and wisely so, I think - that there should be no
Member country which would find itself in the position of only being a contributor, not receiving any type of services. We should not regard ourselves as consisting of donors and recipients. We are working in solidarity to solve our mutual problems.
The next very important problem to which several speakers have referred is the question of evaluation of the activities of the World Health Organization.
Now evaluation, or assessment, is a word which is à la mode at the present time. Fortunately here WHO has had great foresight, and since 1950 - namely, fourteen years ago - the Organization has been constantly in process of evaluating its various activities with a view to rationalization, efficiency, the saving of money, personnel, etc. I would like to refer you to document
FR33/33 Rev.1, where the Director -General in his report has listed the various steps in this direction. Time would not permit me to read them all, but let me read at least some to give you an impression of the various organizational studies already carried out by the Executive Board and thereafter presented to the Assemblies: organizational structure and administrative efficiency; organizational structure with particular reference to decentralization; staffing; examination of Assembly procedures; documentation; necessity for travel, etc.; the question of biennial Assemblies, to save money; the education and training programmes, including fellowships; the question of regionalization; programme analysis and evaluation, in 1954; programme А17/VR/5 page LF1 planning, in 1955 and 1956; measures for providing effective assistance in medical education and training to meet priority needs of the newly independent and emerging countries, in 1963. At present a study is going on on methods of planning and execution of projects, according to the decision of the
Fifteenth World Health Assembly, and we will at this Assembly discuss further studies. My feeling, Mr Vice -President, is that there may be some mis- understandings in this field, and I would venture to suggest that delegates should carefully look info the work which is going on and they may find themselves in the same position as myself - not wanting to interfere with the process, as it is going on satisfactorily in my opinion.
My final point would be on the proposal for the establishment of a World
Health Research Centre - and, again, some misunderstandings seem to prevail.
May I refer to document Аl7 /P&В /8, where the note by the Director -General on the medical research programme also includes part of the statement by the
Director -General to the Sixteenth World Health Assembly on 8 May 1963. is speaking there of the new tasks in medical research, and he says, I quote:
"In addition to our endeavours to apply new knowledge effectively, we must now
search for fresh approaches and methods . . ." In other words, the intention is not to detract from the work in the field, but to add to it by increased knowledge. Nobody would lose anything in his country, but he would get more.
One representative from a developing country yesterday asked for assistance as to the question of handling chronic psychosis in tropical areas. How could A17 /VR /5 page 42
that be done without research? The distinguished delegate of the United
States referred just now to cholera. How can we do anything fruitful or very fruitful in the field of cholera until certain basic ecological problems with regard to cholera have been solved? The distinguished delegate of the
Soviet Union in his very interesting statement quite correctly reminded us of the change in the nosological picture of the causes of death. How much do we know at the present time as to the perhaps complicated multiplication of heart and circulatory diseases, of cancer, rheumatism, psychosis? It may sound like being wise after the event but I venture the statement that if more basic and applied research, both of them, had been possible before we started the malaria eradication programme, the nations of the world would have saved so much money that we could have run the World Health Research Centre for ten years. Secondly, the idea, as I understand it, is not to establish a health research centre which would be all- comprehensive - exhaustive, in the sense that any problem in the field of health would immediately fall within the research activities of the centre. The Director -General and his scientific advisers have made perfectly clear that it is only a limited approach, that 4 the areas of research should fulfil certain criteria before they would be eligible for the research centre: namely, first they have to be important problems affecting large populations, perhaps the whole world; secondly that they are not likely to be explored adequately by conventional methods used in national institutions or in institutions based on a nation; thirdly, А17/vR/5. page 2+3 that the compiling of data calls for international co- operation, which, presumably, could be best undertaken by the World Health Organization. Now these are three quite clear -cut criteria. Also, in speaking in favour of a positive instead of a negative attitude towards the idea, I would like fully to join the delegate of the United States of America when he underlines the necessity for a communication centre of knowledge, which is also very strongly underlined in the statement of the Director -General. Electronic equipment, which is now great enough, well served enough, to get the data from all over the world, compile it, analyse it, and use it again, is a new thing in the field of medical research, and I cannot express it better, of course, than the
Director -General when he stated again at the opening of the last World Health
Assembly. I quote Dr Candau: "Can we pretend that we have even begun to take advantage of the remarkable advances in mathematics, physics, and engineering for a true scientific study, in the laboratory and in the field, of both communicable and non -communicable diseases ?" He speaks of the necessity of integration of biology with the social sciences, etc. Some delegates have expressed to me their fear that the establishment of such a world health centre for medical research would drain their countries in regard to scientists
- that they would all gather here. May I here refer, for example, to the experience of another already established international research institution with a budget of about twenty -five million dollars which is not far from that A17 /VR /5 page 44
suggested for this health research centre - the European Organization for
Nuclear Research. Sir, the experience there is that, contrary to the fear that has been expressed, there is a feed -back of scientists from this international centre to national governments which is most encouraging, and the preliminary policy of the World Health Research Centre would be the same.
Under its Constitution, this organization has to act as the directing and co- ordinating authority on international health work. For several years now it has been evident to scientists all over the world that certain problems can no longer be solved at the national level. For that reason, and as correctly referred to by the delegate of the United States, se�reral countries are at present looking into the possibility of establishing such centres, and the co- ordinating authority of WHO is highly necessary.
Let me finish with these words, Mr Vice -President. The world is, generally speaking, in trouble: countries do not trust one another, wars are raging in various parts of the world at this very moment. Wise statesmen all over the world have tried time and again to find areas for international co- operation, and at the San Francisco Conference in 1945, when the specialized agencies were established, it was stated quite clearly that the intention with these specialized agencies was to try to bring the scientists, the technicians, the administrators together so that they might prepare a better soil, a more fruitful soil, for the politicians when they were trying to bring the nations in line. Already in the days of the League of Nations the Health Section of that organization was perhaps the most successful one, and WHO has certainly А17 /VR /5 page 45 carried the traditions with great results, and again now wise statesmen are turning to us. The late President Kennedy even found the idea before us so fruitful that he specifically mentioned it in his speech to the United Nations in September last year. To me the question is not whether a centre for international health research will be established or not - it must, because scientific and technical development will bring it forward. The question is whether WHO would like to be a sleeping partner to it, or miss the bus completely. If international democracy is going to grow, health co- operation is a field where it can happen, and therefore I am strongly in favour of getting on in a positive attitude with working out this idea.
Le PRESIDENT PAR IN'l RIМ (traduction de l'espagnol): Je vous remercie,
Dr Evang. Je donne la parole au délégué de la Grèce. A17/vR/5 page 46
Ce Rapport, nous l'avons étudié avec le plus haut intérêt et nous avons, une fois de plus, apprécié l'étendue, le caractère complet et efficient de la tâche de
TOMS, dont l'objectif est d'assurer à tous le niveau de santé le plus élevé en fonction des possibilités existantes. Nous avons donc relёvé les réussites, et nous avons aussi médité sur les difficultés. Celles -ci, d'ailleurs, semblent se multiplier d'année en année dans certains domaines. Telles sont, par exemple, celles de l'éra- dication du paludisme contre Dans ces deux domaines, il et de la lutte les vecteurs. 4 y a dix ou quinze ans à peine, les insecticides semblaient constituer l'arme essen- tielle, sinon unique, tandis que, dans les années qui suivirent,les différentes formes de la résistance, soit des vecteurs, soit des agents pathogènes, ont eu une double conséquence: d'une part, un retour à des méthodes tellement classiques qu'on les croyait périmées, d'autre part, l'expérimentation avec des procédés extrêmement modernes et assez complexes. Le Rapport du Directeur général souligne ainsi le rôle qu'est appelée à jouer la génétique formelle et appliquée, soit sous la forme de la manipulation génétique des populations d'insectes par l'introduction délibérée de gènes pathologiques, soit sous la forme du lâchage de sujets stérilisés par des agents physiques ou chimiques. Il nous a aussi fait rapport des efforts entrepris afin d'améliorer et de raffiner les méthodes biotiques de lutte contre les vecteurs.
