OFFICIAL RECORDS OF THE WORLD HEALTH ORGANIZATION No. 127
SIXTEENTH WORLD HEALTH ASSEMBLY
GENEVA, 7 - 23 MAY 1963
PART I
RESOLUTIONS AND DECISIONS ANNEXES
WORLD HEALTH ORGANIZATION GENEVA
September 1963 The following abbreviations are used in the Official Records of the World Health Organization:
ACABQ Advisory Committee on Administrative and Budgetary Questions ACC Administrative Committee on Co- ordination BTAO Bureau of Technical Assistance Operations CCTA Commission for Technical Co- operation in Africa CIOMS Council for International Organizations of Medical Sciences ECA EconomicCommission for Africa ECAFE EconomicCommission for Asia and the Far East ECE EconomicCommission for Europe ECLA EconomicCommission for Latin America FAO Food andAgriculture Organization IAEA - International Atomic Energy Agency ICAO - International Civil Aviation Organization ILO - International Labour Organisation (Office) IMCO - Inter -Governmental Maritime Consultative Organization ITU - International Telecommunication Union MESA - Malaria Eradication Special Account OIHP - Office International d'Hygiène Publique OPEX - Programme (of the United Nations) for the provision of operational, executive and administrative personnel PAHO - Pan American Health Organization PA SB - Pan American Sanitary Bureau SMF - Special Malaria Fund of PAHO TAB - Technical Assistance Board TAC - Technical Assistance Committee UNESCO- United Nations Educational, Scientific and Cultural Organization UNICEF - United Nations Children's Fund UNRWA - United Nations Relief and Works Agency for Palestine Refugees in the Near East UNSCEAR - United Nations Scientific Committee on the Effects of Atomic Radiation WFUNA - World Federation of United Nations Associations WMO - World Meteorological Organization
The designations employed and the presentation of the material in this volume do not imply the expression of any opinion on the part of the Director -General concerning the legal status of any country or territory or of its authorities, or concerning the delimitation of its frontiers.
PRINTED IN SWITZERLAND The Sixteenth World Health Assembly, held at the Palais des Nations, Geneva, from
7 to 23 May 1963, was convened in accordance with resolution WHA15.28ofthe Fifteenth
World Health Assembly and resolution EB30.R9ofthe Executive Board (thirtieth session).
The proceedingsofthe Sixteenth World Health Assembly are being published in two
parts.The resolutions, with annexes, are contained in this volume. The recordsofplenary
and committee meetings will be printed, along with the listofparticipants, agenda and other
material, inOfficial RecordsNo. 128.
56502 In this volume the resolutions are reproduced in the numerical order in which they were adopted. However, in order to facilitate the use of the volume in conjunction with the Handbook of Resolutions and Decisions, they have been grouped by title in the table of contents under the subject -headings of the Handbook. There has also been added, beneath each resolution, a reference to the section of the Handbook containing previous resolutions on the same subject.The sixth edition of the Handbook -which is indexed both by subject and by resolution symbol- contains most of the resolutions adopted up to and including the Fourteenth World Health Assembly and the twenty- eighth session of the Executive Board. The following reference list of sessions of the Health Assembly and Executive Board shows the resolution symbol applicable to each session and the Official Records volume in which the resolutions were originally published. Held Resolution Official symbol Records No.
First World Health Assembly 24 June - 24 July 1948 13 Executive Board, First Session 16 -28 July 1948 14 Executive Board, Second Session 25 October - 11 November 1948 14 Executive Board, Third Session 21 February - 9 March 1949 17 Second World Health Assembly 13 June - 2 July 1949 WHA2.- 21 Executive Board, Fourth Session 8 -19 July 1949 22 Executive Board, Fifth Session 16 January - 2 February 1950 25 Third World Health Assembly 8 -27 May 1950 WHA3.- 28 Executive Board, Sixth Session 1 -9 June 1950 EB6.R- 29 Executive Board, Seventh Session 22 January - 5 February 1951 EB7.R- 32 Fourth World Health Assembly 7 -25 May 1951 WHA4.- 35 Executive Board, Eighth Session 1 -8 June 1951 EB8.R- 36 Executive Board, Ninth Session 21 January - 4 February 1952 EB9.R- 40 Fifth World Health Assembly 5 -22 May 1952 WHA5.- 42 Executive Board, Tenth Session 29 May - 3 June 1952 EB10.R- 43 Executive Board, Eleventh Session 12 January - 4 February 1953 EB11.R- 46 Sixth World Health Assembly 5 -22 May 1953 WHA6.- 48 Executive Board, Twelfth Session 28 -30 May 1953 EB12.R- 49 Executive Board, Thirteenth Session 12 January - 2 February 1954 EB13.R- 52 Seventh World Health Assembly 4 -21 May 1954 WHA7.- 55 Executive Board, Fourteenth Session 27 -28 May 1954 EB14.R- 57 Executive Board, Fifteenth Session 18 January - 4 February 1955 EB15.R- 60 Eighth World Health Assembly 10 -27 May 1955 WHA8.- 63 Executive Board, Sixteenth Session 30 May 1.955 EB16.R- 65 Executive Board, Seventeenth Session 17 January - 2 February 1956 EB17.R- 68 Ninth World Health Assembly 8 -25 May 1956 WHA9.- 71 Executive Board, Eighteenth Session 28 -30 May 1956 EB18.R- 73 Executive Board, Nineteenth Session 15 -30 January 1957 EB19.R- 76 Tenth World Health Assembly 7 -24 May 1957 WHA10.- 79 Executive Board, Twentieth Session 27 -28 May 1957 EB20.R- 80 Executive Board, Twenty -first Session 14 -28 January 1958 EB21.R- 83 Eleventh World Health Assembly 28 May - 13 June 1958 WHA11.- 87 Executive Board, Twenty- second Session 16 -17 June 1958 EB22.R- 88 Executive Board, Twenty -third Session 20 January - 3 February 1959 EB23.R- 91 Twelfth World Health Assembly 12 -29 May 1959 WHAl2.- 95 Executive Board, Twenty- fourth Session 1 -2 June 1959 EB24.R- 96 Executive Board, Twenty -fifth Session 19 January - 1 February 1960 EB25.R- 99 Thirteenth World Health Assembly 3 -20 May 1960 WHA13.- 102 Executive Board, Twenty -sixth Session 25 October - 4 November 1960 EB26.R- 106 Executive Board, Twenty- seventh Session 30 January - 2 February 1961 EB27.R- 108 Fourteenth World Health Assembly 7 -24 February 1961 WHA14.- 110 Executive Board, Twenty- eighth Session 29 May - 1 June 1961 EB28.R- 112 Executive Board, Twenty -ninth Session 15 -26 January 1962 EB29.R- 115 Fifteenth World Health Assembly 8 -25 May 1962 WHA15.- 118 Executive Board, Thirtieth Session 29 -30 May 1962 EB30.R- 120 Executive Board, Thirty -first Session 15 -28 January 1963 EB31.R- 124 Sixteenth World Health Assembly 7 -23 May 1963 WHA16.- 127 Executive Board, Thirty- second Session 27 -28 May 1963 EB32.R- 129 .. .+ i/s"+i s fka - IV ! _ l Index to resolutions: page 211
CONTENTS
RESOLUTIONS AND DECISIONS Page Resolutions on Programme
WHA16.31 Continued Assistance to Newly Independent States 15
BIOLOGY AND PHARMACOLOGY
WHA16.36 Clinical and Pharmacological Evaluation of Drugs 18 WHA16.38 Clinical and Pharmacological Evaluation of Drugs :Standards of Drugs 19
MALARIA Malaria Eradication WHA16.23 Report on the Development of the Malaria Eradication Programme 10
COMMUNICABLE DISEASES Virus and Rickettsial Diseases WHA16.37 Smallpox Eradication Programme 19 International Quarantine WHA16.34 Additional Regulations of 23 May 1963 amending the International Sanitary Regula- tions, in particular with respect to Notifications 16 WHA16.35 Committee on international Quarantine :Eleventh Report 18
HEALTH PROTECTION AND PROMOTION Mental Health
WHA16.25 Television Influence on Youth 1 l Nutrition WHA16.42 Joint FAO /WHO Programme on Food Standards (Codex Alimentarius) 21
REPORTS AND EVALUATION Annual Report of the Director - General WHA16.12 Annual Report of the Director- General fór 1962 6
Resolutions on Programme and Budget
CONSIDERATION AND APPROVAL OF PROGRAMME AND BUDGET ESTIMATES
WHA16.6 Supplementary Budget Estimates for 1963 2 WHA16.8 Addition to Schedule A to the Appropriation Resolutions for the Financial Years 1962 and 1963 3 -V - Page WHA16.13 Effective Working Budget and Budget Level for 1964 6 WHA16.28 Appropriation Resolution for the Financial Year 1964 12
Resolutions concerning the World Health Assembly and Executive Board
WORLD HEALTH ASSEMBLY Time and Place WHA16.16 Selection of the Country in which the Seventeenth World Health Assembly will be held 7
EXECUTIVE BOARD Membership of the Board WHA16.11 Election of Members entitled to designate a Person to serve on the Executive Board 5 Minutes, Resolutions and Reports WHA16.44 Reports of the Executive Board on its Thirtieth and Thirty -first Sessions 22
Resolutions on Regional Matters
INDIVIDUAL REGIONS Africa WHA16.9 Accommodation for the Regional Office for Africa 3 WHA16.43 Meetings of the Regional Committee for Africa 21
Resolutions on Constitutional and Legal Matters
MEMBERSHIP Decisions Concerning Individual States and Territories
WHA16.3 Admission of New Associate Members :Mauritius 1
WHA16.4 Admission of New Associate Members : Kenya 1
Resolutions on Financial and Administrative Matters
FINANCIAL MATTERS Assessments andContributions WHA16.10 Scale of Assessment for 1964 4 WHA16.7 Assessments of New Members for 1962 and 1963 3 WHA16.20 Status of Collection of Annual Contributions and of Advances to the Working Capital Fund 8 Financing of theMalaria Eradication Programme - Malaria Eradication Special Account WHA16.17 Malaria Eradication Special Account 7 WHA16.18 Malaria Eradication Postage Stamps 7 Voluntary Fund for Health Promotion WHA16.26 Voluntary Fund for Health Promotion :Medical Research 11 WHA16.27 Voluntary Fund for Health Promotion : Community Water Supply 12 - VI - Page Accounts and External Audit WHA16.14 Appointment of the External Auditor 6 WHA16.5 Financial Report on the Accounts of WHO for the Year 1962 and Report of the External Auditor 2
STAFF MATTERS Staff Regulations and Rules WHA16.15 Amendments to the Staff Rules 6
Pension Fund WHA16.19 Annual Report of the United Nations Joint Staff Pension Board for 1961 8 WHA16.21 Appointment of Representatives to the WHO Staff Pension Committee 9
Director - General
WHA16.1 Appointment of the Director -General 1
WHA16.2 Contract of the Director -General 1
WHO HEADQUARTERS Construction of Separate WHO Building WHA16.22 Headquarters Accommodation :Progress Report 9
ORGANIZATIONAL STUDIES WHA16.29 Organizational Study on Measures for providing Effective Assistance in Medical Education and Training to meet Priority Needs of the Newly Independent and Emerging Countries 14 WHA16.30 Organizational Study on Methods of Planning and Execution of Projects 15
Resolutions on Co- ordination and External Relations
UNITED NATIONS AND ITS AGENCIES General WHA16.32 Decisions of the United Nations, Specialized Agencies and IAEA affecting WHO's Activities : Administrative, Budgetary and Financial Matters; Inter -organization Machinery for Matters of Pay and Allowances 15 WHA16.33 Decisions of the United Nations, Specialized Agencies and IAEA affecting WHO's Activities : Conference Arrangements 16 WHA16.39 Decisions of the United Nations, Specialized Agencies and IAEA affecting WHO's Activities : Programme Matters 20 Social and Economic Matters WHA16.40 United Nations Development Decade 20 Health of Children - Co- operation with UNICEF WHA16.24 Developments in Activities assisted jointly with UNICEF 11
Co- operation with the United Nations on Other Subjects WHA16.41 Extension of the Agreement with UNRWA 20 - VII - Page Procedural Decisions
(i)Composition of the Committee on Credentials 23 (ii)Composition of the Committee on Nominations 23 (iii)Verification of Credentials 23 (iv)Election of Officers of the Sixteenth World Health Assembly 24 (v)Election of Officers of the Main Committees 24 (vi)Establishment of the General Committee 24 (vii)Adoption of the Agenda 24
ANNEXES
1. International Quarantine : I. Eleventh Report of the Committee on International Quarantine 27 2. Discussion by the Executive Board on the Eleventh Report of the Committee on Inter- national Quarantine 60 2. Financial Report on the Accounts of WHO for 1962 and Report of the External Auditor : Report of the Ad Hoc Committee of the Executive Board 63 3. Supplementary Budget Estimates for 1963 : 1. Report of the Ad Hoc Committee of the Executive Board 65 2. Report by the Director -General 66 4. Accommodation for the Regional Office for Africa : 1. Report of the Ad Hoc Committee of the Executive Board 71 2. Report by the Director- General 72 5. Malaria Eradication Special Account 74 6. Malaria Eradication Postage Stamps 79 7. Headquarters Accommodation : 1. Report of the Ad Hoc Committee of the Executive Board 87 2. Progress Report by the Director -General 89 8. Development of the Malaria Eradication Programme in 1962 92 9. Review and Approval of the Programme and Budget Estimates for 1964 : 1. Report of the Ad Hoc Committee of the Executive Board 157 2. Report by the Director -General 158 10. Summary of Budget Estimates for the Financial Year 1 January - 31 December 1964 161 11.Decisions of the United Nations, Specialized Agencies and the International Atomic Energy Agency affecting WHO's Activities (Administrative, Budgetary and Financial Matters) 165 12. Clinical and Pharmacological Evaluation of Drugs 166 13. United Nations Development Decade 168 14. Meetings of the Regional Committee for Africa 180 15. Organizational Study on Measures for Providing Effective Assistance in Medical Education and Training to meet Priority Needs of the Newly Independent and Emerging Countries 182 16. Smallpox Eradication Programme 195
Index to Resolutions and Decisions 211
- viii - RESOLUTIONS AND DECISIONS
WHA16.1 Appointment of the Director -General
The Sixteenth World Health Assembly, On the nomination of the Executive Board, REAPPOINTS Dr M. G. Candau as Director -General of the World Health Organization.
Handb. Res., 6th ed., 7.3.10.2 Fourth plenary meeting, 8 May 1963
WHA16.2 Contract of the Director -General
The Sixteenth World Health Assembly,
1. Pursuant to Article 31 of the Constitution and Rule 106 of the Rules of Procedure of the World Health Assembly, APPROVES the contract establishing the terms and conditions of appointment, salary and other emoluments for the post of Director -General; 1 and II.Pursuant to Rule 110 of the Rules of Procedure of the World Health Assembly, AUTHORIZES the President of the Sixteenth World Health Assembly to sign this contract in the name of the Organization.
Handb. Res., 6th ed., 7.3.10.2 Fourth plenary meeting, 8 May 1963
WHA16.3 Admission of New Associate Members : Mauritius
The Sixteenth World Health Assembly ADMITS Mauritius as an Associate Member of the World Health Organization, subject to notice being given of acceptance of associate membership on behalf of Mauritius in accordance with Rules 115 and 116 of the Rules of Procedure of the World Health Assembly.
Handb. Res., 6th ed., 6.2.1.2 Sixth plenary meeting, 9 May 1963
WHA16.4 Admission of New Associate Members : Kenya
The Sixteenth World Health Assembly ADMITS Kenya as an Associate Member of the World Health Organization, subject to notice being given of acceptance of associate membership on behalf of Kenya in accordance with Rules 115 and 116 of the Rules of Procedure of the World Health Assembly.
Handb. Res., 6th ed., 6.2.1.2 Sixth plenary meeting, 9 May 1963
1 Of. Rec. WO Hlth Org. 124, Annex 16, Appendix. - 1 - SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
WHA16.5 Financial Report on the Accounts of WHO for the Year 1962 and Report of the External Auditor The Sixteenth World Health Assembly, Having examined the Financial Report of the Director -General for the period 1 January to 31 December 1962 and the Report of the External Auditor for the same financial period, as contained in Official Records No. 126;and Having considered the report of the Ad Hoc Committee of the Executive Board on its examination of these reports,' ACCEPTS the Director -General's Financial Report and the Report of the External Auditor for the financial year 1962.
Handb. Res., 6th ed., 7.1.11.3 Seventh plenary meeting, 14 May 1963 (Committee on Administration, Finance and Legal Matters, first report)
WHA16.6 Supplementary Budget Estimates for 1963
The Sixteenth World Health Assembly, Having considered the proposals of the Director -General and the recommendations of the Executive Board concerning supplementary budget estimates for 1963, 2 1. APPROVES the supplementary estimates for 1963; 2. DECIDES to amend the Appropriation Resolution for 1963 (resolution WHA15.42) by increasing the amounts voted under paragraph I as follows :
Appropriation Purpose of Appropriation Amount Section US $ PART II : OPERATING PROGRAMME 4. Programme Activities 95 250 5. Regional Offices 23 700 7. Other Statutory Staff Costs 142 180
Total - Part II 261 130
PART III: ADMINISTRATIVE SERVICES
8. Administrative Services 27 350 9. Other Statutory Staff Costs 36 620
Total - Part III 63 970
PART IV : OTHER PURPOSES
10. Headquarters Building Fund 113 000
Total - Part IV 113 000
TOTAL - PARTS II, III AND 1V 438 100
' See Annex 2. 2 See Annex 3. RESOLUTIONS AND DECISIONS 3
3. DECIDES further to amend paragraph III of resolution WHA15.42 by increasing the amounts under sub -paragraphs (i) and (iii) as follows : (i)the amount of $35 990 available by reimbursement from the Special Account of the Expanded Programme of Technical Assistance (iii)the amount of $ 402 110 representing miscellaneous income available for the purpose
$ 438 100
H ando. Res., 6th ed., 2.1 Seventh plenary meeting, 14 May 1963 (Committee on Administration, Finance and Legal Matters, first report)
WHA16.7 Assessments of New Members for 1962 and 1963 The Sixteenth World Health Assembly, Noting that several States became Members of the Organization during 1962 and 1963 by depositing with the Secretary -General of the United Nations a formal instrument of acceptance of the WHO Consti- tution,
DECIDES that these Members shall be assessed as follows : Member State 1962 1963 Per cent. Per cent. Algeria 0.04 0.04 Burundi 0.04 0.04 Rwanda 0.04 0.04 Trinidad and Tobago 0.04 Uganda 0.04 Jamaica 0.04 Handb. Res., 6th ed., 7.1.2.2 Seventh plenary meeting, 14 May 1963 (Committee on Administration, Finance and Legal Matters, first report)
WHA16.8 Addition to Schedule A to the Appropriation Resolutions for the Financial Years 1962 and 1963 The Sixteenth World Health Assembly DECIDES that, since Algeria, Burundi, Rwanda, Trinidad and Tobago, Uganda, Jamaica, Kenya, and Mauritius are carrying out malaria programmes, they are eligible for credits in 1962 and /or 1963 in the same way as those Members listed in Schedule A attached to the Appropriation Resolutions for the financial years 1962 and /or1963.1 Handb. Res., 6th ed., 2.1; 2.1.15 Seventh plenary meeting, 14 May 1963 (Committee on Administration, Finance and Legal Matters, first report)
WHA16.9 Accommodation for the Regional Office for Africa The Sixteenth World Health Assembly, Having considered the report of the Director -General on accommodation for the Regional Office for
Africa and the report of the Executive Board thereon;2
1Resolutions WHA14.43 and WHA15.42.
2See Annex 4. 4 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Having noted with gratification the further generous contributions offered by Members in the African Region to help finance the cost of extending the accommodation of the Regional Office; Recalling the provisions of paragraph 4 of resolution WHA15.14, authorizing the Director -General, notwithstanding the provisions of part II, paragraph 1(2) of resolution WHA13.41, to advance from the Working Capital Fund an amount not exceeding $300 000 to be credited to the African Regional Office Building Fund;and Noting that the Director -General will exercise this authority to the extent of $200 000, reimbursement being provided for in the proposed programme and budget estimates for 1964, 1. INVITES all the Members in the African Region that have not yet done so to make contributions for the extension of the Regional Office accommodation;and 2. AUTHORIZES the Director -General, notwithstanding the provisions of part II, paragraph 1 (2) of reso- lution WHA13.41, to advance from the Working Capital Fund an amount not exceeding $100 000 to be credited to the African Regional Office Building Fund to help finance the said construction, reimbursement to the Working Capital Fund of the sum so advanced to be provided for, if necessary, in the programme and budget estimates for 1965. Handb. Res., óth ed., 5.2.1.2 Seventh plenary meeting, 14 May 1963 (Committee on Administration, Finance and Legal Matters, first report)
WHA16.10 Scale of Assessment for 1964 The Sixteenth World Health Assembly
I DECIDES that the scale of assessment for 1964 shall be as follows :
Member (Percentage) Member (Perscentage) Afghanistan 0 05 El Salvador 0 04 Albania 0 04 Ethiopia 0 05
Algeria 0 04 Federation of Rhodesia and Nyasaland . . 0.02 Argentina 0 92 Finland 0 33 Australia 1 50 France 5 39 Austria 0 41 Gabon 0 04 Belgium 1 09 Germany, Federal Republic of 5 17 Bolivia 0 04 Ghana 0 08 Brazil 0 93 Greece 0 21 Bulgaria 0 18 Guatemala 0 05 Burma 0 06 Guinea 0 04 Burundi 0 04 Haiti 0 04 Byelorussian SSR 0 47 Honduras 0 04 Cambodia 0 04 Hungary 0 51 Cameroon 0 04 Iceland 0 04 Canada 2 83 India 1 84 Central African Republic 0 04 Indonesia 0 41 Ceylon 0 08 Iran 0 18 Chad 0 04 Iraq 0 08 Chile 0 24 Ireland 0 13 China 4 14 Israel 0 14 Colombia 0 24 Italy 2 03 Congo (Brazzaville) 0 04 Ivory Coast 0 04 Congo (Leopoldville) 0 06 Jamaica 0 04 Costa Rica 0 04 Japan 2 06 Cuba 0 20 Jordan 0 04 Cyprus 0 04 Kenya 0 02 Czechoslovakia 1 06 Korea, Republic of 017 Dahomey 0 04 Kuwait 0 04 Denmark 0 53 Laos 0 04 Dominican Republic 0 05 Lebanon 0 05 Ecuador 0 05 Liberia 0 04 RESOLUTIONS AND DECISIONS 5
Member - Scale Member Scale (Percentage) (Percentage) Libya 004 Somalia 004 Luxembourg 0 05 South Africa 048 Madagascar 004 Spain 0 78 Malaya, Federation of 0 12 Sudan 0 06 Mali 004 Sweden 1 18 Mauritania 004 Switzerland 0 86 Mauritius 0 02 Syria 0 05 Mexico 0 67 Tanganyika 0 04 Monaco 004 Thailand 014 Mongolia 004 Togo 004 Morocco 0 13 Trinidad and Tobago 004 Nepal 004 Tunisia 0 05 Netherlands 0 92 Turkey 0 36 New Zealand 0 37 Uganda 0 04 Nicaragua 0 04 Ukrainian SSR 1 80 Niger 0 04 Union of Soviet Socialist Republics 13 58 Nigeria 0 19 United Arab Republic 0 22 Norway 0 41 United Kingdom of Great Britain and Northern Pakistan 0 38 Ireland 6 88 Panama 004 United States of America 31 29 Paraguay 004 Upper Volta 004 Peru 0 09 Uruguay 0 10 Philippines 0 36 Venezuela 0 47 Poland 1 16 Viet -Nam, Republic of 014 Portugal 014 Western Samoa 004 Romania 0 29 Yemen 004 Rwanda 004 Yugoslavia 0 34 Saudi Arabia 0 06 Senegal 0 05 Total100.00 Sierra Leone 0 04
II Considering that the WHO scale of assessment for 1964 is based on the latest available scale adopted by the United Nations, in accordance with the provisions of resolution WHA8.5, paragraph 2 (5), adopted by the Eighth World Health Assembly; and Noting that the General Assembly of the United Nations in its resolution 1870 (XVII), in paragraph 7, provides for possible revisions in the scale of assessment as may appear warranted, DECIDES that, if the General Assembly of the United Nations retroactively adjusts the United Nations scale of assessment for 1963, the WHO scale of assessment for 1964 should be similarly adjusted, provided, however, that such adjustments shall be taken into account in calculating the contributions to be paid by Members in respect of the budget of the Organization for the year 1965.
Handb. Res., 6th ed., 7.1.2.1 Seventh plenary meeting, 14 May 1963 (Committee on Administration, Finance and Legal Matters, first report)
WHA16.11 Election of Members entitled to designate a Person to serve on the Executive Board
The Sixteenth World Health Assembly,
Having considered the nominations of the GeneralCommittee,1 ELECTS the following Members as Members entitled to designate a person to serve on the Board : Brazil, Indonesia, Iran, Mali, Netherlands, New Zealand, Norway and Sierra Leone.
Handb. Res., 6th ed., 4.2.1 Ninth plenary meeting, 15 May 1963
1For report of the General Committee, seeOff. Rec. Wld Hith Org. 128. 6 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
WHA16.12 Annual Report of the Director -General for 1962
The Sixteenth World Health Assembly, Having reviewed the Report of the Director -General on the work of WHO during 1962,' 1. NOTES with satisfaction the manner in which the programme was planned and carried out in 1962, in accordance with the established policies of the Organization; and 2. COMMENDS the Director -General for the work accomplished.
Handb. Res., 6th ed., 1.14.1 Tenth plenary meeting, 16 May 1963
WHA16.13 Effective Working Budget and Budget Level for 1964
The Sixteenth World Health Assembly DECIDES that : (1)the effective working budget for 1964 shall be US $34 065 100; (2)the budget level for 1964 shall be established in an amount equal to the effective working budget as provided in paragraph (1) above, plus the assessments represented by the Undistributed Reserve; and (3)the budget for 1964 shall be financed by assessments on Members after deducting (i)the amount of US $756 990 available by reimbursement from the Special Account of the Expanded Programme of Technical Assistance; and (ii)the amount of US $849 100 available as casual income for 1964.
Handb. Res., 6th ed., 2.1 Tenth plenary meeting, 16 May 1963 (Committee on Programme and Budget, first report)
WHA16.14 Appointment of the External Auditor
The Sixteenth World Health Assembly RESOLVES that Mr Uno Brunskog be appointed external auditor of the accounts of the World Health Organization for the three financial years 1964 to 1966 inclusive, to make his audits in accordance with the principles incorporated in Article XII of the Financial Regulations, with the provision that, should the necessity arise, he may designate a representative to act in his absence.
Handb. Res., 6th ed., 7.1.11.1 Eleventh plenary meeting, 18 May 1963 (Committee on Administration, Finance and Legal Matters, second report)
WHA16.15 Amendments to the Staff Rules
The Sixteenth World Health Assembly NOTES the amendments to the Staff Rules made by the Director -General and confirmed by the Executive Board.2
Handb. Res., 6th ed., 7.3.1.2 Eleventh plenary meeting, 18 May 1963 (Committee on Administration, Finance and Legal Matters, second report) 1 Off. Rec. Wld Hlth Org. 123. 2 Of Rec. Wld Hlth Org. 124, resolution EB31.R37 and Annex 6. RESOLUTIONS AND DECISIONS 7
WHA16.16 Selection of the Country in which the Seventeenth World Health Assembly will be held
The Sixteenth World Health Assembly, Considering the provision of Article 14 of the Constitution with regard to the selection of the country or region in which the next Health Assembly will be held, DECIDES that the Seventeenth World Health Assembly shall be held in Switzerland.
Handb. Res., 6th ed., 4.1.1.2 Eleventh plenary meeting, 18 May 1963 (Committee on Administration, Finance and Legal Matters, second report)
WHA16.17 Malaria Eradication Special Account
The Sixteenth World Health Assembly, Having considered the report of the Director - General on the Malaria Eradication Special Account; Having noted that the financing of the " regular " malaria eradication programme for the year 1963 is assured and that, according to resolution WHA14.15, the full cost of the " regular " malaria eradication programme for the year 1964 is included in the proposed regular budget estimates; Realizing, however, that funds are available only for financing a portion of the " accelerated " malaria eradication programme planned for 1963 and 1964; Noting further that the " accelerated " programme will be financed through funds set aside by the Director -General not only for the current year's obligations but also for continuing commitments in the ensuing year either up to the full completion of any individual activity approved for implementation within a period of two years, or to such appropriate phase of the activity as would be decided in each instance depending upon its nature,
1. REQUESTS the Director - General to transmit this resolution together with the report of the Director - General to all Members of the Organization, calling particular attention to the Assembly's expression of appreciation to the donors to the Malaria Eradication Special Account; and 2. REITERATES its appeal to Members in a position to do so, and especially to economically more developed Members, to make voluntary contributions to the Malaria Eradication Special Account in order to enable the Organization to carry out planned " accelerated " operations.
Handb. Res., 6th ed., 7.1.8 Eleventh plenary meeting, 18 May 1963 (Committee on Administration, Finance and Legal Matters, second report)
WHA16.18 Malaria Eradication Postage Stamps
The Sixteenth World Health Assembly, Having considered the Director -General's report on the malaria eradication postage stamp campaign,
" The World United against Malaria ";2 and Taking into account the final list of participants, with the dates of issue of their stamps and related philatelic material, under the World Health Organization's malaria eradication postage stamp plan, as shown in Appendix 2 of the report,
1. NOTES with satisfaction the results obtained through this philatelic campaign in publicizing the world malaria eradication programme and in raising funds for the Malaria Eradication Special Account;
1See Annex 5.
2See Annex 6. 8 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
2. THANKS the governments that have participated in the project;
3. EXPRESSES its appreciation to those governments that have offered donations either in stamps and other philatelic material or in cash;
41 NOTES that the sale of stamps and related philatelic material will close during the year 1963 and that any unsold philatelic material will be duly destroyed by the Organization in the manner described in the report of the Director -General; and
5. REQUESTS the Director -General to submit a final financial report on this project to a subsequent session of the Executive Board or the World Health Assembly.
Handb. Res., 6th ed., 7.1.8 Eleventh plenary meeting, 18 May 1963 (Committee on Administration, Finance and Legal Matters, second report)
WHA16.19 Annual Report of the United Nations Joint Staff Pension Board for 1961
The Sixteenth World Health Assembly NOTES the status of the operation of the Joint Staff Pension Fund as indicated by the annual report for the year 1961 and as reported by the Director -General.
Handb. Res., 6th ed., 7.3.7.2 Eleventh plenary meeting, 18 May 1963 (Committee on Administration, Finance and Legal Matters, second report)
WHA16.20 Status of Collection of Annual Contributions and of Advances to the Working Capital Fund
The Sixteenth World Health Assembly,
1 Having considered the report of the Director -General on the status of collection of contributions and of advances to the Working Capital Fund as at 30 April 1963; Noting with satisfaction that a large number of Members have paid their annual contributions and advances to the Working Capital Fund,
1. CALLS THE ATTENTION of Members to the importance of paying their contributions as early as possible in the Organization's financial year;
2. REQUESTS Members which have not done so to provide in their national budgets for regular payment to the World Health Organization of their annual contributions; and
3. URGES those Members concerned to make special efforts to liquidate their arrears in the shortest possible time;
II Considering that the continued non -payment of arrears could make it necessary to abandon or curtail approved programmes of the Organization; Noting further with regret that the arrears of Bolivia, Guatemala, Haiti, Panama and Uruguay make it necessary for the Assembly to consider, in accordance with Article 7 of the Constitution and the provisions of paragraph 2 of resolution W HA8.13, whether or not their right to vote should be suspended at the Sixteenth World Health Assembly,
1. DECIDES not to suspend the voting rights of the delegations concerned at the Sixteenth World Health Assembly; RESOLUTIONS AND DECISIONS 9
2.REQUESTS the Executive Board, at its sessions when the agenda of the World Health Assembly is prepared, to make specific recommendations, with the reasons therefor, to the Health Assembly with regard to any Members in arrears in the payment of contributions to the Organization to an extent which would invoke the provisions of Article 7 of the Constitution; 3. INVITES Members that are in arrears to an extent which would invoke the provisions of Article 7 of the Constitution to submit to the Executive Board a statement of their intentions as to payment of their arrears, so that the Health Assembly, when it considers the matter in accordance with the provisions of reso- lution WHA8.13, will be able to make its decision on the basis of the statements of such Members and the recommendations of the Executive Board; 4. REQUESTS the Director - General to study with the Member States concerned the difficulties of these countries and to report to the appropriate sessions of the Executive Board and the World Health Assembly; 5. REQUESTS further the Director -General to communicate this resolution to the Members which may be concerned.
Handb. Res., 6th ed., 7.1.2.4; 7.1.3.3 Eleventh plenary meeting, 18 May 1963 (Committee on Administration,Finance and Legal Matters,third
report) .
WHA16.21 Appointment of Representatives to the WHO Staff Pension Committee
The Sixteenth World Health Assembly RESOLVES that the member of the Executive Board designated by the Government of Mali be appointed as member of the WHO Staff Pension Committee, and that the member of the Board designated by the Government of New Zealand be appointed as alternate member, the appointments being for a period of three years.
Handb. Res., 6th ed., 7.3.7.3 Eleventh plenary meeting, 18 May 1963 (Committee on Administration,Finance and Legal Matters,third. report)
WHA16.22 Headquarters Accommodation : Progress Report
The Sixteenth World Health Assembly, Noting the reports and recommendations of the Executive Board,' its Standing Committee on Head- quarters Accommodation,' and its Ad Hoc Committee,' as well as the report of the Director -General on headquarters accommodation;' Noting the substantial increase in construction costs since the Thirteenth World Health Assembly authorized the construction of a headquarters building; Recognizing the importance of adhering to good quality standards of construction in the interest of staff efficiency and of long -term economy in maintenance; Taking into account that making a reasonable provision for underground parking at this stage in the construction programme will result in an economy for the Organization over a period of years; and Considering therefore that it is necessary to re- establish such provision as was included in the original arrangement for the building,
1. EXPRESSES its appreciation to the Executive Board, and to its Standing Committee on Headquarters Accommodation, for the continuing surveillance of this undertaking;
' Of Rec. Wld Hlth Org. 124, resolutions EB31.R22 and EB31.R25 and Annex 15. ' Of Rec. Wld Hith Org. 124, Annex 15, part 1. 3 See Annex 7. 10 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
2. ACKNOWLEDGES with appreciation the action of those Member governments which have contributed to the building project and invites other Member governments to do likewise;
3. DECIDES to revise operative paragraph 1 of resolution WHA13.46 by authorizing the construction of the building at a cost not exceeding Sw. fr. 60 000 000; 4. DECIDES furthermore that, subject to the total authorization of funds for the building project, provision for underground parking for about 300 vehicles should be made; 5. REAFFIRMS its expressions of appreciation to the Government of the Swiss Confederation and of the Republic and Canton of Geneva for the generous assistance already provided toward the realization of the headquarters building; 6. EXPRESSES its hope that the host government will find it possible to provide on an interest -free basis the remaining credits required; and
7. REQUESTS the Executive Board and the Director - General to report further to the Seventeenth World Health Assembly, including a report on the definitive arrangements for the financing of the additional costs.
Handb. Res., 6th ed., 7.4.2.1 Eleventh plenary meeting, 18 May 1963 (Committee on Administration,Finance and Legal Matters,third report)
WHA16.23 Report on the Development of the Malaria Eradication Programme
The Sixteenth World Health Assembly, Having considered the report of the Director -General on the development of the malaria eradication programme; 1 Noting that the objectives of the co- ordinated plan for continental Europe had been successfully fulfilled in that all the remaining malarious areas had reached the consolidation phase by the end of 1962; Noting the outstanding progress towards eradication during the past year, in which areas inhabited by millions of people passed from the attack to the consolidation phase, mainly in South -East Asia and in the Americas; and Recognizing that administrative and technical problems such as inadequate health services, particular epidemiological patterns, insecticide resistance or changes in the behaviour of the vectors, as well as parasite resistance to drugs, may delay the effective development of malaria eradication in certain areas,
1. INVITES governments to undertake preliminary operations or to pursue with vigour the eradication pro- grammes to their planned conclusion and to collaborate with neighbouring countries on a regional basis to permit progress to be made on a broad geographical area and for mutual protection against reintroduction of the disease;
2. RECOMMENDS, in countries without the administrative and public health facilities for full implementation of malaria eradication programmes, the parallel development in a flexible way of a minimum public health service on the basis of total coverage, to support effectively such programmes especially during the consolida- tion and maintenance phases;
3. REQUESTS the Director - General to provide appropriate assistance for the study and solution of the technical difficulties found in problem areas and to pursue research into the development of methods to overcome the technical difficulties encountered in malaria eradication;
4. REQUESTS the Director -General to study the present position in regard to the implementation of the malaria eradication programme, its achievements, shortcomings and prospects, including the provision of adequate staff and finances for the global eradication programme, and to submit a report on the matter to the World Health Assembly as early as possible; and
1 See Annex 8. RESOLUTIONS AND DECISIONS 11
5. REQUESTS the Director -General to report further progress in the malaria eradication programme to the Seventeenth World Health Assembly.
Handb. Res., 6th ed., 1.4.2 Eleventh plenary meeting, 18 May 1963 (Committee on Programme and Budget, second report)
WHA16.24 Developments in Activities assisted jointly with UNICEF
The Sixteenth World Health Assembly, Having considered the report of the Director - General on developments in activities assisted jointly with UNICEF,
1. NOTES the report of the Director -General;
2. ENDORSES the views expressed by the Executive Board at its thirty -first session,' with particular emphasis on UNICEF's continued support of programmes for the establishment of basic health services, education and training, and for mass control and eradication campaigns against communicable diseases, and the importance of assistance to malaria eradication activities, particularly in Africa;
3. EXPRESSES its satisfaction with the continuing close and efficient co- operation between the two organi- zations in jointly- assisted programmes; and 4. REQUESTS the Director -General to transmit to UNICEF the concern of WHO in that any reduction in material assistance to joint UNICEF /WHO activities would adversely affect the health and welfare of children.
Handb. Res., 6th ed., 8.1.4.1 Eleventh plenary meeting, 18 May 1963 (Committee on Programme and Budget, second report)
WHA16.25 Television Influence on Youth
The Sixteenth World Health Assembly, Aware of the great influence of television programmes and of the risk that those based on violence and crime may adversely affect mental health, particularly of the younger viewers; Taking into account the need to obtain a scientific assessment of the effects of such programmes; and Mindful of the different measures taken by governments to secure the avoidance of harmful influences,
1. STRESSES the educational value of television, with special regard to programmes in the field of health education and medical training; and 2. RECOMMENDS that national health authorities encourage the study of television influence on mental health, particularly of children and young adults.
Handb. Res., 6th ed., 1.7.2 Twelfth plenary meeting, 22 May 1963 (Committee on Programme and Budget, third report)
WHA16.26 Voluntary Fund for Health Promotion :Medical Research
The Sixteenth World Health Assembly, Considering that the programme planned under the Special Account for Medical Research as set forth in Official Records No. 121, Annex 4, is satisfactory;
1 Resolution EB31.R32. 12 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Noting that this programme is complementary to the research programme included in the regular budget of the Organization; and Emphasizing the world -wide importance of medical research,
1. EXPRESSES the hope that more countries will make voluntary contributions to the Special Account;
2. REQUESTS the Director - General to implement the medical research programme, within the broad concept of the third general programme of work for a specific period, to the extent that funds become available through voluntary contributions to the Special Account; and
3. INVITES the Director - General to take such further action as would most effectively contribute to the development of the medical research programme.
Handb. Res., 6th ed., 7.1.9; 1.11 Twelfth plenary meeting, 22 May 1963 (Committee on Programme and Budget, third report)
WHA16.27 Voluntary Fund for Health Promotion : Community Water Supply
The Sixteenth World Health Assembly, Considering that the programme planned under the Special Account for Community Water Supply as set forth in Official Records No. 121, Annex 4, is satisfactory; and Believing that this programme is of considerable importance in stimulating and assisting countries to develop plans for community water supply systems,
1. EXPRESSES the hope that more countries will make voluntary contributions to the Special Account;
2. REQUESTS the Director- General to implement the planned programme, within the broad concept of the third general programme of work for a specific period, to the extent that funds become available through voluntary contributions to the Special Account; and
3. INVITES the Director- General to take such further action as would most effectively contribute to the development of the community water supply programme.
Handb. Res., 6th ed., 7.1.9; 1.8 Twelfth plenary meeting, 22 May 1963 (Committee on Programme and Budget, third report)
WHA16.28 Appropriation Resolution for the Financial Year 1964 1
The Sixteenth World Health Assembly RESOLVES to appropriate for the financial year 1964 an amount of US $36 288 230 as follows :
I. Appropriation Purpose of Appropriation Amount Section US $ PART I : ORGANIZATIONAL MEETINGS
1. World Health Assembly 317 210 2. Executive Board and its Committees 189 090 3.Regional Committees 100 530
Total - Part I 606 830
1See Annex 9.For analysis of these appropriations under chapters, see Annex 10. RESOLUTIONS AND DECISIONS 13
Appropriation Purpose of Appropriation Amount Section US $ PART II : OPERATING PROGRAMME
4. Programme Activities 16439819 5. Regional Offices 2663706 6. Expert Committees 226600 7. Other Statutory Staff Costs 5521280
Total - Part II 24851405
PART III :ADMINISTRATIVE SERVICES
8.Administrative Services 1925182 9.Other Statutory Staff Costs 618683
Total - Part III 2543865
PART IV: OTHER PURPOSES
10.Headquarters Building Fund 500000 11.Transfer to the Malaria Eradication Special Account 5363000 12. Reimbursement of the Working Capital Fund 200000
Total - Part IV 6063000
SUB -TOTAL - PARTS I, II, III AND IV 34065100
PART V : RESERVE
13.Undistributed Reserve 2223130
Total - Part V 2223130
TOTAL - ALL PARTS 36288230
II. Amounts not exceeding the appropriations voted under paragraph I shall be available for the payment of obligations incurred during the period 1 January to 31 December 1964 in accordance with the provisions of the Financial Regulations. Notwithstanding the provisions of this paragraph, the Director -General shall limit the obligations to be incurred during the financial year 1964 to the effective working budget established by the World Health Assembly, i.e. Parts I, II, III and IV. III. The appropriations voted under paragraph I shall be financed by contributions from Members after deduction of : (i)the amount of $ 756 990available by reimbursement from theSpecial Account of the Expanded Programme of Technical Assistance (ii)the amountof $ 98860representing assessments on new Members from previous years (iii)the amountof $ 454733representing miscellaneous income available for the purpose (iv)the amountof $ 295507available by transfer from the cash portion of the Assembly Suspense Account
Total $1 606 090
thus resulting in assessments against Members of $34 682 140. 14 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
IV. The Director -General is authorized to transfer an amount not exceeding US $190 060 from the cash balance available in the Malaria Eradication Special Account to cover the credits towards the payment of contributions of Members in accordance with Schedule A attached.
SCHEDULE A TO THE APPROPRIATION RESOLUTION FOR THE FINANCIAL YEAR 1964 Members eligible for credits of 25 per cent.' towards the payment of their contributions in respect of that portion of their assess- ments corresponding to the total amount voted for Appropriation Section 11 under Part IV (Other Purposes) of paragraph I of the Appropriation Resolution :
Afghanistan Ecuador Laos Rwanda Albania El Salvador Lebanon Saudi Arabia Algeria Ethiopia Liberia Senegal * Argentina Federation of Rhodesia and Libya Sierra Leone Bolivia Nyasaland Madagascar Somalia * Brazil Gabon Malaya, Federation of South Africa Bulgaria Ghana Mali * Spain Burma Greece Mauritania Sudan Burundi Guatemala Mauritius Syria Cambodia Guinea * Mexico Tanganyika Cameroon Haiti Morocco Thailand CentralAfricanRepublic Honduras Nepal Togo Ceylon * India Nicaragua Trinidad and Tobago Chad Indonesia Niger Tunisia * China Iran Nigeria Turkey Colombia Iraq Pakistan Uganda Congo (Brazzaville) Israel Panama United Arab Republic Congo (Leopoldville) Ivory Coast Paraguay Upper Volta Costa Rica Jamaica Peru Venezuela Cuba Jordan Philippines Viet -Nam, Republic of Dahomey Kenya Portugal Yemen Dominican Republic Korea, Republic of Romania Yugoslavia
Handb. Res., 6th ed., 2.1 Twelfth plenary meeting, 22 May 1963 (Committee on Programme and Budget, third report)
WHA16.29 Organizational Study on Measures for providing Effective Assistance in Medical Education and Training to meet Priority Needs of the Newly Independent and Emerging Countries
The Sixteenth World Health Assembly, Having considered the report of the Executive Board on its organizational study on " Measures for providing effective assistance in medical education and training to meet priority needs of the newly independent and emerging countries ",2 prepared at the request of the Fifteenth World Health Assembly,3
1. THANKS the Board for the study made; and 2. REQUESTS the Director- General to develop the education and training programme further, taking into account the contents of the report and the comments of the Committee on Programme and Budget of the Sixteenth World Health Assembly.
Handb. Res., 6th ed., 7.5 Twelfth plenary meeting, 22 May 1963 (Committee on Programme and Budget, fourth report)
* Eligible under resolution WHA15.35. ' In accordance with resolution WHA14.15. 2 See Annex 15. 3 Resolution WHA15.59. RESOLUTIONS AND DECISIONS 15
WHA16.30 Organizational Study on Methods of Planning and Execution of Projects
The Sixteenth World Health Assembly NOTES the report on the progress of the organizational study on the methods of planning and execution of projects.
Handb. Res., 6th ed., 7.5 Twelfth plenary meeting, 22 May 1963 (Committee on Programme and Budget, fourth report)
WHA16.31 Continued Assistance to Newly Independent States
The Sixteenth World Health Assembly, Having studied the report of the Director -General on continued assistance to newly independent States ; Noting resolution EB31.R39 adopted by the Executive Board at its thirty -first session; Recognizing the urgent need to accelerate the assistance to newly independent and emerging States in accordance with the programme laid down by the Fifteenth World Health Assembly in resolu- tion WHA15.22; and Realizing that the implementation of such an accelerated programme requires larger resources than are currently available to the Organization,
1. NOTES the report of the Director -General;
2. ENDORSES the actions taken by the Director- General to implement an accelerated programme for assisting newly independent and emerging States; and
3. INVITES Members that are in a position to do so to make voluntary contributions to the Special Account for Accelerated Assistance to Newly Independent and Emerging States, as established by the Fifteenth World Health Assembly in its resolution WHA15.22.
Handb. Res., 6th ed., 1.1.4; 7.1.9 Twelfth plenary meeting, 22 May 1963 (Committee on Programme and Budget, fourth report)
WHA16.32 Decisions of the United Nations, Specialized Agencies and IAEA affecting WHO's Activities : Administrative, Budgetary and Financial Matters; Inter -organization Machinery for Matters of Pay and Allowances
The Sixteenth World Health Assembly, Having considered the report of the Director -General 1 on decisions of the United Nations, specialized agencies and the International Atomic Energy Agency affecting WHO's activities; Having taken into account the views expressed in resolution EB31.R43 adopted by the Executive Board at its thirty -first session,
1. NOTES with satisfaction that progress continues to be made in the co- ordination of administrative, budgetary and financial matters;
2. EXPRESSES its satisfaction that the Administrative Committee on Co- ordination has agreed that, subject to the views of the Board itself, the International Civil Service Advisory Board might serve as an independent body to make recommendations to the appropriate authorities on problems arising in the administration of the common system of salaries and allowances;
1 See Annex 11. 16 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
3. CONSIDERS that, if new terms of reference and authorities extending the competence of the International Civil Service Advisory Board are approved by all concerned, this will become one of the most important actions thus far taken to improve co- ordination on administrative matters; and 4. REQUESTS the Director -General, in the further consideration of this matter in the Administrative Com- mittee on Co- ordination, to take into account the views expressed in the discussion in the World Health Assembly. Handb. Res., 6th ed., 8.1.1.5; 7.3.4 Twelfth plenary meeting, 22 May 1963 (Committee on Administration, Finance and Legal Matters, fourth report)
WHA16.33 Decisions of the United Nations, Specialized Agencies and IAEA affecting WHO's Activities : Conference Arrangements
The Sixteenth World Health Assembly, Having considered the report of the Director -General ' on decisions of the United Nations, specialized agencies and the International Atomic Energy Agency affecting WHO's activities; Noting that the Administrative Committee on Co- ordination has established arrangements to facilitate the exchange of information regarding the scheduling of conferences by the various organizations; Considering that such inter -secretariat co- ordination, while useful, can only be effective if those concerned take full account of established recurring requirements for scheduled conferences; Considering further that disruption of established conference schedules results in unnecessary expense to governments; Recalling that the World Health Assembly has always met in the Palais des Nations in the month of May when it has been convened in Geneva,
1. EMPHASIZES the necessity for facilitating annual assemblies of organizations such as the World Health Organization at the normal time in order to avoid disruption of the established cycle of operations of the Organization ; 2. EXPRESSES the hope that there will be continuing and improved co- ordination and co- operation in the scheduling of meetings among the agencies concerned; 3. REQUESTS the Director -General to transmit this resolution to the Secretary -General of the United Nations with the request that he transmit it to the Economic and Social Council; and 4. EXPRESSES the hope that the Economic and Social Council will, in the exercise of its responsibility under Article 63, paragraph 2, of the Charter of the United Nations, take into account the requirements of the specialized agencies when it considers conference schedules. Handb. Res., 6th ed., 8.1.1.5 Twelfth plenary meeting, 22 May 1963 (Committee on Administration, Finance and Legal Matters, fourth report)
WHA16.34 Additional Regulations of 23 May 1963 amending the International Sanitary Regulations, in particular with respect to Notifications
The Sixteenth World Health Assembly, Considering the need for the amendment of certain of the provisions of the International Sanitary Regulations, as adopted by the Fourth World Health Assembly on 25 May 1951, in particular with respect to notifications; Having regard to Articles 2 (k), 21 (a) and 22 of the Constitution of the World Health Organization, ADOPTS, this 23rd day of May 1963, the following Additional Regulations :
' See Annex 11. RESOLUTIONS AND DEOISIONS".. : . 17
ARTICLE I In Articles 1, 3, 36 and 97 of the International Sanitary Regulations, there shall be made the following amendments : Article 1 Imported case:Delete this definition and replace by : " ` imported case ' means an infected person arriving on an international voyage : ". Infected local area.Delete paragraph (a) and replace by : " (a)a local area where there is a case of plague, cholera, yellow fever, or smallpox that is neither an imported case nor a transferred case; or ". Transferred case. Add the following definition : " ' transferred case' means an infected person whose infection originated in another local area under the jurisdiction of the same health administration; ". Article 3 Insert as paragraph 2: " 2.In addition each health administration shall notify the Organization by telegram within twenty- four hours of its being informed (a)that one or more cases of a quarantinable disease have been imported or transferred into a non- infected local area -the notification to include information on the origin of infection; (b)that a ship or aircraft has arrived with one or more cases of a quarantinable disease on board -the notification to include the name of the ship or the flight number of the aircraft, its previous and subsequent ports -of -call, and whether the ship or aircraft has been dealt with." Re- number paragraph 2 as paragraph 3. Article 36 Insert as paragraph 3: " 3.Where a health administration has special problems constituting a grave danger to public health a person on an international voyage may, on arrival, be required to give a destination address in writing." Article 97 In paragraph 1, after the wordsAppendix 6 ", insert the words : " except when a health administration does not require it ". ARTICLE H The period provided in execution of Article 22 of the Constitution of the Organization for rejection or reservation shall be three months from the date of the notification by the Director - General of the adoption of these Additional Regulations by the World Health Assembly. ARTICLE HI These Additional Regulations shall come into force on the first day of October 1963.
ARTICLE IV The following final provisions of the International Sanitary Regulations shall apply to these Additional Regulations : paragraph 3 of Article 106, paragraphs 1 and 2 and the first sentence of paragraph 5 of 107, 108 and paragraph 2 of 109, substituting the date mentioned in Article III of these Additional Regulations for that mentioned therein, 110 to 113 inclusive. IN FAITH WHEREOF we have set our hands at Geneva this 23rd day of May 1963. M. A. MAJEKODUNMI President of the Sixteenth World Health Assembly M. G. CANDAU Director- General of the World Health Organization Handb. Res., 6th ed., 1.5.7.5 Thirteenth plenary meeting, 23 May 1963 (Committee on Programme and Budget, fifth report) 18 SIXTEENTH WORLD HEALTH ASSEMBLY, PART 1
WHA16.35 Committee on International Quarantine :Eleventh Report
The Sixteenth World Health Assembly, Having considered the eleventh report of the Committee on International Quarantine,'
1. THANKS the members of the Committee for their work; and
2. ADOPTS the eleventh report of the Committee on International Quarantine.
Handb. Res., 6th ed., 1.5.7.6 Thirteenth plenary meeting, 23 May 1963 (Committee on Programme and Budget, fifth report)
WHA16.36 Clinical and Pharmacological Evaluation of Drugs
The Sixteenth World Health Assembly, Having noted the resolution of the Executive Board on the clinical and pharmacological evaluation of drugs; 2 Having examined the report by the Director -General on the clinical and pharmacological evaluation of drugs; 3 Considering that international co- operation is essential for the achievement of the best possible protection against hazards for man arising out of the use of drugs; Agreeing to the definition of a " drug " as any substance, or mixture of substances, destined for use in the diagnosis, treatment, mitigation or prevention of disease in man, as set out in the report of the Study Group on the Use of Specifications for Pharmaceutical Preparations; Realizing the technical and administrative difficulties of securing regular exchange of information on all drugs,
1. REAFFIRMS the need for early action in regard to rapid dissemination of information on adverse drug reactions;
2. REQUESTS Member States (a)to communicate immediately to WHO (i)any decision to prohibit or limit the availability of a drug already in use, (ii)any decision to refuse the approval of a new drug, (iii)any approval for general use of a new drug when accompanied by restrictive provisions, if these decisions are taken as a result of serious adverse reactions; and (b)to include in this communication as far as possible the reasons for the action taken and the non- proprietary and other names, and the chemical formula or the definition;
3. (a)RECOGNIZES the importance of accurate appraisal, at the national level, of the toxic effects of drugs; and (b)INVITES Member States to arrange for a systematic collection of information on serious adverse drug reactions observed during the development of a drug and, in particular, after its release for general use
4. REQUESTS the Director -General (a)to transmit immediately to Member States the information received under paragraph 2;
1 See Annex 1. 2 Resolution EB31.R6. 3 See Annex 12. 4 Wld Huth Org. techa. Rep. Ser. 1957, 138, 14. RESOLUTIONS AND DECISIONS 19
(b)to study the value and feasibility, including the administrative and financial implications, of WHO collecting from and disseminating to Member States (i)the non -proprietary and other names, chemical formulae and definitions of new drugs released or approved, (ii)the information contained in 3 (b) above; (c)to continue the study of the possibility of formulating, and of seeking international acceptance of, basic principles and requirements applicable to the toxicological, pharmacological and clinical evaluation of drugs; and (d)to pursue action in the matter and report to the Executive Board and to the Seventeenth World Health Assembly.
Handb. Res., 6th ed., 1.3 Thirteenth plenary meeting, 23 May 1963 (Committee on Programme and Budget, fifth report)
WHA16.37 Smallpox Eradication Programme
The Sixteenth World Health Assembly, Having considered the report of the Director -General on the progress so far achieved in the world -wide programme of smallpox eradication, 1
1. NOTES (i)that smallpox continues to be a serious health problem in the endemic areas, and exposes the rest of the world to risk, of infection; (ii)that the implementation of many national eradication programmes is making slow progress owing to inadequacy of national resources, particularly in transport, equipment, and the potent and stable vaccine so necessary for tropical and sub -tropical areas; 2. INVITES Member States to make voluntary contributions in cash or in kind to enable the Organization to provide assistance to requesting countries to meet their deficiencies of transport, equipment and vaccine;
3. RECOMMENDS to those countries where the disease is still present (i)that they intensify their control programmes aiming at eradication and take the necessary steps to ensure the provision of a potent and stable vaccine; (ii)that neighbouring countries, and particularly contiguous ones, co- ordinate their smallpox control activities and /or eradication campaigns in order to diminish the risk of spread of the disease between their respective territories during their programmes; and 4. REQUESTS the Director -General to submit a further report on the progress of the smallpox eradication programme to the Seventeenth World Health Assembly.
Handb. Res., 6th ed., 1.5.4 Thirteenth plenary meeting, 23 May 1963 (Committee on Programme and Budget, sixth report)
WHA16.38 Clinical and Pharmacological Evaluation of Drugs :Standards of Drugs
The Sixteenth World Health Assembly, Recognizing the urgent need of securing a high standard of drugs for human use in all countries,
1 See Annex 16. 20 SIXTEENTH WORLD HEALT,H ASSEMBLY, PART I
I.REQUESTS the Executive Board to examine ways and means of ensuring that drugs exported from a producing country comply with the drug control requirements which apply in that country for domestic use; and 2. REQUESTS the Executive Board to report thereon to the Seventeenth World Health Assembly.
Handb. Res., 6th ed., 1.3 Thirteenth plenary meeting, 23 May 1963 (Committee on Programme and Budget, sixth report)
WHA16.39 Decisions of the United Nations, Specialized Agencies and IAEA affecting WHO's Activities : Programme Matters
The Sixteenth World Health Assembly, Having considered the report of the Director -General on the decisions of the United Nations, specialized agencies and the International Atomic Energy Agency affecting WHO's activities on programme matters, NOTES the report.
Handb. Res., 6th ed., 8.1.1.6 Thirteenth plenary meeting, 23 May 1963 (Committee on Programme and Budget, sixth report)
WHA16.40 United Nations Development Decade
The Sixteenth World Health Assembly, Having studied the report of the Director -General i on the United Nations Development Decade; Reaffirming the decisions on the Development Decade set forth in resolution WHA15.57 of the Fifteenth World Health Assembly; and Mindful of the aims of the United Nations Development Decade and the contribution which the World Health Organization can make to their achievement, particularly through assistance to governments, on their request, in national health planning and the education and training of professional and auxiliary health staff, I.NOTES the report of the Director -General; 2. EMPHASIZES the importance of investment in health as a vital component of economic and social develop- ment; and
3. STRESSES the need for expanding WHO activities in keeping with the health objectives of the United Nations Development Decade, both through the Organization's regular programme and the use of other available resources.
Handb. Res., 6th ed., 8.1.2 Thirteenth plenary meeting, 23 May 1963 (Committee on Programme and Budget, sixth report)
WHA16.41 Extension of the Agreement with UNRWA
The Sixteenth World Health Assembly, Considering that, on 29 September 1950, an agreement was concluded between the Director -General of the World Health Organization and the Director of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) on the basis of principles established by the Third World Health Assembly;
1 See Annex 13. RESOLUTIONS AND DECISIONS 21
Considering that the Thirteenth World Health Assembly, in resolution WHA13.62, extended the dura- tion of this agreement until 30 June 1963; Considering that, subsequently, the General Assembly of the United Nations, at its seventeenth session, extended the mandate of UNRWA until 30 June 1965; 1 and Considering that the World Health Organization should continue the technical direction of the health programme administered by UNRWA, AUTHORIZES the Director -General to extend the duration of the agreement with UNRWA until 30 June 1965. Handb. Res., 6th ed., 8.1.5.1 Thirteenth plenary meeting, 23 May 1963 (Committee on Programme and Budget, sixth report)
WHA16.42 Joint FAO /WHO Programme on Food Standards (Codex Alimentarius)
The Sixteenth World Health Assembly
1. APPROVES the establishment of a joint FAO /WHO programme on food standards whose principal organ will be the Codex Alimentarius Commission;
2. ADOPTS the statutes of the Codex Alimentarius Commission; 2
3. AGREES to the calling of the first session of the Codex Alimentarius Commission in June 1963; 4. EXPRESSES the hope that the Codex Alimentarius Commission will give priority to the health aspects of its work and will further preparatory work on a regional basis wherever this appears desirable in order to achieve the fundamental aims laid down for the Commission;
5. REQUESTS the Director- General to ensure the fullest participation of WHO in the joint food standards programme; and
6. FURTHER REQUESTS the Director -General to report to the thirty -third session of the Executive Board on the progress made by the Codex Alimentarius Commission, and on the outcome of the review of the method of financing the work of the Commission to be made by the FAO Conference in November 1963.
Handb. Res., '6th ed., 1.7.3; 8.1.6.2 Thirteenth plenary meeting, 23 May 1963 (Committee on Programme and Budget, sixth report)
WHA16.43 Meetings of the Regional Committee for Africa
The Sixteenth World Health Assembly, Having considered the report of the Director -Generals on meetings of the Regional Committee for Africa and the request of the Regional Committee for Africa to the World Health Assembly; Noting that the Government of the Republic of South Africa, in spite of a number of resolutions adopted over several years, and in particular resolution 1761 (XVII) of 6 November 1962, by the General Assembly of the United Nations on the policies of apartheid of the Government of the Republic of South Africa, has not complied with those resolutions; Taking into account the humanitarian principles and the objective enunciated in the Constitution of the World Health Organization and especially with reference to the control of communicable diseases, which do not recognize national boundaries; Taking into account, in addition, that the resolution of the Regional Committee for Africa calls atten- tion to the necessity of safeguarding the health rights of all African populations concerned;
1 General Assembly resolution 1856 (XVII). 2 See Off. Rec. Wld Hlth Org. 124, 74. 3 See Annex 14. 22 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Considering that the conditions imposed upon the non -white populations of South Africa seriously prejudice their physical, mental and social health, and are contrary to the principles of the Organization; Considering the necessity to avoid any action that may hamper the proper functioning of the Regional Organization for Africa; and Noting that the Director of the African Regional Office, after consultation with the Director -General, has notified the Member States in the Region that the thirteenth session of the Regional Committee for Africa will be held in September- October 1963 at the African Regional Office because of the circumstances which have not made it possible to convene it at the place previously selected by the Regional Committee at its eleventh session,
1. APPROVES the actions taken by the Regional Director and by the Director -General to ensure the func- tioning of the African Regional Organization and the fulfilment of the constitutional functions of the African Regional Committee for the protection of the health rights of all populations of the Region;
2. CALLS ATTENTION to General Assembly resolution 1761 (XVII) of 6 November 1962, and invites the Government of the Republic of South Africa to renounce the policy of apartheid in the interests of the physical, mental and social well -being of the population;
3. UNDERTAKES, within the provisions of the Constitution of the World Health Organization, to support all measures that may be taken to contribute towards the solution of the problem of apartheid;
4. INVITES the Government of the Republic of South Africa to take appropriate measures so that all the populations of South Africa shall benefit by the public health services of that country;
5. EXPRESSES the hope that Members of the Region will do whatever is possible to further the effective functioning of the African Regional Organization, promote the humanitarian goals of the World Health Organization, and protect the health rights of the South African population;
6. REQUESTS the Director -General to transmit this resolution to the Secretary -General of the United Nations with the request that it will be made available to the Special Committee appointed under the terms of General Assembly resolution 1761 (XVII) of 6 November 1962;
7. REQUESTS further that the Director -General report to each session of the World Health Assembly on this matter until such time as it is resolved to the satisfaction of the Regional Committee for Africa and the World Health Assembly.
Handb. Res., 6th ed., 5.2.1.4 Thirteenth plenary meeting, 23 May 1963 (Committee on Administration, Finance and Legal Matters, fifth report)
WHA16.44 Reports of the Executive Board on its Thirtieth and Thirty -first Sessions
The Sixteenth World Health Assembly
1 NOTES the reports of the Executive Board on its thirtieth' and thirty -first sessions; 2 and
2. COMMENDS the Board on the work it has performed.
Handb. Res., 6th ed., 4.2.5.2 Thirteenth plenary meeting, 23 May 1963
1 Off Rec. Wld Hlth Org. 120. 2 Off Rec. Wld Hlth Org. 124; 125. RESOLUTIONS AND DECISIONS 23
PROCEDURAL DECISIONS
(i)Composition of the Committee on Credentials
The Sixteenth World Health Assembly appointed a Committee on Credentials consisting of delegates of the following twelve Members :Australia, Bulgaria, Canada, Cyprus, Federation of Malaya, Ghana, Madagascar, Nepal, Peru, Spain, Sweden, Syria.
First plenary meeting, 7 May 1963
(ii)Composition of the Committee on Nominations
The Sixteenth World Health Assembly appointed a Committee on Nominations consisting of delegates of the following twenty -four Members : Argentina, Cambodia, Congo (Leopoldville), France, Gabon, India, Iran, Israel, Jamaica, Lebanon, Mexico, Morocco, Netherlands, New Zealand, Nigeria, Norway, Romania, Thailand, Tunisia, Union of Soviet Socialist Republics, United Arab Republic, United Kingdom of Great Britain and Northern Ireland, United States of America, Venezuela.
First plenary meeting, 7 May 1963
(iii)Verification of Credentials
The Sixteenth World Health Assembly recognized the validity of the credentials of the following delegations :
Members Afghanistan, Albania, Algeria, Argentina, Australia, Austria, Belgium, Bolivia, Brazil, Bulgaria, Burma, Burundi, Cambodia, Cameroon, Canada, Central African Republic, Ceylon, Chad, Chile, China, Colombia, Congo (Brazzaville), Congo (Leopoldville), Cuba, Cyprus, Czechoslovakia, Dahomey, Denmark, Ecuador, Ethiopia, Federal Republic of Germany, Federation of Malaya, Finland, France, Gabon, Ghana, Greece, Guatemala, Guinea, Hungary, Iceland, India, Indonesia, Iran, Iraq, Ireland, Israel, Italy, Ivory Coast, Jamaica, Japan, Jordan, Kuwait,' Laos, Lebanon, Liberia, Libya, Luxembourg, Madagascar, Mali, Mauri- tania, Mexico, Monaco, Mongolia, Morocco, Nepal, Netherlands, New Zealand, Nicaragua, Niger, Nigeria, Norway, Pakistan, Panama, Paraguay, Peru, Philippines, Poland, Portugal, Republic of Korea, Republic of Viet -Nam, Romania, Rwanda,' Saudi Arabia, Senegal, Sierra Leone, Somalia, South Africa, Spain, Sudan, Sweden, Switzerland, Syria, Tanganyika,' Thailand, Togo,' Trinidad and Tobago, Tunisia, Turkey, Uganda, Union of Soviet Socialist Republics, United Arab Republic, United Kingdom of Great Britain and Northern Ireland, United States of America, Upper Volta, Venezuela, Western Samoa, Yemen, Yugoslavia.
Associate Members Kenya, Mauritius. First, third, seventh and thirteenth plenary meetings, 7, 8, 14 and 23 May 1963
'Credentials provisionally accepted. 24 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
(iv)Election of Officers of the Sixteenth World Health Assembly
The Sixteenth World Health Assembly, after considering the recommendation of the Committee on Nominations, elected the following officers : President: Dr M. A. Majekodunmi (Nigeria); Vice- Presidents: Professor R. Gerie (Yugoslavia), Dr Sushila Nayar (India), Mr Abdul Rahman bin Haji Talib (Federation of Malaya). Second plenary meeting,. 7 May 1963
(v)Election of Officers of the Main Committees
The Sixteenth World Health Assembly, after considering the recommendations of the Committee on Nominations, elected the following officers of the main committees : COMMITTEE ON PROGRAMME AND BUDGET : Chairman, Dr V. V. Olguín (Argentina); COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS : Chairman, Mr I. T. Kittani (Iraq).
Second plenary meeting, 7 May 1963
The main committees subsequently elected the following officers :
COMMITTEE ON PROGRAMME AND BUDGET :Vice- Chairman, Dr S. P. Tchoungui (Cameroon); Rapporteur, Dr M. Sentici (Morocco); COMMITTEE ON ADMINISTRATION, FINANCE AND LEGAL MATTERS :Vice- Chairman, Dr J. Vysohlíd (Czecho- slovakia); Rapporteur, Dr A. L. Bravo (Chile).
(vi)Establishment of the General Committee
The Sixteenth World Health Assembly, after considering the recommendations of the Committee on Nominations, elected the delegates of the following fourteen countries as members of the General Committee :Cambodia, Canada, Congo (Leopoldville), Dahomey, France, Indonesia,Iran,Israel, Mexico, Sweden, Tanganyika, Union of Soviet Socialist Republics, United Kingdom of Great Britain and Northern Ireland, United States of America. Second plenary meeting, 7 May 1963
(vii)Adoption of the Agenda
The Sixteenth World Health Assembly adopted the provisional agenda prepared by the Executive Board at its thirty -first session.' Third plenary meeting, 8 May 1963
' Two items (3.13, Housing of staff of the Regional Office for Africa, and 3.15, Working Capital Fund) were deleted because they were no longer necessary. ANNEXES
Annex 1
INTERNATIONAL QUARANTINE
[A16 /P &B /2 -8 March 1963]
In accordance with resolution EB31.R2, the Director -General has the honour to submit to the Sixteenth World Health Assembly the eleventh report of the Committee on International Quarantine, together with the minutes of the discussion which took place during the thirty -first session of the Executive Board.