Mais tout cela est trop familier aux honorables délégués pour que j'insiste. Mon intention serait plutôt de rapporter ici brièvement quelques -unes des réalisations récentes dans le domaine de la santé publique dans mon pays. A17/V1/5 page 47
Des progrès importants ont été enregistrés en ce qui concerne les maladies transmissibles en général, surtout celles véhiculées par les arthropodes. C'est ainsi que la dengue, la fièvre à pappataci, le typhus épidémique, le typhus murin, la leishmaniose cutanée et la fièvre boutonneuse ont été totalement éradiqués. Les cas autochtones de paludisme ont à peine dépassé la quinzaine en 1963. Nous avons intensifié la lutte contre la leishmaniose viscérale, dont on enregistre encore quelques dizaines de cas dans les régions montagneuses, dans l'espoir d'en venir bientôt à bout. De bons progrès ont été aussi réalisés dans la lutte contre la diphté- rie, les zoonoses et surtout la rage, dont un seul cas a été signalé l'année dernière dans tout le pays. Des avances satisfaisantes ont, de même, été obtenues dans le cas des infections véhiculées par l'eau de boisson. Ainsi qu'on aura l'occasion de le signaler au cours des discussions techniques, des efforts très importants ont été faits pour l'amélioration des conditions d'approvisionnement en eau, dont l'incidence a été favorable sur les conditions sanitaires et sociales du pays. Dans l'ensemble, des programmes spéciaux de lutte contre toutes les maladies transmissibles sont en cours d'exécution, concernant entre autres la poliomyélite au sujet de laquelle une décision toute récente prévoit la vaccination de toute la population réceptive au moyen d'un vaccin per os à virus atténué. Bien entendu, depuis de longues années, aucun cas de maladie quarantenaire n'a été signalé en Grèce. A17/VR/5 page 148
Ce qui est aussi d'une importance fondamentale, c'est l'amélioration considé- rable dans la déclaration des maladies infectieuses; le Ministère de la Prévoyance sociale regoit maintenant des informations de toutes parts dans un délai de vingt - quatre heures. Ce progrès est surtout dû à l'amélioration dense du réseau des dis- pensaires ruraux, réseau qui s'étend à présent dans presque toutes les zones rurales.
Leur personnel - médecins, infirmières, sages -femmes - sui des cours de perfection- nement intensifs qui les orientent de plus en plus vers la prévention et la promotion de la santé.
On insiste de plus en plus sur l'amélioration des services d'hygiène maternelle et infantile. Plusieurs centaines de stations de consultations sont déjà en opération et, les cours de perfectionnement aidant, nous pensons que la mortalité infantile, qui est encore de 140 pour 1000 baissera assez rapidement, de manière à aller bientôt de pair avec la mortalité générale qui, elle, fluctue aux environs de 8 pour 1000.
Pour ce qui est de l'assurance contre la maladie, la fraction de la population qui en bénéficie atteint déjà près de 85 %.
Parallèlement, des services de santé publique s'apprêtent à mieux envisager les problèmes contemporains: santé mentale, maladies chroniques et dégénératives, néo- plasies. Notre gouvernement attache aussi une importance toute particulière à la coordination et, éventuellement, à l'intégration des programmes de santé publique, patronnés à présent par divers services et institutions. La zone pilote de Thessalie, où les opérations sont menées conjointement avec 1'OMS et le FISE et sont couronnées de succès, jouera certainement à cet égard un rôle de premier plan. А17/VR/5 page 49
En terminant, je voudrais dire combien il est difficile de mettre en relief l'activité de l'OMS qui est la plus précieuse. Si je pouvais me permettre d'exprimer une préférence personnelle, c'est au torrent continu de publications et de documents techniques de haute qualité distriЫ.' par l'Organisation que je sens devoir le plus dans l'exercice de mes fonctions.
Le PRESIDENT PAR INTERIM (traduction de l'espagnol) : Je vous remercie,
Professeur Belios. Le délégué de la Roumanie a la parole.
Dr MARINESCU (Romania) (translation from the Russian): Mr President, fellow delegates, ladies and gentlemen, on behalf on the delegation of the Romanian People's
Republic I cordially congratulate Dr Afridi on his election as President of the
Assembly. I also congratulate our three distinguished Vice -Presidents and wish them every success in guiding out work.
In regard to the work carried out by the World Health Organization in 1963, I wish to congratulate Dr Candau, the DirectJr- General, on his sound report, in which he analyses the most important health problems in all parts of the world.
There is no doubt that the importance and acuteness of some health problems differ in different regions and countries, depending on the pattern of morbidity, the social and economic situation, development plans and prospects, etc. Certain problems and measures are of special importance for some countries and regions, whereas for others they have already dropped to second place. In this position international experience is a valuable help, and a comparison of data obtained and measures taken makes it possible to assess the situation and to work out plans for short -term and long -term measures. А17 /VR /5 page 50
In this connexion it is particularly important to work out a standard system of methods for ascertaining, analysing and interpreting given situations and morbidity phenomena on the basis of comparable data. During recent years the World Health Organization has made special efforts to work out a statistical terminology, to determine the indices needed for a scientific evaluation of the health situation, and to standardize on an international scale the terminюlogy used in the health services.
Nevertheless, although the Expert Committee on Health Statistics has 1 succeeded in establishing many criteria, difficulties are still being encountered with regard to the comparability of morbidity data. Morbidity figures based on attendances at medical establishments, or on surveys based on questioning, are not comparable with the data obtained by combined medical surveys carried out by specialists.
Health protection requires a thorough knowledge of many different aspects of the health situation, the structure and evolution of morbidity, and the effect on them of social and economic conditions. In the light of these considerations, investigations into the state of health of the people of Romania, on the basis of demographic indices and measurement of the physical development of children and adolescents and into the effectiveness of the work of the health services and so on, pay special attention to the structure and evolution of morbidity.
Our health system has made it possible to work out standard methods for primary registration and for regular reporting on health questions and the activities of the health services. With a view to studying the actual morbidity A17 /VR /5 page 51 structure and the complex links between that structure and economic, social, geoclimatic and other conditions, we organized in Romania, in 1959 and 1960, a comprehensive medical survey covering one million people, or five per cent, of the total population. This is to be repeated every five years on the same population group.
Analysis of the morbidity data in this representative group showed that they differed considerably from the data based merely on attendances for medical attention, particularly as regards cardiovascular diseases, digestive disorders, urinogenital conditions and rheumatic diseases. The difference was most marked in cases when the comparison concerned data for the rural population.
The findings of this comprehensive medical survey of the state of health of the Romanian people enabled us to determine the basic health problems in various areas or in the country as a whole; the order of urgency of various measures; and the organizational and operational requirements involved (finance, buildings, equipment, instruments, drugs, and medical and health personnel).
On the basis of this information, and of the financial and material resources allocated to the health services by our Government (in 1962, 6.7 per cent. of the total State budget), we have worked out and applied in practice combined plans for control measures in respect of specific problems such as cardiovascular diseases, cancer, rheumatism, tuberculosis, etc.
In the Introduction to the Director- General's Report for 1963 emphasis was rightly laid on the fact that "As a whole, and in spite of the remarkably efficient tools available, tuberculosis cannot be said to have been. eliminated as a public - health problem in any country - no matter what stage of development it has reached ". A17/ин/5 Page 52
In spite of the fact that in the Romanian People's Republic mortality from
tuberculosis has fallen over four -fold, and morbidity by roughly`sixty per cent.,
since 1950, the disease is still a public- health problem.
Our plan envisages three stages: (1) the strengthening of the material
resources available and the intensification of technical and organizational measures;. (2) a considerable reduction in mortality and morbidity; and
(З) the stage when tuberculosis will have been eradicated as a mass disease.
The work will include: regular biological control by means of the tuberculin test, covering the whole population up to twenty -five years of age; obligatory
BCG vaccination for new -born babies and revaccination every three to five years, depending on the results of the biological tests; X -ray examination of the whole population over fourteen years of age before the end of 1965, and re- examination regularly every two years; the extension of chemoprophylaxis to selected population groups; and the development of research with a view to improving methods of biological detection, fluorography, vaccination and chemoprophylaxis. During recent years 15 000 000 tuberculin tests, 15 000 000
X -ray examinations arid 5 000 000 BCG vaccinations have been carried out.
Passing on to consideration of the organization of medical services, I must mention that we consider as very important the initiative taken by the
World Health Organization with regard to conducting research on hospital utilization and the effectiveness of hospital care. Many health administrations that are interested in developing their hospital services do not yet possess complete documentary information from other countries on the most effective types А17 /VR/5
© page 53
and systems of hospital establishment. The effectiveness of out -patient and
hospital services depends. on their accessibility, their equipping with the
necessary aids for diagnosis and treatment, and the provision of a sufficient
number of highly qualified medical staff.