1.ELEVENTH REPORT OF THE COMMITTEE ON INTERNATIONAL QUARANTINE
[WHO /IQ /134 - 19 Oct. 1962 CONTENTS
Page Page
Composition of the Committee 27 Part VI. Sanitary Documents 53 Introduction 28 Part VII.Sanitary Charges 54 General Aspects 29 Part VIII. Various Provisions 54 The International Sanitary Regulatiors 30 Appendices 55 Part I. Definitions 30 Part II. Notifications and Epidemiological Informa- tion 32 Part III. Sanitary Organization 35 Appendix I Cases of Quarantinable Disease (Smallpox) imported by International Traffic Part IV. Sanitary Measures and Procedure 36 1. Cases imported by Ship 57 Part V. Special Provisions relating to each of the Quarantinable Diseases 37 2. Cases imported by Aircraft 58 Plague 37 Cholera 37 Yellow Fever 43 Appendix 2 - Divergent Opinion on the Question of Smallpox 45 Amendment to the International Certificate of Vaccina- Typhus 53 tion or Revaccination against Smallpox 58
Composition of the Committee
The Committee on International Quarantine held Dr J.C. Azurin, Director, Bureau of Quarantine, its eleventh meeting in the Palais des Nations, Geneva, Department of Health, Manila, Philippines from 15 to 19 October 1962. Dr M. H. El Bitash, Under - Secretary of State, Ministry Members of Public Health, Cairo, United Arab Republic Dr O. B. Alakija,2 Acting Chief Medical Adviser to Dr W. A. Karunaratne,2 Director of Health Services, theFederal Government, FederalMinistry of Colombo, Ceylon Health, Lagos, Nigeria Dr L. H. Murray, Principal Medical Officer, Ministry Dr A. Allard, Director of Medical Services, Sabena of Health, London, United Kingdom of Great Airlines, Brussels, Belgium Britain and Northern Ireland
1 See resolutions WHA16.34 and WHA16.35. Dr H. M. Penido, Superintendent, Special Public 2 Unable to attend. Health Service, Rio de Janeiro, Brazil - 27 - 28 SIXTEENTH WORLD HEALTH ASSEMBLY, PART 1
Dr G. M. Redshaw, Assistant Director -General of threat of quarantinable diseases ".That resolution Health, Commonwealth Department of Health, also stated that it was believed that " health administra- Canberra, Australia tions by improving sanitary conditions and expanding their health and medical services...are thereby Dr J. G. Telfer, Medical Director, Division of Foreign securing their own protection against the entry and Quarantine, United States Public Health Service, establishment of quarantinable diseases ", and that Department of Health, Education and Welfare, " thefreestpossible movementofinternational Washington, D.C., United States of America traffic is highly desirable in the interests of world RepresentativeoftheInternationalCivilAviation economic and social, including health, progress ", Organization and recommended to all governments that " they.. . raisethelevelof protection, by vaccination... Mr H. A. Seidelmann, Technical Officer, Facilitation against ... smallpox ". He informed the Committee and Joint Financing Branch that, as the Organization continued to assist countries in smallpox eradication programmes, more was being Representativeof theInternationalAirTransport learned about vaccines, procedures and reactions Association to vaccination. The Organization was also supporting Mr R. W. Bonhoff certain research studies relating to smallpox and had already proposed further studies.Those included Secretariat research on the comparative value of different animals Dr R. I. Hood, Chief Medical Officer, International for the production of smallpox vaccine, on the Quarantine, Division of Communicable Diseases protectiveandtherapeuticvalueof antivaccinia (Secretary) gamma -globulin of human and animal origin, on the correlation between vaccination reactions and anti- The Committee met on the morning of 15 October body levels at the time of vaccination, and on other 1962.Dr P. M. Kaul, Assistant Director -General, epidemiological and immunological problems con- opened the meeting on behalf of the Director -General, nected with smallpox.In his programme for 1964, and welcomed the members and representatives of the Director -General had proposed an expert com- ICAO and IATA.He recalled that at the World mittee on smallpox. Health Assembly in May 1962 some concern had Dr H. M. Penido was unanimously elected Chairman been expressed by delegates about the importation of and Dr M. H. El Bitash Vice -Chairman. The Chair- eight smallpox cases into Europe in the preceding man was requested to act as Rapporteur. months.During the discussion on this matter some The draft agenda was approved. questions had been raised about the status of smallpox The Committee considered the annual report by immunity after revaccination and about the need for the Director -General on the functioning of the Inter- revising the present procedures. He further recalled national Sanitary Regulations during the period from that, in1951, in resolution WHA4.80, the World 1 July 1961 to 30 June 1962. This report is reproduced Health Assembly had expressed the opinion that " the below, the various sections being followed, where International Sanitary Regulations ... represent only appropriate, by the comments and recommendations part of the action required to remove the international of the Committee (in italics).
INTRODUCTION
1. This report on the functioning of the International 3.This report follows the same general lines as it Sanitary Regulations and their effects on international predecessors and considers the application of the traffic is prepared in accordance with the provisions Regulations from three aspects : as seen by the Organi- of Article 13, paragraph 2, of the Regulations.It zation initsadministrative role of applying the covers the period from 1 July 1961 to 30 June 1962. Regulations;asreported by Member Statesin accordance with Article 62 of the Constitution of 2. Previous reportscover the period beginning the Organization and Article 13, paragraph 1, of the with the time of entry- into -force of the Regulations Regulations; and as reported by other organizations (1October 1952). directly concerned with the application of the Regula- tions.For ease of reference the three aspects are ' Off. Rec. Wld Hith Org. 56, 3; 64, 1; 72, 3; 79, 493; 87, 397; consolidated and presented in the numerical order of 95,471;102,35;110,31;118,35. the articles of the Regulations. ANNEX 1 29
4.By reason either of their importance or of the Assembly also adopted, in resolution WHA15.38, procedure leading to their study, other questions the tenth report of the Committee on International have necessitated the preparation of special documents, Quarantine -on its special meeting held on 3 May independently of this report.They are nevertheless 1962.2 These reports and the proceedings of the briefly mentioned in it. Assembly relating to international quarantine matters 5.The ninth report of the Committee on Inter- were published in Official Records Nos 118 and 119 national Quarantine was adopted by the Fifteenth respectively. An offprint of the ninth and tenth reports World Health Assembly on 23 May 1962 (resolution of the Committee on International Quarantineis WHA15.37). On the same day the Fifteenth Health available.
GENERAL ASPECTS Position of States and Territories under the Inter- The Singapore Naval Radio Station and other national Sanitary Regulations stations in Asia began in the first week of January 1962 to retransmit the text of the daily epidemio- Information showing the position of States and 6. logical radiotelegraphic bulletin issued from Geneva territories under the Regulations as of 1 January 1962 and covering the whole world. The Abu -Zabal was included in the Weekly Epidemiological Record, (Cairo)Station retransmitted the Geneva bulletin 1962, No. 7.Since that date one more State has for the first six months of 1962 and then ceased to become a party to the Regulations -the Mongolian do so; during this period it was determined that the People's Republic, on 18 July 1962; the information States that received the retransmission from Abu - inWeekly Epidemiological Record was published Zabal (Cairo) could easily and effectively receive the No. 29 of 20 July 1962. direct transmission from Geneva -Prangins. Countries not bound by the Regulations 1 Periodicity of Meetings of the Committee on Inter- 7. Australia, Burma, Chile and Singapore, although national Quarantine not parties to the Regulations, apply their provisions in nearly all respects. 9.The Fifteenth World Health Assembly (in reso- lution WHA15.36) authorized the Director -General Administration of the Regulations (a) to postpone as from 1963, at his discretion, the 8. In its previous report the Committee noted the annual meeting of the Committee to the following decision of the Director- General that headquarters year, provided that the Committee is convened at should assume sole responsibility for the administra- least every other year; and (b) to convene a meeting tion of the Regulations as from1 January 1962. of the Committee at other times when he considers it During a six months' transition period beginning on necessary. The Assembly further requested the 1 July 1961, the WHO quarantine offices in Alexandria, Director -General to submit for review to the Com- Singapore and Washington continued to carry out mittee, in1966, the question of periodicity of its some of the functions previously delegated to them. meetings and to present the report and recommend- Largely owing to their extensive efforts, the change- ations of the Committee to the Twentieth World over at the end of 1961 operated smoothly.The Health Assembly. SingaporeWeekly Epidemiological Report,which began publication on1 March 1925, ceased to be International Protection against Malaria published with the issue dated 28 December 1961. The Weekly Epidemiological Bulletin of the Regional 10. At its ninth session the Committee on Inter- Office for the Eastern Mediterranean ended publication nationalQuarantine recommended a meeting of on 29 December 1961.The Weekly Epidemiological malaria and international quarantine experts to review Report of the Pan American Sanitary Bureau /WHO thesituationasregardsinternational protection Regional Office for the Americas continued publica- against malaria.' The Expert Committee on Malaria tion, but ceased in1962 to be a mechanism for in its ninth report made a similar recommendation.' dissemination of information under the Regulations. An Expert Committee on Malaria is scheduled for For the most part States have become accustomed 1963toconsider internationalprotectionagainst to direct communication with headquarters on all matters concerning the Regulations. 2 See section 18. 3 Off. Rec. Wld Hlth Org. 118, 37, section 11. ' See also sections 29, 69 and 106. Wld Hlth Org. techn. Rep. Ser., 1962, 243, 24, 40, 30 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
malaria, and to recommend procedures for establishing tamed in the seventh and eleventh reports of the Expert effective protective measures. Committee on Insecticides. The Committee draws The attention of the Committee is invited especially especial attention to the recommendations concerning to sections 4.2 and 9.5 (Prevention of re- introduction " blocks away " disinsection contained in the eleventh of infection) of the ninth report of the Expert Com- report of the Expert Committee.' mittee on Malaria.' The Committee understands that in aviation termi- nology the words " in flight " mentioned in Article 73, The Committee notes the ninth report of the Expert paragraph 2, include the time an aircraft begins moving Committee on Malaria. on the ground beforeits actual take -off, and con- sequently disinsection carried out at the " blocks away " Aircraft Disinsection period can be considered as disinsection in flight. 11.At its ninth session the Committee recommended, The Committee was informed that the Director - inter alia, further trials on aircraft disinsection at the General is prepared to furnish technical assistance to " blocks away " period in tropical areas where con- States,onrequest,withanyaircraftdisinsection ditions of high humidity or - extreme dryness are problems. present.2Results of such trials are reported in a separate document. Mosquito Vectors of Disease The Committee noted the extract from a document 12.At its ninth session the Committee requested the entitled °i Studies on Aircraft Disinsection at` blocks Director -General to inform it at its next session about away 'in Tropical Areas " and especially thatdis- action on circular letter No. 14 of 5 May 1961.6 The insection of aircraft carried out at the " blocks away " number of replies by States has in the interim been period was biologically effective in the tropics.The more satisfactory. Committee reaffirms the opinion giveninits eighth Information on the Aedes aegypti situationat report that the operation referred to as " blocks away " international airports will be published in the Weekly disinsection is regarded as a " technically acceptable Epidemiological Record at an early date. Information alternative method for disinsection of the passenger on other mosquito vectors of disease, particularly cabin with aerosols ",3 and recommends that health anophelines, will follow. authorities,together with operators of international flights, examine the possibilities for the early application International Protection against Trachoma of this procedure for aircraft disinsection. The Committee recommends that single -use type of 13.The attention of the Committee is invited to aerosol dispensers should be used for disinsection of the section 10 of the third report of the Expert Committee passenger cabin of aircraft, and that this type of dispenser on Trachoma, dealing with prophylaxis of trachoma should be made widely available. in international traffic.' The Committee notesthatthe procedures and The Committee notes the third report of the Expert formulations at present recommended are those con- Committee on Trachoma, and particularly section 10.
THE INTERNATIONAL SANITARY REGULATIONS PART I.DEFINITIONS
Article 1 words " imported case " have been interpreted to include an infected person (seedefinition) in the 14. Imported Case and Transferred Case. In previous incubation period.Thus an " imported case " has reports the Committee has stated that the terms of the definition of an " imported case " are intended to meant an infected person who has arrived on an international voyage, i.e., an infected person coming apply only to a case introduced into a territory from outside that territory.¢The word " territory " has from another territory under the jurisdiction of another national health administration. occasionally been misunderstood. In practice the
1 Wld Hlth Org. techn. Rep. Ser., 1962, 243, 23, 40. ' Wld Hlth Org. techn. Rep. Ser., 1961, 206, 8 (reproduced in Annex VII of the second annotated edition, 1961, of the Inter- 2 Off Rec. Wld Hlth Org. 118, 38, section 14. national Sanitary Regulations, p. 106, paras 1-4). 3 Off Rec. Wld Hlth Org. 110, 33, section 8. 6 Off Rec. Wld Hlth Org. 118, 38, section 17. 4 Off Rec. Wld Hlth Org. 64, 32; 110, 34. ' Wld Hlth Org. techn. Rep. Ser., 1962, 234, 38. ANNEX 1 31
The Committee recommends that, in Article 1, the a section had been declared infected, or is infected by definition of " imported case " should be amended to definition.This question rarely arises in respect of read: international travellers who have complied with the " imported case " means an infected person arriving provisions of Article 34. on an international voyage. The Committee recommends to health administrations The Committee further recommends that Article 1 that,inheavily populated sections of a State,the be amended by adding the following definition: designation of local areas should take into consideration " transferred case " means an infected person whose the extent of movement of population within several infection originated in another local area under the adjacent administrative districts. jurisdiction of the same health administration. 17.Infected Local Area - Cholera: Hong Kong. 15. Infected Local Area. According to paragraph (a) The Government sends the following comments : of the definition, a plague, cholera, yellow -fever or " The size of an area to be declared a cholera smallpox infected local area is a local area in which ' infected local area 'has an important bearing on there is a non -imported case.The Committee, in its the epidemiology.Where more than one prefecture third report,' has given its opinion that when a case is or county of a country is declared infected, restrictions hospitalized in an area other than the actual infected should apply to the whole country ideally or to at local area the local area of hospitalization does not least a distinct geographical area, for example, an become an infected local area solely because of the islandor other geographical unit which can be hospitalized case.It is to be noted, however, that regarded as such.The declaration of infected local such hospitalized cases are usually non -imported. areas on a district basis, where borders are contiguous They are sometimes referred to as transferred cases, and where there is free movement of people to and in that they have been first notified from the local fro, pays no heed to the epidemiology of cholera." area actually infected. In practice the Director - General has interpreted the above opinion to cover 18. Quarantinable Diseases - Cholera.On 23 May 1962,3 the Fifteenth World Health Assembly adopted the following circumstances :a person infected in one local area A of a State and moving to another the tenth report of the Committee on International local area B within the same State before being notified Quarantine, which met in Geneva on 3 May 1962 to as a case is, of course, a non -imported case. However, consider the question of El Tor infection and its it has been considered that local area E, which was relationship to the International Sanitary Regulations. previously free from infection, is not an infected local Extracts from theCommittee'sreportaregiven area solely on the basis of such a case having been below : introduced into it.In most instances local area B has The Committee recalls that in 1957, at the time of its fifth session and for some decades before that time, all reported cases been a hundred or more kilometres from the infected of the disease due to El Tor vibrios had been limited to the local area A. Celebes.It was on this basis that the Committee was of the The Committee recommends that, in Article 1, the opinion that this disease should not be included in the term cholera, a quarantinable disease under the International Sanitary definition of " infected local area" be amended by Regulations.4The Eleventh World Health Assembly endorsed adding, in paragraph (a),the words " or non-trans- this opinion.5 ferred" after the word " non-imported". The Committee studied the detailed reports of the several 16.Infected Local Area - Size.Initsfourth outbreaks of El Tor infection (in Indonesia, in Sarawak (July report 2 the Committee stated that one of the basic 1961), in Macao (August 1961), in Hong Kong (August 1961), principles of the International Sanitary Regulations in the Philippines (September 1961) and in North Borneo is the acceptance by all States of local areas designated (January 1962)) and considered the views of the experts on these by any national health administration. When several outbreaks, including the conclusions and recommendations of local areas are adjacent to one another in heavily the Scientific Group on Cholera Research 8 and the findings of the meeting in Manila 7 . . . populated sections of a country and it is known that The Committee, noting that the Scientific Group on Cholera there is considerable daily movement of population Research "having given very careful consideration to all the within these sections, some States believe that it is available evidence about the epidemiology and clinical features unrealistic to consider as infected only one such local area.These States have been apt to consider as 3 Resolution WHA15.38. infected the entire heavily populated section in the 4 Off. Rec. Wld Hlth Org. 87, 400, section 17. Resolution WHA11.44. other State, although only one local area within such 6 Scientific Group on Cholera Research, Geneva, 2 -6 April 1962. ' Off Rec. Wld Hlth Org. 72, 38, section 27. Meeting for the Exchange of Information on Cholera El Tor, 2 Off. Rec. Wld Huth Org. 79, 497, section 22. Manila, 16 -19 April 1962. 32 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I of El Tor infection, recommends that this disease be regarded studies of cholera and cholera El Tor, including standards for as essentially identical with classical cholera and . . . dealt and efficacy of the vaccine, which will, it is hoped, supply the with as such ", is of the opinion that, in the light of the best necessary information to enable the Committee to keep under information and knowledge available, cholera El Tor does not review its opinion stated above). differ from classical cholera in its epidemiological, clinical and pathological aspects and in measures of treatment.The Com- Beginning with the issue dated 25 May 1962, mittee endorses the recommendation of the Scientific Group notifications of cholera El Tor have been included on Cholera Research that: " In regard to the use of prophy- in the Weekly Epidemiological Record. In the current lactic vaccines . . . classical cholera vaccines be used until such time as evidence is produced from experimental or field notifications section of the Record a suitable footnote vaccine studies of the absence of cross -protection between has been added to indicate that the disease was cholera classical cholera and El Tor vaccines ". El Tor. In the infected area list of the Record no such differentiation has been made. The Committee is therefore now of the opinion that cholera, The Committee noted the method of dissemination under the definition of quarantinable diseases in of information on cholera El Tor made in the Weekly Article 1 of the Regulations, should include cholera due to the El Tor vibrio, and recommends that its opinion given at its fifth Epidemiological Record. The Committee was informed session and endorsed by the Eleventh World Health Assembly thatinthedailyepidemiologicalradiotelegraphic should be amended accordingly. bulletin no differentiation is made between cholera and The Committee recognizes that there are several gaps in cholera El Tor.The Committee is in agreement with fundamental knowledge, both in relation to El Tor and classical the practices described above for the dissemination of cholera, and that the World Health Organization is engaged in information -on cholera El Tor.
PART II.NOTIFICATIONS AND EPIDEMIOLOGICAL INFORMATION 19. No notifications required by the Regulations surveillance operations of persons, especially when (Articles 3 to 6 and Article 9) have been received from : the disease is smallpox. the Democratic People's Republic of Korea (since The notifications described above are not provided 1956); for in the International Sanitary Regulations.The Committee will wish to consider whether such notifica- the Democratic Republic of Viet -Nam (since 1955); tions and subsequent dissemination of information by China (mainland) (since March 1951); the Organization should be an obligation under the Yemen (since March 1958) (an annual report on the Regulations. working of the Regulations for the year under Informationis given in separate documents on
review has been received from Yemen). imported cases and related matters . and on cases of quarantinable diseases imported by ship and aircraft. 20. For many decades it has been routine practice, See also the recommendation of the Comm ittee under especially in Asia, to notify cases of quarantinable section 21. diseasesdisembarkedfromships. Telegraphic information includes date and port of arrival, name of ship, previous ports of call, name of disease, number Article 3 of cases among crew or passengers, the fact that all necessary measures have been taken to deal with the 21. In itsninth report the Committee urged all ship, and subsequent ports of call, with expected dates health administrations to notify the Organization of arrival.Table 9 of the WHO CODEPID was by telegram within twenty -four hours when one or constructed to facilitate such telegraphic notifications. more cases of a quarantinable disease have been Subsequent airmail notifications confirm thetele- imported into a non -infected local area.2In the graphic notification and include details on the ship discussion on this report at the Fifteenth World itself, previous ports of call, with dates, subsequent Health Assembly it was requested that the Committee ports of call, with dates, sanitary measures taken and consider making such notifications an obligation under particulars on each case, including probable source the Regulations.3 Both in the Committee and at the of infection and vaccination certificate. In recent years Health Assembly it was clearly stated and definitely similar notifications have been made for infected agreed that such notifications of themselves would aircraft.These notifications have facilitated inter- not mean that the non -infected local area thereby nationaltraffic;theOrganization knowsofno became an infected local area. instance where carriers or personsat subsequent ports of call have been subjected to unnecessary . Off: Rec. Wld Hlth Org. 118, 61-62. sanitary measures.These notifications have assisted 2 Off: Rec. Wld Hlth Org. 118, 39, section 19. other health administrations to carry out permitted 3 Off. Rec. Wld Hlth Org. 119, 196. ANNEX 1 33
The Committee recommends that Article 3 should be In the past year a case of smallpox developed in a amended by adding the following paragraph after the nurse who had already been isolated in hospital with first paragraph: close contacts of an imported case.Isolation began on the 1st of the month, she fell ill on the 12th and 2.In addition each health administration shall notify died on the 20th.Since she had been isolated on the the Organization by telegram within twenty-four hours 1st, the health administration, with the concurrence of its being informed of the Director -General, notified the area as free (a)that one or more cases of a quarantinable from infection on the 30th of the month. Three disease have been imported or transferred into a days later a nurse in a ward adjoining but separated non- infectedlocalarea -the notificationshall from the isolation ward fell ill, developed smallpox include information on the origin of infection; and died. The second nurse had been vaccinated on (b)that a ship or aircraft has arrived with one or the 1st of the previous month and had had a papular more cases of a quarantinable disease on board reaction (read as successful). -the notification shall include the name of the ship The Committee will wish to consider the policy or the flight number of the aircraft, its previous and described above inrelation to the provisions of subsequent ports of call, and whether the ship or Article 6. aircraft has been dealt with. The Committee is of the opinion that the period The present paragraph 2 of Article 3 should be re- stipulated in Article 6 should begin when the last case numbered paragraph 3. is identified as a case, irrespective of the time that this person may have been isolated. Article 6 Article 8 22. In previous reports the Committee has stated that the time- limits inArticle 6, paragraph 2 (a), 24.Ethiopia.The Government reports as follows : equal to twice the incubation period of the disease, " As personnel available in embassies, legations or are minimum limits, and health administrations may consulates usually are not able to understand quaran- extend them before declaring an infected local area in tine questions and interpret the International Sanitary their territory free from infection and continue for a Regulations,itisrecommended thatVaccination longer period their measures of prophylaxis to prevent the recurrence of the disease or its spread to other Certificate Requirements for International Travel be put at the disposal of allairline services and all areas.' It is recalled that the health administration of India diplomatic missions, and that it be stressed that only has for some years extended these minimum limits the quarantine services in the countries where the to three times the incubation period in respect of diplomatic missions or airlines are located have the cholerà. Because notifications are normally submitted authoritytointerprettheInternationalSanitary on a weekly basis, three times the incubation period of Regulations. Any case of dispute should be referred five days (fifteen days) in practice usually means tothese quarantineservices and notsettled by three weeks. The health administrations of the diplomatic missions or the employees of airlines." Philippines, Hong Kong and China (Taiwan) have The Committee urgeshealthadministrationsto informed the Organization that they will also use arrange that diplomatic missions of their governments atleastthisextended period before declaring a are kept up todate on national requirements for cholera- infected local area free from infection. vaccination certificates for international travel. The Committee notes the policy of India, Hong Kong, China (Taiwan) and the Philippines, and commends this practice to other health administrations. Article 9 25.The provisions of Article 9 require a weekly 23.The provisions of Article 6 permit a health telegraphic report of the number of cases of the administration to notify a local area as free of infection quarantinable diseases and deaths therefrom in towns when, inter alia, " twice the incubation period of the disease... has elapsed since the last case identified and cities adjacent to a port or airport. In the absence has died, recovered or been isolated ". of such cases airmail reports are required for certain specified periods.It is the opinion of the Director - General that these provisions apply alsoto any 1 Off. Rec. Wld Hlth Org. 72, 38, section 23; 79, 499, section 28; 110, 36, section 17. imported cases and cases transferred into such towns 34 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I or cities, e.g., for hospitalization, from another local mittee on International Quarantine atitsseventh area within the same territory. session 6 on the need for the use of potent vaccines, The Committee is in agreement with this opinion. correct vaccination procedures, and the importance for medical and other personnel who come in contact Article 11 with travellers to maintain a high level of immunity by repeated vaccination. 26. From 1 January 1962 the obligations of the The section " Epidemiological Notes " continued Organization under Article 11 for dissemination of to present summaries of reports on influenza outbreaks. all epidemiological and other information which it has received under Articles 3 to 9 inclusive have been 28. Separate publications were : the responsibility of headquarters. These obligations, (í) the revised Geographical Index of CODEPID, as well as those to disseminate other information on which came into force on 1 October 1961; the Regulations, have been carried out by head- (ii) Yellow -FeverVaccinating Centres for Inter- quarters by means of the Weekly Epidemiological national Travel: situation as on 28 July 1961; Record, the daily epidemiological radiotelegraphic (iii)Vaccination Certificate Requirements for Inter- bulletins,telegrams,telephonecalls,and airmail memoranda giving advance information which will national Travel: situation as on 20 December 1961; subsequently appear in the Record.For reasons of (iv)Ports designated in Application of the Inter- economy and accuracy, telegrams are usually sent in national Sanitary Regulations: situation as on 6 April CODEPID (WHO Epidemiological Cable Code and 1962. its 1961 revised Geographical Index). Amendments to publications(ii),(iii)and (iv) The Geneva -Prangins transmission of the daily appeared as usual in theWeekly Epidemiological epidemiologicalradiotelegraphicbulletin(atext Record.In addition, seven lists of amendments to covering the whole world) is retransmitted free of Vaccination Certificate Requirements for International charge by fourteen stations in Asia. One -third of Travel were issued for those addressees (mainly travel these retransmissions are made more than once a week. agencies) which do not receive the Weekly Epidemio- See section 8 for the situation from 1 July 1961 to logical Record. 31 December 1961. Article 13 27. The Weekly Epidemiological Record, in the section " Epidemiological Notes ",published a summary, 29.In accordance with Article 13, paragraph 1, of including maps, of the reported occurrence of cholera,' the Regulations and Article 62 of the Constitution, the plague,2 smallpox,' and yellow fever 4 during 1961. following 123 States and territories have submitted Information on imported cases and outbreaks of information concerning the occurrence of cases of quarantinable diseasesinthe followingcountries quarantinable diseases due to or carried by inter- was also published in this section : national traffic, and /or on the functioning of the Cholera:in Burma, Hong Kong, Macao and Regulations anddifficultiesencounteredintheir Sarawak; application : Afghanistan Central African Republic Cholera El Tor: in Indonesia, North Borneo and the Albania Ceylon Philippines; Angola Chad Plague: in United States of America, and Venezuela; Australia Chile Austria China Smallpox: in Basutoland, Belgium, Central African Barbados Colombia Republic, Congo (Brazzaville), Congo (Leopold- Basutoland Comoro Archipelago Bechuanaland Congo (Brazzaville) ville), Federal Republic of Germany, Muscat and Belgium Congo (Leopoldville) Oman, Poland, Trucial Oman, Union of Soviet Bermuda Cook Islands Socialist Republics, and United Kingdom of Great British Guiana Cuba Britain and Northern Ireland. British Solomon Islands Pro- Cyprus A summary of the smallpox situation in Europe tectorate Czechoslovakia British Virgin Islands Dahomey was followed by the recommendations of the Com- Burma Denmark Burundi Dominica ' Wkly epidem. Rec., 1962,21,254. Cambodia Ecuador 2 Wkly epidem. Rec., 1962,29,355. Canada El Salvador 3 Wkly epidem. Rec., 1962,25,306. Cape Verde Islands Ethiopia 4 Wkly epidem. Rec., 1962,27,333. 5 Wkly epidem. Rec., 1962, 3, 37. 6 Of Rec. Wld Huth Org. 102, 47, section 59. ANNEX 1 35
Falkland Islands Libya Sarawak Togo Federal Republic of Germany Macao Seychelles Tonga Federation of Rhodesia and Mali Sierra Leone Trinidad and Tobago Nyasaland Mauritania South Africa Turkey Fiji Mauritius Spain Uganda Finland Mexico St Helena UnionofSovietSocialist France (including French Mongolia St Kitts -Nevis -Anguilla Republics Guiana, Guadeloupe, Mar- Montserrat St Lucia United Kingdom of Great tinique and Réunion) Morocco St Pierre and Miquelon Britain and Northern French Polynesia Mozambique St Vincent Ireland French Somaliland Nepal Sudan United States of America Gabon Netherlands, Kingdom of the Swaziland Venezuela Gambia (including Netherlands, Su- Sweden Western Samoa Ghana rinam, Netherlands Antilles, Switzerland Yemen Gibraltar as well as Netherlands New Tanganyika Yugoslavia Gilbert and Ellice Islands Guinea) Thailand Zanzibar Guatemala New Caledonia Honduras New Hebrides The Committee notes with concern that the number Hong Kong New Zealand of States submitting annual reports in accordance with Hungary Niger Article 13 of the Regulations and Article 62 of the India Nigeria Indonesia North Borneo Constitution of the Organization has decreased for the Iraq Norway year under review, and requests the Director - General to Iceland Paraguay continue his efforts to obtain annual reports on the Israel Philippines functioning of the Regulations from all States and Jamaica Poland Japan Portuguese Guinea territories. Jordan Portuguese Timor Kenya Puerto Rico 30. Details of cases of quarantinable diseases due to Kuwait Republic of Korea Laos Romania or carried by international traffic are given in Part V, Lebanon SaoTomé and Principe in Appendix 1, and also in a separate document.