In order to combine therapeutic and prophylactic work and to achieve some
economy in the provision of highly complicated apparatus and equipment, the
hospitals recently constructed in Romania are combined blocks, which include
out - patient. departments (polyclinics) and hospital departments, both staffed by
specialists. This has made possible the joint and more rational use of
.laboratories, X -ray departments, and departments for functional diagnosis.
As a result of the extensive use of comprehensive methods of diagnosis
in the polyclinic (X -ray examinations and laboratory investigations) before
patients are sent to hospital, the number of days spent in hospital has been
reduced. This is shown by the over -all statistics which indicate that the
number of beds in hospitals has risen by 2.6 per cent. while the number of
persons treated in hospitals during the same period has increased by five per
cent. In Romania, hospitals with 500, 700 and 1000 beds have been and are
being built, the size depending on the size of the town concerned. Hospitals
with more than 1000 beds are envisaged only in cities that are also university
centres.
In the part of the Director -General's Report on health protection and
promotion, mention is made of the basic tasks and activities of the World Health
Organization with regard to occupational health and safety and also co- operation
with other international organizations. The Report mentions the conclusions A17/VR/5 page 5k
reached by the symposium held in Geneva in April 1963. These state that a medical inspector, if he is to carry out his task effectively, must be given special rights and powers with regard to the medical examination of workers, and must have access to information on the production process. At the same time the inspectors must have a many -sided training in many technical subjects in addition to medicine. These special conditions lead to great difficulties in many countries in regard to the protection of employees' health. In view of this, with your permission, I shall explain the measures taken in Romania in regard to this problem.
For the organization, co- ordination and technical supervision of this work there is a special branch of the Ministry of Health and Social Welfare, called the State Inspectorate of Occupational Health and Labour Protection, which in the capital and the provinces alike works on the three -fold task of hygiene, epidemiology, and occupational safety. The Oblast and rayon departments of the
State Inspectorate of Occupational Health and Labour Protection possess bacterio- logical, virological and parasitological laboratories, chemical laboratories for studying problems of environmental sanitation, and laboratories concerned with industrial toxicology, environmental hygiene, protection against ionizing radiation, etc.
In carrying out its functions the State Inspectorate is authorized to investigate infractions of sanitational and epidemiological regulations, and regulations on labour protection, to inflict fines, to block the bank accounts of particular firms to prohibit them from operating as a temporary or permanent measure, and in serious cases to take them before the course. А17/VR/5 page 55
In its special technical work the State Inspectorate depends on the combined activities of all research institutes, and particularly on the institutes of occupational health and labour protection.
In accordance with a decree of the State Council of the Romanian People's
Republic and an order issued jointly by the Council of Ministers and the Central
Council of Trades Unions, labour protection in Romania is a state responsibility, governed by the following principles:
- Labour protection is a constituent and integral part of the production process.
- To ensure that measures of labour protection are applied is the responsibility at state level of the Ministry of Health and Social Welfare, acting through the
State Inspectorate of Occupational Health and Labour Protection.
- The trades unions ensure the participation of the workers in collective tests of technical knowledge regarding labour safety and the strict application of the regulations for labour protection.
The taking of the necessary organizational and technical measures with regard to equipment and the lay -out of the place of work, the assignment of workers to
jobs on the basis of their level of training, age, experience, capacity for adaptation and stamina, the prevention of fatigue and over -work, etc., are only a few aspects of a whole series of measures for the protection of workers, measures which must be taken into account by those who organize and manage production and for whose observance they bear material or even penal responsibility. Thus there is an organic link between production, productivity of labour, and protection of the worker. This is given practical expression by ensuring that the worker and the persons responsible for production have a material interest in the problem. A17/vR/5 page 56
In drawing up plans for new undertakings, installations or equipment, the planning organizations are bound by law to abide by the rules on safety measures and occupational health. The scientific and technical councils that check them must take steps to ensure that the regulations are observed when the plans are drawn up. Through the State Inspectorate of Occupational Health and
Labour Protection, the Ministry of Health and Social Welfare develops legislation on labour protection and keeps a vigilant eye on the application of all the measures arising from such legislation.
Mr President, fellow delegates, those aspects of the Director -General's
Report that we have, emphasized are particularly important for guiding the development and planning of the health services. No doubt for some countries the importance and order of priority of the individual problems will differ.
The service rendered by our organization is that, aware of this position, it has successfully proceeded to give due consideration to it, and, subject to resources being available, has begun to carry out programmes of research and practical measures in connexion with the main problems of the health services.
However, the further improvement of the health or the peoples depends in the first place on the material resources of the countries concerned and consequently on their economic arid social development.
The experience of history shows that economic and social progress finds the most favourable conditions and occurs at the fastest rate in an atmosphere of peace, mutual understanding and co- operation between peoples. As defenders of the people's health we must fight untiringly to eradicate the means of destruction and to eliminate the threat of war from the life of mankind. A17/VR/5 page 57
The President took the chair. Le Président prend place au fauteuil présidentiel.
The РRESIDЕNТ: Thank you, Professor Marinescu. Now I give the floor to the delegate of Jordan.
Le Dr NABULSI (Jordanie) : Monsieur la Président, honorables délégués,
Mesdames et Messieurs, la délégation jordanienne se félicite de voir à la prési- dence de cette auguste assemblée un grand ami, le colonel Afridi. Vous avez assisté, Monsieur le Président, à la naissance de notre organisation, dont vous avez été un des fondateurs. Vous avez en outre suivi toutes les étapes de la progression vers la promotion de la santé dans le monde entier, soit comme délégué de votre pays, soit au sein méme du Conseil exécutif où j'ai eu l'honneur de collaborer avec vous. Vos travaux en tant qu'expert dans le domaine de la santé publique et spécialement dans celui du paludisme sont connus au point que votre nom est lié à la lutte contre ce fléau.
Je saisis également cette occasion pour féliciter les trois vice -présidents de cette assemЫée et les présidents des deux commissions principales.
Monsieur le Président, l'exposé clair et précis de M. le Directeur général nous a donné une idée réelle de l'activité de TOMS durant l'аnnéе éсouléе. Les projets exécutés ou en voie d'exécution montrent que l'année 1963 a été très satisfaisante. C'est pourquoi je tiens à remercier et à féliciter chaleureusement
M. le Directeur général et ses collaborateurs de l'excellent travail accompli. A17/VR /5 page 58
Je voudrais, Monsieur le Président, mentionner devant cette honorable assemblée que l'étroite collaboration entre l'Organisation et mon pays a donné les meilleurs résultats et que tous nos projets sanitaires ont été couronnés de succès. Je ne citerai pas ici en détail les travaux exécutés ou en cours d'exé- cution en Jordanie, mais il est impossible de passer sous silence les brillants résultats que nous avons obtenus dans le domaine de l'éradication du paludisme.
En effet, la plus grande partie du territoire jordanien se trouve maintenant en phase de consolidation et nous espérons que, très prochainement, le paludisme n'aura plus de prise sur notre pays.
Avant de terminer, Monsieur le Président, je voudrais appuyer la remarque faite hier par l'honorable délégué de l'Irak ainsi que par d'autres éminents délégués en ce qui concerne les taches principales de notre assemblée, qui sont strictement humanitaires et scientifiques, car les questions politiques n'ont aucune raison de s'introduire dans nos discussions.
The PRESIDENT: Thank you, Dr Nabulsi. I give the floor to the delegate of Paraguay.
Le Professeur GONZAТRZ TORRES (Paraguay) (traduction de l'espagnol) :
Monsieur le Président, Messieurs les délégués, c'est pour moi un plaisir que de vous saluer, Monsieur le Président, et de vous présenter mes félicitations pour l'élection qui vous a confié la mission de diriger les travaux de la Dix- Septième
Assemblée mondiale de la Santé. Mes félicitations s'adressent également au A17/'ТR /5 page 59
Directeur général, le Dr Candau, qui nous a soumis un remarquable rapport sur
l'activité de l'Organisation mondiale de la. Santé au cours de l'année écoulée.
Je voudrais. en outre saluer le Dr Hórwitz, Directeur régional pour les Amériques,
le- _sympáthique,ami..дe tous ceux qui, en Amérique, s'occupent d'action sanitaire,
et adresser: �пes, souhaits d bienvenцe aux délégués des pays récemment admis à
1' Organisation. La délégation du Paraguay tient.. leur.prés.enter. ses -salutations
les plus cordiales,._, de méme qu'à. tous les délégués ici présents.
Je me permettrai, Monsieur.. le Président,• pour ne..pas.vous...faire perdre de
temps., de me borner à citer les titres de mon rapport sur.: l'organisation sani-
taire au Paraguay;. le texte intégral de ce document. sera remis au Secrétariat
quien assurera la publication..1 Ce rapport traite de.V avancement et de l'avenir
des. programmes en cours d'exécution, de la mise sur pied et du.dévelвppement.des
centres de santé, de la lutte contre les maladies transmissibles, la tuberculose,
les maladies vénériennes, la lèpre, le paludisme, de la protection. maternelle et
infantile, de l'assainissement, de 1'éducation.sanitaire, de la formation profes-
sionnelle, de. ]j alimentation et de l'éducation nutritionnelles, de l'assistance médicale, des relations internaeíonales.et. de.-diverses innovations. Parmi celles -ci,
il faut citer, l'obligation faite depuis 1963. aux médecins, aux infirmières et aux
sages - femmes d'exercer leur activité pendant un an. au deux dans les centres ruraux avant de recevoir leur diplóme, la.mise sur pied de services de planification
1 Le texte intégral de cet exposé parattra dans les Actes officiels. А17/VR/5 page 60
non seulement au niveau de l'exécutif, mais aussi dans chaque ministère, et l'établissement d'un budget fonctionnel pour l'ensemble du pays et pour chacun des ministères, la création d'un département des affaires sociales, qui collabore
étroitement avec la division de la protection sociale, la réorganisation des régions sanitaires, où des programmes sont mis en oeuvre pour mieux tenir compte des réalités géo- éeonomiques et culturelles, ainsi que la mise en place d'une division de la coordination exécutive des zones sanitaires.
Je ne voudrais pas terminer sans citer la coopération précieuse que nous ont prétée l'Organisation mondiale de la Santé, le Bureau sanitaire Panaméricain, le FISE, l'Operation Mission des Etat: -Unis, le Bureau de l'Assistance technique des Nations Unies, la Fondation Kellogg, l'Université de Buffalo (Etats -Unis) et diverses fondations nationales.
Enfin, Monsieur le Président, Messieurs les délégués, le Paraguay continue
à remplir fidèlement les engagements qu'il a contractés à l'égard de pays amis et voisins dans l'action pour la promotion de la santé de nos populations. Notre
áouvernement est fermement résolu à lutter énergiquement par tous les moyens dont il dispose pour que la population jouisse du niveau de santé et de vigueur
.c-3 raire pour pouvoir accomplir son destin de grandeur et de solidarité avec tous les peuples d'Amérique et tous les autres peuples du monde.
The PRESIDENT: Thank you, Professor Gonzalez Torres.
Now we have time for one more speaker, and I give the floor to the delegate of Nigeria. А17/vтi/5 page б1
Dr OмIТОWOJU (Nigeria): Mr President, I would like to join all the delegates
in congratulating you on your election to the most coveted and responsible office of
President of this Assembly. I have no doubt that in your able hands this Assembly will achieve every success, as have previous Assemblies.
I wish also to congratulate the Director -General on the very informative and
incisive manner in which the Report for 1963 has been prepared. During the year under review WHO has passed through another period of great achievements in all
fields. Although the achivements are so noteworthy, yet the immensity of the task
to be accomplished by our organization is apt to make us feel as if nothing has been
achieved. This would certainly be a wrong approach to our problem: the size of
the task left undone should act as a challenge to spur us to further achievements.
It will not be out of place to mention briefly some of our problems in Nigeria
and the way we are tackling them. The year 1963 has been for us one of great encouragement and optimism in the field of health. The emphasis in all our health development in Nigeria is on the preventive side. We are planning to broaden the basis of the preventive services and to integrate both the preventive and the curative aspects of medicine. We believe strongly that if efforts are concentrated on improving preventive health measures they will, in course of time, yield high dividends in the form of improved health and decreasing expenditure on curative
services. In this direction the new health centres which are being built in Lagos, and which are already operating in the rural areas of the country, will provide А17/VR/5 page ½È
comprehensive health services on a community basis to ensure that adequate health measures, in the widest sense of the term, are within reach of every member of the community. In Ibadan, the largest and most populous indigenous African city in the whole of the African continent, we have a School of Hygiene where health inspectors, health sisters and similar categories of paramedical staff are being trained in public health so as to ensure that when they go out into the community they will help to lay a firm-foundation for preventive medicine.
Already plans are afoot for the pre -eradication phase of the gigantic task of / eradicating malaria from the whole of the country. The international malaria eradication centre in Lagos, financed by WHO with substantial financial and other assistance from Nigeria, has already started and is discharging its functions in a most able way.
One of the greatest scourges in Nigeria is smallpox. After carefully examining the problem, and with competent advice from WHO, we have decided that the best
course of action would be to embark upon a nation-wide eradication of this disease.
Already all the governments in the Republic of Nigeria have geared their health machineries to this great task of smallpox eradication. We are fortunate to have
in Lagos an up -to -date laboratory where freeze -dried vaccine is being produced; and
it is our plan that this laboratory should produce twenty million doses of freeze - dried vaccine a year, to allow us to supply the vaccine required for the national
smallpox eradication programme. Incidentally, I should mention that a vaccine A17/V/5 page 63 produced in Nigeria has attained international reputation for its potency, as witnessed by the large quantity supplied to WHO during the Congo emergency.
Medical research in all its facets is a subject which is very dear to our hearts. For the time being9 an effort is being made to gear medical research to national needs. At the same time, Nigeria is fully aware of the need for inter- national co- operation, in this field as in other fields of scientific endeavour.
Ti this end the possibility of active co- operation between the Medical Research
Organization in Nigeria and the already functioning Organization for Co- ordination and Co- operation in the Control of Major Endemic Diseases, (OCdE), has been examined. I am happy to say that the aims and objectives of these two research organizations are very similar, and my Government is most anxious that co- operation between the two should begin without delay. It is hoped that both the Medical
Research Organization in Nigeria and the OCCGE will co- operate with and function under the umbrella of the Health, Nutrition and Sanitation Commission of the
Organization for African Unity.
Our plans for medical education are progressing but slowly, the main obstacle being the lack of adequate finance. As was referred to earlier in this Assembly, we are experimenting with a type of medical education for doctors that will emphasize the training of physicians in the preventive aspect of medicine and will integrate as far as possible pre -clinical and clinical teaching. The new medical school in
Lagos will utilize existing government hospitals for clinical teaching. This will ensure that medical students have their practical training in the type of hospitals Al7i rn 5 page 64 where they will eventually work, as well as saving the money that would have been spent in building new teaching hospitals.
The most important problem in the training of personnel concerns the training of the paramedical staff. It is not always easy, nor is it always desirable, to send these categories of staff outside the country for training. Firstly, the expenses involved are great, and secondly their services are lost to the country during the years of training. This means in effect that we have to establish various centres to cater for these categories of staff and, although the result has already been very satisfactory, yet when resources are very slender the cost could be rather heavy on the country's exchequer. It should be mentioned, in this connexion, that the practice whereby WHO seconds consultants to Member States for the training of these categories of staff is welcome and should continue.
One of the greatest problems facing developing countries in reorganizing their health services is the cost of drugs. Many of these countries have no factories or laboratories where the simplest drugs can be manufactured, and they have to depend on imports from other manufacturing countries. It would certainly be a big help to these countries if WHO can explore the possibility of having a pool of drug manufac- turers who would be prepared either to set up, under the aegis of WHO, manufacturing projects in various countries or groups of countries, or to sell in bulk to WHO, for distribution at a little above cost price to some of the developing countries. It will also be a big help if this organization can explore the possibility of standardizing some of the hospital equipment, and the possibility of prefabricating cottage or village hospitals. А17/vR/5 page 65
It is appropriate that I should acknowledge in this Assembly the generous assistance which Nigeria has received from UNICEF from time to time. I would also like to record my appreciation of the invaluable services rendered by all WHO staff who have been sent to work in Nigeria during the past year: they were men and women who were devoted to the cause of this great organization, and it is only proper that this appreciation be recorded by this Assembly.
Finally, Mr President, I would like to thank the staff of the Director- General's
Secretariat and also the large army of WHO staff all over the world for the excellent services rendered to the cause of humanity during the past year.
The PRESIDENT: Thank you, Dr Omitowoju.
2. AWARD OF THE TON BERNARD FOUNDATION PRIZE ATTRIBUTION DU PRIX DE LA FONDATION LEON BERNARD
The PRESIDENT: We now turn to item 1.14 of the agenda, which pertains to the award of the Léon Bernard Foundation Prize. You have two documents before you: document A17/6, the report of the meeting of the Léon Bernard Foundation Committee, and document A17/7, the financial report on the Léon Bernard Foundation Fund.