PART III.SANITARY ORGANIZATION
31. Yemen.The Government states that, with the Annual General Meeting approved the recommend- helpof theOrganization,quarantineservicesin ation of its Medical Committee that WHO be asked Yemen have recently been well organized and are to carry out a world -wide survey of international working satisfactorily. airports to ensure implementation of recommendations contained in the WHO Guide to Hygiene and Sanitation Article 14 in Aviation.' 32. Information on the provision of pure drinking - The Committee requests the Director -General to refer water at international ports and airports has been this question to appropriate bodies of the Organization. received from thirty -eight countries in reply to circular The Committee notes that the Director -General has letter No. 17 of 18 May1961. The information already invited the attention of health administrations received from countries will be published in the Weekly to the recommendations of the Expert Committee on Epidemiological Record. Four countries have reported Hygiene and Sanitation in Aviation and is prepared to that water supplies in all their ports and airports are assist States on request. satisfactory. Fifteen countries have indicated that The Committee urges health administrations to make all the ports and airports listed by them have satis- a review of the airports designated as sanitary airports factory water supplies.For the remaining countries, in order to determine whether they meet the present some of their ports and airports are satisfactory, conditions of traffic. but others fail to meet international standards in one respect or another, and in some cases the data available Article 21 are insufficient. 34. Health administrations of104States and terri- 649ports Article 19 tories have notified the Organization that
33. TheInternationalAirTransportAssociation ' World Health Organization (1960) Guide to hygiene and (TATA) informed the Organization that itsrecent sanitation in aviation, Geneva. 36 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I have been approved under Article 17 for the issue of Airports with direct transit areas number twenty -eight Deratting Certificates and /or Deratting Exemption in twenty -one States and territories.' Certificates; of those, 145 have been approved for the issue of Deratting Exemption Certificates only.' Article 22 36. Ghana. The Government states that the situation 35.Notifications of 222 sanitary airports have been in ports and airports of entry has remained as reported received from ninety -ninehealth administrations. previously.¢
PART IV.SANITARY MEASURES AND PROCEDURE
Article 27 arrival, whether or not passengers have come from a given infected local area -knowledge which could 37. Canada.The Government reports as follows : " As reported in previous years 2surveillance as be provided accurately and easily by the health provided in Article 27 of the International Sanitary authorities of the country of origin. " In view of the foregoing, it is suggested that, Regulationsisimpossible to enforce inCanada. Over one -fifth of persons placed under surveillance without prejudice to the present provisions of the fail to report, give fictitious addresses, or cannot be Regulations, the health authorities of countries in traced at the destination they have reported." which smallpox infected local areas exist should be required to take the responsibility of preventing the departure of any person who has not been vaccinated Article 30 (and who therefore does not possess a valid vaccination 38.Spain.The Government reportsasfollows certificate) or who is suspected of having had contact (translation from the Spanish) : with the infection during the fourteen days preceding " It is pointed out in connexion with the disquieting his intended departure by air." situation created in Western Europe by the appearance The Committee emphasizes that under the provisions of smallpox foci (which started at the end of December of Article 30 the health authority for a local area which 1961, following the importation of cases of the disease is an infected local area has the obligation to take all in the incubation period, and persisted over the first practicable measures to prevent the departure of any six months of 1962), that the fact that no cases infected person or suspect.At its eighth session the appeared outsidethecountriesaffected may be Committee stated thatinareas where smallpoxis considered as proof of the efficacy of the frontier present," healthadministrationsmay, inpartial quarantine services.The same may be said of the fulfilment of theseobligations,require a smallpox WHO quarantine service, thanks to which we received vaccination certificate of departing travellers ".5 timely information concerning the international health The Committee further recalls that persons under situation and data concerning the evolution of the foci surveillance may move to another territory, but in in question. that instance the provisions of Article 27, paragraph 2 " In short, it may be said that the abnormal situation apply. referred to provided satisfactory proof of the efficacy of the present protective measures against quaran- Article 34 tinable diseases in general and smallpox in particular. 39. See section 62. This result is all the more worthy of mention because the quarantinable disease concerned is perhaps the Article 35 most dangerous on account of its epidemiological 40.Seychelles. The Government reportsthat, characteristics and prolonged period of incubation, during the epidemic of smallpox in Karachi, granting and also because of the intensity of air traffic. of pratique by radiotoshipswas temporarily " In this connexion it is true that the present practice suspended. of demanding a smallpox vaccination certificate from passengers arriving by air upsets the smooth flow of Article 36; Article 48 such traffic.On the other hand, in the case of air 41. See sections 96 and 93 respectively. traffic, it is usually difficult to tell, in the countries of ' World Health Organization (1960) Airports designated in 1 World Health Organization(1962)Ports designated in application of the International Sanitary Regulations, Geneva - application of the International Sanitary Regulations, Geneva - as brought up to date on 31 August 1962. as brought up to date on 31 August 1962. 4 Off. Rec. Wld Filth Org. 118, 43, section 46. 2 Off Rec. Wld Huth Org. 118, 45, section 55. 5 Of . Rec. Wld Hlth Org. 110, 47, section 68. ANNEX 1 37
PART V.SPECIAL PROVISIONS RELATING TO EACH OF THE QUARANTINABLE DISEASES
42.Information, including maps, on plague, cholera, in the Regulations by an item calling for isolation, for yellow fever and smallpox notified for the calendar medical observation, of persons who have been in year 1961, is given in a separate document, consisting direct contact with a cholera patient during an inter- of extracts from the Weekly Epidemiological Record.' national journey, regardless of whether on not they possess valid vaccination certificates. Plague This suggestion is based on the fact that vaccination against cholera provides immunity for a very short Article 52 period (six months) and it is impossible to be certain 43.A health administration has stated that difficulties that a person who has been in close contact with a arise when certain other countries insist that when patient will escape infection, particularly in the later deratting is done the fumigation agents must be hydro- part of the " guaranteed " vaccination period. In any cyanic acid or sulfur dioxide. case, it should be possible to authorize the health The Director -General has replied quoting the opinion authoritiestosettlethisquestioninaccordance given by the Committee at itsthird session that with the epidemiological circumstances. " Deratting Certificates should be held to be valid 46. Sanitary measures in respect of cholera taken by irrespective of the agent used, provideditisof oneState against arriving international travellers recognized effectiveness and inspection of the ship exceeded those permitted by the Regulations.This after deratting shows it to be free from rats ".2 action occurred after cases of cholera El Tor were The Committee reaffirms itsopinion given atits notified in China (Taiwan) in July 1962 and in Hong third session and quoted above. Kong in August 1962. Crew and passengers on healthy ships coming from these two areas were submitted 44. United States of America.The Government to stool examination or rectal swabbing and when reports as follows : one or more carriers were found all travellers were " Evidence of appreciable numbers of rats was placed in isolation until three consecutive negative found on only a small percentage of ships entering the ship, which had United States ports. This was attributed to improved been in quarantine during this period, was then given sanitation, more extensive use of rat -proof construc- free pratique. An aircraft having stopped in Taipei tion, wider practice of rat trapping carried on con- was subsequently quarantined for nearly twenty -four tinuously at sea and in port, and rodent control in hours, together with its crew and passengers, although port areas. all except a few were in possession of valid international " The over -all sanitation improvement programme certificates of vaccination against cholera.Two of has resulted in considerable improvements on many those without vaccination certificates, who had some vessels.Four foreign flag vessels received certificates diarrhoea, had embarked at Taipei, but were shown of sanitary vessel operation this past year.It is anti- by examination after arrival not to have cholera. cipated that this number will more than double in the 47.Canada.The Government reports as follows : next year." " Due to the prevalence of cholera incertain countries, it was necessary during the early months Cholera of 1962 to regard El Tor cholera as true cholera. Persons entering Canada from areas infected with In a communication to the Organization a health 45. El Tor cholera were held subject to the same require- administration has raised the following questions, ments as persons from areas infected with cholera. which are submitted to the Committee for con- Canada's deviation from the International Sanitary sideration. Regulations inregard to El Tor cholera was, of The wide spread of cases of cholera El Tor in a course, corrected by the action subsequently taken by number of countries of Asia in1961isarousing the Organization to interpret the Regulations with anxiety as to the possibility of their further spread if respect to El Tor cholera." $ prophylactic quarantine measures are not introduced against them. 48. Hong Kong. The Government reports as follows : It is considered desirable to supplement the system " During the period 1 July 1961 to 30 June 1962, of prophylactic measures against cholera laid down Hong Kong in common with certain other countries in the region was infected with cholera El Tor. An 1 Wkly epidem. Rec., 1962, 21, 254; 25, 306; 27, 333; 29, 355. 2 Of Rec. Wld Hlth Org. 72, 37, section 13. 3 Resolution WHA15.38. 38 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I account of the outbreak in Hong Kong has been quarantine restrictions on account of cholera, even published as a White Paper and copies of this White though they may have come from an infected area Paper have already been forwarded to the Director - to the airport. General of WHO... The place of oral antibiotics in the treatment of " From the experience gained of the epidemiology the contact -carrier state requires intensive investiga- of cholera during the outbreak in Hong Kong, it is tion with a view to determining whether or not suggested that Articles 60 to 69 ... of the International their use could replace surveillance or isolation of Sanitary Regulations should be reviewed. Despite the suspected or proved contact- carriers." considerable powers conveyed by these articles, it has not proved possible to prevent the entry of Vibrio 49. Japan.The Government reports as follows : cholerae infections into countries in the region despite " 1.At the time of the epidemic of cholera due to rigid application of the quarantine measures allowed El Tor vibrio in Indonesia, Sarawak, North Borneo, by the Regulations. Hong Kong and the Philippines toward the end of " The role of the contact -carrier in the dissemination 1961, we came to the conclusion that cholera due to of cholera is not fully understood, but there is evidence El Tor vibrioisa communicable disease which to support the view that the contact -carrier without merited the same treatment as the cholera under the clinical symptoms of the disease may be the agent InternationalSanitaryRegulationsandsucha of dissemination from country to country, particularly conclusion was based on actual observation by our those contact -carriers moving by sea in small vessels scholars and various information accumulated. It over short distances which do not normally go through was under such a conviction that the Japanese members quarantine inspections. of the WHO Expert Advisory Panel, as well as the " It is evident that the powers at present given under Ministryof Health and Welfare,proposedthe the Regulations are not wide enough to prevent the revision of the Regulations in this respect. We were dissemination of cholera for the following reasons: 1 certainly glad about the action of the Fifteenth World In the past, passengers travelling by air were not Health Assembly adopting the tenth report of the Com- normally of the socio- economic group likely to be mittee on International Quarantine thus including the cholera due to El Tor vibrio under the Regulations. infected.This no longer applies and increasing use is being made of air transport, particularly charter paved way for us rely on the epidemio- flights, to move groups of people in the lower logical information from the WHO headquarters and income groups. Accordingly, the risk of introducing to be prepared not only in our quarantine policy but theinfectionthroughcontact -carrierswithout also in the prevention of the spread of this disease if symptoms is a very real one. and when it entered this country. These preparations Before action can be taken under the existing consisted of inoculating approximately 600 000 persons of priority groups, such as seamen, port workers, etc. Regulations, a ship or aircraft can only be suspected if a case of cholera has occurred on board during in about forty ports which were likely to be called at by ships from the Philippines, etc. the voyage. With the speed of modern travel this is not realistic and passengers embarking on a ship or " 2.We were thus prepared when, on 21 July 1962, aircraft calling at a port in an infected country are we obtained information on the outbreak of cholera not subject to any quarantine restrictions if that port in Taiwan, generally speaking at a distance from our occurs in, but has been excluded from, an infected country of two or three days' voyage by ship. We then local area. Where a port or airport is surrounded carefully watched arrivals from Taiwan. A Japanese by or is adjacent to an infected local area, that port cargo ship, MIKAGE -MARU, arrived at Kanmon Port should be regarded as infected and only transit on 31 July, after calling at the port of Kaohsiung, passengers who have been accommodated in a Taiwan, from 19 to 27 July. At the time of routine direct transit area should be excluded from restric- quarantine inspection it was learned that there was tions. The tendency not to declare ports and airports at least one crew member who had diarrhoea while as infected areas other than for use as transit areas the ship was calling at Kaohsiung Port.Therefore, gives a very wide loophole in the powers of protec- as a precaution, with the consent of the captain, the tion by receiving countries. Both ports and airports stools of the entire crew were examined.However, are usually surrounded by infected local areas; since the entire crew had been inoculated against as a result the tendency is for passengers embarking cholera, and also since Kaohsiung Port was not notified at these ports to claim they are not subject to by WHO as a cholera infected local area, the ship was given a provisional pratique under Article 18 of the Japanese Quarantine Law, and the entire crew was 1See further reasons given by the Government of Hong Kong under sections 17, 55, 59 and 61. placed under surveillance. On 1August, in the ANNEX 1 39 evening, three patients and fourteen carriers were on the sixth day after sailing from the locally infected detected out of thirty -eight crew members. Measures area. were taken to invalidate the provisional pratique, the " 6. Information was obtained from WHO head- entire crew were isolated, and the ship was disinfected. quarters that on23August a case of cholera occurred Disinfection as well as stool examination was extended in Hong Kong. We then required one stool exami- to cover2400contacts and some 100 houses which nation with respect to ships arriving from Hong Kong. were visited by the crew. In order to deal with possible Thus we detected two carriers on board the United contamination of the sea water, fishing as well as States cargo shipHONG KONGBEAR which arrived swimming was forbidden over a certain expanse of the at Hakata Port on27August, sailing from Hong sea and beaches.Drastic measures were taken to Kong on24August, arriving at Naha Port in Okinawa forestall a secondary infection, and as a result the on26August, and leaving the same on27August. disease did not extend beyond these imported cases. Isolation of the two carriers and other necessary However, it must be noted that on the second stool measures were taken. examination five additional carriers were detected from among the crew who had been negative at the time of " 7. On28August, we obtained information from the first stool examination, and placed under sur- a reliable source in Okinawa that one case of cholera veillance. occurred, although United States authority maintained this was merely a carrier, and together with the con- " 3. From the experience stated above, and also sideration of the case ofHONG KONGBEAR, we from the consideration that the invasion of Taiwan adopted a policy of dealing with Okinawa in the by cholera must be a sizeable one, we reached the same way as we did with Hong Kong from 1Sep- conclusion that the mere presentation of a valid tember.Three carriers were detected on board the certificateof inoculationdidnot safeguardthis Japanese cargo shipFUYO-MARU and one carrier country and that in order to prevent the invasion of on another JapanesecargoshipSHOZUI-MARU, cholera into this country we would have to adopt a both arriving at Tsukumi Port on 1 September. The formula of ascertaining the presence or absence of crew was isolated at the Hikoshima detention quarters carriers. Accordingly, we started on 2 August of the Moji Quarantine Station. The measures against requiring stool examination and closure of lavatory arrivals from Okinawa were lifted and replaced by the (toilet cans to be used instead), as well as prohibiting normal procedure starting on 11September, after discharge of waste matter and waste water, with being satisfied that there was no case following the respect to ships arriving from Taiwan. first one, and such a fact was ascertained by a mission who went there to study the situation. " 4. In connexion with the stool examination, in no case has rectal swabbing been ordered, locally or " 8. On29August, the Japanese cargo shipKYOTO - from the Ministry, in compliance with the provision MARU arrived at Tokyo Port leaving Cagayan de of the International Sanitary Regulations. However, Oro, a Philippines port in a locally infected area, on it has been undertaken on some occasions in which a 23August. There was a crew member who had crew member or a passenger has voluntarily requested diarrhoea when the ship arrived, and stool examination such a recourse. was conducted. The first examination revealed three carriers and the second examination three additional " 5.On 10 August, the Chinese cargo ship Ru-YUNG carriers outside the one who had diarrhoea.This is This ship had left Kaohsiung arrived at Kobe Port. noteworthy as a case of detection of carriers after six Port on7August and Keelung Port on8August. days beyond the incubation period of five days. While the result of the first stool examination was negative, one carrier was detected by the second " 9.In order to observe the actual situation in examination. A Japanese cargo ship, HIRASHIMA- Taiwan and co- ordinate our measures with the efforts MARU, arrived at Kanmon Port on21August after in Taiwan, and also in response to the invitation leaving Kaohsiung Port on 15 August. Four carriers extended through the diplomatic channel, we dis- were detected at the time of the first stool examination patched four persons representing the cholera scholars' and one additional carrier was detected at the time group and two administrators from the Ministry of of the second examination.Both ships were imme- Health and Welfare to Taiwan on28August. Through diately quarantined and disinfected and crews were this visit we ascertained that the cholera epidemic had isolated or placed under surveillance. These and by then been controlled to the extent that the locally related disease prevention measures enabled us to infected areas had been narrowed down to the five stop the invasion.It is worthy of attention that the provincesinthesouth,namely Yunlin,Chiayi, latter case demonstrates that carriers were detected Tainan, Kaohsiung, and Pingtung, and the two cities 40 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I of Tainan and Kaohsiung. Therefore, the quarantine Regulations be reviewed with a view to amending the measures were brought back to normal routine with quarantine formula to deal more adequately with respect to ships leaving Keelung, Taipei and other preventing the spread of cholera by international uninfected areas in Taiwan on and after 14 September, traffic. and arriving at our shores. " Now, here are the facts about aircraft. The " On 19 September Taiwan was declared free from particular aircraft, TG 600, Thai Airways, undet joint cholerainfection,theinformationabout which operation with SAS, arrived from Taipei on 20 August reached us on 20 September. In compliance with the with eleven crew members and fifty -eight passengers : Regulations,wewithdrewthespecialmeasures one from Bangkok, eleven from Hong Kong and against arrivals from Taiwan departing from Taiwan twenty -three from Taipei. Two of the passengers from on and after 20 September. Taipei had diarrhoea at the time of arrival and volun- tarily underwent stool examination from fear that they " 10.With respect toships arriving from Hong might have contracted cholera.There were seven Kong also, on the basis of information as of 9 Sep- other passengers from Taipei and six from Hong tember that only four cases and four carriers of Kong, who did not possess valid vaccination certificates. cholera existed, without showing a sign of further We judged them to be possible suspects, and they also spread, and in consideration of the fact that preventive underwent stool examination. We did not order the inoculation of the inhabitants has covered a greater aircraft to be detained.However, we accepted the portion of the population, normal routine measures offer to let passengers stay overnight on the plane, areappliedtoshipssailingfrom Hong Kong until the results of the examination were known." on and after 15 September, so long as they meet certain conditions, such as the presence of a ship's 50.Japan.The following further communication doctor on board, good health management on board, has been received from the Government : etc. " PROPOSAL FOR THE AMENDMENT " In summary, the initial experience with MIKAGE- OF THE INTERNATIONAL SANITARY REGULATIONS MARU was that of discovering at the time of the WITH RESPECT TO QUARANTINE PROCEDURE AGAINST CHOLERA routine quarantine procedure no suspected case among " In facing the outbreak of epidemic of cholera the entire crew who had had preventive inoculation. due to El Tor vibrio in Indonesia and the Western However, when the stool examination was conducted Pacific Region since last year, the health administration with the consent of the captain, three patients and in Japan has actively exerted itself, in compliance fourteen carriers were detected.As stated in para- with the provisions of the International Sanitary graph 2 above, the crew had been permitted to go Regulations, in an effort to prevent the spread of this ashore, and a very drastic measure had to be taken disease through international voyage.On the basis affecting many citizens.This gave rise to a great of our experience of the incidence of the Japanese shock and anxiety to the Japanese people in general, cargo ship MIKAGE -MARU on 31 July, and the sub- and to criticism that the quarantine measure was not sequent quarantinepolicyadopted, about which sufficient. explanation has been separately presented, it is hereby " In connexion with this experience, we came to the requested that the International Sanitary Regulations conclusion that under the prevailing condition of be partially amended with respect to the following environmental sanitation and of food habits in this points and thereby improve the existing quarantine country, the adherence to the International Sanitary format. Regulations, in particular the provisions of Article 69, paragraph 2, would not safeguard this country against " I.' Infected local area' the invasion and spread of cholera.Therefore, we " The definition of the ` infected local area ' provided were forced to take recourse to administering the for in Article 1 of the International Sanitary Regula- least necessary measures of stool examination.The tions is liable to variable interpretation from country results have been, as stated in paragraphs 5 through to country,specifically there may be wider and 8 above, the discovery of eighteen carriers with narrower delineation of the area in the absence of respect tosix ships following the discovery with uniformity of its application.Some country may MIKAGE -MARU. It is our belief that by such detection delimit its boundary to an extremely small area, and we were barely able to forestall the invasion of this there have been instances that such delimitation was country by cholera. not conducive to the prevention of the spread of the " The measures taken have been temporary and disease. It is proposed that the definition of the emergency measures under very pressing circumstances. ` local area ' be amended to include the port or the For the reasons stated above, we would wish that the airport as a matter of course and that it would be ANNEX 1 41 definedas an area of province, prefecture,city, possesses a valid vaccination certificate because it town, etc., which may include the neighbouring areas is possible that he may be a carrier; which are judged to be liable directly or indirectly (3)to enlarge the scope of requirement for sub- to affect the ship or the aircraft present in the port or mission to stool examination to include any person the airport. arriving from an infected local area within a certain " The reasons: period of time. " The information on the outbreak of cholera in Yunlin, Chiayi and Tainan in Taiwan reached our " In the instance of the Japanese ship MIKAGE -MARU health administration through radio from Geneva about which reference has been made above, Kaoh- on 20 July. A cable was also received from the World siung Port had not been declared an infected local Health Organization on 23 July : the same information, area, and the entire crew had been vaccinated against with additional information that the seaports and cholera, and further there was no suspicion as to their the airport were not infected.In the meantime, the health at the time of arrival.However, on learning Japanese ship MIKAGE -MARU, which left Kaohsiung that at least one member of the crew had diarrhoea Port on 27 July, arrived at Kanmon Port on 31 July, when the ship was calling at Kaohsiung Port, the and, out of its thirty -eight crew, three patients and entire crew was subjected to stool examination with nineteen carriers were detected.From the Organi- the consent of the captain. The provisional pratique zation, however, we received information on 9 and had been given to the ship which docked and the crew 11 August that Kaohsiung City had been designated was permitted to go ashore. The result of examination as infected on 28 July.In the same information, the revealed the presence of vibrio in twenty -two out of port of Kaohsiung was still excluded from the infected thirty -eight crew (in fact, three patients and nineteen local area, and it was by the Organization's information carriers). Fortunately, secondary cases have been dated 17 August that the port of Kaohsiung had been forestalled through rigorous preventive measures. designated as locally infected. " If these patients and carriers had not been detected " Again in the meantime, one carrier was detected and were permitted to move about freely a disastrous on board the Chinese ship Ru -YuNG which had left situation might have been brought about affecting Kaohsiung Port on 7 August, Keelung Port on our citizens.Through the policy adopted on the 8 August and arrived at Kobe Port on 10 August. requirement of stool examination vibrios have been " The above instances form the basis of our request detected in a total of forty persons (namely three for' the amendment of the provisions with respect to patients and thirty -seven carriers) out of seven ships the definition of the` infected local areas '. concerned.It is our belief that such an experience reveals the importance of quarantine policy in which " II.On the measures with respect to carriers the stool examination plays the major role and also " Under the current International Sanitary Regula- the necessity for applying quarantine measures to tions,the quarantine measures are provided for persons who possess valid vaccination certificates. against the dangers of cases of cholera, as in Article 63 " It has been pointed out and emphasized at the wherein it is implied that on arrival of an infected time of the conference for the exchange of information ship or aircraft any person in possession of a valid on paracholera due to El Tor vibrio, held in Manila certificate of vaccination will have to be permitted in April this year, that the presence of many carriers to go ashore or leave the aircraft, although under played an important role in the spread of infection survei11are, or, as in Article 69, under which only in the epidemic of El Tor cholera in the Western a person who has symptoms indicative of cholera Pacific Region.It is our submission that the same may be subjected to stool examination. The Regula- measures should be applied to carriers as with the tionslack any provision for measures to prevent patients. the spread of cholera through carriers. With the belief " For your information, Annex I 1gives the list that there is a great danger of spread of cholera of cholera infected ships and the way in which the through carriers, we would request the amendment of patients and carriers have been detected. the Regulations to provide for the following : " III.On the period of time during which stool (1)to treat the carrier, once detected, similarly examination may be required the present International as the case -for instance, the carrier, once detected, Sanitary Regulations delimit the requirement for should be reported as such together with the case, stool examination to a person arriving from an infected if any, and treated similarly as the case as far as local area within the incubation period of cholera. quarantine measures are concerned ; However, on a number of occasions it has been found (2)to enable isolation of any person arriving on board an infected ship or aircraft even if one 1 Not reproduced in this volume. 42 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I that the presence of vibrio may be detected beyond only recourse was to invoke powers under its Quaran- the limit of five days. It is therefore submitted that the tine Ordinance.Cholera El Tor was declared to be Regulations be amended to enable requirement for stool a dangerous infectious disease under that Ordinance examination up to fifteen days after departure from an and the quarantine measures described... above infected local area for the following reasons. were enforced whenever possible. " The reasons: " Between 17 January and 31 May, there were 46 " As quoted from many reports in the WHO definite cases of cholera El Tor in North Borneo, six Monograph `Cholera" by Pollitzer, over 90 per cent. of them were fatal.In addition, some 100 deaths of instances of vibrio discharge terminate within ten occurred at remote coastal and island places during days.Also, as shown in Annexes II 2 and I11,2 the the first half of the year, which, from inquiries and first dealing with the survey on the period of vibrio descriptions, were very likely caused by cholera El Tor discharge among the patients and carriers found in vibrio. The peak of North Borneo's epidemic occurred Taiwan in 1962, and the second dealing with the during the period 1 March to 10 March and the area number of days since the departure from infected most severely affected was the Semporna district local areas and the date on which carriers were which reported more than half of the confirmed cases, detected, the period in which stool examination may and about half of the deaths probably due to the berequiredinthequarantinemeasuresagainst disease.All other cases occurred in coastal areas in cholera should be extended to fifteen days maximum the north and east of the territory, with the exception since the date of departure from an infected local of one small focus along the Sugut river, some 25 miles area, on the basis of the incubation period of five upstream." days plus ten days in which vibrio discharges may 52. Philippines. The Government reports as follows : continue." " Cases of cholera El. Tor first appeared in Manila 51. NorthBorneo.The Government reportsas on 22 September 1961, and from this focus the disease follows : spread to areas in island groups comprising Luzon, "...there can be no doubt that infection by cholera Visayas and Mindanao.Up to the week ending El. Tor was introduced to North Borneo by inter- 30 June 1962, a total of 16 616 cases and 2223 deaths national traffic -not on large vessels, but on small have been reported from 45 of the 56 provinces and kumpitstravellingbetweentheSuluProvince 33 of the 39 cities of the archipelago.The El Tor (Philippines) and North Borneo. Difficulties have vibrio has been identified in about 50 per cent. of the been experienced in applying Article 62, since kumpits cases in Manila and suburbs, and in 20 per cent. of do not land only at recognized ports, but also at all cases. small places along thecoast. Furthermore the " It is possible that this disease has been introduced journey is so short that even if persons did not suffer into the country from any of the neighbouring El Tor from cholera El Tor during the voyage, they could be infected areas...From the time cholera El Tor has incubating it. Article 62 also does not meet the danger been considered a quarantinable disease (23 May 1962), of healthy carriers.Therefore the North Borneo Article 30 of the Regulations has been complied with." Quarantine Rules (under the Quarantine Ordinance) 53. Sarawak.The Government reports that during were enforced which gave powers to quarantine these an outbreak of cholera El Tor, which started on boats and their passengers in the quarantine anchor- 12 July, the following cases were recorded : ages for the duration of the incubation period, even First Division . . 226 cases, with 45 deaths though no case had occurred on them before arrival.. Second Division . . 33 cases, with 15 deaths In addition mass vaccination with anticholera vaccine Third Division . . 41 cases, with 10 deaths was given to large sections of the local population, Fourth Division. . 1 case, with 0 death Fifth Division . . . 0 case notably in coastal areas exposed to risk.The Philip- pine Republic was declared a locally infected area Total 301 cases, with 70 deaths with cholera El Tor and inoculation regulations enforced fortravellers(videGazetteNotification The last case was reported on 5 October 1961 and No. 57 of 20 January 1962). the country was declared free from the disease on "It was only recently that cholera El Tor was declared 19 October. No cases have been notified since that to be the same as cholera under the International date. Sanitary Regulations. Before then this country's 54. United States of America.The Government reports as follows : 1 Pollitzer, R. (1959) Cholera, Geneva (World Health Organ- ization: Monograph Series No. 43). " The inclusion of El Tor type of cholera in the 2 Not reproduced in this volume. definitionof quarantinable diseasesinthe Inter- ANNEX 1 43 national Sanitary Regulations resolved the question to carry infection.Signatory countries should be of Member countries exceeding the Regulations in urged to respect the spirit and intention of Article 68." respecttotheapplicationof certainquarantine measures to persons arriving from areas in which 60. Philippines.The Government states that one country banned the importation of all foodstuffs from this disease became epidemic during the past year. the Philippines. The World HealthOrganizationistobecon- gratulated for its diplomatic handling of this problem and for facilitating its resolution." Article 69 61. Hong Kong.The Government comments as Article 60 follows : 55.Hong Kong. The Government submits the follow- " Article 69 should be revised to give powers to ing comments : require a non -vaccinated individual without symptoms " In view of the knowledge of the duration of the indicative of cholera to submit to stool examination contact -carrier state, for quarantine purposes con- if coming from an infected local area and disembarking sideration might be given to a review of the duration in a non- infected country, provided that the disembar- of the incubation period." kation takes place within the incubation period." Sections 45 -61.The Committee notes that several Article 61 States have proposed, have taken, or are taking measures 56.Philippines. The Government reportsthat, in excess of the Regulations and invites the attention contrary to Article 61, paragraph 2, two injections of health administrations to the provisions of Article 23 of cholera vaccine within one week's interval were of the Regulations. required by the health authorities of certain countries. The Committee understands the difficult situation created in the area where cholera outbreaks are now Article 63 occurring, but is not prepared at present to recommend any amendment to the Regulations. 57.Philippines. The Government reports that ships The Committee recognizes that while the gaps in of Philippine registry were regarded by the health fundamental knowledge continue to exist, difficulties authorities of certain countries as cholera- infected will in large part remain.The Committee considers, ships; the water on board was removed (without prior however, that many of the practical difficulties for health laboratory examination) and replaced by fresh water administrations would be eased to a great extent if, in before the ships were given free pratique. addition to fulfilment of obligations under Article 8, full and frequent consultations and exchange of informa- Article 68 tion, particularly on preventive measures, were to take 58. Under the conditions specified in Article 68 a place between the health administrations concerned. health authority may, inter alia, prohibit the import Notification of measures should be made as far in of fruit which is to be consumed uncooked. During advance of their application as possible. the cholera El Tor outbreaks in Asia some health The Committee notes, as mentioned in its ninth report, administrations, in exerciseof theirrights under that the Organization is engaged in research on cholera. Article 68, have prohibited the import of bananas and The Committee stresses again the need for research to mangoes.These and other similarfruit, although close the gaps in fundamental knowledge and requests eaten uncooked, have a thick skin or rind which is not the Director- General to pursue such research vigorously eaten and which is normally intact when the fruit is and energetically. exported. There would appear to be little if any danger of the spread of cholera by international traffic in this Yellow Fever type of fruit.However, no controlled studies are known which would give an authoritative answer to 62.(a)In adopting the ninth report of the Com- this hypothesis. mittee on International Quarantine the World Health Assembly excepted section 74 of that report and 59. Hong Kong. The Government sends the follow- requested the Director -General to refer this section ing comments : to the Committee for reconsideration.'It reads : " Article 68 has been widely and variously inter- Many travellers coming directly from Réunion by air are preted by the countries concerned during the year obliged by the Egyptian sanitary authorities at Cairo airport to under review, and sanitary measures have been applied produce a yellow -fever vaccination certificate or are put in qua- without relation to the present state of knowledge of the epidemiology of cholera and of the vehicles likely Resolution WHAI 5.37. 44 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
rantine when they are in transit at Cairo or their aircraft touches The Committee recalls its opinion given at its first there.However, according to the requirements in regard to session that the procedure for establishing that direct vaccination certificates notified to the Organization by the United Arab Republic, the Department of Réunion is not considered as transit of passengers at airports in yellow fever infected an endemic or infected area.Thus, passengers coming directly local areas fulfils the required conditions should consist from Réunion who have merely been in transit through Nairobi of direct contact between the governments concerned. Airport (Kenya) under the conditions laid down in Articles 34 If agreement cannot be reached the Organization may, and 75 of the Regulations should not be required to produce a certificate. on request, make any appropriate investigation, but the The Committee notes that the Department of Réunion is not a Organization does not thereby assume responsibility for yellow fever infected area, that the airport local area of Nairobi the fulfilment of the conditions required.3 (Embakasi) has been removed from the endemic zone under the provisions of Article 70, paragraph 2, unamended, and that this 63.India.The Government reports as follows airport is provided with a direct transit area. ...since monkeys can act as reservoir of yellow- Consequently the Committee is of the opinion that the measures fever infection and play an important part in interna- taken at Cairo are in excess of the provisions of the Regulations.' tional spread of yellow -fever infection, it is suggested (b)The yellow -fever vaccination requirements of that suitable provisions may be made in case of the United Arab Republic, as published by the Organi- transport of monkeys from one country to another. zation in 1962, read as follows : The International Sanitary Regulations already contain Air passengers in transit coming from an endemic provisions relating to vectors of quarantinable diseases zone or infected area, and not holding a certificate, and as such there cannot be any objection to the shall be detained in the precincts of the airport until inclusion of such provisions of quarantine measures they resume their journey. The following countries against monkeys." and territories are regarded as endemic zones or The Committee takes note of the communication from infected areas :Africa : Kenya ...... the Government of India on the question of monkeys (c)The following information has been provided carried in international traffic and reaffirms its opinion by the United Arab Republic :2 given in its ninth report that this problem could best be The United Arab Republic " did not in fact solved by agreements between the States concerned, demand vaccination certificates in the circumstances outside the provisions of the Regulations.' described in the complaint, but it had to ensure that passengers had not left the transit area in Nairobi. Article 70 All that was required was a certificate to that effect from the health authorities of the airport. A ` direct 64.Notifications of areas considered as receptive or transit area' was defined in Article 1 of the Interna- no longer receptive under Article 70 were published tionalSanitary Regulations as' aspecial area in the Weekly Epidemiological Record. An up -to -date established in connexion with an airport, approved list of yellow -fever receptive areas appeared in Weekly by the health authority concerned and under its Epidemiological Record, 1962, No. 8, and in Vaccina- direct supervision, for accommodating direct transit tion Certificate Requirements for International Travel, traffic and, in particular, for accommodating, in 1962. segregation, passengers and crews breaking their air voyage without leaving the airport ' ". Article 70 (unamended) The Committee recalls that, under the Regulations, 65.Information, including maps, on the delineation airport directtransit areas are for the purpose of of the yellow -fever endemic zones in Africa and in facilitating international traffic.The Committee is of America was publishedinVaccinationCertificate the opinion that, especially where areas outside a direct Requirements for International Travel, 1962. Quarterly transit area or outside an airport may present a danger reports received on the Aedes aegypti index in localities of transmission of a quarantinable disease, the airport excluded from these endemic zones were also published health authority has the obligation to ensure that transit in the Weekly Epidemiological Record. passengers do not leave the designated direct transit area. When the airport is not yet provided with a direct 66.Ethiopia.The Government reportsthat the transit area, the same obligation applies as regards the Ethiopian Quarantine Services are often blamed for segregation and transfer of persons referred to under measures imposed on their services by the countries Article 34 (b). which consider Ethiopia as a yellow -fever endemic zone. Passengers from North America and Europe 1 Off. Rec. Wld Hlth Org. 118, 48, section 74. cannot understand why they have not been requested 2 Statement made by the delegate of the United Arab Republic at the Fifteenth World Health Assembly (Off. Rec. Wld Hlth 3 Off Rec. Wld Huth Org. 56, 58, section 66. Org. 119, 195). 4 Off Rec. Wld Hlth Org. 118, 54, section 117. ANNEX 1 45 to be vaccinated before leaving their countries for phylactic measures adopted no secondary case was Ethiopia while they are required to produce a certificate reported.Details concerning this imported case are when leaving Ethiopia for some countries. given below : The Committee recommends that health administra- On 12 October 1961, a child aged seventeen months tions should advise travellers that the requirements of and his mother arrived at Brussels Airport from countries are related not only to the health conditions Leopoldville, via Rome. The child had been vaccinated prevailing inthe country of departurebut alsoto six months and again eight days before arrival. On conditions in countries in which the traveller disembarks 14 October he was hospitalized; the diagnosis of or transits during his journey except in so far as he smallpox was established on 16 October, and he died follows the provisions of Article 34. on 18 October. Before her departure from the Congo, the mother was working in a hospital at Bakwanga, Article 73 where smallpox patients were treated. 67.Philippines.The Government again reports In connexion With smallpox outbreaks in Europe, that insects, including mosquitos, are found in aircraft the Government reports as follows (translation from arriving at Manila Airport. This may be due to the the French): fact that disinsection is not carried out or that the " During the period in question special quarantine techniques used are inadequate. measures -in particular the requirement of a valid smallpox vaccinationcertificate -were appliedin toits comments The Committee invites attention regard to persons coming from Düsseldorf, Simmerath- under section 11 and is of the opinion that the " blocks Montjoie, Aix -la- Chapelle (Federal Republic of Ger- away " procedure for aircraft disinsection may help many); Bradford, Tipton, Hornchurch, Ilkley, Wool- to solve the problem raised. wich,Llantrisant,Rhondda,Pennybont(United Article 74 Kingdom of Great Britain and Northern Ireland) and Nowy Port -Gdansk (Poland) when there were cases 68.Seychelles. The Government reports as follows : of smallpox in these areas. " It has been deemed advisable to amend the " While these smallpox foci were present in neigh- vaccinationcertificaterequirementsinrespectof bouring countries, we met with some difficulties in yellow fever because of delays in obtaining information applying the International Sanitary Regulations and concerning infectedlocalareas.2The recognized asked the opinion of the Organization on certain concession for children under one year of age, however, points, in particular on the : has been introduced in respect of yellow -fever and cholera inoculations." (1)interpretation of Article 6, 2 (a) of the Regula- tions, relating to the date when an infected local Article 75 area may again be considered as being free from 69.Burma. The Organization was informed by the infection (letters of 19 February and 14 March Government on 19 September 1962 that the arrange- 1962); ments concluded between Burma and India and (2)interpretation of the definition of' infected between Burma and Pakistan were terminated on local area' (letter of 12 April 1962) ;6 1 September 1962. (3)interpretation of the terms primary vaccina- Smallpox tion and revaccination (letters of 2 May and 31 July 1962). 70.Basutoland.The Government reports that, by " Furthermore, experience of smallpox epidemics the end of July 1962, the epidemic of smallpox 3 which started in 1961 appeared to have been controlled. on our land frontiers has shown that there should be special provisions for frontier areas where the popula- 71.Belgium. The Government reports that one case tion of the two countries is mixed, particularly, measures of smallpox was imported from the Congo (Leopold- to ensure the rapid and direct notification through the ville),' but thanks to the energetic isolation and pro- local health authorities in the border areas of any case of quarantinabledisease,with indications of the 1 For previous report, see Off. Rec. Wld Hlth Org. 118, 49, origin and evolution of the case, and of the measures section 81. taken." 2 The Government of Seychelles decided to require a yellow - fever vaccination certificate from arrivals from the endemic zones; previously the requirement applied to arrivals from 72. Ceylon. The Government reports that it was not infected local areas.The Organization is in communication possible to trace the source of infection of the three with the health administration concerned. 3 Off. Rec. Wld Hlth Org. 118, 50, section 90. See section 23. ' See Appendix 1. 6 See section 16. 46 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
outbreaks which occurred during the period under infected persons who had approached the child no review. A total of sixty -six cases, with twelve deaths, more than at a distance of about twenty metres. was reported. " The measures for combating the disease followed normal routine regarding isolation and protective 73.Dahomey. The Government states that eighty - vaccination.The persons who had been in contact four cases of smallpox, with fourteen deaths, occurred with smallpox cases were placed under a more or less in the country during the period under review; no severe isolation according to the intensity of their cases, however, were reported by the health authorities previous contact. Thus, the endeavours to check the of the airport and the port of entry. spreading of the disease from its focus to the popula- tion in general were successful. Immediately following 74.Denmark. The Government reports as follows : " ... only in one instance we had reason to believe the confirmation of smallpox by laboratory tests, large -scale vaccination campaigns were started. that a case of smallpox, originating in Nigeria, was In Düsseldorf about 150 000 people and in the district carried to our country.However, the ...clinical of Monschau and in Aachen about 208 000 people picture was most doubtful and no secondary cases have occurred. We would not consider it to have were vaccinated against smallpox. been a case of modified smallpox." " The evaluation of the measures taken by other countries following the smallpox outbreaks in the 75.Federal Republic of Germany. The Government Federal Republic has shown that some countries do reports as follows : not adhere to the measures admissible pursuant to " .there occurred one outbreak of smallpox each the International Sanitary Regulations, but exceed in Düsseldorf (Regierungsbezirk Düsseldorf) and in by far the limits set by these instructions.Thus, Lammersdorf /Simmerath (Regierungsbezirk Aachen), travellers by air or rail were more or less forced to both situated in the Land of Northrhine -Westphalia.' submit to protective vaccinations, requirements were The smallpox outbreak in Düsseldorf was initiated placedupon internationalvaccinationcertificates by a German engineer, returning on 2 December 1961 which find no support in the International Sanitary from Liberia. The outbreak in the Regierungsbezirk of Regulations, health certificates for goods were required Aachen occurred in the rural district of Monschau and the whole territory of the Federal Republic was and was caused by a German mechanic, who returned considered as a ' local infected area '.These incidents on 23 December 1961 from India. In Dusseldorf there may be attributed partly to inadequate co- operation were five cases, two of which ended fatally, whereas between the officials of the frontier control and of in the rural district of Monschau and in the town the health authorities... borough of Aachen thirty -three cases were noted, one " In addition hereto, the two smallpox outbreaks of which ended fatally. have given rise to a number of fundamental problems. " Both outbreaks had their source intravellers These concern the accommodation of persons suffering returningfrom tropicalareas where smallpoxis from smallpox and of suspect cases and their personal endemo- epidemic. At the time of their arrival in the and material care as well as the prevention of cases Federal Republic both travellers did not show any and their spread by international traffic. symptoms of the disease. Both were in possession of " The accommodation of smallpox cases and of valid international vaccination certificates.Thus, the suspect persons in the ward for infectious diseases importation of smallpox could not be prevented by within a general hospital, where the ward is not applying the measures provided for in the Interna- located in a special isolation house or, still worse, in tional Sanitary Regulations. isolated rooms of a ward for internal diseases, must " However, in both cases the spread of the disease be considered as fully inadequate. In future, smallpox could be checked efficiently.That an outbreak of cases will have to be kept in special isolation hospitals. smallpox occurred among the patients in the Sim- For their care and treatment medical and nursing merath hospital, where thefirstcase within the personnel must be available who dispose of a satisfac- Monschau area was isolated and treated, must be tory protection by vaccination,i.e.,these persons attributed to the fact that, up to now, too little atten- must be revaccinated at regular intervals.Their tion has been devoted to the spread of smallpox suitability for working in quarantine wards will also through the air.In the Simmerath hospital it has been observed that the smallpox virus, which was depend upon the degree of their reaction to vaccina- continually spread by a highly infectious child suffering tion. Considering the training of doctors and auxiliary from pharyngitis variola and from a barking cough, medical personnel, the treatment of smallpox will be paid more attention to and the diagnostic methods ' See Appendix 1. will be improved. ANNEX 1 47
" In addition, the question has been raised whether 79. Libya. The Governmentreportsthatfull smallpox might be spread by mail traffic and which attention was given to the development of the smallpox measures against this hazard might be taken. Whether outbreaks in the Federal Republic of Germany and and in how far the measures admissible in accordance in the United Kingdom of Great Britain and Northern with Article 48 of the International Sanitary Regula- Ireland, and that Libya depended a great deal on the tions should be considered as satisfactory is still the notificationsandinformationreceivedfromthe subject of thorough tests .. Organization. " Apart from these two outbreaks of smallpox, no 80.Mauritania.The Government reports that no further cases of quarantinable diseases occurred in the cases of quarantinable diseases due to international Federal Republic of Germany during the period under traffic were recorded, and adds the following com- review." ments (translation from the French): 76.Federation of Rhodesia and Nyasaland.The " It should however be noted that there is a move- Government reportsthatsmallpox infectionwas ment of persons between Mauritania and Senegal and introduced into Luapula Province from the adjacent between Mauritania and Mali which cannot be area of the Congo (Leopoldville).It is not certain, controlled :periodic migration of shepherds in search however, that cases carried across a river frontier of water and pasturage; crossing of rivers by persons can be considered as being due to international traffic. working on one side and living on the other. These population movements were certainly the cause of 77.Ghana. The Government reports the following a number of cases of smallpox which appeared in imported cases : June 1962, but their nature and the extent of the (1)Nigerian, aged 16 years. He arrived in Ghana frontiers make control impossible." on 8 December 1961, from Northern Nigeria, by land, through Togo; developed smallpox on 16 December 81.Poland. The Government reports that between and was isolated on 19 December. 21 March and 9 June 1962 there was an outbreak of smallpox duetointernationaltrafficatGdarísk.. (2)Ghanaian, aged 32 years; resident in Bouake, No deaths were reported.2 Ivory Coast. He became sick with high fever and was brought back home; a rash appeared en route to 82. Togo. The Government states that 465 cases of Ghana. He was isolated on 21 January 1962 and died smallpox, with eighteen deaths, were observed in on 23 January. Togo during the period under review, and adds the (3)Ghanaian girl, aged 9 years; resident in Palime, following comments (translation from the French) : Togo.She arrived home at Avloto on 25 February " Some cases of smallpox are imported owing to the 1962; developed smallpox on 27 February and was numerous exchanges between Ghana and Dahomey isolated on 5 March. across the Togo frontiers -where control is impossible. " The best way of ensuring mass vaccination is by (4)Togolese, aged 46 years; resident in Ghana. He travelled to Togo on 26 January 1962 and returned the well -tried method of using mobile teams. At the on 30 January; developed smallpox on 10 February present time, vaccinations are performed at fixed and was isolated, on 19 February. units in the principal hospital centres.When an epidemic occurs, a team goes out and puts a cordon (5)Togolese woman aged 24 years.She travelled round the markets and vaccinates the greater part from Togo to Ghana while already suffering from of the population." the disease; detected during traffic checking at Akroso Ferry and isolated on the same day (22 March). 83. Trucial Oman.In a report dated 19 February (6)Togolese woman, aged 39 years.She arrived 1962, on the smallpox outbreak in Dubai, the Govern- from Palime, Togo, on or about 22 April and developed ment stated that, through the foresight of the Senior smallpox a few days after arrival.The patient was Medical Officer,allschoolchildrenof Dubai had found concealed in a house on 12 May and was beenvaccinatedassoonasthenews reached isolated on the same day. Trucial Oman that smallpox in Pakistan was causing All cases except the second recovered. concern. Therefore, by the time the first case in Dubai was reported on 20 January, a large proportion of the 78.Kenya. The Government reports that the ship most vulnerable section of the population had been LOCH ALVIE coming from Karachi arrived at Mombasa given protection. With one or two exceptions, all cases on 17 December 1961 with a case of smallpox on in Dubai were among pilgrims on their way to Saudi board. Arabia.