I call on Dr Layton, Chairman of the Léon Bernard Foundation Committee, to be so kind as to present these two reports. Al r/VR /5 page 66
Dr LAYTON (Chairman of the Leon Bernard Foundation Committee): Mr President, distinguished delegates, honoured guests, the President has invited your attention to the two documents pertaining to this item. The first to which I would refer is the financial statement, showing the resources of the Fund, its income, and the gratifying fact that at its last meeting the Léon Bernard Foundation Committee found that there was sufficient accrued interest to permit the award of the prize in 1964. The second report represents a résumé of the deliberations of the Committee and I will now present this to you.
The Léon Bernard Foundation Committee met on 23 January 1964 in conformity with the statutes of the Léon Bernard Foundation, to propose to the Seventeenth World
Health Assembly a candidate for the award of the Léon Bernard Foundation Prize in 1964.
The Committee noted the replies received from governments to the Director -General's circular letter of 22 May 1963 requesting nominations, and examined in detail the documentation proved to support candidatures. The Committee was greatly impressed by the exceptional merit of all of the candidates, by their high scientific qualifi- cations and their contribution to the advance of medical science and the alleviation of human suffering.
Professor J. de Castro proposed the nomination of Professor Robert Debré, and the
Committee decided unanimously to recommend to the World Health Assembly that the
Léon Bernard Foundation Prize be awarded in 1964 to Professor Robert Debré in recognition of his outstanding contribution and practical achievements in the field of social medicine. A17/VR /5 page 67
In the course of his long career Professor Robert Debré has been first and foremost a doctor conscious of the many aspects of medical science. He gave his preference to paediatrics and his work as a clinician in this field has been very important, covering the whole range of children's diseases. Infantile tuberculosis in which he was interested from the outset, with his master Léon Bernard, and more recently rheumatic fever and poliomyelitis are only a few of the principal subjects of his studies.
However, Professor Robert Debré realized at a very early stage that the role of the clinician acquires its full importance only within the framework of the wider conception of disease, its origins and its social consequences. He was one of the first, with Albert Calmette, to study the effects of BCG on children; he took a leading part in organizing the family placement of babies born to tuberculosis mothers, and later on he made full use of all the possibilities of the newly discovered chemical agents, not only for the treatment of the disease but also for tuberculosis control in the community. He was also interested in vaccination against diphtheria with toxoid, the prevention of cardiac complications in rheumatic fever and the prevention of poliomyelitis, as well as the treatment and re- education of poliomyelitic children.
Professor Robert Debré has devoted a considerable part of his activities to research, especially in the field of microbiology which he taught, moreover, for several years at the Medical Faculty, University of Paris. Thanks to him, the laboratories attached to the hospital departments for which he was responsible expanded on an exceptional scale. А17/R /5. page 68
As professor of clinical paediatrics in the Children's Hospital, Paris, he attained the pinnacle of his university career, and it is in this capacity that he has exercised all his influence as a teacher. He has trained, in clinical and social paediatrics, generations of doctors in France and from many other countries.
In recent years he has been the moving spirit behind the reform of medical studies in France.
Professor Debré has been active in the field of international health ever since the days of the League of Nations Health Organization. As representative of France on the Executive Board of UNICEF, he has played an important part in the promotion of child health all over the world. Thus, under the joint auspices of UNICEF and the French Government, he created the International Children's Centre. As a member and chairman of the UNIСEF/WHO Joint Committee on Health Policy, he has endeavoured in particular to promote mass campaigns against certain communicable diseases.
Professor Robert Debré has always considered that his task as a doctor forms part of a wider mission. Never at any time in his career has he felt that medicine can be separated from social action. His activities as a research worker, clinician and teacher have been animated by the ever- increasing effort for the promotion of social medicine and hygiene.
To conclude, Mr President, may I repeat that the Léon Bernard Foundation
Committee decided unanimously to recommend to the World Health Assembly that the
Léon Bernard Foundation Prize be awarded in 1964 to Professor Robert Debré.
(Applause) (Applaudissementp) A17/VR/5 page б9
The PRESIDENT: Thank you, Dr Layton.
The first part of our task today is to note the financial report contained in document A17/7, which has been indicated to you by Dr Layton. Are there any comments? Has the Assembly any comments to offer on this document?
In the absence of comments'I take it that the Assembly wishes to note the financial report of the Léon Bernard Foundation Fund as contained in document A17/7.
It is so decided.
We now come to the second part. Is there any comment on the report of the
Léon Bernard Foundation Committee, contained in document A17/6? No comments?
In that case I would propose a resolution for adoption:: it will be read out by the Deputy Director -General.
Le DIRECTEUR GENERAL ADJOINT : Attribution de la Médaille et du Prix de la
Fondation Léon Bernard :
La Dix- Septième Assemъlée mondiale de la Santé
PREND ACTE des rapports du Comité de la Fondation Léon Bernard;
FAIT SIENNE la proposition unanime de ce comité concernant l'attribution de la Médaille et du Prix de la Fondation Léon Bernard pour 196+;
DECERNE la Médaille et le Prix au Professeur Robert Debré; et
REND HOMMAGE au Professeur Robert Debré pour ses travaux et ses réalisa- tions remarquables dans le domaine de la médecine sociale.
Tel est, Monsieur le Président, le texte du projet de résolution que vous
soumettez à l'approbation de l'Assemb ée. А17/VR/5 page 70
The PRESIDENТ: Are there any comments on this draft resolution? No comments?
Then this resolution is hereby adopted.
(Applause) (Applaudissements)
I shall now ask the Chief of Protocol to invite Professor Debr6 to come to
' the rostrum.
Professor Debré, fellow delegates, ladies and gentlemen. It is a very
agreeable task for me today to present the Léon Bernard Prize to its ninth holder.
It was in 1937 that the prize of the Léon Bernard Foundation was established
to honour the memory of one of the founders of social medicine and to pay a tribute
to persons whose research work or practical achievements in social medicine were
considered particularly outstanding.
The administration of the Léon Bernard Prize was first entrusted to the Health
Committee of the League of Nations and, when the World Health Organization was
founded, it took over responsibility for it.
A prize derives its value from the personality of those to whom it is awarded
and its prestige increases with the number of recipients. The first eight holders
of the Prize are among the pioneers of social medicine. In adding today the name
of Professor Robert Debré to this distinguished company, I think that our Assembly
is fully maintaining the lofty traditions extending over three decades. Indeed,
it is thus paying a well -deserved tribute to the work of an eminent specialist in
social medicine, who has devoted his life to improving the condition of mankind
and has applied himself, above all, to the solution of numerous medico- social
problems of childhood. А17/VR /5 page 71
I would like to mention briefly some of the many phases in a very busy life that have brought Professor Robert Debré here today.
Before commencing his medical studies Robert Debré, who was born at Sedan,
France, in 1882, had been educated in the humanities. After secondary studies in
Paris at the Lycée Janson de Sailly, he obtained a degree in philosophy at the
Sorbonne. Attracted by medicine, he achieved brilliant academic distinction and became, in succession, an interne of the Paris hospitals, then clinical chief, then chief of laboratories in the hospitals of Paris, and then professeur agrégé in 1920.
He was appointed professor of bacteriology in 1933 and a year later entered the
Academy of Medicine. In 1940 he was appointed to the Chair of Clinical Paediatrics at the Hospital for Diseases of Children, where he created a centre for treatment and for the training of students, as well as advanced laboratories for the study of biochemistry, the use of isotopes, pathological histology, bacteriology and virology.
The group of workers that has gathered around Professor Debré includes specialists in all fields: haematology, biology and psychology, among many others, and this has made very fruitful teamwork possible on the part of a large general staff.
Continuing the Pasteur tradition of those masters whose pupil he was, namely of
Roux, Albert Calmette, Maurice and Charles Nicolle (the latter called on Professor
Debré to assist him in his courses at the Collège de France), as well as Ramon, with whom he never ceased to collaborate, and trained in human pathology by Netter,
Marfan, Landouzy, Letulle and Léon Bernard, Robert Debré started his career by studying problems of immunology and the infectious diseases of children. A17/VR /5 page 72
In the field of tuberculosis, since his early studies to distinguish as
rigorously as possible between the part played by a hypothetical inheritance of
predisposition to the disease on the one hand, and that played by early infection,
on the other, he has contributed to our knowledge of the etiology, transmission and
anatomical and clinical characteristics of primary tuberculosis in children. Indeed,
we owe to him our knowledge of the pre- allergic period and the complete description
of primary tuberculosis in infants. He has added to our knowledge of acute
tuberculosis and has extended clinical, electro- encephalographic and biological
knowledge of tuberculous meningitis and its treatment.
Together with Ramon, he defined the essential pathogenic power of the diphtheria
bacillus, indicated and applied a reliable method for the bacteriological and epidemio-
logical investigation of an epidemic, clearly described the technique of serotherapy,
demonstrated for the first time the experimental reproduction of diphtheria paralysis,
and showed, finally, that although a single injection of toxoid confers a certain
degree of immunity, booster injections are necessary to develop and prolong the state
of immunity.
While studying, together with Netter, cerebrospinal meningitis (which had been
the subject of his doctorate thesis) he personally gave the first description of the
disease in the infant, extending our knowledge of, or first mentioning, several
clinical forms, in particular the cachectic form.
He contributed to our knowledge of the modern treatment of acute meningitis and
of its progressive characteristics, revealed the existence of latent forms of meningitis caused by intestinal bacteria in the toxicosis of infants, and indicated how such conditions should be treated. ^з. г /VR/5
page i1'
He drew attention to certain clearly marked features in the etiology of measles,
in particular congenital measles and measles of the newborn, described the sero-
attenuation produced by convalescent serum, and discovered the local inhibition of the rash, a phenomenon which bears his name.
In the study of whooping -cough, scarlatina, endocarditis lenta, staphylococcia and Still's disease, as wr11 as of infections of intestinal origin in infants, he has either contributed new clinical or immunological factual observations, or has exten- ded those already known.
He established a virological laboratory at Longchamp, as well as the Research and Treatment Society for Poliomyelitic Children, and initiated a series of investi- gations concerning the value of the virological and serological diagnosis of polio- myelitis. By means of studies in the epidemiological field, carried out under varying circumstances and in different environments among the child population of several French cities, in the crèches of the Paris area, in children's hospitals and in the town and outskirts of Dakar, he brought together facts on the distribution and propagation of the virus infection, as well as on the behaviour of subjects from birth to maturity, and also commenced experiments with the Macacus cynomolgus monkey.
Together with Thief fry, he contributed to a study on the symptoms and diagnosis of poliomyelitis, published by the World Health Organization in 1955 in a monograph on that disease.
Furthermore, Robert Debré made a methodical study of the hormone treatment of rheumatic fever, covering almost 300 patients followed up by the same team. He soon became convinced of the effectiveness of hormone therapy and endeavoured to make this A17/VR/5 page 7�+
treatment widely known to doctors, as well as to the families of convalescents.
Nowadays the rheumatic fever relapses that were formerly so frequent and so dangerous have disappeared almost completely, although the part played in this phenomenon by the particular technique adopted is not absolutely certain.
He was the first to describe a disease previously unknown, namely benign sup- purating adenitis, which had occasionally been the source of serious diagnostic errors. This complaint is known as "cat- scratch disease ", and although we appear to have a full clinical, biological, histological and therapeutic picture, its causative organism still remains unknown.
Convinced of the primary importance of biochemical research, Robert Debré embarked on investigations of the metabolic diseases of children and contributed to our knowledge of the group of "overload" diseases. He has defined these under the name of "polycorias" and described "lipidic polycoria" of the liver. He introduced the new concept of the syndrome of renal diabetes associated with rickets, hypo - phosphataemia and excessive amino -acid excretion, which bears the name of the
"Debré -De Toni -Fanconi syndrome ", and he helped to define the lines along which research on diseases of the tubules is now proceeding.
He was one of the first, together with the German worker, Fibiger, to discover the suprarenal lesions responsible for disturbances of the water -salt balance and
of sexual development, subsequently known as the "Debré- Fibiger syndrome ". He was the first to describe, together with Julien Marie, the syndrome of dwarfism with
oligodipsia and oliguria, a pituitary syndrome which is the reverse of diabetes
insipidus and is known as the "Debré -Marie syndrome ". r-1so with Julien Marie, he А17/ын/5 page 75 described the neuro- oedematous syndrome, which can perhaps now be explained by dis- turbances in aldosterone secretion. He contributed to our knowledge of accidents connected with D2 hypervitaminosis, and with paroxysmal myopathy accompanied by myoglobinuria. Together with Semelaigne he described the syndrome of muscular hyper- trophy- hypertonia linked with hyperthyroidism, known as the "Debré- Semelaigne syndrome ". Finally, he guided research on myopathy towards the chemical study of muscle biopsy specimens, thus removing this disease from the traditional neurological framework in which it had been confined. His contribution to our knowledge of acrodynia, his explanation of milk fever and his original study of the "sobbing spasm ", which he accurately defined and described, should also be noted.
Convinced of the importance of genetics, of the study of embryopathy and of the significance of congenital disease, he directed his efforts to the study, from this viewpoint, of respiratory diseases such as bronchial dilatation, pulmonary cysts, diseases of the urinary system, such as congenital nephropathy, and malformation of the urinary tract, as well as liver diseases, describing congenital and familial cirrhosis and defining in several cases the mode of transmission of antitoxins through the placenta.
Finally, by vigorous analysis of the data pertaining not only to tuberculosis but also to syphilis, he developed some precise concepts that had often been obscured by traditional but mistaken views. А17/VR/5 page 76
To take one example - the study of hunger and appetite - he elucidated the etiology, prophylaxis and treatment of anorexia nervosa in small children and demonstrated the importance of team work between clinical paediatricians, psychologists and physiologists in gaining and applying knowledge of psychosomatic medicine. Connected with this study is the new concept of selective thirst in infants suffering from dehydration, and research on insomnia in children.
On the basis of the known facts concerning the physiology of sleep, falling asleep and awaking in children, he demonstrated how disorders of sleep were linked with disorders in the development of the child or faults in the behaviour of the persons around the child. He distinguished between various types of insomnia according to cause, indicated their causes at different ages and showed that treatment consisted first in establishing a normal waking state.
This work as a clinician made it possible for Robert Debré in several cases to dismiss on biological grounds the classical concepts that proved to be erroneous: to begin, as it were, by clearing the ground and then to go forward, to bring to light hitherto unknown syndromes and diseases and to give guidance to research workers.
A children's doctor is bound to devote part of his efforts to social work.
Thus Robert Debré contributed to the campaign against tuberculosis, common infectious diseases and poliomyelitis, not only in France but throughout the world; participated in the efforts for maternal and child welfare, in which he was supported by that active and perspicacious adminstrator, Professor Aujaleu; co- operated with the demographers, took part in the investigations carried out by the A17 /vR /5 page 77
I*�:lоnal Institute of Hygiene, and in particular conducted those made recently in
Paris into the causes of death and the percentage of "avoidable" deaths among children between birth and the age of one month, and on the systematic treatment of primary tuberculosis. This work is in a way the continuation twenty years later of the international investigation of foetal and infant mortality carried out under the auspices of the Health Organization of the League of Nations.
He directed the investigation undertaken with Professor Bugnard on chemoprophylaxis against tuberculosis in children.
He took part in the drafting of the "Code de la Famille" which has been of great importance in France and has contributed to the demographic recovery of that country.
His concern for community medicine and prevention also found expression in the establishment in the Faculty of Medicine in Paris of a chair of social paediatrics, the first in the world, an example which has just been followed by
Australia.
It can be said of Professor Debré that he has played the role of a truly international paediatrician, whose teachings have spread in medical and university circles in Europe and the rest of the world.
Professor Debré has not been a sedentary man. He has made numerous study trips to America, Africa and Asia. His advice has been asked on several occasions by governments in regard to the organization of medical education and public health. Two particular examples are the establishment of the Institute of
Social Paediatrics at Dakar and the rural application centre in the village of
Khombole. A17 /VR/5 page 78
As representative of France on the Executive Board of UNICEF, of which he was
Chairman several times, he has played an important part in the efforts of that organization on behalf of all the children of the world.
Finally, he created the International Children's Centre in Paris, the purpose of which is to encourage the study in all countries of problems affecting childhood and to serve the specialized agencies and services of the United Nations and the various national institutions for the welfare of mother and child. The main activities of the Centre are the study and analysis of the latest facts concerning child welfare from the medical, psychological and social points of view, the application of those data to all countries, particularly those whose technical development still requires international assistance, and dissemination of knowledge of the work undertaken in various countries on the problems of childhood.
As a clinical professor, Dr Debré directed the building at the Hospital for
Diseases of Children of a centre for treatment, teaching and research, which in- spired the establishment of similar centres not only in France but in several other countries.