1 See Appendix 1. 2 See section 92 and Appendix 1. 48 SIXTEENTH WORLD HEALTH ASSEMBLY, . PART I
84. Union of Soviet Socialist Republics. The Govern- had a short stop -over within Western Europe and ment states that, in February 1962, a suspected case travelled further on an aircraft free from health of smallpox was found in the Kizyl Atreks rayon of the contról. This category had been accepted as a risk. Turkmenian S SR.The diagnosis of smallpox was " Smallpox had been present in Karachi during not confirmed, but all necessary measures had been 1961.In mid- December a significant increase in the taken. number of cases occurred. Five Pakistani immigrants among the many who entered this country through 85. United Kingdom of Great Britain and Northern Ireland.The Government reports as follows : London Airport between16 December 1961 and " The fact that some twenty out of sixty -four persons 12 January 1962 developed smallpox after arrival. Two of them died. who were seen by smallpox consultants during 1961 All five had valid international had recently arrived from abroad indicates that the certificates of recent revaccination.Three arrived by risk of importations of smallpox is continually present. direct flight, two by indirect flights which were not On 28 December 1961, the first of what was to be subject to formal health control on arrival here. a series of five separate importations of smallpox 1 " More stringent controls were, as an emergency came to light. measure, progressively put into effect as evidence came " _Airport Health Control. The airport health control to hand that revaccinations taking place in Karachi aspects which are of interest were as follows : were not taking effect in an appreciable number of " Under the system of health control at London persons. When the third importation had been Airport normally in operation during the year all identifiedspecialarrangementsweremadeon persons arriving on an aircraft by direct flight from a 15 January 1962 to regard as ' suspects ' travellers who smallpox endemic or epidemic area (this includes had been in Karachi within fourteen days prior to India, Pakistan, as well as countries in South -East arrival. The measures taken included clinical examin- Asia, Central and South America and parts of Africa) ation of vaccination sites and, where necessary, offering were given a yellow warning card. While a certificate vaccination and subsequent isolation for fourteen days of vaccination against smallpox was not formally or until the vaccination had taken. Destination required from people arriving in this country from addresses of disembarking passengers were taken and smallpox infected areas, all were asked if they had an they were put under formal surveillance. The Depart- internationalcertificateofvaccinationagainst ment advised that these precautions should be taken smallpox.If the scrutiny of the certificate was satis- at all ports and airports throughout the country at factory, no further action was taken. If the certificate this time. Checks made during February and March did not satisfy scrutiny or the passenger did not hold showed that some 67 per cent.of arrivalsfrom one, the name and destination address of the traveller Pakistan came on directflights. The remainder was taken and filed at the airport in case it was needed, (33 per cent.) came by' indirect flight '- having should an importation later be traced to that aircraft. changed their aircraft at one of nine different airports, " This practice originated in 1952 when the Inter- four of them being within the ` excepted area '. nationalSanitaryRegulationscameintoforce. " From 15 January until 9 March while these TheseRegulationsdidawaywiththepersonal stringent measures were in force, ninety -six suspects declaration of origin and health which was a form on out of the 4138 arrivals from Karachi were isolated which arriving travellers were requested to state their either in Denton Hospital or the Eastern Hospital. destination addresses. The Regulations did not permit Thirty -seven of these suspects showed evidence, by a health authorities to obtain a written statement from successfulrevaccinationat theairport or at the arriving travellers. hospital, that they were susceptible to vaccinia and " Also in force was an arrangement concluded by presumably also to smallpox on arrival. (This number the Western European Union whose health functions represents less than one per cent. of the arrivals from have now been taken over by the Council of Europe Karachi during the time the measures were in force.) (Partial Agreement). Under this arrangement, aircraft " During the period when arrivals from Karachi flying solely within the territory of the States party were being placed under formal surveillance oppor- to this agreement, i.e., the United Kingdom, Ireland, tunity was taken to check its effectiveness.In several France, Belgium, Netherlands, Luxembourg, Federal cities and towns in the Midlands the percentage of Republic of Germany and Italy, were free from health immigrants from Karachi who were later traced to the control. It was known by the parties to the agreement destination addresses which they gave on arrival lay that on such aircraft there would be persons from between 85 per cent. and 100 per cent. The impression infected areas who had changed planes in transit or was gained that the higher rates reflected the time and effort which local authorities spent on following
1See Appendix 1. recently arrived immigrants through several changes ANNEX 1 49 of address. A comparable figure of 33 per cent. from Smallpox Hospital at a relevant time.The mode of one London borough was the result of immigrants not transmission was not determined. knowing their destination address and giving the " Importation No. 2.One secondary case only, a address of an embassy or an hotel to which they did medical officerof health who had examined the These results must be looked at against the not go. imported case. fact that many of the immigrants were illiterate, were unable to speak English and had arrived without any " Importation No. 3.This patient sickened with firm knowledge of their subsequent movements. smallpox in Bradford Children's Hospital, where she " Cases of Smallpox in England and Wales. In order, was under treatment for another condition.She died briefly, to complete the description of the importations within twenty -four hours of onset, and, during life, the details of the imported cases and the outbreaks infected seven other children in the same ward of the they caused are given below : hospital, a visitor and one of the hospital cooks. A pathologist who performedthepost -mortem " A.Imported Cases.Arranged in the order in examination also acquired the infection and sub- which they were recognized to be suffering from sequently died. The total number of cases in the first smallpox these fivé imported cases are shown in generation was ten, of whom five died. Table I by dates of arrival, onset of illness and removal " One of the children developed smallpox after from the community. transfer to a long -stay hospital, where the infection was transmitted to one other child.The visitor to TABLE I Bradford Children's Hospital was admitted, before the diagnosis was established, to St Luke's General
Date of Hospital where he infected two other patients.The Im- total number of cases in the second generation was ports- District tion arrival onset of removal from three, of whom one died, though this death was not No. at illness community London assigned to smallpox. " Importation No. 4. No secondary case developed. 1 St Pancras 25.12.6125.12.61 28.12.61 Metrop. Borough (died 6.1.62) " Importation No. 5. This patient, who was taken ill 2 West Bromwich 19.12.6121.12.61 28.12.61 in Cardiff on 13 January 1962, was admitted on County Borough 16 January to a smallpox hospital situated in the 3 Bradford 16.12.6129.12.61 30.12.61 Rhondda Valley. No secondary case occurred among County Borough (died unre- persons known to have been in contact. cognized) " On 25 February it became evident that cases of 4 Birmingham 4.1.62 8.1.62 15.1.62 County Borough smallpox were occurring in the Rhondda district.In 5 Cardiff 12.1.62 13.1.62 16.1.62 retrospect the first case of the outbreak was recognized County Borough to be a young married woman whose home was at a distance of about half a mile from the smallpox hospital.This woman died on 9 February, the day " Importation No. 3 first came to light with the after she had been delivered of astill -born child. recognition of secondary cases on 11 January 1962. Smallpox was not suspected as the cause of death. Subsequent events showed that this woman infected "B.Indigenous Cases.From 11 January 1962 four persons with whom she had been in contact indigenous cases began to be recognized.The total during life. A gynaecologist who attended the post- was sixty -two cases of whom twenty -five died. These mortem examination also acquired the infection and figures include two persons who died of illnesses subsequently died. diagnosed retrospectively as smallpox without labora- " During the period 9 February to 15 March the tory confirmation and one person confirmed as a case total number of cases in the Rhondda and neigh- of smallpox who died of another cause. bouring district of Llantrisant was twenty -five, out of " The relationship of the indigenous to the imported whom six died.These figures include the woman cases was as follows : who died on 9 February. The cases fell into several " Importation No. 1.No secondary case occurred groups of close contacts, but the links between some among persons known to have been in contact. Two of the groups were tenuous and the possibility of a apparently sporadic cases in the Greater London missed case or cases was considered. Vaccination was area were taken ill during January. Both were known offered on a very wide scale throughout the affected to have been working not far from Long Reach area. 50 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
" After it was hoped that the outbreak had ended, CONCLUSION a further incident came to light during the first week in April when a number of patients who were occupy- 1. The riskof importationsof smallpoxwill ing a ward in a mental hospital, near Bridgend, were continue so long as smallpox remains endemic in found to be suffering from smallpox.This outbreak, several countries of the world.The risk appears to which has been confined to the one ward of the have increased in recent years consistent with changes hospital, was also related to a death recognized as due in the nature, volume and speed of international to smallpox only in retrospect.An elderly woman air traffic. It seems necessary, therefore, to concentrate who had been in the ward for more than a year died on eradication of endemic foci by mass vaccination on 25 March after a short febrile illness.During the campaigns using a potent vaccine and a method which period 25 March to 15 April a total of twenty -one gives immunity against smallpox. cases occurred, all confirmed by laboratory investiga- The International Certificate of Vaccination tion, of whom thirteen died.These figures include " 2. against Smallpox isthe evidence an international the woman who died on 25 March. The hospital was effectively closed to outside contact from 7 April traveller carries that he has an immunity against and the whole hospital remained in quarantine until smallpox. It may be false evidence because revaccina- tion performed was not successful and hence gave no 30 April.The method by which the infection was immunity or because the certificate issued was bogus introduced into the ward remains unknown. and fraudulent or because the patient was already " The total number of cases in the two outbreaks incubating smallpox. in South Wales was forty -six, of whom nineteen died. " The fraudulent certificate when itoccurs isa " Theimportationsandindigenouscasesare matter for national action, but it is felt that the World analysed in Table II. Heálth Organization can make thecertificateof vaccination against smallpox better evidence of success- TABLE 11 ful revaccination by requiring it to show the result of revaccination. Indeed it is a matter for consideration Importation England Wales whether the certificate of revaccination should not only record the result and a second insertion if no result No. Cases Deaths Second- Deaths Second- Deaths ary cases ary cases of the firstisseen, but require also that the first insertion be made at least fourteen days before the
I 1 certificate of revaccination becomes valid. 1 2 --- 2 1 - 1 --- " It is fully realized that this return to a form and 3 1 1 13 6* -- model on the lines of the certificate issued under the 4 1 ----- 1944 Conventions would impose delays and diffi- 5 1 46 19 --- culties on international travel, but these could in some measure be reduced if the requirements of a valid Including one death from other causes. certificate could be demanded under the International England and Wales were declared free from small- Sanitary Regulations only from arrivals from an pox on 20 May 1962. infected area and not, as at present, quite illogically, from arrivals from anywhere in the world." " Vaccination.While mass vaccination was not advocated for the population generally as a control 86. United States of America.The Government measure, the demand for vaccination increased during reports that State and local health officers co- operated the outbreaks. No accurate figures are available of the in smallpox vaccination programmes at ports of entry number of vaccinations carried out but some indication for persons in the port area and adjacent community is given from the fact that over seven million doses who would have contact at some time with interna- of vaccine lymph were distributed. tional traffic because of the nature of their employment. " As regards complications of vaccination pro- visional information was received of : 87.Zanzibar.The Government reports as follows : 3 cases of vaccinia gangrenosa with nil deaths; " On 7 July 1961, S.S. AMRA arrived from Bombay 39 cases of eczema vaccinatum with 10 deaths; via Mombasa, after having landed a suspected case 40 cases of post -vaccinal encephalomyelitis with of smallpox at Mombasa... The fifty -two passengers 4 deaths; disembarking at Zanzibar were placed under sur- 91 cases of generalized vaccinia with 3 deaths. veillance for fourteen days." 1 In addition, in five other deaths the death certifi- cate mentioned vaccination. 1 The diagnosis of this suspected case was not confirmed. ANNEX 1 51
Article 83 mittee has reviewed present knowledge of the disease, the status of susceptibility among various populations, 88. St Kitts -Nevis -Anguilla. The Government reports and the methods for the prevention of spread including follows : as the methods and practicabilities of immunization pro- " The outbreak of smallpox in the United Kingdom earlier this year necessitated quarantine measures to cedures.The Committee has reached a conclusion that be instituted on all ships arriving in the territory in a good degree of protection against the importation of is availableto so far as disembarking passengers were concerned." smallpox into a territory the health administration of the territory within the terms of the 89. France. The Government reports as follows existingInternationalSanitaryRegulations. The (translation from the French) : Committee is ever anxious for improvements inthis " The appearance in Great Britain and the Federal protection.It recognizes that absolute protection is not Republic of Germany of several smallpox foci led attainable within present limits of knowledge without the French administration to apply the provisions of marked interference with international traffic. Article 83, paragraph 2,to travellers coming from The Committeeinvitestheattentionof health infected local areas... administrations to their obligations under the provisions " The application of these provisions in the cir- of Article 30 to take all practicable measures to prevent cumstances mentioned above gave riseto certain the departure of any infected person or suspect.The difficulties. Committee urges such health administrations, in partial " Pursuant to these provisions, an international fulfilment of these obligations, to require a valid inter- certificateofvaccinationagainstsmallpoxwas nationalcertificateof vaccinationorrevaccination required on arrival in France of all travellers coming against smallpox of departing travellers. from an infected local area either directly or within The Committee recalls that international vaccination fourteen days of being in such an area.However, certificates are issued under the authority of a govern- since the countries involved were neighbouring ones ment and consequently governments have the responsi- with which there is a great deal of traffic and the local bility to ensure that potent vaccines and proper pro- areas were, for the most part, small, with no ports or cedures are used, so that smallpox vaccination will airports, control operations on arrival proved difficult. result in an adequate immunity to smallpox. In order to make sure that all travellers arriving in The Committee was informed that some States issue France from an infected local area or within fourteen to travellers arriving from a smallpox infected area a days of being in such an area do in fact possess an warning card stating that if they fall ill they should seek international certificate of vaccination against small- medical advice and present the warning card. The pox, it is necessary to question a very large number Committee believes this could be a useful procedure. of travellers." The Committee again stresses the need for medical 90. United States of America.The Government and other personnel who come in contact with travellers reports that sixty -five persons were detained long to maintain a high level of immunity against smallpox enough for a differential diagnosis for smallpox or by repeated vaccination.' cholera, or for development of satisfactory evidence The Committee isextremely concerned with the of vaccination or immunity among persons arriving record of importation of smallpox ininternational from infected local areas. All but three arrived by air. traffic and the secondary spread which has occurred In contrast to the sixty -five, only eleven persons were since itslast meeting. The Committee recalls that detained the previous year. additional sanitary measures may be applied to the special groups listed in Artcile 103 of the Regulations Sections 70 -90. The Committee continues to view and notes that several of the imported cases were of as a major threat to world health the reintroduction of these categories. smallpox from the several foci of this disease about the One member of the Committee, as a direct result of world into territories where itis no longer present. recent importations into Western Europe, has proposed Aware of the Organization's objective that smallpox be a recommendation for a series of changes in the Inter- eradicated from all territories and of the problems which national Sanitary Regulations, intended to lessen the will delay attainment of this objective for at least risk of such importations.The Committee has con- several years, the Committee fully realizes its great sidered this proposal at length and in detail. The responsibility for making appropriate recommendations Committee believes that greater knowledge of smallpox to the Assembly with the aim of providing the various and vaccination is necessary to permit a practicable healthadministrationswithInternationalSanitary and effectivesolution. Accordingly,the Director- Regulations which will allow effective prevention of the passage of smallpox in international traffic.The Corn- 1 Off. Rec. Wld Hlth Org. 102, 47, section 59. 52 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
General is requested to refer this problem to appropriate " 1 n view of such contradictory evidence and also from experts and provide the Committee with recommenda- the point of view of judicious application of quarantine tions at an early date. It has concluded that the specific measures, it is considered most desirable that facilities terms of the proposal might interfere with world traffic should be provided to get the diagnosis confirmed at without any proportionate degree of enhancement of a WHO approved referral laboratory and a number protection, and without, in fact, providing for complete of such laboratories distributed all over the world protection against all importations of the sort recently may be approved by WHO. Specimens could be sent experienced. by the port health authorities either on behalf of the The member referred to above is of the opinion that shipping companies who may so request, or on their this procedure does not offer early hope of additional own behalf in case facilities are not locally available. safeguards to those countries at risk, and accordingly Reports from the referral laboratories may similarly has recorded his divergent opinion in Appendix 2.' be. sent direct to the port health authority concerned. The Committeeinvitestheattentionof health Shipping companies will perhaps have no objection administrations to the recommended requirements for to meeting the expenditure involved in regard to cases smallpox vaccine 2 drawn up by a WHO study group referred from their ships.It is highly probable that and again stresses the advantages of dried smallpox favourable findingsof an internationally reputed vaccine.3 laboratory will at least have the effect of mitigating The Committee was informed that the Organization is the rigid quarantine measures which some countries prepared to arrange for the potency testing of smallpox are only too apt to apply, if not of completely elimin- vaccine, on request of the country producing it. ating them." See comments of the Committee under section 92. 91.India.In connexion with the outbreak of small- pox on board the INDIAN RESOLVE,4 the Government 92.Poland. The following communication has been gives the following information received from the Government (translation from the "... twenty-five cases were confirmed as smallpox French): by laboratory examination; eight cases were diagnosed " With reference to your letter of 13 September clinically 5 and thirty -seven were classified as suspects. 1962 concerning smallpox cases among members of The first case which broke out on 5 March 1962 was the crew of the ship INDIAN RESOLVE,6 I can give you diagnosed as chickenpox by the port health officers the following information : at Aden, Suez and Kiel.Before leaving Calcutta on (1)the smallpox cases notified to the World Health 19 February, most of the persons on board were Organization were confirmed both clinically and in revaccinated by the company's medical officer with the laboratory (isolation of the virus); fresh vaccine obtained the same day from the Vaccine (2)the diagnosis of varicella in the case of the Institute of Calcutta Corporation.Those who were first patient on the boat, made by the port medical not vaccinated before they leftCalcutta were in officers at Aden, Suez and Kiel, was not confirmed possession of valid certificates.Since it is the practice by the laboratory' examination; in India to enforce vaccination of all crew members once in three years, these vaccinations were not the (3)cases of smallpox among persons recently first of their kind but were probably the second, third vaccinated againstthedisease,orrevaccinated or fourth vaccinations in their lives. The occurrence of several times, are possible, since vaccination does so many cases of smallpox among the crew members not exclude the possibility of smallpox of a clinically revaccinated on different days with thedifferent mild or abortive nature, a fact we have confirmed batches of fresh potent vaccine, unanimous diagnosis here among the staff of the quarantine service who of chickenpox made by three port health officers and have been revaccinated several times ; total absence of any secondary case among the non - (4)we fully agree that there is a need to create a immune population coming in contact with the ship at diagnosis reference centre approved by WHO, which the previous ports give rise to certain doubts about could collaborate with the laboratory centres in the the correctness of the clinical and laboratory diagnosis different countries and place standardized strains, arrivedat .... sera and antigens for diagnostic purposes at their disposal." ' See p. 58. The Committee was informed that the Organization 2 Wld Hlth Org. techn. Rep. Ser., 1959, 180. has assisted countries to set up diagnostic laboratories, 3 For previous comment of the Committee on this subject, see Off. Rec. Wld Hlth Org. 102, 47, section 59. has conducted one course in the laboratory diagnosis ' See section 92 and Appendix 1. 5 Four of them were later confirmed. 6 See sections 81 and 91. ANNEX 53 of smallpox, is prepared to furnish consultants for this The Committee is not aware of any evidence of trans- purpose and, for difficult cases, is prepared to arrange mission of smallpox by mail since the Regulations for the examination of laboratory specimens at the entered into force, and consequently, at present, does request of the countries concerned.The Organization not recommend any change in the provisions of Article 48, is also considering the designation of a WHO reference but requests the Director - General to study this question laboratory for the study and characterization of pox and report to a subsequent meeting of the Committee. viruses. Typhus 93.International Transport of Mail 94.Republic of Korea.The Government states that Information on this subject was presented to the during the period under review fifty -two cases of Committee in a separate document. typhus (with one death) occurred in the territory.
PART VI.SANITARY DOCUMENTS
Article 97 its submission when there are any persons on board known to be suffering from illness other than air- 95.(a)The provisions of paragraph 1 of Article 97 appear to make it mandatory for the pilot, or his sickness or the effects of accidents, when cases of illness have been disembarked during the flight, or authorized agent, to complete and deliver the health part of the Aircraft General Declaration; this to be when there is any condition on board which may lead done whether or not there is anything of epidemio- to the spread of disease. logical significance to report and independently of The Committee recommends that Article 97 should whether the health authority wishes to receive this be amended in paragraph 1 by adding, after the words document. " Appendix 6 ",the words " except when a health administration does not require it ". (b)One arrangement among States under Article 104, inestablishing an" excepted area "forsanitary measures under the Regulations, has eliminated the obligation to submit the health part of the. Aircraft Article 100 General Declaration under conditions laid down in the 96.United Kingdom.The Government reports as arrangement.' It is assumed that this action has been follows : taken in view of the general policy stated in Article 23 " The World Health Organization should... give that" thesanitary measurespermittedbythe consideration to the difficulties imposed on health Regulations are the maximum measures applicable administrations in tracing arrivals from infected areas to international traffic ", and the basic purpose of the without documentary evidenceof theirintended agreement - to facilitate international traffic and the destination. The volume and nature of international simplification of sanitary measures. traffic now warrants a re- examination of the decision (e)Except for abnormal circumstances, itis con- taken by the World Health Assembly in 1952 when sidered that for many parts of the world the routine such documentary evidence was made illegal under the submission of the health part of the Aircraft General International Sanitary Regulations.A destination Declaration may be an unnecessary formality. address is important. To obtain it from the passenger from an infected area on a form completed during the (d)The Committee's opinion is desired on whether voyage or flight would save time and obviate the delays the provisions of Article 97 require theroutine and inefficiency which will continue if the limitations submission of thisdocument or whether health imposed by the International Sanitary Regulations are administrations can in normal circumstances forego maintained." this requirement.It would be understood that, if Information on proposed sanitary documents is this document is no longer required routinely,it given in a separate document; see also section 89. would still remain the duty of the pilot to arrange for The Committee discussed the question of permitting healthadministrationstorequirein ' These conditions provide as follows : "An aircraft which writing from begins its flight at any place within the ' excepted area ' and arriving travellers details of their travel before arrival does not call during its voyage at any place outside that area, and a destination address. is not subjected to health control on its arrivals at any other place within the ' excepted area '."The arrangement contains The Committee concluded that health administrations, a temporary suspension clause for abnormal circumstances. other than those of States whose reservations have 54 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I already been accepted, should not be permitted to require general requirement would impose delays oninter- in writing from travellers on an international voyage, on national traffic. The Committee recommends that, where arrival, detailsoftheir travel during the days before a health administration has special problems, arriving their arrival and, consequently, no amendment to the passengers may berequired togive adestination Regulations is proposed. address in writing. The Committee then considered the desirabilityof The Committee therefore recommends the addition granting power to a health authoritytorequire a of a third paragraph to Article 36 as follows: destination address in writing from arriving travellers. The Committee notes that Article 103 does allow such 3. Where ahealthadministrationhasspecial a requirement to be enforced for special groups.The problemsconstituting a gravedangerto public Committee appreciatesthedesire of some health health a person on an international voyage may, administrationsto have destinationaddresses from on arrival, be required to give a destination address arriving travellers but realizes that to permit it as a in writing.
PART VII.SANITARY CHARGES
Article 101 thisinformation presumably . obtainitfromthe published tariffs of States. 97. The provisions of Article101, paragraph 3, require States to notify the Organization immediately The Organization has used the information received of tariffs for sanitary charges and of any amendments to answer inquiries of other health administrations and, thereto.States are also required to publish the tariff as necessary, to invite attention to excessive tariffs. at least ten days in advance of any levy thereunder. The Organization plans now tocease routine Although notrequired by theRegulations to dissemination of information received on tariffs of disseminate such information, the Organization has sanitary charges. done so. A review of the small amount of information The Committee notes the action proposed. received and disseminated by the Organization in the past year and of older information shows clearly 98.Netherlands. The Government reportsthat that much of the information is undoubtedly out of charges are still levied which do not conform with date.Shipping companies and airlines which require Article101.2
PART VIII.VARIOUS PROVISIONS
Article 104 been transferred to the aegis of the Council of Europe. Countries parties to this arrangement are :Belgium, 99.(a)An arrangement for the direct and rapid exchange of epidemiological information was con- the. Federal Republic of Germany, France, Greece cluded between the Governments of Ceylon and (as from 1 February 1962), Ireland, Italy, Luxembourg, the Netherlands and the United Kingdom (including India;1it came into force on 1 January 1962. the Channel Islands and the Isle of Man). (b)On 2 February 1962, recommendations for the unification of the sanitary rules applicable to the (d)At a meeting called in Manila in April 1962, by Danube River traffic were adopted in Budapest by the Regional Director for the Western Pacific, for the Danube River Commission. These recom- exchange of information on cholera El Tor it was mendations had been drawn up with the assistance of agreed that bilateral or multilateral arrangements the Organization. By 18 September 1962 two of the underArticle104would undoubtedlyfacilitate countries concerned (Czechoslovakia and the USSR) application of the Regulations in Asia in respect of had notified their adoption of these recommendations. cholera El Tor. As requested, the Organization suggested to States concerned a number of items for (c)The arrangement of 15 June1956, formerly consideration. under the aegis of the Western European Union, has
2The Organization took up the matters mentioned in the 1SeeWkly epidem. Rec., 1962, 8, 102. report of the Netherlands directly with the countries concerned. ANNEX 1 55
APPENDICES
Appendix 2 105. Uganda.The Government reports as follows : 100.Philippines.The Government reports that in " Difficulties were again experienced due to the some countries travellers were required to possess Government of India's insistence on children under certificates of vaccination showing that seven instead the age of one year being inoculated against yellow of six days had elapsed after the first injection of the fever. vaccine.' " This problem has been overcome by requiring shipping companies to refuse passages on ships bound for India to anyone not in possession of a valid inter- Appendices 2, 3 and 4 national certificate." 101. Philippines. The Government reports again that The Committee notes that the Government of Uganda arrivals are not always in possession of the required itself requires a yellow fever vaccination certificate for vaccination certificates. In some cases, the certificates departing travellers proceeding to India. The Committee are not issued on the international form,2 or they are notes that since the legal relationships between Uganda signed by registered nurses and do not carry the and India are governed by the reservations made by approved stamp. India to the Additional Regulations of 1955, the Govern- ment of Uganda has an obligation under Article 72 102.Union of SovietSocialistRepublics. The Government states that a considerable number of to require " any person leaving an infected local area on an international voyage and proceeding to a yellow fever travellersdo notcarry therequiredvaccination certificates. receptive area " to possess a certificate of vaccination against yellow fever. 103.Ethiopia. The Government reports that the The Committee reaffirms the opinion giveninits Ethiopian Airlines have included in their Operations eighth report that it is the responsibility of each health Manual information obtained from the diplomatic administration to inform prospective travellers, travel missions in Addis Ababa for visa and vaccination agencies, shipping firms and airlines of its own require- requirements. As travellers cannot obtain their visas ments.' if they do not comply with the other requirements of the diplomatic services, the airlines have to follow " diplomatic information " on quarantine rather than Appendix 4 theInternationalSanitaryRegulationsandthe 106. Australia.The Government reports as follows Vaccination Certificate Requirements for International as regards age for smallpox vaccinations : Travel. " Itisagain stressed 6that the World Health As an example, information given by one embassy Organization should issue an authoritative statement in Addis Ababa for travel to a nearby country was on requirements so that a lead can be given to all directly contrary to the stated requirement of that authorities concerned with international travel because health administration.It took the Ministry of Health the present variations create confusion and embarrass- about six months to get the situation corrected.' ment for international travellers." The Committee was informed of research in progress Appendix 3 which, it is hoped, will reduce or eliminate the reported incidence of complications. 104.Ethiopia. The Government reports thata relatively high percentage of yellow -fever vaccination certificates issued in those parts of the world where d Off. Rec. Wld Huth Org. 110, 50, section 85. yellow fever does not exist and cannot develop are e The question of possible amendment to the form of the not fully completed and therefore not valid. certificate has been raised by several health administrations. The previous report of Australia on this subject read as follows :" It would appear that countries in Southern Europe 1 When the Committee met, this excessive measure had been maintain the attitude that vaccination against smallpox is not withdrawn. desirable under the age of twelve months and that recently 2 See previous recommendation of the Committee; second countries in Central Europe have adopted the attitude of pre- annotated edition, 1961, of the International Sanitary Regula- venting vaccination after the age of three years.For inter- tions, pp. 42 -43, footnotes (4), (9) and (10). national travellers these variations create great confusion and 3 The difficulty described above is not restricted to Ethiopia. embarrassment, and it is essential that the World Health Organ- The WHO Secretariat in Geneva is often questioned about ization publish in the immediate future an authoritative state- information given by a consulate, since this information is ment on requirements so that a lead can be given to all authorities different from that notified to the Organization by the health concerned with international travel."(Of. Rec. Wld Hlth Org. administration concerned.See also section 24. 118, 55, section 118). 56 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
107.Ireland.The Government reports that during Appendix 6 the outbreak of smallpox in Europe some problems 110. United States of America.The Government have arisen in regard to the dependability of some reports as follows : vaccination and revaccination certificates. " There were a number of cases of failure to report illness on aircraft, in the health part of the Aircraft 108.Seychelles. The Government reports that, during General Declaration, Appendix 6 of the International the epidemic of smallpox in Karachi, allarriving passengers from Pakistan were required to show Sanitary Regulations. An outstanding example was failure to report ten cases of chickenpox in infant evidence of a recent successful vaccination against Korean orphans who were accompanied by a physician smallpox rather than to possess a vaccination certifi- and four nurses.One case developed during flight. cate.This was deemed necessary in view of the fact There was also failure to report measles and an that the travellers who introduced the disease into individual with prostration accompanied by diarrhoea theUnitedKingdompossessedvalidsmallpox and dehydration. Thesespecific problems were vaccinationcertificates. Disembarkingtravellers brought to the attention of the airlines involved. who could not show evidence of a successful vaccin- There have been instances also where crew members ation were revaccinated before landing and kept under have refused to sign the declaration. surveillance.Transit passengers -whether or not in " To help provide that significant illness on an possessionofcertificates -werenotallowedto aircraft will be brought promptly to the attention of disembark. These emergency regulations were in the port health authority, the following amendment force for approximately two months. to the health part of the Aircraft General Declaration, Appendix 6, page 60, International Sanitary Regula- 109. United States of America. The Government tions, 1961, is recommended : reports as follows : " 1.Delete first paragraph and insert - " A uniform ' approved stamp 'was adopted for Persons on board with known or suspected illness use by state and local health departments on inter- other than airsickness or the effects of accidents, as national certificates of vaccination against smallpox well as those cases of illness disembarked during and cholera.It is anticipated that such stamps will the flight (include persons with any possible sign be in effect at the end of this year in all states and of illness, for example, chills, fever, rash, collapse).. possessions of the United States, the Trust Territory and the Commonwealth of Puerto Rico. Other " 2.Insert ` by the country of entry ' after ` Signa- ' approved stamps ' of the United States include the ture, if required,'." stamp of the Department of Defense, the stamp The Committee was informed that some airlines assigned to official yellow -fever vaccination centres, provide instructions totheir aircrews on significant the seal of the Public Health Service, and the special signs of illness to be reported and recommends that all ` S -C ' stamp approved by the Public Health Service." airlines pursue the same policy. ANNEX 1 57
Appendix 1
CASES OF QUARANTINABLE DISEASE (SMALLPDX) IMPORTED BY INTERNATIONAL TRAFFIC from 1 July 1961 to 30 June 1962
1. CASES IMPORTED BY SHIP
Number of cases Ship Date Port From and probable Remarks of arrival of arrival source of infection
1961 DUMRA 4 Dec. Umm Said (Qatar) Bombay 1 confirmed case - Gwadar (Pakistan)
LOCH ALVIE 17 Dec. Mombasa (Kenya) Karachi, 1 case - Onset of disease 12 Dec.; vaccina - Mombasa, Karachi tion certificate dated 7 May 1961. Dar -es- Salaam, Tanga 1962 DUMRA ? Jan. Kuwait Bombay, 1 confirmed Deck passenger aged 13 years; case Karachi, case reported on 23 Jan. on arrival of the Gwadar, Muscat, ship at Umm Said; disembarked at Dubai, Umm Kuwait. Said, Bahrain
INDIAN RESOLVE 21 Mar. Gdalísk (Poland) Calcutta 37 cases - 29 confirmed cases and 4 clinical (19 Feb.), Aden,Calcutta cases among crew; onset of disease Suez, Kiel 3 March. (In addition, one clinical case (Polish Quarantine Officer) and 3 confirmed cases (Polish guards) in Nowy Port, which was declared a smallpox infected localarea on 4 May and free from infection on 9 June.)