He contributed to the organization of hospital services and nursing centres for poliomyelitic, tuberculous and rheumatic children in the Paris area.
Called upon to act as Chairman of the Committee on Alcoholism, he set his heart on the protection of the younger generation against the dangers of alcoholism, instituted a series of investigations, and suggested various measures based on as thorough a study as possible of the scourge. A17/VR /5 page 79
Finally, for the last four years he has been Chairman of an Interministerial
Reform Committee in France which has advocated important changes in the organization of hospitals and faculties of medicine: the establishment of university hospital centres to ensure the closest co- operation between faculties and schools of medicine on the one hand and the hospitals in university towns on the other; the modernization of hospitals; the establishment of full -time posts for staff responsible at one and the same time for treatment, teaching and research; an increase in the number of teaching staff in the university hospitals; the development of laboratories for clinical and biological research; a closer association of the teaching staff in basic sciences with hospital work; the teaching of students in small, guided groups; and the establishment of national recruiting of teaching staff. The integration of the teaching of clinical medicine, morbid anatomy and biology is one of the essential factors in this reform, together with the organized life of the students in the university hospital centre and the provision of facilities for research workers, brought in this way into close contact ,with human pathology.
When comparing the various methods of medical education in Europe,
W. Hobson recently wrote: "One of the most important changes in medical education in recent years has taken place in France. This is the greatest reform since Claude Bernard wrote his Introduction to the Study of Experimental
Medicine. The two main pillars of the reform are, first, the revision of the curriculum and construction of university hospital centres and, second, the fusion of hospital and university appointments, which will be held as full -time posts. As a result, a great expansion of research facilities is envisaged." А17/vR/5 page 80
Such, in short, are some of the reasons which have led the Seventeenth
World Health Assembly to pay tribute to Professor Robert Debré by awarding him the Léon Bernard prize.
In the short time at our disposal I cannot list all the marks of esteem, gratitude and admiration that he has won in the course of his brilliant and active career. The distinctions and official honours awarded to
Professor Debré, not only in France but in numerous countries where he enjoys incomparable prestige, are proof of the affection and esteem in which he is held, for these rewards are conferred not only on an eminent doctor for his professional work but also on the man, for the greatness of his heart that is so well known to us all.
Professor Debré, it is my honour and pleasure to award you this high distinction today.
Amid applause, the President handed the Léon Bernard Foundation Prize to Professor Debré. Au milieu des applaudissements, le Président remet le Prix de la Fondation Léon Bernard au Professeur Debré.
4 А17/vR/5 page 81
Le Professeur DEERE : Monsieur le Président, Messieurs les délégués à la Dix -
Septième Assemblée de la Santé, ratifiant le vote de votre Comité Léon Bernard, que je remercie, vous voulez bien me désigner comme le neuvième lauréat du Prix
Léon Bernard.
Cet honneur insigne, que je n'avais jamais espéré, représente pour moi, après une longue carrière, á la fois un couronnement conféré par un aréopage international doué du plus grand prestige et aussi l'évocation poignante de mon maître Léon Bernard.
Ce prix fut fondé jadis - dans un monde passé - par le Comité d'Hygiène de la
Société des Nations sous l'inspiration de deux hommes dant je veux évoquer le nom, le Professeur Th. Madsen et le Dr L. Rajchman, qui étaient l'un et l'autre des amis très proches de Léon Bernard et avaient collaboré avec lui.
Le Comité d'Hygiène de la Société des Nations ne put donner le prix qu'une fois, le 4 mai 1939, au Dr Wilhelm Sawyer, Directeur de la Division de l'Hygiène interna- tionale à la Fondation Rockefeller. Etaient ainsi honorés à la fois un grand hygiéniste et le représentant d'une noble entreprise américaine vouée avec générosité à la coo- pération internationale. La guerre et ses horreurs étaient proches.
Plus tard, dans un monde nouveau, l'Organisation mondiale de la Santé établie sur des bases élargies devait hériter de cette fondation. A partir de 1951 vous avez dési- gné presque chaque année un homme de haute et légitime réputation. Permettez -moi d'ap- peler leurs noms, comme ceux des combattants les plus célèbres pour la santé publique
et la collaboration mondiale : le Professeur René Sand, de Belgique, le Profes- seur Charles -Edward Amory Winslow, des Etats -Unis d'Amérique, le Dr Johannes Frandsen, du Danemark, le Professeur Jacques Parisot, de France, le Professeur Andrija Stampar, A 17ivR/5 page 82
de Yougoslavie, le Professeur larcin Kacprzak, de Pologne, le Dr Thomas Parran, des
Etats -Unis, et, enfin, la dernière fois, Sir John Charles, de Grande- Bretagne.
En rappelant tout haut les noms de cette cohorte, qui compte des disparus - que
l'on n'oublie pas - et des hommes vivants, et bien vivants - qu'entoure notre respec-
tueuse admiration - je ressens aujourd'hui toute la fierté de me ranger modestement
parmi eux et de m'abriter à l'ombre de leur réputation universelle. Peut -être en me
citant dans ce palmarès avez -vous surtout voulu retenir celui qui a été l'élève, le
collaborateur et l'ami du grand Patron que fut Léon Bernard et qui a cherché après sa mort à continuer son oeuvre.
Je ne saurais donc manquer cette unique occasion de rappeler parmi nous la mémoire de cet homme, en joignant, si vous le permettez, l'expression de mes sentiments per-
sonnels à l'éloge de ses mérites.
Lorsqu'il nous préparait au métier de médecin, Léon Bernard ne négligeait pas
de nous montrer la profession du praticien sous son aspect le plus noble : au souci du corps du malade il fallait joindre le souci de son être moral. De lui on ne peut
oublier cette parole qui traduit sa pensée profonde : "La médecine doit être pratiquée
comme une forme de l'amitié ".
De lui nous avons appris aussi à ne pas nous contenter de la médecine tradition- nelle, du diagnostic posé, de la prescription des médicaments et de la parole conso-
lante, mais encore à envisager l'aspect social de la maladie, sa prévention, ses ré-
percussions économiques, familiales, psychologiques qu'elle entraîne : suivre le ma-
lade hors de l'hôpital, l'accompagner chez lui et protéger les siens. Pour une telle
besogne, l'effort du médecin isolé ne peut suffire, il faut une équipe. Ayant le goût du travail en commun, Léon Bernard se plaisait en la compagnie d'hommes jeunes qui à
ses côtés écoutaient, discutaient, travaillaient. А17/%/5 page 83
Il avait aussi vu clairement que la nation doit s'armer pour lutter contre la maladie et que l'action démocratique exige l'éducation de tout le peuple, la pres- sion de l'opinion publique, l'effort des autorités, la mise en oeuvre des bonnes volontés, enfin la création et l'exécution d'une législation sociale. Cette pensée l'anima lorsqu'il fonda avec des hommes d'Etat, de grands administrateurs, des femmes généreuses, ses oeuvres principales. Celles -ci lui survivent et se sont dé-
veloppées après lui : les offices publics d'hygiène sociale des départements fran-
çais, le placement familial des tout -petits, le service social à l'hôpital, avec
Mlle Chaptal, les dispensaires antituberculeux avec Albert Calmette, le Comité na- tional de Défense contre la Tuberculose, avec Fernand Besançon et Edouard Rist. Il consacrait à cette tache son intelligence si vigoureuse et si claire, son énergie d'homme fort et plein d'espoir.