CIRCASSIA 5 May Suez (United Arab Bombay, 2 confirmed Passengers embarked at Bombay on Republic) Karachi cases 25April;vaccinationcertificate issued in New Delhi on 31 March 1962.
INDIAN 11 May Suez (United Arab Kaninada, 1 confirmed Modified smallpox in member of TRADITION Republic) Aden case - crew, aged 24; onset of disease Kaninada 7 May; vaccination certificate issued (India) in Calcutta on 8 July 1961.
In addition, the following outbreaks were presumably due to sea traffic : Trucial Oman (Dubai and Masafi), January -April 17 cases Muscat and Oman (Masna -Batina District), January- February 8 cases 58 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
2. CASES IMPORTED BY AIRCRAFT
Date of From arrival Airport or country of arrival Number of cases
1961 12 Oct. Brussels Leopoldville, via Rome 1 imported case. 2 Dec. Düsseldorf Monrovia, via Dakar, Marseilles, Paris 1 imported case and 4 secondary cases. 16 Dec. London Pakistan 1 imported case and 13 secondary cases. 19 Dec. London Pakistan 1 imported case and 1 secondary case. 23 Dec. Federal Republic of Germany India I imported case and 32 secondary cases. 25 Dec. London Pakistan 1 imported case and 2 secondary cases. 1962 4 Jan. London Pakistan 1 imported case. 12 Jan. London Pakistan 1 imported case and 46 secondary cases.
Appendix 2
DIVERGENT OPINION ON THE QUESTION OF AMENDMENT TO THE INTERNATIONAL CERTIFICATE OF VACCINATION OR REVACCINATION AGAINST SMALLPDX
by Dr L. H.MURRAY
Recent experience in Western Europe has shown that importa- and those of members of the Secretariat responsible for dealing tions of smallpox continue to occur.This will remain a problem with smallpox questions, and to the individual views of its until eradication of the disease has been achieved in the endemic members. areas. Furthermore, the Public Health Committee of the Council of Until this is achieved, and bearing in mind the changed nature, Europe, representing as it does the health administrations of the volume and speed of international traffic, in particular air traffic, eight countries of Western Europe party to the Agreement on safeguards to cut down the risk, additional to those already Health Control of Sea and Air Traffic, had transmitted through provided by the International Sanitary Regulations, are needed. the Committee of Ministers of the Council a formal request to There is a growing body of well- informed and responsible the Organization to re- examine the International Certificate of opinion which is seeking amendment to the International Cer- Vaccination with a view to adding information on the result of tificate of Vaccination which would make it better evidence of revaccination.Being aware of this request I felt it my duty successful revaccination by showing the result of revaccination, and by requiring a second insertion if no result of the first is to place it on record through the medium of this divergent opinion. seen.In addition it may be desirable to cover the risk of infec- tion from a person primarily vaccinated during the incubation The Committee's recommendations do not offer hope of any period by requiring a second insertion if no result of the first additional safeguards at an early date to those countries which is seen, and requiring that the first insertion of lymph be made are at risk.Because of this, it is my opinion that the Sixteenth at least fourteen days before the certificate becomes valid. World Health Assembly should consider amending Appendix 4 The Committee gave careful consideration to the comments and Article 85 of the International Sanitary Regulations, which made by delegations to the Fifteenth World Health Assembly, will provide some additional safeguards.The proposed amend- to the reports made by Member States in their current reports ments which follow aim to do so. ANNEX 1 59
attempt at primary vaccination or not less than four days after the attempt I.Replace existing Appendix 4 by the following: at revaccination. In such cases the validity of the certificate shall extend for a period of three years beginning in the case of attempts at primary vaccination fourteen days after the date of the first attempt and in the case of attempts at APPENDIX 4 revaccination on date of the second attempt. The approved stamp mention- ed above must be in a form prescribed by the health administration of the INTERNATIONAL CERTIFICATE OF VACCINATION OR territory in which the vaccination is performed. Any amendment of this certificate, or erasure, or failure to complete any REVACCINATION AGAINST SMALLPDX relevant part of it may render it invalid. This is to certify that date of birth sex whose signature follows has on the date indicated been vaccinated or revaccinated II.Article 85, paragraph 1, sub -paragraph (a): against smallpox. Add at the end of this sub -paragraph :" or who is in posses- sion of a valid certificate of vaccination which does not show a Signature and successful vaccination or successful revaccination within the professional Approved Date Show by " X" whether : status stamp previous three years ". of vaccinator
1.Primary vaccination or revaccination Explanatory Notes on these Amendments 1st or 2nd attempt 1. The certificate reverts to the practice in force before 1951 Primary Perfor- fVaccination of requiring the result of a revaccination to be recorded. med t Revaccination 2.The certificate requires a second attempt to be made should the first attempt at primary vaccination or at revaccination not Read as successful . . be successful. Unsuccessful 3. The certificate defines for the purposes of the International 2.Primary vaccination or revaccination Sanitary Regulationssuccessful vaccination and successful 1st or 2nd attempt * revaccination.
f Primary 4.The validity of the certificate extends for three years begin- Perfor- Vaccarination med i Revaccination ning fourteen days after successful primary vaccination and four days after successful revaccination. When a first attempt at primary vaccination or revaccination Read as successful . is not successful, a second attempt must be made.The second Unsuccessful attempt must be made not less than eight days after the attempt at primary vaccination or not less than four days after the 3.Revaccination 1st or 2nd attempt attempt at revaccination.In such cases the validity of certificate extends for three years beginning in the case of attempts at primary vaccination fourteen days after the first insertion and Performed in the case of revaccination on the date of the second attempt.
Read as successful . . 5. The rules of the certificate permit a certificate to be valid Unsuccessful. even if it does not show a successful result of revaccination. This will Iimit the amount of interference with international travel. * Delete primary vaccination or revaccination and 1st or 2nd as appro- priate. The amendment to Article 85 allows the measures of that article to be applied to a suspect who is in possession of a cer- The validity of this certificate shall extend for a period of three years beginning fourteen days after a successful primary vaccination or four days tificate which does not record a successful result during the after a successful revaccination. previous three years. Vaccination or revaccination shall for the purposes of this certificate be recorded as successful only when it results in vesicle formation. When the first attempt at primary vaccination or revaccination is un- successful a second attempt shall be made not less than eight days after the (signed) L. H. MURRAY 60 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
2.DISCUSSION BY THE EXECUTIVE BOARD ON THE ELEVENTH REPORT OF THE COMMITTEE ON INTERNATIONAL QUARANTINE
(Extracts from the Minutesofthe First Meeting of the Thirty-first Session, 15 January 1963)
[From EB31 /Min /1 Rev. 1 - 11 March 1963]
5.Eleventh Report of the Committee on International relation to the importation of such infection, and its Quarantine conclusions were recorded in the paragraphs following Agenda, 2.3 those sections.The Committee had not been con- Dr KAUL, Assistant Director -General, introducing vinced that any amendments to the Regulations in document EB31/26, which submitted the eleventh respect of smallpox should be made at that time, and report of the Committee on International Quarantine it had noted especially that the Director- General had (WHO/IQ/134),1said that the Committee had con- proposed an expert committee on smallpox in his sidered the annual report of the Director -General, programme for 1964.That expert committee might preparedinaccordancewiththeprovisionsof provide the opportunity for experts to review the Article 13 of the International Sanitary Regulations, development in scientific knowledge with regard to on the functioning of the Regulations and their effect smallpox. The Board would also note that, as men- on international traffic, and its recommendations on tioned on page 52 of the report, one member of the the annual report were contained in the document. Committee on International Quarantine had recorded In considering the administration of the International his divergent opinion (Appendix 2 to the report) on Sanitary Regulations, the Committee had reviewed the decision of the Committee not to make any amend- the adequacy of certain definitions used for the purpose ments at that stage. of the International Sanitary Regulations.In sec- The Committee had discussed (section 96) whether tions 14 and 15, the Committee recommended to the any additional sanitary documents inrespect of Assembly certain amendments whose purpose was to arriving international travellers were justified, and achieveclarificationandepidemiologicalrealism had concluded that the health administrations should regarding quarantinable diseases and toestablish not be permitted generally to require any additional formally the practice in use in the administration of details in writing.It did, however, recommend to the the Regulations. The definitions involved concerned World Health Assembly the amendment of Article 36 imported cases, and a new phrase -" transferred by the addition of a third paragraph permitting health case " -was introduced and defined. administrations with special problems constituting a The Committee proposed to the Assembly (section grave danger to public health to require a destination 21) that Article 3 be amended by adding a new para- address in writing of arriving international travellers. graph whose purpose was to provide more current The report of the Committee on International information on the movement of the quarantinable Quarantine was usually discussed and noted by the diseases. Executive Board and transmittedtotheHealth Information was given in sections 45 -61 concerning Assembly for its consideration. cholera El Tor.The Committee had discussed the Sir George GODBER, referring to Appendix 2 to the present situation in great detail but, because of the report of the Committee on International Quarantine, gaps in fundamental knowledge about the spread of expressed regret that the Committee had not found it that disease, it had felt that it had not yet reached the possible to make any recommendations to ensure time to recommend any amendments to the Regula- greater reliability of the international certificate of tions.The Committee was fully informed of the vaccination, which was described (on page 50) as Organization's programme of research in the field " the evidence an international traveller carries that of cholera. he has an immunity against smallpox ". For instance, In sections 70 -90, a very full record could be found of sixseparate importations of smallpox had been the development of cases of smallpox imported into introduced into the United Kingdom during 1962, in Europe during 1962.The Committee had discussed every case of which the patients had carried a valid that situation in considerable detail, and had also international certificate of revaccination. The certificate reviewed the International Sanitary Regulations in of revaccination as it stood was therefore certainly
1See part 1 of this annex. not reliable evidence. The primary concern was not, ANNEX 1 61
of course, with producing certificates, but with getting would be brought to bear in countries where the people effectively vaccinated. From the point of problem received insufficient attention. view of countries to which many people might travel He suggested that maps giving data on the distribu- from areas where infection occurred, the absence of tion of smallpox might be regularly published by the reliable evidence was a much more serious difficulty Organization asa further means of maintaining now than it had been ten years ago. Large numbers awareness of the problem. might arrive by air within the incubation period, as had happened in the United Kingdom during the Dr WATT said that the report emphasized a point earlier part of 1962, and in spite of the efforts made in discussed by the Fifteenth World Health Assembly - the countries of origin to secure that travellers were the importance of the Committee's meeting regularly, vaccinated it was quite inevitable that some of them so that it could consider the effects of changes in the should be unsuccessful. At a later stage, when efforts world travel situation.The key issue in the whole had been intensified, 98 per cent. of the travellers problem was the effectiveness of the vaccinator and of had been effectively vaccinated or revaccinated, and the vaccine used. The certificate would not change the of the remaining 2 per cent., half were susceptible to minds and attitudes of those who did not treat vaccination and the remaining half resistant. He vaccination with the importance it deserved.There could only express regret that the Committee had not were two effective lines of approach to the problem. given more weight to that point.It might be that the The first was to ensure effective vaccines and proper suggestion embodied intheminorityreportof production and storage facilities, etc., and the second Dr Murray (which appeared in Appendix 2 to the was to make it fully clear to those using the vaccine report of the Committee on International Quarantine) that there must be effective use of the material. To to try and secure a reliable certificate would impose enlarge the certificate would merely penalize the delays that would be very difficult for travellers to sus- conscientious and do nothing to change the omissions tain, but he considered it at least desirable to try to make of those who were not so meticulous and careful. the certificate more reliable evidence than at present. The issue of the certificate itself could easily divert attention from the important point to be kept in mind, Mr SAITO,alternateto Dr Omura, saidthat Dr Omura had asked him to emphasize the importance and he would strongly urge that in considering the he attached to the work of the Committee on Inter- problem the Committee should concern itself with national Quarantine and to express appreciation of the the basic issue rather than with the certificates. work of the Secretariat. He hoped that the Committee Professor AUJALEU said he fully shared Sir George and the Secretariat would continue with that most Godber's regret that the modifications in the vaccina- important aspect of the Organization's work by tion certificate proposed by Dr Murray had not utilizing all the available knowledge and experience been accepted by the Committee.The vaccine was of countries. important but -and here he was sorry that he could Professor ZDANOV expressed regret that the construct- not agree with Dr Watt -the certificate was also of ive proposals contained in Appendix 2 to the report great importance. for the amendment of Appendix 4 to the Regulations The CHAIRMAN drew attention to the fact that the had not been reflected in the Committee's own pro- supplementary agenda contained an item on smallpox posals. They were of value since they would remind eradication, under which the subject could be dealt physicians and authorities concerned with quarantine with more fully. The report under consideration had that it was not sufficient to make vaccines but that been prepared, in fact, for submission to the Health their efficacy must also be ensured. He asked that the Assembly and remarks made by Board members on it Committee on International Quarantine be notified were transmitted to the Health Assembly to be taken of the Board's discussions, since he was concerned into account.In bringing those facts to the Board's that smallpox was so widespread throughout the attention, he was not trying to restrict the present world, possibly because vaccination was not properly discussion. carried out. Professor ZDANOV said that, following the Chair- He would repeat his recommendation made at the man's explanation, he would reservehisfurther Fifteenth World Health Assembly that smallpox comments until discussion of the item on smallpox should receive more publicity.There were many eradication. possibilities of influencing the quality of vaccination and of quarantine measures and thus of contributing Dr VANNUGLI, although recognizing that smallpox to the reduction of smallpox, and the more that was control was not effected simply by the issue of vaccina- published on the subject the more public opinion tion certificates, nevertheless shared the opinion that 62 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I there would be great advantage in thoroughly studying On the other hand, it should not be assumed that the possibility of improving their content. He saw no national officials responsible for verifying vaccination major difficulty in adding a note stating the result of certificates and interviewing travellers were completely vaccination, which would be of particular advantage devoid of knowledge. The request put forward to the to countries like his own where the disease had long Committee by Dr Murray had been that the vac- since disappeared. cination certificate should show what happened after Dr KAUL, Assistant Director- General, answering vaccination so that national officials might draw their points raised in the discussion, said that the problem of own conclusions. To diverge for a moment, he would smallpox had been a major subject for discussion by again point out that there was no difference between a the Committee on International Quarantine at its so- called " immune " reaction and complete absence eleventh session.It had devoted a considerable part of vaccination; therein lay the trouble and the reason of its time to that problem and had thus given due for the view that the vaccination certificate should, weight to its importance. without any reference whatsoever to scientific data, show exactly what happened after vaccination. Secondly, in the course of discussing protection of Professor GAY PRIETO remarked that a very high riskof imported smallpox populations from the percentage of negative results was obtained in revac- infection, attention had been given to certain scientific cination and there was good reason to believe that data that were pertinent, in addition to the vaccination routine methods of revaccination by scarification were Such questions as the exact constitution certificate. responsible for that result. The percentage of positive of a successful vaccination, primary or secondary; results was infinitely higher where revaccination was period before immunity was established after primary done by intradermal injection. The general objection vaccination and revaccination, and duration of such put forward to adoption of that procedure was simply ofinterferencewith immunity;andavoidance that scarification was a much easier process.It would international traffic through use of the vaccination be worth while for the Organization to organize certificate until there was adequate scientific justifica- studies to determine the percentage of positive results tion therefor, had been thoroughly reviewed.The obtained by each method; he was sure their results Committee had felt that it had had no new knowledge would be highly significant. before it on those questions, and that was one of the reasons that had led the Director -General to propose Dr SERPA- FLÓREZ said that the speed of present - the convening of an expert committee on problems of day travel,especially by air, added daily to the smallpox in 1964 -the earliest date he could suggest importance of the Organization's world campaign for for such a meeting. The experts who would review the the eradication of smallpox.But the problem could situation then would be able to make recommendations not be separated into two component parts, relating on those scientific matters and in the meantime the respectively to the countries where the disease was Organization might perhaps take action to stimulate endemic and those that had succeeded after tremendous inquiry into them. efforts in stamping itout.Accordingly, it would be worth while for the Board to request those countries The Committee on International Quarantine had that had had no case of smallpox over many years to in addition to considering the suggestions put forward ensure that every effort was made to maintain a high for improving the vaccination certificate reviewed the immunity level in their populations. relevant International Sanitary Regulations tosee Dr FARAH, Rapporteur, read out the following draft to what extent immediate action could be taken with resolution for the Board's consideration : a view to strengthening them.Its conclusions and recommendations,assetoutintheparagraphs The Executive Board following sections 70 - 90 of the report, had been 1. NOTES the eleventh report of the Committee reached only after that review, and they showed that on International Quarantine; the Committee had been deeply concerned with the 2. THANKS the members of the Committee for problem and would take it up again at a future session their work; and when further information might be expected to be 3. TRANSMITS the report, together with the minutes available. of the discussion which took place at the Executive Professor AUJALEU said he was well aware that, as Board, to the Sixteenth World Health Assembly for Dr Kaul had said, all the scientific problems connected its consideration. with the outward appearance of immunity through Decision: The draft resolution was adopted (reso- smallpox vaccination had not as yet been resolved. lution EB31.R2). Annex 2
FINANCIAL REPORT ON THE ACCOUNTS OF WHO FOR 1962 AND REPORT OF THE EXTERNAL AUDITOR 1 [A16 /AFL /15 - 8 May 1963]
REPORT OF THE AD Hoc COMMITTEE OF THE EXECUTIVE BOARD
1. At its thirty -first session, the Executive Board (in regional offices and formed the opinion that the finan- resolution EB31.R52) established an Ad Hoc Com- cial and administrative aspects of the work in these mittee, consisting of Dr M. K. Afridi, Professor offices were being performed satisfactorily. As a E. Auialeu and Dr A. Nabulsi, to meet on 6 May result of my audit of the accounts of the Organization 1963 to consider the report of the External Auditor as a whole, I can state that they are well kept and on the accounts of the Organization for the year 1962, comply with established policies, rules and regulations and to submit to the Sixteenth World Health As- of the Organization and the Health Assembly.In sembly, on behalf of the Board, such comments as it keeping with past practice I have during 1962 drawn deemed necessary. attentionto minor errors, discovered during the 2. The Committee met on 6 May 1963 in the Palais course of the audit, which have immediately been des Nations and Dr Afridi was elected Chairman. adjusted and thereforecall for no further audit observation. Such minor errors, involving for instance 3. Mr Uno Brunskog, the External Auditor, in- small calculating mistakes, are unavoidable in any troduced his report and commented on the more international organization with fairly large operations. important matters raised therein and in the Financial It is the frequency of errors that would be of signifi- Report of the Director- General.2 cance, but I am pleased to report that in the World 4. The Committee then reviewed the report of the Health Organization the number of such errors has External Auditor in detail and received, either from been negligible.In fact, it has given me great satis- the External Auditor or from representatives of the faction to see that one of the regional offices, with Director -General,explanationson variouspoints sudden considerable expansion of activities in 1962, raised by the members of the Committee. while not fully staffed was nevertheless able with 5. On the basis of its review, the Committee desires substantial overtime to carry out its financial and to bring the following items to the attention of the administrative work very efficiently indeed." Assembly : 5.3The Committee desires to bring to the attention 5.1 In paragraph 1.1of his report, the External of the Assembly the following comment by the External Auditor comments on the scope and character of his Auditor in paragraph 1.4 of his report :" Again this audit and states :" The scope and character of the year the result of my audit leads me to confirm that audit in 1962 has been essentially the same as in earlier the different funds of the Organization have been well years.Transactions, accounts and inventories were managed." examined to the extent necessary to satisfy myself as 5.4In paragraph 2.2 of his report, the External to their correctness. The financial statements submitted Auditor noted that the total obligations incurred in to me for audit have been certified accordingly. I have 1962 amounted to $24 164 650, representing 97.19 per also examined the reports of the internal auditors and cent. of the effective working budget for that year. reviewed their work, which has given me complete The comparable figure for 1961 was 97.07 per cent. satisfaction. In connexion with the 1962 audit, I wish to state specifically that to my knowledge there have 5.5In paragraph 2.3 of his report, the External been no cases of fraud or presumptive fraud." Auditor remarks on the cost of the administrative services of the Organization as follows : "From the above 5.2In paragraphs 1.2 and 1.3 of his report, the External Auditor states :" During 1962 I visited two table it will be seen that, while the percentage of the obligations for the operating programme increased 1 See resolution WHA16.5. by 2.4 percent.,thatrelatingtoadministrative 2 Off. Rec. Wld Huth Org. 126. services decreased by 1 per cent. in 1962. Taking into - 63 - 64 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I account the total obligations incurred by the Organi- " In my audit report concerning the accounts for zation in 1962 from all its resources, amounting to 1957, I stated inter alla : `... the control exercised some $35.7 million (as shown in Appendix 1 to the over all transactions has attained such a standard that FinancialReport),obligationsforadministrative I feel obliged to felicitate the World Health Organi- services represented 6.02 per cent. only.This does zation on the occasion of its Tenth Anniversary on not include the activities carried out by the Organi- its very good and sound financial administration '. zation in the Congo (Leopoldville) against reimburse- Now, fifteen years after the inception of WHO, during ment by the United Nations. Disbursements totalled which time the activities of the Organization have $2.58 million in 1962.If these disbursements are increased by about nine times, I am pleased to state added to the above total obligations, the percentage that what I said in 1958 is still valid. Good adminis- for administrative services would be 5.6." tration in an organization of WHO's structure is 5.6In section 5 of his report, the External Auditor particularly important to enable the technical activ- comments on the position of the Working Capital ities to be carried out efficiently." Fund. He advised the Committee that he intended to 6.The Committee wishes to commend the External make a further study of the position of this Fund Auditor on his report and to express its appreciation during 1963.The Committee also noted that, in of the explanations given by him and by the represen- resolution WHA13.41, the Assembly had requested tatives of the Director -General during the review of the Executive Board to review the situation of the the report. Working Capital Fund at its first session in 1965. 7.The Committee recommends to the Sixteenth 5.7In paragraph 6.3 of his report, the External World Health Assembly the adoption of the following Auditor noted that there were proceeds of $181 303 from the postage stamp project of WHO's malaria resolution : eradication programme and stated : " I have reviewed The Sixteenth World Health Assembly, the Agreement between WHO and the Inter- Govern- Having examined the Financial Report of the mental Philatelic Corporation, the guarantee from the Director -General for the period 1 January to bank in New York acting as custodian of the stamps, 31 December 1962 and the Report of the External and related material, and also the quarterly accounts Auditor for the same financial period, as contained covering payments and inventory of stamps etc.I in Official Records No. 126; and have found all these arrangements satisfactory in Having considered the report of the Ad Hoc safeguarding the interests of the Organization and Committee of the Executive Board on its examin- have no observation to make on the accounts." ation of these reports, 5.8In summing up his report on the regular funds ACCEPTS the Director -General's Financial Report of the Organization, the External Auditor drew special and the Report of the External Auditor for the attention to paragraph 9 of his report, which states : financial year 1962. Annex 3
SUPPLEMENTARY BUDGET ESTIMATES FOR 1963
1. REPORT OF THE AD Hoc COMMITTEE OF THE EXECUTIVE BOARD
[A16 /AFL /8 Add. 1 Rev. 1 -9 May 1963
1. At its thirty -first session the Executive Board, in and that one Member had resumed active participation resolutionEB31.R52,established" an Ad Hoc in the work of the Organization. Committee of the Executive Board consisting of : 6. As a result of its study of the proposals made by Dr M. K.Afridi,ProfessorE.Aujaleu,and the Director -General for provision to assist in meeting Dr A. Nabulsi, to meet on Monday, 6 May 1963, some of the additional costs of the headquarters to ... report to the Sixteenth World Health Assembly building, the Committee concluded that the steps on the minor adjustments reported by the Director - proposed by the Director- General were prudent and General in the cost estimates for the supplementary desirable.In reply to a question as to why, at the budget for 1963 ". time of the preparation of the proposed programme 2. The Committee met on 6 May 1963 in the Palais and budget estimates for 1963, it had not been foreseen des Nations, Geneva, and Dr Afridi was elected that a deferment might be possible with regard to the Chairman. repayment of loans for the headquarters building, 3. In considering the adjustments reported by the it was explained that the loan agreement with the Swiss Director -General, the Committee noted that they Confederation stipulates that the first instalment of were of two kinds -first, those which are mandatory repayment of the loans should take place on 31 Decem- under the Staff Regulations and Staff Rules of the ber 1963. At that time also it could not be foreseen Organization (set forth in paragraphs 2, 3 and 4 of that delay in the construction work to the extent the Director -General's report) (part 2 of this annex) which has now taken place would necessarily occur. and, secondly, those of a discretionary nature (set For these reasons the Director - General was bound forth in paragraphs 5 and 6 of that report). to include provision in the proposed programme and budget estimates for 1963 for repayment of the loans 4. With regard to the former, the Ad Hoc Committee, from the Swiss Confederation and the Republic and following its review of these items, considered the Canton of Geneva.As explained in his report, no estimates to be satisfactory and recommends their portion of the loans has yet been used and therefore approval by the Sixteenth World Health Assembly. no difficulties should be experienced in arranging a 5. In the course of its review of the provisions of a deferment of the repayment. discretionary nature proposed, the Committee was 7.The Committee decided to recommend to the informed that the provision of $40 000 for services to Sixteenth World Health Assembly that it also approve new Members and Associate Members and to Mem- the inclusion in the supplementary estimates for 1963 bers resuming active participation was intended to of the provisions proposed by the Director -General meet such minimum requests for services as may be for the purposes referred to in paragraphs 5 and 6 forthcoming from such Members. In this connexion above. the Committee recalled that since the Fifteenth World Health Assembly the following new Members (some 8. The Committee noted that sufficient income was of which were previously Associate Members) had available to meet the financing of the total supple- joined the Organization :Algeria, Burundi, Jamaica, mentary estimates of $438 100 for 1963 by using Rwanda, Trinidad and Tobago, and Uganda.The (a) $35 990 representing an increase in the amount Committee was also informed that applications for of the lump -sum allocation to WHO from the Special Associate Membership were before theSixteenth Account of the Expanded Programme of Technical World Health Assembly for Kenya and Mauritius Assistance towards the administrative and operational services costs of that programme, and (b) $402 110 I See resolution WHA16.6. available from casual income over and above the - 65 - 66 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Appropriation Purposeof Amount amount recommended by the Director -General to Section Appropriation US $ be used to help finance the proposed programme and budget estimates for 1964. PART III :ADMINISTRATIVE SERVICES 8. Administrative Services 27 350 9. Should the Sixteenth World Health Assembly 9. Other Statutory Staff Costs 36 620 accept the above recommendations of the Ad Hoc Committee on behalf of the Board, it may wish to Total - Part III 63 970 adopt the following resolution in place of that set forth in paragraph 2 of resolution EB31.R13: PART IV : OTHER PURPOSES The Sixteenth World Health Assembly, 10. Headquarters Building Fund 113 000 Having considered the proposals of the Director -General and the recommendations of the Executive Board concerning sup- Total - Part IV 113 000 plementary budget estimates for 1963, TOTAL - Parts II, III and IV 438 100 1. APPROVESthe supplementary estimates for 1963; 2. DECIDESto amend the Appropriation Resolution for 1963 (resolution WHA15.42) by increasing the amounts voted under 3. DECIDES further to amend paragraph IIIof resolution paragraph I as follows : WHA15.42 by increasing the amounts under sub -paragraphs (i) and (iii) as follows : Appropriation Purpose of Amount (i)the amount of $35 990 available by reimbursement from Section Appropriation US$ theSpecialAccountofthe PART II : OPERATING PROGRAMME Expanded Programme of Tech- 4. Programme Activities 95 250 nical Assistance 5. Regional Offices 23 700 (ii)the amount of $402 110 representingmiscellaneousin- 7. Other Statutory Staff Costs 142 180 come available for the purpose
Total - Part II 261 130 Total $438 100
2. REPORT BY THE DIRECTOR - GENERAL [A16 /AFL /8 - 3 May 1963]
1.Introduction Assembly through the Ad Hoc Committee of the Executive Board, meeting on 6 May 1963. 1.1 In accordance with the provisions of Financial Regulation 3.10, the Director -General submitted to 1.3 The adjustments to the estimates which the the Executive Board at its thirty -first session sup- Director -General finds it necessary to report result plementary estimates for 1963 1in the amount of from : $162 000 including : (a)increasesinpost- adjustmentclassifications (a)$120 000 required to meet the costs of a change which have become effective in 1963; in the post- adjustment classification for Geneva from class 1 to class 2; and (b)increases in the salary scales for general service staff in certain locations; (b)$42 000 to meet additional costs anticipated because of changes in post- adjustment classifications (c)increased payment to pensioners of the Office for some of the regional offices, where cost -of- living International d'Hygiène Publique; surveys are in progress or about to be undertaken. (d)provision for services to new Members and 1.2Having considered these supplementary estimates Members resuming active participation; and and the recommendation of the Director -General (e)provision toward increased costs of the head- concerning their financing, the Executive Board, in quarters building. resolution EB31.R13, recommended to the Sixteenth Details of these adjustments are set forth below. World Health Assembly that it approve the supple- mentary estimates for 1963 and their financing as 2.Increases in Post -adjustment Classifications proposed by the Director -General, subject to minor adjustments in cost estimates, to be reported by the As reported to the Executive Board 1 $120 000 is Director -GeneraltotheSixteenth World Health required in consequence of the change from class1 to class 2 in the post- adjustment classification for I Off Rec. Wld Hlth Org. 124, Annex 11. Geneva, which became effective as from 1 November ANNEX 3 67
1962. The Director - General now reports that a 5.Provision for Services to New Members and to further amount of $41 200 is required to meet the Members resuming Active Participation additional expenditure resulting from increases in The Director- General proposes that an amount the post- adjustment classificationsfor New Delhi of $40 000 be included in the supplementary estimates and Copenhagen, as follows : for 1963 for the purpose of meeting requests from new Estimated Members and Associate Members, as well as from additional Costs Members resuming active participation in the work US $ of the Organization. New Delhi (Regional Office for South -East Asia) Changed from class 2 to class 3 as from 1 April 1963 10100 Copenhagen (Regional Office for Europe) 6.Provision towards Increased Costs of the Head- Changed from class 0 to class 1 as from 1 January quarters Building and from class 1 to class 2 as from 1 March 1963 31100 The Director -Generalissubmittingaprogress 41200 report on headquarters accommodation under pro- visional agenda item 3.11 to the Sixteenth World Health Assembly,' which refersinteralia to the 3.Increases in the Salary Scales for General Service increased costs.The Executive Board at its thirty - Staff in Certain Locations first session adopted resolution EB31.R25, paragraph 5 of which requested " the Director - General to examine Increases in the salary scales for general service with the authorities of the Swiss Confederation an staff in the employ of international organizations increase in the amount of the interest -free loan offered in certain centres will result in increased costs to WHO to the Organization, with a view to the financing of under the regular budget in 1963, as follows : the additional cost foreseen ", and paragraph 6 of which requested the Director -General to report on US$ this matter " through the Ad Hoc Committee of the Geneva (headquarters) Executive Board ". At the time of the preparation of From 1 March 1963 and from 1 September 1963 85400 this report information was not available to enable Copenhagen (Regional Office for Europe) From 1 January 1963 25400 the Director -General fully to report on this matter. New Delhi (Regional Office for South -East Asia) However, it is clear that the increase in cost of the From 1 January 1963 10700 headquarters building will require a number of steps to be taken. There are two steps which the Director - 121500 General believes can be taken now.First, in view of the fact that no portion of the loan has yet been used because of delay in the construction work, the Director- 4.Increased Payments to Pensioners of the Office International d'Hygiène Publique (OIHP) General has reason to believe that arrangements can be made with the Swiss Confederation to defer until In resolution EB27.R24 the Executive Board at its 1965 or 1966 the first instalment on the repayment of twenty- seventhsession,believingthatthe World the loan.The terms of the loan agreement with the Health Organization " as the successor organization Republic and Canton of Geneva are such that in the to the OIHP, has a moral responsibility to ameliorate light of construction progress it is not now anticipated the situation of the OIHP pensioners in a manner that repayment will have to be started until 1965 at consistent with that approved by the General Assem- the earliest. The Director -General, therefore, proposes bly of the United Nations for pensioners of the United that the amount of $387 000 appropriated by the NationsJointStaffPensionFund ",authorized Fifteenth World Health Assembly under Appropria- " the Director - General to make future adjustments tion Section 10, " Headquarters Building : Repayment in the payments to those pensioners should further of Loans ", of the Appropriation Resolution for the adjustments be made inthe JointStaff Pension Financial Year 1963 (WHA15.42) be used for a credit Fund by the General Assembly of the United Nations ". tothe Headquarters Building Fund, thetitleof In exercise of this authority, the Director -General, Appropriation Section10 being changed toread in consideration of increases inthe payments to " Headquarters Building Fund ". Secondly,the pensioners of the United Nations Joint Staff Pension Director -Generalproposesthattheamountof Fund approved by the General Assembly of the United $387 000 be increased to $500 000 by including an Nations with effect from 1 January 1963, has accorded additional amount of $113 000 in the supplementary similar increased payments to OIHP pensioners at an estimated total cost in 1963 of $2400. ' See Annex 7, part 2. 68 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I estimates for 1963 to be financed from available 8.Proposed Method of Financing the Supplementary casual income.In this way, an additional $500 000 Estimates for 1963 credit will be provided to the Building Fund, which 8.1 As stated in paragraph 1 above, the Executive will assist in meeting some of the additional costs Board recommended to the Sixteenth World Health involved. Assembly that it approve the method of financing the supplementary estimates for 1963 as proposed 7.Total Supplementary Estimates for 1963 by the Director -General, namely by using : 7.1 Taking account of the increased requirements (a)the increase of $35 990 in the amount of the explained in paragraph 2 to 6 above, the supplementary lump -sum allocation to WHO from the Special estimates for 1963 proposed by the Director - General Account of the Expanded Programme of Technical amount to $438 100, as follows : Assistance towards the administrative and ope- rational services costs of that programme; and uS $ (b) Paragraph 2 161200 casual income available over and above the Paragraph 3 121500 amount of $500 000 which the Director- Gëneral Paragraph 4 2400 recommends be used to help finance the1964 Paragraph 5 40000 budget. Paragraph 6 113000 8.2Since sufficient casual income is available for the 438100 purpose, the Director -General recommends that the supplementary estimates for 1963, as adjusted above 7.2These supplementary estimates are set forth in and totalling $438 100, be financed by using the Appendix 1, by appropriation section and by purpose - increase of $35 990 in the amount of the lump -sum of- expenditure code.Appendix 2 shows, by appro- allocation to WHO from the Special Account of the priation section, the amounts appropriated for 1963, Expanded Programme of Technical Assistance referred the supplementary estimates and the revised totals to in paragraph 8.1 (a) above, and by using available for 1963. casual income in the amount of $402 110.