Mais son élan l'entraînait au -delà des limites de son pays. Il sentait que la solidarité entre les hommes devait se traduire par des institutions et des actions internationales. La Société des Nations fut avant les folies meurtrières et les massacres de la Deuxième Guerre mondiale un essai, précurseur de l'Organisation des
Nations Unies. Or Léon Bernard fut intimement associé à sa création imaginée par le Président Wilson. En effet, il fut aux côtés de Lord Balfour et Léon Bourgeois l'un des hommes qui ont conçu et fondé la Société des Nations elle -même, ses insti- tutions et parmi celles -ci le Comité d'Hygiène. Dès 1919, á Londres, il participait
au Comité provisoire qui organisa la lutte contre les épidémies, dont le fléau mena-
çait le monde après la Première Guerre mondiale. Puis il devint président de la Com- mission de la Tuberculose du Comité d'Hygiène et animateur de ce comité. Il alla en А17 /VR/5 page 84
Grèce, où le Gouvernement de ce pays demandait l'aide de la Société des Nations pour l'expansion de ses services d'hygiène, en Amérique du Sud, en divers pays de l'Europe et de l'Afrique, à la Ligue des Sociétés de Croix -Rouge, aux séances de laquelle il ne manquait jamais, dispenser ses avis, ses encouragements, comme un apôtre de l'hygiène sans frontière. Il fut l'un des promoteurs des Ecoles nationales d'Hygiène de Zagreb, de Budapest, de Dresde, de Londres et contribua à en définir les programmes et le travail... Je m'arrête mais ne puis oublier combien était dure alors la tache de ces
pionniers : contre la tuberculose point de médicaments actifs, capables de la guérir; il fallait alors dépister, isoler, soigner de son mieux et promouvoir le vaccin de
Calmette encore contesté Contre le paludisme la lutte se limitait à l'assèchement des marais et à la quinine. Contre la syphilis, à l'emploi des médicaments tradition- nels et des arsénobenzènes. Et la lèpre, symbole affreux du péché originel, quelles armes avaient nos cinés contre ell J'ajoute aussi que les législations de sécurité sociale, si efficaces à présent, n'étaient qu'ébauchées. Et cependant, de toutes leurs forces Léon Bernard et ses collègues se battaient.
Léon Bernard appartenait à une belle génération qui croyait au triomphe de la raison, à la noblesse de la pensée libre, à l'union des peuples et à la paix. Il était iui-mgme confiant dans les hommes, soucieux du travail bien fait, accompli avec le soin du détail, la recherche de l'exactitude, le souci de la forme bien modelée. Il savait aussi jouir des charmes de la vie; à l'époque tendre du Paris de sa jeunesse il en aimait respirer l'air léger qu'anime, dans son cadre de beauté, le souffle tantôt doux, tantôt fort da la liberté. А17/VR/5 page 85
De ceux qui ont disparu nous gardons en notre mémoire une image, celle que nous nous sommes faite, puisque nous créons pour nous -mêmes les êtres et les objets. La vision qui m'est restée de Léon Bernard est celle d'un homme à la démarche ferme, à
l'allure fière, au visage très beau, aux yeux noirs et brillants enfoncés sous la voûte orbitaire, à l'esprit animé par le besoin d'action et de générosité.
Monsieur le Président, Messieurs les délégués, ce n'est sans doute pas seulement
le disciple de Léon Bernard que vous avez bien voulu honorer, mais aussi un médecin voué tout le long de sa carrière à la protection des enfants, qui a essayé de défendre
la cause de l'enfance dans les Institutions des Nations Unies, avant tout au Conseil
du FISE, à qui vous me permettrez de rendre hommage, et aussi parmi vous et avec vous,
Messieurs, délégués des gouvernements, Directeur, fonctionnaires et experts de l'Orga-
nisation mondiale de la Santé, travaillant sur le terrain, dans des terrains bien
variés à la surface de la terre, où nous avons ensemble prêché la pédiatrie sociale
et, du mieux que nous le pouvions, essayé de réaliser des institutions en faveur de
l'enfance et de la jeunesse.
Faut -il le rappeler une fois encore : l'enfance et la jeunesse sont les premières
victimes non seulement de l'ignorance, des préjugés, des traditions nocives, mais aussi
du fatalisme, de la résignation devant le malheur. Ils souffrent plus que les adultes
de la faim dans de vastes contrées du globe - la "Géopolitique de la Faim ", du Pro-
fesseur Josué de Castro, nous l'a bien montré. Nous savons reconnattre ses effets
nocifs et pitoyables chez ces petits au regard triste, dont la mélancolie traduit les
misères du corps. Par ailleurs, ils sont bien souvent atteints, dès leur âgе le plus
tendre, par les attaques des germes microbiens, des protozoaires et des virus et les A17/'ТR/5 page 86
infestations diverses. Dans de nombreux territoires beaucoup meurent, ayant à peine vécu, et s'ils survivent ils restent, sans doute pour leur existence, marqués par les séquelles de la malnutrition et des infections. Dans les pays défavorisés ils forment le groupe le plus vulnérable, le plus digne de notre effort. Ils appellent à leur se- cours et profitent heureusement de celui que leur apportent l'Organisation mondiale de la Santé, le FISE et la FAO. Comment ne pas rendre hommage aux animateurs de ces institutions, soucieux du petit homme qui dans les zones tropicales et subtropicales est comme perdu au fond des montagnes, des forets, de la brousse et de la savane ?
C'est là que vous cherchez à établir des dispositifs adaptés de protection maternelle
et ;_nf antile .
Prenant le droit de parler au nom de tous les enfants et au nom de la pédiatrie sociale, je me permets de vous remercier profondément pour votre politique en faveur de l'enfance. Il nous faut sans cesse évoquer ce problème, montrer que quelle que soit la politique de natalité prônée par les gouvernements des pays où persiste la fécon- dité naturelle des couples, le souci de l'enfant considéré comme un bien infiniment précieux est non seulement une oeuvre de charité et de solidarité humaine, mais un bon placement. Car rien d'efficace ne peut étre fait sans une population saine, á la croissance et à l'équilibre bien assurés. Et il faut commencer cette tâche de préven- tion et de protection dès avant la naissance, et durant l'enfance et la jeunesse, car les traces des dégâts subis, le corps et l'âme les gardent toute leur vie. Cette tâche, l'Organisation mondiale de la Santé, aidée du FISE qu'elle inspire, la remplit de son mieux. А17'ДТR/5 page 87
Le monde où nous vivons et où l'Organisation mondiale de la Santé exerce son action est bien différent de celui que j'évoquais tout à l'heure. Ce monde est vio- lent et passionné, les libérations successives et jamais achevées de la femme, de l'enfant, des classes sociales, des peuples et des continents se sont accompagnées et s'accompagnent chaque jour d'agitation, de guerres et de meurtres. Dans le même temps, la science et la technique font en quelques décades plus de progrès qu'en mille ans et leur audace n'a pas de limites. Et aussi les distances diminuent, les peuples se rapprochent et la terre entière semble devenir bien petite.
C'est dans ce monde en perpétuel et rapide changement que l'Organisation mondiale de la Santé, au nom de l'humanité entière, entreprend son oeuvre salvatrice, sa croi- sade contre la souffrance et les morts évitables, rassemble l'effort de libération contre les fléaux, la faim et les maladies. Elle veut aussi orienter les recherches des savants et faire profiter de leurs découvertes magiques tous ceux qui dans le monde devraient en bénéficier. Son rôle historique, qui ne peut que grandir, est notre fierté. L'Organisation des Nations Unies l'a placée à Genève, dans l'ancien continent où naquirent les civilisations de l'occident et de l'orient, à côté du tombeau de
J. -J. Rousseau, citoyen de Genève, philosophe français, un des plus célèbres parmi les "amis des hommes". Ici nous trouvons, dans ce Palais des Nations, une réunion d'hommes qui aiment leur patrie et aussi toutes les patries des autres, qui sont imbus des principes de cette égalité entre les hommes qui féconde et enchante notre pensée et notre action. Votre bonne volonté et votre volonté vous permettent de vaincre les obstacles que votre sens des réalités définit, que la science étudie et que votre enthousiasme surmonte. En voulant, pour ne citer qu'un exemple, faire disparaître le А17/`VR /5 page 88 paludisme de la terre, vous attaquez le monstre de la fable antique, l'Hydre de Lerne, qui vit dans les marais, un monstre aux mille .têtes repoussant, quand on les tranche.,.
Vous avez ainsi repris la tache d'Hercule à l'échelle du monde. La science et la foi guident l'Organisation mondiale de la Santé et, lorsque sont survenus d'inévitables obstacles financiers et techniques, vous ne vous découragez pas. Votre fraternité prend le plus grand souci des nations déshéritées de la terre pour une collaboration efficace. Votre morale est la recherche de l'égalité parmi tous les hommes devant la maladie. Votre doctrine, l'indifférence la plus absolue vis -à -vis de la diversité des races humaines, des régimes et des gouvernements. Vous savez bien que vous devez votre secours également à tous les hommes. La science et la technique modernes ne sont pas sans ressentir la honte de leur emploi prodigieux pour des destructions catastrophiques.
En appliquant cette science et cette technique, comme vous le faites, à la santé et à la vie, vous leur donnez, vous nous donnez à tous, une meilleure conscience. Soyez -en
remerciés. .
The PRESIDENТ: Thank you, Professor Debré, and once again warmest congratulations.
The meeting is adjourned.
The meeting rose at 1.05 p.m. La séance est levée à 13 h.05.