Appendix 1
DETAILS OF SUPPLEMENTARY BUDGET ESTIMATES FOR 1963 by Appropriation Section and by Purpose of Expenditure Code
Services to new Members Increases Increases in Increased and to Headquarters in post salary scales payments to Members Building Total adjustments for general OIHP resuming Fund US $ US $ service staff pensioners active US $ APPROPRIATION SECTION 4: PROGRAMME US $ US $ participation ACTIVITIES US $ Chapter 00Personal Services 01 Salaries and wages 53600 53600
Total - Chapter 00 53600 53600
Chapter 40Other Services 43Other contractual services 1650 1650
Total - Chapter 40 1650 1650
Contingency provision 40000 40000
TOTAL - APPROPRIATION SECTION 4 53600 1650 40000 95250
APPROPRIATION SECTION 5: REGIONAL OFFICES Chapter 00Personal Services 01 Salaries and wages 23700 23700
Total - Chapter 00 23700 23700
TOTAL - APPROPRIATION SECTION 5 23700 23700 ANNEX 3 69
Services to Increases in Increased new Members Increases and to Headquarters in post salary scales payments to Members Building Total adjustments for general OIHP resuming service staff pensioners Fund US $ US $ active US $ APPROPRIATION SECTION 7: OTHER STATUTORY US $ US $ participation STAFF COSTS US $ Chapter 10Personal Allowances 12Pension fund 7 560 7 560 13 Insurance 1 590 1 590 15Other allowances 129 200 3 830 133 030
Total - Chapter 10 129 200 12 980 142 180
TOTAL - APPROPRIATION SECTION 7 129 200 12 980 142 180
APPROPRIATION SECTION 8: ADMINISTRATIVE SERVICES Chapter 00Personal Services 01 Salaries and wages 26 600 26 600
Total - Chapter 00 26 600 26 600
Chapter 40Other Services 43Other contractual services 750 750
Total - Chapter 40 750 750
TOTAL - APPROPRIATION SECTION 8 26 600 750 27 350
APPROPRIATION SECTION 9: OTHER STATUTORY STAFF COSTS Chapter 10Personal Allowances 12Pension fund 3 080 3 080 13Insurance - 560 560 15Other allowances 32 000 980 32 980
Total - Chapter 10 32 000 4 620 36 620
TOTAL - APPROPRIATION SECTION9 32 000 4 620 36 620
APPROPRIATION SECTION 10: HEADQUARTERS BUILDING FUND Chapter 80Acquisition of Capital Assets 83Land and buildings 113000 113 000
Total - Chapter 80 - 113000 113 000
TOTAL - APPROPRIATION SECTION 10 113000 113 000
GRAND TOTAL 161 200 121 500 2 400 40 000 113000 438 100 70 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Appendix 2
AMOUNTS APPROPRIATED FOR 1963, SUPPLEMENTARY ESTIMATES, AND REVISED TOTALS FOR 1963 UNDER THE REGULAR BUDGET
Appropriation Amounts Supplementary Revised Section Purpose of appropriation appropriated estimates for totals for19631 1963 for 1963 US$ US$ US$
PART I : ORGANIZATIONAL MEETINGS
1. World Health Assembly 326110 326110 2. Executive Board and its Committees 189090 189090 3. Regional Committees 84420 84420
Total-Part I 599620 599620
PART II : OPERATING PROGRAMME
4. Programme Activities 14823216 95250 14918466 5. Regional Offices 2517489 23700 2541189 6. Expert Committees 220400 - 220400 7. Other Statutory Staff Costs 4573268 142180 4715448
Total-Part II 22134373 261130 22395503
PART III: ADMINISTRATIVE SERVICES
8. Administrative Services 1716432 27350 1743782 9. Other Statutory Staff Costs 536575 36620 573195
Total-Part III 2253007 63970 2316977
PART IV: OTHER PURPOSES
10. Headquarters Building Fund 387000 113000 500000 11. Contribution to the Malaria Eradication Special Account 4000000 - 4000000
12. African Regional Office : Building Fund 100000 100000
13. African Regional Office : Staff Housing 482000 482000
Total-Part IV 4969000 113000 5082000
Sub -total-Parts I, II, III and IV 29956000 438100 30394100
PART V: RESERVE
14. Undistributed Reserve 2149570 2149570
Total-Part V 2149570 2149570
TOTAL-Au. PARTS 32105570 438100 32543670
1Appropriation Resolution WHA15.42, taking into account transfers between sections concurred in by the Executive Board in resolution EB31.R10. ANNEX 4 71
Annex 4
ACCOMMODATION FOR THE REGIONAL OFFICE FOR AFRICA 1
1. REPORT OF THE AD Hoc COMMITTEE OF THE EXECUTIVE BOARD
[A16 /AFL /7 Add. 1 - 8 May 1963]
1. At its thirty -first session the Executive Board (in $301 846, as reflected in the appendix to the Director - resolutionEB31.R52)established" an Ad Hoc General's report (part 2 of this annex). Committee of the Executive Board, consisting of : 5. The Committee noted that, subject to additional Dr M.K.Afridi,ProfessorE.Aujaleu,and Dr A. Nabulsi, to meet on Monday, 6 May 1963, to .. . contributions becoming available from Members, (c) report to the Sixteenth World Health Assembly the Director -General would have to have recourse to the full authorization of advancing $300 000 from such further information asissubmitted by the Director -General on accommodation for the Regional the Working Capital Fund.However, since cons- Office for Africa...including the budgetary and truction work can hardly begin before early 1964, the financial aspects ". Committee agrees with the proposal of the Director - General that the Sixteenth World Health Assembly 2.The Committee met on 6 May 1963 in the Palais authorizehimtowithdraw$100 000 from the des Nations, Geneva, and Dr Afridi was elected Working Capital Fund, such advance to be reimbursed Chairman. to the Working Capital Fund by provision in the 3.The Committee had before it a report of the proposed programme and budget estimates for 1965. Director -General on the accommodation forthe The Committee therefore recognized that no action Regional Office for Africa (as contained in part 2 was necessary with regard to the provision in the of this annex). From this report the Committee noted proposed programme and budget estimates for 1964. that the Director -General had included an amount 6.The Committee was informed that, with regard of $200 000 in the proposed programme and budget to paragraph 4 of resolution EB31.R20, the Director - estimates for 1964 for reimbursement of the Working Capital Fund, in pursuance of the authority vested General had communicated with the Government of in him by the Fifteenth World Health Assembly in the Republic of South Africa and that he would report resolution WHA15.14, " to advance from the Working any further developments to the Sixteenth World Capital Fund an amount not exceeding $300 000 to Health Assembly (see part 3 of this annex). be credited to the African Regional Office Building 7. Should the Sixteenth World Health Assembly Fund, to help finance the said construction, reimburse- accept the proposal of the Director -General,the ment to the Working Capital Fund of the sum so Ad Hoc Committee, on behalf of the Executive advanced to be provided for,if necessary, in the Board, recommends for the approval of the Health programme and budget estimates for 1964 ".At the Assembly the following draft resolution : time those estimates were prepared, taking into account The Sixteenth World Health Assembly, the $100 000 appropriated by the Fifteenth World Having considered the report of the Director - Health Assembly for 1963, the amount of contribu- General on accommodation for the Regional Office tions and pledges from Members and the estimated for Africa and the report of the Executive Board cost of the construction of the extension, the Director - thereon; General had anticipated that $200 000 only would be Having notedwithgratificationthefurther required. generous contributions offered by Members in the 4.The revised preliminary estimates in the light of African Region to help finance the cost of extending current construction costs in Brazzaville indicate that the accommodation of the Regional Office; thetotalestimatedcostwillbeapproximately Recallingtheprovisionsof paragraph 4of $700 000.Contributions and pledges from Member resolution WHA15.14, authorizing the Director - governmentsasat 25 April1963 amounted to General, notwithstanding the provisions of Part II, paragraph 1 (2)of resolution WHA13.41,to 1 See resolution WHAI6.9. advance from the WorkingCapital Fund an 72 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
amount not exceeding $300 000 to be credited to 2. AUTHORIZEStheDirector -General,notwith- the African Regional Office Building Fund; standing the provisions of Part II, paragraph 1 (2) Noting that the Director -General will exercise of resolution WHA13.41, to advance from the this authority to the extent of $200 000, reimburse- Working Capital Fund an amount not exceeding ment being provided for in the proposed programme $100 000 to be credited to the African Regional and budget estimates for 1964, Office Building Fund to help finance the saidcons- 1. INVITES all the Members in the African Region truction, reimbursement to the Working Capital Fund that have not yet done so to make contributions of the sum so advanced to be provided for,if for the extension of the Regional Office accom- necessary, in the programme and budget estimates modation ; for 1965.
2.REPORT BY THE DIRECTOR- GENERAL [AI 6/AFL/7 - 29 April 1963]
1. In his report on this subject to the Fifteenth interest of the most effective utilization of the addi- World Health Assembly 1 the Director -General stated tional space, the total estimated cost of the work is that the transfer of property rights in the Djoué Estate now approximately $700 000. from the French Government to the World Health 5.The revised preliminary plans are virtuallycom- Organization had taken place. He drew attention to pleted and it is anticipated that detailed drawings will the need for an extension of the regional office building, be finished during 1963; on the basis of these it will indicating that such extension was tentatively estimated be possible to obtain bids.At that time the final to cost about $600 000.Toward the cost of this cost can be more accurately determined. extension certain governments of Africa had at that date pledged slightly more than $182 000 and provision 6. As of 25 April contributions from Member govern- in the amount of $100 000 had been included in the ments had been received or pledged in a total amount proposed programme and budget estimates for 1963. of $301 846, as set forth in the appendix to this report. These contributions,togetherwith 2.The Health Assembly, in resolution WHA15.14, the$100 000 authorized the Director -General " to proceed with provided for in the 1963 budget, represent total credits the construction of an extension to the existing of $401 846 towards the presently anticipated cost of building for the Regional Office for Africa " and " to $700 000.The balance required remains within the advance from the Working Capital Fund an amount sum of $300 000 which the Assembly authorized the not exceeding $300 000 to be credited to the African Director -General to advance as necessary from the Regional Office Building Fund, to help finance the Working Capital Fund. said construction, reimbursement to the Working 7.It appears clear now that recourse to this autho- Capital Fund of the sum so advanced to be provided rization will have to be had, and the Director -General for,if necessary, in the programme and budget has made provision in the 1964 budget to reimburse the estimates for 1964 ". Working Capital Fund in that year in the amount of 3. In the Appropriation Resolution for the financial $200 000, which was the amount estimated to be year 1963 (WHA15.42) the Fifteenth World Health required when the proposed programme and budget Assembly included the sum of $100 000 requested estimates were prepared.Since construction work by theDirector -General toward the construction can hardly begin before early 1964, itis assumed cost. that the balance of the authorization, i.e., $100 000, which it might be necessary to advance from the Work- 4.Since the Fifteenth World Health Assembly the architect has been developing detailed plans for the ing Capital Fund could be reimbursed in 1965.Since it appears that a new authorization should be provided extension of the building in consultation both with for this purpose, the Director -General would suggest regional officeofficials and those at headquarters that the Health Assembly consider a resolution along concerned with the planning of office space.The the lines of resolution WHA15.14 with the amount architecthasalsopreparedrevisedpreliminary of $100 000 being substituted for the figure of $300 000 estimates of the cost of the work in the light of current and the year 1965 replacing 1964. construction costs in Brazzaville.Because of rising Obviously, to the extent that additional contributions become available, costs for such work in Africa, as elsewhere, and because and depending upon the ultimate cost of the work, of certain modifications in the original plans in the these advances from the Working Capital Fund and 3 Off. Rec. Wld Hllh Org. 118, Annex 10. consequent reimbursements would be reduced. ANNEX 4 73
Appendix
CONTRIBUTIONS FROM MEMBER GOVERNMENTS TOWARDS THE ACCOMMODATION FOR THE REGIONAL OFFICE FOR AFRICA
(as at 25 April 1963)
US $ Us$ equivalent equivalent Contributions received 123 208 Cameroon CFA francs1 000000 Chad CFA francs1 000000 Contributions pledged Congo (Brazzaville) CFA francs 20 000000 Congo (Brazzaville) . . CFA francs 22 000000 Dahomey CFA francs1 000000 Mauritania CFA francs 500000 Gabon CFA francs1 000000 Nigeria £ 30000 Ivory Coast CFA francs5 000000 Uganda £ 1000 178 638 Madagascar CFA francs 500000 Tanganyika £ 1000 123 208 301 846
3. FURTHER REPORT BY THE DIRECTOR - GENERAL [A16 /AFL /7 Add. 2 -9 May 1963]
The letter which the Director -General sent to the You will note that operative paragraph 4 of this Government of South Africa on 18 February 1963 resolution " Requests the Director -General to explore in pursuance of the request of the Executive Board in the details of the offer with the Government of the paragraph 4 of resolution EB31.R20, and the reply Republic of South Africa, either as a loan or as an which has been received from the Government of outright contribution, and to report thereon to the South Africa are reproduced below. Sixteenth World Health Assembly ". We are at the disposal of your Government with 1.Letter, dated 18 February 1963, from the Director - regard to entering into arrangements, to enable a General of the World Health Organization to the report to be prepared for the Sixteenth World Health Secretary for Health and Chief Health Officer of Assembly, which is convened for 7 May 1963. the Republic of South Africa 1 I have the honour to transmit to you resolution 2.Letter, dated 8 May 1963, from the Ambassador EB31.R20, adopted by the Executive Board at its of the Republic of South Africa to Switzerland to thirty -first session on 18 January 1963 on the subject the Director -General of the World Health Organ- of " Accommodation for the Regional Office for ization Africa ", which refers to the offer by the Government Accommodation for the Regional Office for Africa of the Republic of South Africa of an interest -free loan of US $200 000. With reference to your letter No. A3/416/3 AFRO dated 18 February 1963, I have to inform you that the 1 Copies of this letter were sent to the Minister for Foreign resolution adopted by the Executive Board at its Affairs of the Republic of South Africa, Pretoria, and to the Ambassador of the Republic of South Africa to Switzerland, thirty -first session, relative to the above -mentioned Berne. matter, is still being considered by my Government. 74 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Annex 5
MALARIA ERADICATION SPECIAL ACCOUNT 1 [A16 /AFL /11 -3 May 1963] REPORT BY THE DIRECTOR - GENERAL
1.Introduction 2.4In addition, as shown in Appendix 1, there are The Fifteenth World Health Assembly, in para- pledges amounting to $1 169 698 ($1 035 700 in cash graph 3of resolution WHA15.34, reiterated " its and $133 998 in kind); the cash portion includes $1 000 000 pledged by the United States of America. convictionthat continued voluntary contributions in cash and in kind are essential for accelerating the 2.5The financing of the " regular " malaria eradi- malaria eradication programme " and in paragraph 5 cation operations for the year 1963 is thus assured. requested" theDirector - General tocontinuehis As for the year 1964, the full cost of the " regular " efforts as in the past for increasing voluntary contri- eradication operations is included in the proposed butions to the Malaria Eradication Special Account regular budget estimates in accordance with resolution and to report on this matter regularly to the Health WHA14.15. Assembly ". 2.6The estimated balance of $1 299 835 shown in paragraph 2.3 is available for implementing a portion ofthe" accelerated "programme,estimatedat 2.Status of the Malaria Eradication Special Account $2 115 000 in 1963 3 and at $4 360 000 in 1964.3 The 2.1 Contributions received or pledged from the implementation of projects of the programme desig- inception of the Special Account up to 30 April 1963 natedas" accelerated "willdepend uponthe are shown in Appendix 1 to this report. amounts available from voluntary contributions. The 2.2To complete the information on the voluntary Director -General will set aside funds not only for the contributions made to finance the world malaria current year's obligations, but also for continuing eradication programme, the contributions received commitments for the ensuing year. Consequently funds by and /or pledged to the Pan American Health Organi- in hand will be used to meet obligations either up to the zation's Special Malaria Fund up to 30 April 1963 completion of any individual activity approved for are shown in Appendix 2. implementation within a period of two years, or up 2.3As at 30 April 1963 the status of the Malaria to such appropriate phase of the activity as is decided Eradication Special Account was as follows : in each instance, depending upon itsnature. By financing " accelerated " activities in this manner, the Organization will avoid a situation whereby any Us$ Uss future costs of such activitiesstarted would ipso Balance carried forward on1 January facto have to be financed by recourse to the regular 1963 1241874 budget. Contributions received from 1 January to 30 April 1963 1565441 Contributions from the regular budget for 1963 4000000 3.Importance of Continued Voluntary Contributions Income from the Malaria Eradication Postage Stamp Plan from 1 January to 3.1 The funds for financing the " regular " malaria 30 April 1963 2 105206817835 eradication field operations for the year 1963 being assured, and assuming that theSixteenth World Less: Health Assembly will implement the recommendations Estimated obligations for " regular " contained in resolution WHA14.15 concerning the malaria eradication field operations incorporation in the regular budget of the full cost in 1963 5518000 of the " regular " malaria eradication field programme
Estimated balance available 1299835 for the year 1964, voluntary contributions will continue to be necessary for financing the" accelerated " portion of the programme 1 See resolution WHA16.17. 3.2The advantages of a more rapid and broader im- 2 Derived from promised donations in cash; excludes proceeds from the sale of stamps through the Organization in 1963 for which the return has not yet been received. 3 Off: Rec. Wld Hlth Org. 121, 402. ANNEX5 75 plementation of the eradication campaign have been re- 4.Fund- raising cognized by the Fourteenth and Fifteenth World Health 4.1 As requested by the Executive Board in reso- Assemblies (resolutions WHA14.27, WHA15.20 and lutions EB29.R27 and EB31.R26, and by the World WHA15.34).The Executive Board at its thirty -first HealthAssemblyinresolutionWHA15.34,the session, recalling the relevant provisions of resolutions WHA15.20 and WHA15.34 on the acceleration of Director -General has pursued his efforts to obtain the malaria eradication programme from continued voluntary contributions from governments, voluntary voluntary contributions, appealed " to Members who health organizations, foundations, industries, labour are in a position to do so to make voluntary contri- organizations, institutions and individuals, along the butions to the Malaria Eradication Special Account lines described in his earlier reports on the Special in order to make it possible to implement the pro- Account. gramme operations planned to be financed from 4.2 A limited number of countries have responded that account " (resolution EB31.R26). to WHO's reiterated appeals for voluntary funds. 3.3Mention was made in paragraph 2.6 above of It is thanks to their generosity that the carrying -out theexpenditureplannedforthe" accelerated " of the malaria eradication programme was made operations in 1963 and in 1964, which total $6 475 000. possible during the period when the programme was These funds, if obtained, would contribute primarily wholly financed from voluntary contributions; their tothe promotion of pre- eradicationprojectsin contributions have also assisted in the transfer of the Africa; they would also be used for the undertaking programme to the regular budget by stages.It is of new malaria eradication projects and the speeding - hoped now that all Members of the Organization, up of some projects already under way. and particularly the economically more advanced 3.4It will be recognized that any increased assistance countries, realizing the advantages of a more rapid which the Organization is in a position to offer to the implementation of the global eradication programme malarious countries encourages them to make addi- in terms of its final outcome and of eventual savings tional efforts in the health field.There is no need to in the total cost of eradication, will make an effort to emphasize the importance of this as the health needs provide the Malaria EradicationSpecial Account and the requirements for health investments in the with the necessary means for financing the " accele- developing countries are well known. rated " operations as planned. Appendix 1
CONTRIBUTIONS TO THE MALARIA ERADICATION SPECIAL ACCOUNT Position at 30 April 1963
(Expressed in US dollars)
Received during Received Total Pledged but not Country 1 January received to up to yet 1956 1957 1958 1959 1960 1961 1962 30 April 196330 April 1963 received
Afghanistan 2000 Argentina 5000 5000 Australia 78 166 27916 106082 898 Austria 1936 2.885 23077 27 Belgium 25000 25000 Brunei 9901 9901 Bulgaria 4412 2 206 7353 13971 Burma 2093 2093 3 1000 Cambodia 1000 1 500 580 080 Canada 103 193 193 Ceylon 2012 2000 4012 China (in kind) 4134 4 134 8268 Congo (Leopoldville) 1000 1000 Cyprus 280 280 Czechoslovakia 34 722 34722 Denmark 10135 144 781 72390 50673 277979 Ethiopia 3 000 3000 Federation of Rhodesia and Nyasaland 2 800 2800 Finland 70 000 9607 79607 Germany, Federal Republic of 47619 47619 178 571 125000a 37500 2750b 439059 22250b Ghana 2805 5600 8405 9000 Greece 1000 1000 1 000 3000 3000 Guinea 4100 4100 Iceland 1500 1500 India 31499 21 000 21000 73499 Indonesia 10 000 10000 Iran 15 000 15000 Iraq 4200 8401 8 400 4201 25202 Ireland 5000 5000 Israel 5000 5000 Italy 3200 9600 12800 7200 Japan 10 000 10000 20000 Jordan 10"000 10000 Korea, Republic of 2750 2750 Kuwait 19500 15000 34500 15000 Laos 750 750 Lebanon 2242 1577 1581 2262 1598 4524 13 784 Libya 1500 1 500 Luxemburg 2000 2 000 Malaya, Federation of 4257 4217 8 474 Morocco 2000 3000 5 000 Nepal 1000 1 000 Netherlands 27624 27 624 New Zealand 28000 28000 2800 58 800 Nigeria 280 8512 17020 25 812 Norway 100140 100 140 Pakistan 10000 20000 30 000 Philippines 5000 5 000 Poland (in kind) 83333 83 333 Portugal 10000 10 000 Romania 20000 20 000 Saudi Arabia 4500 5000 5000 14 500 Sierra Leone 280 280 Sudan 3012 2869 5000 10 881 Sweden 19331 135318 154 649 Switzerland 23256 46296 46296 115 848 Thailand 1507 2007 3 514 Tunisia 2000 2000 2000 2000 2017 10 017 Turkey 35714 7111 42 825 Union of Soviet Socialist Republics (in kind) 82500 250000 164474 496 974 57748 United Arab Republic 22523 22 523 United States of America 5000000 6000000 4000000 1500000 16500 000 1000000 Upper Volta 4069 4 069 Viet -Nam, Republic of 2000 1 000 3 000 Yugoslavia 3000 25000 2000 30 000 Holy See 1000 1000 2000 4 000
Totals - Countries 68096 5046003 167620 6260880 1157570 4356495 571664 1561670 19189 998 1105198 Miscellaneous gifts : MISEREOR (German Bishops' cam- paign) 100000 100 000 German Red Crossinthe German
Democratic Republic (in kind) . . . 1400 1 400 54000
Sundry 906 1886 23886 44747 7599 10473 3771 93 268 10500 United Kingdom Committee for WHO 6900 6 900
Totals - Voluntary Contributions 68096 5046909 169506 6284766 1202317 4464094 590437 1565441 19391 566 1169698
Transfer from the regular budget . . . . 2000000 ° 4000000d 6000 000
GRAND TOTALS 68096 5046909 169506 6284766 1202317 4464094 2590437 5565441 25391 566 1169698
a Of which $37 500 in kind. b In kind. C In accordance with resolution WHA14.43. d In accordance with resolution WHA15.42. Appendix 2
CONTRIBUTIONS TO THE SPECIAL MALARIA FUND OF THE PAN AMERICAN HEALTH ORGANIZATION Position at 30 April 1963
(Expressed in US dollars)
Received during Total Pledged Country received but not up to yet 1956 1957 1958 1959 1960 1961 1962 1963 30 April 1963 received
Colombia a 5000 5000 Dominican Republic 100000 100000 200000 300 000 Haiti 5000 5000
United States of America 3 500000 5000000 1500000 1000000 1000000 12000000 Venezuela 299400 299400
Totals (cash) 3 899400 105000 5000000 1505000 1000000 1000000 12509400 300 000
GRAND TOTAL (cash and pledged) 12 809 400
aThis contribution was reported to the Fourteenth World Health Assembly as a pledge to the Malaria Eradication Special Account of the World Health Organization, but it was subsequently ascertained that the contribution was intended for the Special Malaria Fund of the Pan American Health Organization. ANNEX 6 79
Annex 6
MALARIA ERADICATION POSTAGE STAMPS [A16 /AFL /13 Rev. 1 - 11 May 1963]
REPORT BY THE DIRECTOR -GENERAL
1. Background and Purpose 3.Publicity for the Malaria Eradication Programme 3.1Thanks to the large participation in this philatelic 1.1 The plan for the issue of malaria eradication postage stamps was conceived as a part of the con- project, millions of stamps and special cancellations tinuing efforts to disseminate information on and have been transmitting to all parts of the world an appeal for united efforts against the world's most stimulate interest in the campaign against malaria.2 widespread and costliest disease, as nearly all of them In addition to this main objective, the plan was carrytheslogan" The World UnitedAgainst developed with a secondary objective,i.e.,asa Malaria ".The special cancellation slogan in the potential source of income for the world malaria United Kingdom of Great Britain and Northern eradication programme.The date of issue recom- Ireland only, according to the official estimates, was mended was 7 April 1962, but any other date before applied on about 200 million items of mail; over 31 December 1962 was considered satisfactory. In 100 000 items of mail were daily imprinted with the accordance with the decisions of the Executive Board 3 antimalaria sloganinGeneva duringtheweek and the Fifteenth World Health Assembly 4 the issues 7 -14 April 1962; the United States of America issued made after 31 December 1962 are not considered 100 million antimalaria stamps, the Republic of as part of the Organization's malaria eradication Viet -Nam 7 million, Nigeria 4.8 million, Czecho- postage stamp plan. slovakia 4.45million, Poland 3.75million, India 3.5 million -to give but a few illustrations.While drawing the attention of the populations of the more 2.Participation privileged nations to the problem of malaria, these numerous philatelic items, at the same time, have been 2.1 The total number of participants was 114.Out telling the peoples of the malarious countries that the of these, ninety -eight postal administrations issued rest of the world does not forget their struggle for one or more postage stamps commemorating the better health. malaria eradication programme; some of them also issuedrelatedphilatelicmaterial,e.g.,souvenir 3.2The issue of antimalaria postage stamps received sheets, first -day covers, etc.; sixteen postal administra- considerable coverage in the press. Items in the press tions participated by providing special cancellations. ranged from articles and features to official statements Eighty -three countries and territories made or promised on and announcements of individual issues.Medical donations either in stamps, philatelic material, and /or publications also carried articles in connexion with in cash. antimalaria stamps. A review of the clippings received in headquarters gives an indication of the publicity 2.2The number of Members of the Organization obtained in the press. In 1958, the year of the extension that participated is shown by regions, in Appendix 1, of malaria eradication operations on a world -wide part 1. scale, the clippings received in headquarters from thirty -three countries contained 371articles about 2.3The list of the participants, with the dates of malaria. In 1962, the Division of Public Information issue of their stamps and related philatelic material has recorded, in the press of thirty countries from which the Division receives clippings, 1529 articles Organization's malaria under the World Health on the malaria eradication stamp campaign and the eradication postage stamp plan, is given in Appendix 1, eradication programme or the problem of malaria part 2. in general.
1 See resolution WHA16.18. 3.3 Many postal administrations, in advertising their 2 Resolutions EB26.R10, WHA14.27 and EB28.R27. malaria eradication commemorative issues, included 3 Resolutions EB29.R28 and EB31.R41. information and data about malaria and the eradica- 4 Resolution WHA15.47. tion programme intheir respectivebulletins and 80 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I pamphlets.The narratives on malaria were usually work. A thirty- minute programme produced by the prepared with the assistance of WHO staff. Thousands Swiss Broadcasting Corporation (Société romande of such bulletins and pamphlets were distributed deRadio -diffusion,StudiodeLausanne),with throughout the world. recorded material collected on the spot in Africa, 3.4The International Boy Scout Movement, Canada, was broadcast by thirty -two national networks totalling and the Hobbies Committee in the United States forty -five transmitters of the Communauté des pro- of America endeavoured, through their own means grammes delanguefrançaise(includingFrance, and channels, to publicize the malaria eradication Belgium, Switzerland, Luxembourg, Monaco, Canada, stamp plan as an illustration of the world solidarity countries and territories in Africa, Asia, Oceania, in combating malaria. Latin America and the Caribbean area).Although no appeal for funds was made, a sum of Sw. Fr. 6132.20 3.5Several chemical and pharmaceutical companies was donated by listeners and placed to the credit of contributed to the efforts to spread information about the Malaria Eradication Special Account. A similar malaria by printing and distributing brochures or television programme of the same duration, entitled illustrated features relating to the issue of malaria Les Esclaves de la Fièvre (The Slaves of Fever) was eradication stamps, coloured stamp illustrated folders, distributed by Eurovision to be shown in the United articles with coloured stamp reproductions, advertise- Kingdom (BBC), Sweden, Denmark, the Netherlands ments with the design of the model stamp, etc. and Switzerland. The opening of the " MALAREX" ex- 3.6Twelve press releases on the malaria eradication hibition in the Palais des Nations was covered by the stamp plan, prepared by headquarters, were distributed Swiss and French television, the latter having sent a team in 42 000 copies.Regional offices and the Liaison from Paris to prepare a special programme on the sub- Office with the United Nations also issued a number ject. A radio feature on the malaria eradication opera- of press releases.The extra issue of the magazine tions in North Borneo, with an on- the -spot report, was World Health, devoted to malaria, which was printed accepted by nineteen radio stations in different parts in November 1961 in 97 000 copies, was exhausted of the world. The estimated advertising value of these by early 1962.A new special issue was printed in broadcasts, if paid for at the current commercial June 1962 to meet the increased demand for documen- rates, would amount to several hundred thousand tation on malaria. As at 31 December 1962, 103 000 dollars. copies of the latter had been distributed. 3.9Exhibitions of the malaria eradication postage 3.7Other mass information media also gave a great stamps and related philatelic material commemorating deal of attentionto malaria eradication stamps. the world malaria eradication programme included Radio and television stations all over the world carried those organized in Belgium (Brussels and Charleroi); the message " The World United Against Malaria " the Federal Republic of Germany (Essen, Hamburg, and arranged for special programmes, the central Munich); France (Evian); the Republic of Korea theme of which was the battle against malaria.For (Seoul); India (Madras); Iran (Teheran); Philippines this purpose, headquarters sent printed and visual (Manila); Switzerland (Geneva); United States of material and included items concerning malaria in America (Baltimore, Chicago, Los Angeles, Minnea- WHO feature programmes.The Philatelic Agency polis, New York, Philadelphia, Washington).Other for Malaria Eradication Postage Stamps, the Organi- stamps and philatelic material displayed on the zation's sales agent, at its own expense, produced occasion of some of those exhibitions illustrated the 720 shorttelevisionfilms and 3810 phonograph history of WHO and its daily, often little known, work. records. The Agency distributed, mostly to radio and 3.10Arrangements were made for the exhibition of televisionstations for the " Stamp Out Malaria " antimalaria stamps at the Century -21- Exhibition in programme, thousands of kits containing copies of Seattle, the Do- It- Yourself Exhibition in London these films, records, slides, information material, etc. and the Great Toronto Stamp and Coin Show in 3.8The Advertising Council in the United States of Toronto. Antimalaria stamps were also exhibited at America (a non -profit, public service organization) traditionalphilatelicexhibitions,suchas ASDA authorized and recommended the malaria eradication Stamp Show in New York, Europa 62 in Naples, stamp programme to be broadcast by radio and Italy, INTERPEX in New York, NASPEX in Long television stations throughout the country.As a Island, PRAGA 62 World Exhibition of Postage result, during 1962 radio and television stations in the Stamps in Prague, SOJEX 1962 in Atlantic City, United States, including the major national networks, STAMPEX in London. Some of those world- famous daily publicized the malaria eradication programme philatelic events were held in 1962 under the slogan and appealed to the public to support antimalaria of the antimalaria campaign.A number of other ANNEX 6 81
philatelic exhibitions displayed antimalaria stamps, 4.2The value of the postage stamps and related such as :EXPHISALM -62 in Vielsalm, Belgium; philatelic items sold as at 31 March 1963 amounted to BEPEX in Bergen County, United States of America; US $203 271, from which there is to be deducted the the exhibition of the Philatelic Club in Ypres, Belgium; sales agent's commission of $30 491. Thus, US$172 780 the First Philatelic Exhibition in Bangalore, India; was transferred to the Malaria Eradication Special the Dundee and District Philatelic Society in Dundee, Account, together with US $22 094 representing the United Kingdom, etc.Malaria eradication stamps cash donations received, making a total of US$194 874. werealsodisplayedinvariousBraziliantowns, 4.3There still remain quantities of unsold stamps Multan Cantonment in Pakistan, in Manatee County and related philatelic items. This in part is due to the Stamp Club and Eureka Stamp Society in Bradenton, fact that in many instances the donated stamps United States of America, in Venezuela, etc. All these reached the Organization's consignee in New York displays, attended by hundreds of thousands of visitors, long after the date of issue, when the demand on the highlighted the problem of malaria and the efforts philatelic market was already met to a large extent. made to free the world from this disease. The sale of this material continues, but the sale The 3.11Ceremonies took place in some capital cities prospects do not seem particularly promising. on the day of issue, and at the United Nations head- closing date for sale will be fixed some time in 1963 quarters in New York on the occasion of the issue and will be announced at least one month in advance. of the United Nations antimalaria stamps on 30 March 1962. A special message from the President of the 5.Planning and Execution of the Malaria Eradication United States of America was read at the ceremony Stamp Plan held in Washington. In Teheran a donation ceremony 5.1 Some information on the organizational and was organized at which the stamps were handed to the administrative aspects of this undertaking and the WHO representative. The Government of the Republic of Viet -Nam indicated its interest in setting up a work involved is given in Appendix 3. permanent exhibition of malaria eradication stamps in its malaria headquarters. 6.Termination of the Project 6.1 In a report to the thirty -firstsession of the 3.12The foregoing account of the publicity activities and events resulting from the malaria eradication Executive Board the Director -General outlined the action to be followed for the termination of the stamp plan is far from being exhaustive, but itis Organization's malaria eradicationpostage stamp sufficientevidencethatthisplanhas made an appreciable contribution to the spreading of informa- plan. Subsequently thatreport was transmitted tion on malaria and the stimulation of public interest to all Members. The final list of participants, with the in the battle against malaria. The intensified world- dates of issue of their stamps and related philatelic material making part of this stamp plan, and the list wide publicity about the problem of malaria coincides with the Organization's efforts to obtain continuing of donations(Appendices 1 and2)have been voluntary support for the acceleration of the eradica- established according to the envisaged procedure. tion programme, as approved by the Fourteenth and As mentioned in paragraph 4.3 above, the closure of Fifteenth World Health Assemblies. the sale will take place during 1963. 6.2The countries which withdraw their antimalaria stamps before the closing date of the sale are expected 4.Donations to inform the Organization, which will then also withdraw the stamps concerned from its own sale. 4.1 Of theeighty -threecountries and territories which made or promised donations in connexion 6.3All stamps and related philatelic items remaining with the issue of antimalaria stamps, sixty -one donated unsold on the closing date of the WHO sale will be quantities of stamps and some quantities of related destroyed in accordance with Article V(a) of the philatelicmaterial;one country, which did not Agreement between WHO and the Inter -Governmental issue antimalaria stamps, donated envelopes with a Philatelic Corporation in the presence of a witness special cancellation; twenty -one promised the proceeds appointed by WHO. A copy of the relevant certificate from the surcharge or a percentage of the proceeds will be transmitted to the governments concerned. from the sale of stamps. The list showing the donor 6.4The final financial account of income and expend- countries andterritories,the denominations and iture is expected to be submitted to the thirty -third number of series received as well as donations in session of the Executive Board and to the Seventeenth cash promised and /or received is given in Appendix 2. World Health Assembly. 82 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Appendix 1
PARTICIPATION IN THE MALARIA ERADICATION POSTAGE STAMP PLAN
I.SUMMARY
Members and Associate Members of WHO
Members participating Members Total Region not membership Total Donating Not donating participating (1962)
Africa 23 20 3 2 25 The Americas 15 9 6 7 22 South -East Asia 8 6 2 - 8 Europe 17 12 5 15 32 Eastern Mediterranean 17 16 1 - 17 Western Pacific 8 7 1 3 11
Total 88 70 18 27 115
Postal Administrations
Total DonatingNot donating United Nations 1 - 1 Other 25 13 12
Total 26 13 13
TOTAL PARTICIPANTS 114 83 31
2. DETAILS
A. PARTICIPANTS ISSUING POSTAGE STAMPS (INCLUDING SOUVENIR SHEETS AND FIRST -DAY COVERS)
Participants Dates of issue Participants Date of issues Afghanistan 5 October 1962 France 14 April 1962 Albania 7 April 1962 French Somaliland 7 April 1962 Argentina 14 April 1962 Gabon 7 April 1962 Bolivia 4 October 1962 Ghana 1 December 1962 Brazil 24 May 1962 Guinea 7 April 1962 Bulgaria 7 April 1962 Guatemala 4 October 1962 Burundi 10 December 1962 Haiti 30 May 1962 Cambodia 7 April 1962 Holy See 6 April 1962 Cameroon 7 April 1962 Hungary 25 June 1962 Central African Republic 7 April 1962 India 7 April 1962 Ceylon 7 April 1962 Indonesia 7 April 1962 Chad 7 April 1962 Iran 21 June 1962 China 7 April 1962 Iraq 31 December 1962 Colombia 12 April 1962 Israel 30 April 1962 Congo (Brazzaville) 7 April 1962 Italy 31 October 1962 Congo (Leopoldville) 20 June 1962 Ivory Coast 7 April 1962 Cuba 14 December 1962 Jordan 15 April 1962 Cyprus 14 May 1962 Korea, Republic of 7 April 1962 Czechoslovakia 18 June 1962 Kuwait 1 August 1962 Dahomey 7 April 1962 Laos 19 July 1962 Dominican Republic 29 April 1962 Lebanon 1 July 1962 Ethiopia 7 April 1962 Liberia 7 April 1962 ANNEX 6 83
Participants Dates of issue Participants Dates of issue Libya 7 April 1962 Saudi Arabia 7 May 1962 Liechtenstein 2 August 1962 Senegal 7 April 1962 Madagascar 7 April 1962 Sierra Leone 7 April 1962 Malaya, Federation of 7 April 1962 Somalia 25 October 1962 Maldive Islands 7 April 1962 Spain 21 December 1962 Mali 7 April 1962 Sudan 7 April 1962 Mauritania 7 April 1962 Surinam 2 May 1962 Mexico 30 May 1962 Swaziland 2 24 April 1962 Monaco 6 June 1962 Switzerland 19 March 1962 Mongolia 8 July or August 1962 Syria 7 April 1962 Morocco 3 September 1962 Thailand 7 April 1962 Nepal 7 April 1962 Togo 2 June 1962 Nicaragua 27 July 1962 Tunisia 7 April 1962 Niger 7 April 1962 Turkey 7 April 1962 Nigeria 7 April 1962 Union of Soviet Socialist Republics 6 May 1962 Pakistan 7 April 1962 United Arab Republic 20 June 1962 Panama 3 May 1962 United Nations Postal Panama Canal Zone 24 September 1962 Administration 30 March 1962 Papua and New Guinea 7 April 1962 United States of America 30 March 1962 Paraguay 23 May 1962 Upper Volta 7 April 1962 Philippines 24 October 1962 Venezuela 20 December 1962 Poland 1 October 1962 Viet -Nam, Republic of 7 April 1962 Portugal 1 12 March 1962 Yemen 20 June 1962 Ryukyu Islands 7 April 1962 Yugoslavia 7 April 1962
B. PARTICIPANTS ISSUING SPECIAL CANCELLATIONS ONLY
Austria (Bregenz Post Office) . . . 3 September 1962 Federation of Rhodesia and Nyasaland 7 April 1962 British Guiana 7 April 1962 French Polynesia 2 April 1962 British Solomon Islands Protectorate 8 May 1962 Malta 7 April 1962 Burma 7 April 1962 New Zealand 6 April 1962 1 April 1962 Canada Singapore 7 April 1962 17 April 1962 Denmark 16 August 1962 United Kingdom of Great Britain and East African Postal Administration - Northern Ireland 1 August 1962 Kenya, Tanganyika and Uganda . 2 April 1962 Zanzibar April 1962
Appendix 2
DONATIONS TO WHO UNDER THE PLAN
A.STAMPS AND RELATED PHILATELIC MATERIAL
Number of Country Denominations of stamps series donated Afghanistan 2, 2, 5, 10 and 15 puts 1 040 25, 50, 75, 100 150 and 175 puts 800 Albania 0.10, 0.11, 1.50 and 2.50 leks 1 000 Bolivia 600 and 2 000 bolivianos 2 000 Brazil 21 cruzeiros 100 000 Bulgaria 5 and 20 stotinki 10 000 Burundi 8 and 50 francs 3 000 58 francs (first -day covers) 490 Cambodia 2, 4 and 6 riels 6 000 Ceylon 0.25 Ceylonese rupee 100 000 China 0.80 and 3.60 new Taiwan dollars 100 000 Colombia 0.20, 0.40, 0.50, 1 and 1.45 pesos 10 000 (first -day covers) without stamps 1 000 1 Eight overseas provinces each issued one postage stamp. 2 Malaria control. 84 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Number of Country Denominations of stamps series donated Cuba 1, 2 and 3 centavos 100000 Cyprus 10 and 30 mils 25000 Czechoslovakia 0.60 and 3 korunas 5000 0.60 and 3 korunas (souvenir sheets) 4998 0.60 and 3 korunas (first -day covers) 10000 Denmark 12 ore envelopes 4967 Ethiopia 0.15, 0.30 and 0.60 Ethiopian dollars 30000 Guinea 25, 50 and 100 Guinea francs 15000 100 Guinea francs (souvenir sheets) 2000 Haiti 50 centimes 99960 50 centimes (airmail) 100064 5 centimes 96000 10 centimes 99964 20 centimes 99856 1 gourde 100004 2 gourdes (souvenir sheets) 25000 Holy See 15, 40, 70 and 300 lire 100000 15, 40, 70 and 300 lire (first -day covers) 35000 Hungary 2.5 forints 2000 4 stamps at 2.5 forints (souvenir sheets) 1000 Indonesia 0.40, 1.50, 3 and 6 Indonesian rupiahs 100000 Iran 2, 6 and 10 rials 16650 18 rials (first -day covers) 11627 envelopes with cancelled 18 rials stamps 16435 Israel " 0.25 Israeli pound 20000 0.25 Israeli pound(first -day covers) 5000 Jordan 0.015 and 0.035 Jordanian dinar 165000 0.050 Jordanian dinar (first -day covers) 34837 Korea, Republic of 40 hwan 100000 40 hwan (souvenir sheets) 100000 Kuwait 4 and 25 fils 40000 Laos 4, 9 and 10 kips 20000 Lebanon 30 and 70 piastres 24999 Liberia 25 cents and 25 cents airmail 20000 Libya 15 and 50 milliemes 60000 15 and 50 milliemes (imperforated stamps) 4000 15 and 50 milliemes (souvenir sheets) 3000 Liechtenstein 0.50 Swiss franc 100000 0.50 Swiss franc (first -day covers) 10000 Malaya, Federation of 0.25, 0.30 and 0.50 Malayan dollar 50000 Maldive Islands 2, 3, 5, 10, 15, 25, 50 larees and 1 rupee 5000 Mexico 0.40 peso 40000 0.20 peso (mental health stamps) 20000 Mongolia 1, 5, 10, 15, 20, 30, 40, 50 mongo 1000 * Morocco 0.20 and 0.50 dirham 100000 Nepal 12 paisas 50000 1 Nepalese rupee 1680 Pakistan 10 and 13 paisas 93478 10 and 13 paisas (first -day covers) 49995 Poland 0.60, 1.50 and 2.50 zlotys 100000 4.60 zlotys (first -day covers) 34800 3 zlotys (souvenir sheets) 50000 3 zlotys (first -day covers, souvenir sheets) 35200 Portuguese Overseas Provinces: Angola 2.50 escudos 25000 Cape Verde Islands 2.50 escudos 25000 Portuguese Guinea 2.50 escudos 25000 Portuguese India 2.50 escudos 25000 Mozambique 2.50 escudos 25000 São Tomé and Principe 2.50 escudos 25000 Timor 2.50 escudos 25000 Macao 0.40 ayo 25000
* Not yet received. ANNEX6 85
Number of Country Denominations of stamps series donated Saudi Arabia 3, 6 and 8 piastres 30 000 3, 6 and 8 piastres (first -day covers) 9 190 Sierra Leone 3 and 1/, pence 100 020 Somalia 0.10, 0.25, 1 and 1.80 somali 4 000 Spain 1 peseta 30 000 Sudan 15 and 55 milliemes 100 000 Switzerland 0.50 Swiss franc 100 000 0.50 Swiss franc (first -day covers) 35 000 Syria 121/2 and 50 piastres 100 000 Thailand 0.05, 0.10, 0.20, 0.50, 1, 1.50, 2 and 3 bahts 100 000 Togo 10, 25, 30 and 85 CFA francs 25 000 Tunisia 20, 30 and 40 millimes 50 000 Turkey 30 +5 and 75+5 kurus 20 000 United Arab Republic (Egypt) 10 and 35 milliemes 50 000 (Palestine) 10 and 35 milliemes 50 000 Venezuela 0.30 and 0.50 bolívar 100 000 2 bolivars (souvenir sheets) 35 000 Viet -Nam, Republic of 0.50, 1, 2 and 6 piastres 30 000 Yemen 4 and 6 bogshas 50 000 Yugoslavia 50 dinars 20 000
B.DONATIONS IN CASH
Country Donation Value in US $ Cameroon Proceeds from surcharge 634.09 ** Central African Republic Proceeds from surcharge Chad Proceeds from surcharge Congo (Brazzaville) Proceeds from surcharge
Congo (Leopoldville) Percentage of sale : 25 per cent. of issue in cash Dahomey Proceeds from surcharge 2 020.41 ** Dominican Republic RD $5000 5 000 French Somaliland Proceeds from surcharge Gabon Proceeds from surcharge Ghana £G 1000 2 800.34 ** Ivory Coast Proceeds from surcharge Madagascar Proceeds from surcharge Mauritania Proceeds from surcharge :CFA francs 200 000 + 816.33 + CFA francs 100 000 408.16 Monaco NF 30 000, i.e., value of 30 000 stamps 6 123 ** Niger Proceeds from surcharge 1 521.53 ** Nigeria £ 2000 from sale of stamps 5 600.67 ** Paraguay Gs 319 950 in cash 2 580 Philippines Percentage of sale Senegal Proceeds from surcharge Surinam Percentage of sale 814.06 ** Upper Volta Proceeds from surcharge
Appendix 3
PLANNING AND EXECUTION : SOME ORGANIZATIONAL AND ADMINISTRATIVE ASPECTS
1.Co- operation with other Organizations Refugees, which had in 1960 issued postage stamps for refugees. Upon approval of the malaria eradication stamp plan by the In preparing the plan for the issue of malaria eradication Executive Board, the International Bureau of the Universal postage stamps, consultations were held with the Universal Postal Union incorporated the text of the plan in its circular to Postal Union and the Office of the High Commissioner for the postal administrations of the Union's members. The Secretary- General of the United Nations was kept informed. TechnicaladvicewasreceivedfromtheSwisspostal ** Paid. administration. 86 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
2.Preparation of the Emblem and the Model Stamps delivered to the field staff or sent to the respective regional Four artists were invited to submit drawings for both the office or headquarters, and they in turn had to arrange for for- emblem and the model stamps under conditions specially warding them to New York. established for that purpose.An advisory committee was Whenever it was noted that stamps and /or, more specifically, some denominations, souvenir sheets or first -day covers were convened to recommend the selection of the emblem and designs issued in limited quantities, the Director -General drew the of model stamps prepared by the artists.The committee was attention of the countries concerned to the desirability that they composed of experts in the matter coming from three Member States of the Organization (other than those from which the issue adequate quantities to ensure wide and easy distribution. artists had been selected) and two members from the Secretariat. 5.Philatelic Organizations, Stamp Trade and Collectors 3.Arrangements for the Sale of Donated Stamps Various philatelic organizations, including the International For the sale of the stamps and other related philatelic material Philatelic Federation, showed varying degrees of interest in the which would be donated to the Organization, an agreement was plan and communicated with the Organization.Some stamp concluded with the Inter -Governmental Philatelic Corporation. trade circles, presumably dissatisfied with the efforts which the Under this agreement the Corporation was appointed to act as Organization was making in order to implement this project in the exclusive agent of the Organization and to sell the stamps conformity with its objectives and its humanitarian character, contributed to WHO at their face value, through its specially engaged in active propaganda against it, and it was necessary established subsidiary - the Philatelic Agency for Malaria for the Organization to take measures to counteract such Eradication Postage Stamps.The stamps and other contribu- propaganda. ted material were to be consigned to the J. Henry Schroder Numerous private letters were received requesting information Banking Corporation, New York, which acted as custodian of in respect of the stamps; they were referred for action to the such donations on behalf of the Organization.These arrange- Philatelic Agency for Malaria Eradication Postage Stamps or ments relieved the Organization of complex operations of itssub -agents.The lettersrequesting information on the receiving, handling, distributing, advertising, accounting for malaria programme itself were answered by WHO staff. donations, etc.The agreement was transmitted to all Members (by circular letter C.L.32. 1961, of 4 October 1961), and sub- 6.Preparation of Exhibition sequently to other participants, and noted by the Executive Board in resolution EB29.R28. The exhibition of malaria eradication postage stamps in Geneva was organized by WHO staff in co- operation with the Philatelic Agency for Malaria Eradication Postage Stamps, 4.Communications with Participants which bore most of the expenditure involved.This exhibition The carrying -out of the plan required voluminous communica- also included other stamps and philatelic material illustrating tions with Members and other participants.Communications the history of the Organization and itsdaily work.The ranged from general information about the plan to individual Organization contributed to other exhibitions by sending stamps letters dealing with various administrative, financial and technical prepared for display according to the established technical details.Regional offices also followed up the development of requirements and by providing visual material and information the plan and assisted in solving many problems.The same is material about WHO and malaria.In most cases information true for the field staff in a number of the participating countries was also sent to radio, press and television in the cities where and territories.The delays in the dispatch of donated stamps such exhibitions were held.The Philatelic Agency for Malaria and related material caused a considerable amount of additional Eradication Postage Stamps participated in the preparation and correspondence.In a number of cases the donations were arrangements of almost all the exhibitions held outside Geneva. ANNEX 7 87
Annex 7
HEADQUARTERS ACCOMMODATION 1
1. REPORT OF THE AD Hoc COMMITTEE OF THE EXECUTIVE BOARD
[A16 /AFL /12 Add.1 - 9 May 1963]
1. At its thirty -first session the Executive Board, in one thousand it was assumed that provision would resolution EB31.R52, established " an Ad Hoc Com- need to be made for about six hundred vehicles in mittee of the Executive Board consisting of : Dr M. K. total, and of these some four hundred were to be Afridi, Professor E. Aujaleu, and Dr A. Nabulsi ". parked underground. By resolution EB31.R25 the Board delegated to this 5. Among the various measures adopted to bring committee responsibility for examining on behalf of the original building project within the limits of the theBoard theDirector- General'sreporttothe Assembly authorization of Sw. fr. 40 000 000 was the Assembly on headquarters accommodation, specifically elimination of the provision for underground parking. with reference to the anticipated increased cost of the At that time it was hoped that sufficient land area building project and its financing. would be available to permit surface parking entirely, 2. The Committee met on 8 May 1963 in the Palais without too serious prejudice to the appearance of the des Nations, Geneva, to deal with this subject. building. The actual land area made available, however, 3.The Committee had before it a progress report by had been less than originally hoped and this had led the Director -General (see part 2 of this annex) and the Director -General to the conclusion, which he a working paper containing the Director -General's reported to the Standing Committee on Headquarters latestcalculationof theanticipatedcostof the Accommodation, that reintroduction into the pro- construction project. The Committee decided to deal gramme of work of the provision for an underground with the subject in three parts :(1) the problem of garage for about four hundred vehicles was essential. parking, (2) the anticipated increased cost of the 6.The Standing Committee on Headquarters Accom- building project, and (3) the financing of the additional modation, after reviewing the situation indetail, cost. concluded that " while it was already clear that a certain number of underground garages would be Parking necessary, the area to be provided underground could be reduced if additional land could be made avail- 4.The Committee reviewed the history of provisions able ".5 The Standing Committee had therefore asked regarding parking since the inception of the proposal the Director -General to investigate the possibilities of to construct the headquarters building, referring for obtaining extra land from the authorities of the this purpose to the report which the Director -General Canton of Geneva. had made to the Standing Committee on Headquarters Accommodation in November 1962,2 to the con- 7. These several considerations had led the Executive sideration given to the subject by the Standing Com- BoardinJanuary1963,inadoptingresolution mittee at that time as reflected in its report 3 to the EB31.R25, to record the conclusion. Executive Board at its thirty -first session, and to the 3. CONCURS in the view of the Director -General report made by the Director -General to the same that reasonable provision for underground parking session of the Executive Board.4The Committee should be explored with reference to the construc- noted that the original project for the building had tion programme. included provision for underground parking for a While the Ad Hoc Committee considered that under portion of the total anticipated number of vehicles, the terms of resolution EB31.R25 it need not formulate since this was considered essential to preserve the any further conclusions about the parking, it did dignity of the building. For a staff of approximately believe that it would be useful to draw the attention of the Assembly to the contents of paragraph 4.5 of the 1 See resolution WHAI 6.22. Director -General's progress report, in which he reports 2 Off: Rec. Wld Hlth Org. 124, Annex 15, part 1, Appendix. the results of his explorations with the authorities of 3 Off Rec. Wld Hlth Org. 124, Annex 15, part 1. 4 Off Rec. Wld Hlth Org. 124, Annex 15, part 2. Off. Rec. Wld Hlth Org. 124, Annex 15, part 1, para. 7.3. 88 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I the Canton of Geneva with regard to the availability of per annum throughout the entire construction period. additional land areas which might be made available It noted explanations given by the representative of the for parking. The Committee noted that only one such Director - General that the allowance of an average area, which could provide for about one hundred increase of 5 per cent. per annum over the total period vehicles, was to be put at the disposal of the Organi- is intended to cover somewhat higher rates thatmay zation. The Committee also noted from explanations prevail during a portion only of the total construction given by the representatives of the Director -General period. that there are no present indications of an intention to 11. It is the opinion of the Ad Hoc Committee that convey this land to the Organization permanently. the situation as at 30 April 1963 has not altered the Rather it is the Director -General's understanding that basis of the recommendation of the Executive Board, the use of it would be granted to the Organization in paragraph 4 of resolution EB31.R25, which reads under an arrangement whereby, should future develop- as follows : ments so warrant, the authorization to use this land could be withdrawn. 4.RECOMMENDS to the Sixteenth World Health Assembly,inconsequence,thatthefinancial Costs authorization for the accomplishment of the new headquarters building project be increased to about 8.The Committee transmits, as an appendix to this sixty million Swiss francs, the revised amount to be report, for the information of the Assembly the latest determined by the Health Assembly in the light of the cost estimates of the building project prepared by the situation at the time of that Assembly. Director -General. These estimates have been prepared in the same form as those presented by the Directo r- General to the Standing Committee on Headquarters Financing Accommodation in November 1962,1 thus enabling a 12.The Ad Hoc Committee noted the explorations direct comparison tobe made between the two which the Director - General had undertaken with the estimates at two different points in time. authorities of the Swiss Confederation with regard to 9.The Committee noted that the current estimates, an increase in the amount of the interest -free loan which of the further toward the cost of the building project the letter as well as the amounts of the contracts for the second which had been received from the Head of the Swiss section of the work, fully confirm the earlier predictions Federal Political Department (seepart 2 of this of a total cost of approximately Sw. fr. 60 000 000. In annex). fact, the figure is slightly more than Sw. fr. 60 000 000 13. The Ad Hoc Committee would draw the attention if the underground garage to be constructed is for of the Assembly to the recommendations which the approximately four hundred vehicles.It is slightly Committee is making in its reports on the supplemen- less than Sw. fr. 60 000 000 if the underground garage tary budget estimates for 1963 2 and on the review and capacity is reduced to approximately three hundred approval of the programme and budget estimates for places. 1964.2 For the reasons indicated in these reports, the 10. The Committee noted the fact that price increases Committee is proposing that the Assembly adopt during the past twelve months on the contracts for the budgetary adjustments for both years 1963 and 1964 first section of work had in fact amounted to approxi- which, if approved by the Health Assembly, would mately 7 per cent., whereas the rate of increase foreseen assist in the financing of the additional construction in the estimates last autumn was 5 per cent. per annum. cost, with the result that the remaining needs to be The Committee noted thattheDirector -General financed would be approximately Sw. fr. 15 680 000 was still maintaining in his new estimates an assump- (US $3 629 630),i.e.,Sw. fr.20 000 000 lessSw. tion of an overall average price increase of 5 per cent. fr. 4 320 000 (US $1 000 000).
2 See Annex 3. 1 Off. Rec. Wld Hlth Org. 124, Annex 15, part 1, Appendix. 3 See Annex 9. ANNEX 7 89
Appendix
COST ESTIMATES FOR HEADQUARTERS BUILDING
asat 30 April 1963
Sw.fr. Sw.fr. Contracts already awarded (honoraria included), value at 30 April 1963 : Section I (including adjustments) 23353056 Section II (contracts awarded up to 30 April 1963) 4623264 Total of awarded contracts, value at 30 April 1963 27976320 Contracts remaining to be let (honoraria included) : Section II 8415576 Section III, value at 17 July 1961 9119390 Increase, Section III, up to 30 April 1963 based on 5 per cent. per annum 767854
Total of contracts to be let at 30 April 1963 18302820
TOTAL VALUE OF CONTRACTS AT 30 APRIL 1963 46279140 Garages (approximately 400 places), value in April 1962 4000000 Increase, garages, at 30 April 1963 based on 5 per cent. per annum 200000
Total, garages, at 30 April 1963 4200000
Total, all constructions, at 30 April 1963 50479140 Contingencies : 5 per cent. of Sw.fr. 50 479 140 2523957 Increase to be foreseen in the construction cost (5 per cent. per annum) : between 30 April 1963 and 31 December 1963 1765000 between 1 January 1964 and 31 December 1964 2738405 between 1 January 1965 and 30 November 1965 2635714
7139119 Other costs 400000
GRAND TOTAL 60542216
Approximate savings if the capacity of the garages were reduced to about 300 places: Sw.fr. 1 000 768
2. PROGRESS REPORT BY THE DIRECTOR -GENERAL [A16 /AFL /12 - 6 May 1963]
1.Building Progress about three months behind schedule when, in January and February 1963, the exceptional severity of the 1.1 On 24 May 1962, Dr S. V. Kurasov, President of winter completely or partly prevented work on the the Fifteenth World Health Assembly, laid the founda- site for a few weeks. Since the resumption of activities tionstoneof thefutureheadquartersbuilding. on 18 February the main building work has progressed Immediately afterwards earth -moving operations and at a satisfactory rate.Since March the firm has been the main building work began. However, unfortuna- working in two shifts from 4 a.m. until 9.30 p.m. tely, from the very beginning, the contractorre- As a result of these special efforts the building is sponsible for the main building work fell behind his beginning to rise above ground, the larger part of the time -table. basements now having been finished. 1.2Despite the undeniable efforts made by the 1.3 During all this period the films to which contracts contractor to speed up progress, the work was already have been awarded for heating and air -conditioning, 90 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I plumbing, electricity and lifts have been producing ments in cash or in kind received, offered or con- the equipment, which they will begin to install as soon templated as of 7 November 1962. Some governments as the main building work is sufficiently advanced. have since offered gifts in kind or stated that theyare thinking of doing so in the near future.Discussions 2.Tenders and the Award of Contracts forthe are in progress with these governments with a view to Second Section of the Work obtaining details of their proposed contributions to 2.1 For the purpose of letting the contracts, the various the headquarters building. The Standing Committee, types of work involved in the building of the new head- within whose competence falls the acceptance of gifts quarters were divided into several sections, of which in kind, will be informed of all these cases at its next the first is now under way; the second section consists meeting. of the following: 3.2Apart from certain offers of marble, tropical proofing and metal fittings; timber and decorative panels and sculptures, the gifts metal façades; are concerned with the furnishing of the offices for the light metal door- and window -frames; Director -General, the Deputy Director- General and glass; the Assistant Directors -General, and of thestaff movable partitions; lounge.There are still, however, offices, halls and metal ceilings and light fittings ; meeting rooms whose furnishing and decoration could doors and door -frames, usefully be the subject of government donations.In In accordance with the " Procedure for the Inviting particular, there are the Executive Board Room, the of Tenders and the Award of Contracts ",1 drawn up four committee rooms, the entrance hall, etc.Still by the Standing Committee on Headquarters Accom- other possibilities were mentioned in the list attached modation, the tender documents for this work were to a letter sent by the Director -General on 31 October sent out on 15 December 1962 to ninety -one firms 1962 to the governments that had not already at that from ten countries, two of them outside Europe. date indicated their intention to contribute. 2.2The public opening of the tenders received took place as planned on 1 March 1963 in the presence of 4.Cost of the Building representatives of the architect, the consultant electrical engineer and the tendering firms. The tenders opened 4.1 As on Headquarters came from firms in six countries. Four tenders were Accommodation and the Director- General pointed received for proofing and metal fittings, eleven for out in their reports to the Executive Board at its thirty - metal façades, six for the external light metal door- and first session,3 building costs in Geneva increased by window- frames, two for glass, twelve for movable about 25 per cent. between 1959 and 1962.There partitions, twelve for metal ceilings and light fittings, is reason to believe that building costs will continue and seven for doors and door -frames. to increase by at least 5 per cent. per annum, which would involve a further increase of about 15 per cent. 2.3After these tenders had been examined and reports from the architect and the consultant electrical before completion of the work, which is expected at the end of 1965. engineer had been studied, the Director -General, in accordance with paragraph 11 of the " Procedure " 4.2This constantin crease in building costs has mentioned in paragraph 2.1, awarded the contracts had important repercussions on the cost of the head- for proofing and metal fittings, light metal door- quarters building.All earlier forecasts of the cost frames and window- frames,glass,metal ceilings, have been upset. The original project, which formed light fittings and doors and door -frames to the firms the basis for the authorization to build given in 1960 which had submitted the lowest acceptable tenders. by the Thirteenth World Health Assembly (resolution At the date of this report no decision had yet been WHA13.46) has had to be revised several times to made regarding the award of contracts for metal keep the cost within the limits fixed by that Assembly. façades and movable partitions. The report of the Standing Committee 4 referred to above summarizes the various reductions made in 3.Gifts from Governments the original project. 4.3With the report of the Director -General on the 3.1 The December 1962 report submitted to the financial situation as of 2 November 1962 s before Executive Board by the Standing Committee on Head- it, the Standing Committee " discussed whether it quarters Accommodation 2 lists the gifts from govern- 3 Of Rec. Wld Hlth Org. 124, Annex 15, parts 1 and 2. 1 Off Rec. Wld Hlth Org. 106, 47. 4 Of Rec. Wld Hlth Org. 124, Annex 15. 2 Off. Rec. Wld Hith Org. 124, Annex 15, part 1. 3 Of Rec. Wld Hith Org. 124, Annex 15, part 1, Appendix. ANNEX7 91 would be possible to recommend to the Board sub- tually valid price increases since the contracts were stantial amendments to the building programme " signed in1962. but concluded " that any further large -scale change 4.8The same tendency was also noted when the in the programme might seriously affect the utility tenders for the second section of the work were of the building ".1 opened. Although inall these cases the lowest 4.4At the same time the Committee, at the suggestion acceptable tender was approved, the totalof the of the Director -General, reconsidered the question contracts already awarded for this section of the work of the underground garages, which had been eliminated by 30 April 1963 was 9.15 per cent. higher than the for reasons of economy even before the original estimates made by the architect in 1961.As to the project had been submitted to the Thirteenth World two large contracts for the metal façades and movable Health Assembly. Since the land area made available partitions, which have not yet been awarded, the to the Organization by the Canton of Geneva has offersreceivedforecastan even more important proved too small to provide for the estimated six increase. hundred vehicles to be parked without detracting too 4.9This latest information can leave no doubt that much from its appearance, an underground garage for the recommendation made by the Executive Board about four hundred vehicles was included in the to the World Health Assembly that the sum envisaged estimate of the building costs in paragraph 5 of the for completing the building should " be increased to Director -General's above -mentioned report on the about sixty million Swiss francs " was well founded. financial situation.2 4.5TheStanding Committee concurredinthe Director- General's view that an underground garage 5. Finance for a certain number of vehicles would be necessary 5.1 InaccordancewiththeExecutiveBoard's in addition to the surface parking. In pursuance of the request(inresolutionEB31.R25), theDirector - suggestion made by the Standing Committee when General initiated discussions with the authorities of the itconsideredthisquestion,theDirector -General Swiss Confederation with a view to examining the approached the authorities of the Canton of Geneva in possibilities of increasing the amount of the interest - order to explore every possibility that might arise of free loan offered to the Organization, in order to using additional land to increase the available outside cover these additional costs. parking areas.The only immediate result of the discussions was that authorization was received from 5.2 A letter, dated 4 May, from the Head of the the Department of Public Works to use an area of Swiss Federal Political Department to the Director - adjacent land which would provide parkingfor General is reproduced below (translation from the about a hundred vehicles. French): With reference to our correspondence and various 4.6The Executive Board, after considering at its interviewsconcerningtheadditionalfinancial thirty -first session the report of the Standing Com- means requested from Switzerland for the construc- mittee on Headquarters Accommodation,3 and the tion of the headquarters building of the World report by the Director- General on the progress of Health Organization in Geneva, we have the honour work,4 adopted the resolution EB31.R25. to inform you that this question is now being studied 4.7Since January 1963 new indications have con- by the competent federal and cantonal authorities. firmed the tendency for building costs to rise.Thus We can assure you that it will be given sympathetic the various firms awarded contracts in 1962 have consideration; nevertheless, since no decision in notified new price changes which increase by 4.78 regard to the extent and conditions of our possible per cent. the total amount of their contracts for the participation has so far been reached, we are un- period between 1 January and 30 April 1963 alone, fortunately not yet ina positiontogiveyou and bring up to 7.06 per cent. the increase in the fuller information. However, we hope to be able to amount of those contracts resulting from contrac- do so in the near future.
1 Off. Rec. Wld Hlth Org.124,Annex 15, part 1, para. 7.2. 2 Off. Rec. Wld Hlth Org.124,Annex 15, part 1, Appendix. 3 Off Rec. WId Hlth Org.124,Annex 15, part 1. 4 Off. Rec. Wld Hlth Org.124,Annex 15, part 2. 92 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Annex 8
DEVELOPMENT OF MALARIA ERADICATION PROGRAMME IN 1962 [A16 /P &B /3 - 12 March 1963] REPORT BY THE DIRECTOR - GENERAL
CONTENTS
Page Page Introduction 92 7. Problems facing Malaria Eradication 109 7.1Problem Areas 1. General Progress and Prospects 93 109 7.2 Resistance of Malaria Parasites to Drugs . 110 1.1 The Over -all Picture 93 7.3 Vector Reactions to Insecticides 110 1.2 Global Epidemiological Assessment 94 8. Research 117 2. Training of National Malaria Eradication Staff . 97 8.1Parasitology of Malaria 118 3. WHO Technical Services in the Field of Malaria 8.2 Chemotherapy 118 Eradication 99 8.3 Immunology 119 8.4 Epidemiology 119 4. General Health Services and Malaria Eradication 8.5 Entomology 120 100 Programmes 8.6 Developments in Insecticides 120 101 5.Operational Aspects 9. Co- ordination 121 5.1Eradication Programmes 101 5.1.1 Planning, Organization and Management101 10.Status of Malaria Eradication, by Regions . 122 5.1.2 Spraying Operations 101 10.1African Region 122 5.1.3 Drug Administration 102 10.2 Region of the Americas 124 5.1.4 Epidemiological Evaluation and Surveil- 10.3 South -East Asia Region 128 lance Operations 103 10.4 European Region 131 5.2 Pre- eradication Programmes 104 10.5 Eastern Mediterranean Region 134 5.2.1 Planning 105 10.6 Western Pacific Region 139 5.2.2 Health Infrastructure 106 5.2.3 National Malaria Service and Antimalaria Appendix 1.Detailed Status of Malaria Eradication as Activities 106 at 31 December 1962 144 5.2.4 Progress in Pre -eradication Programmes . 107 Appendix 2.ProfessionalStaff employed in National 6.Registration of Areas where Malaria has been Eradi- Malaria EradicationServicesasat31 cated, and Maintenance of Achieved Eradication . 108 December 1962 154
INTRODUCTION
A giant stride in 1962 has been the transfer to the people are covered by the Indian programme, but consolidation phase of the 168 million people living 13 million are in the Americas and 2 million in in areas where transmission of malaria has ceased the Eastern Mediterranean Region.Another stimu- for a sufficient time to allow the reservoir of infection lating event has been the addition of 13 million in the population to reach such a low level that people to the total of those living in areas from which spraying operations could safely be stopped and malaria is considered to have been eradicated. replaced by surveillance.Most of these 168 million After the attainment of the consolidation phase progress is sometimes handicapped by a slackening 1 See resolution WHA16.23. of interest and by a premature reduction of financial ANNEX 8 93 support to the campaign, just when the mopping up The Expert Committee on Malaria, which included of the last hidden cases and foci demands the greatest expertson publichealthadministration, met in screening effort and deployment of talent and ima- April 1962 and, after considering a report by a gination. consultant, made important recommendations 1 on the Considerable preparatory progressisalso being parallel development of an adequate health infra- made in areas not yet ready for malaria eradication structure as being essential for the achievement of programmes. The formulation of the policy of pre - malaria eradication.It laid special stress on the eradication programmes has found enthusiastic accep- necessity for the closer relationship between the tance in the less developed countries. Such pro- general health services and the malaria eradication grammes are now being developed in twenty -three services at all stages of the malaria eradication pro- countries of Africa and Asia.A marked impetus grammes. WHO is putting great emphasis on the has been given to the development of these program- implementation of these recommendations, which mes by the Organization's readiness to accelerate the will stimulate and speed up the organization of the global malaria eradication programme. Unfortunately, public health services of the developing countries to the progress of such momentum is dependent on the a level at which they will be able to assist in the continuation of voluntary contributions. development of the malaria eradication programme.
1. GENERAL PROGRESS AND PROSPECTS
1.1The Over -all Picture basis, and which gives strong justification for the pursuit of the programme with unrelenting vigour Achievements in 1962 have been apparent in every and determination until the final goal is reached. aspect of the global malaria eradication programme. Following resolution WHA15.20 of the Fifteenth The greatest advance has been in the population in World Health Assembly, calling for acceleration of areas under consolidation, which has increased to the development of basic public health and organiz- 243 million in 1962, as compared with 75 million in ationalfacilitiestoshorten the time needed for 1961. Table A gives a summary of the status of malaria total malaria eradication, particular emphasis has eradication by regions asat31 December 1962. been placed on pre- eradication programmes in 1962. Early in1963, the whole of continental Europe By the end of theyear there were twenty -three reached the consolidation phase of the programme, countries with this type of programme, either started thus achieving the aims of the Co- ordinated Plan or at the advanced planning stage. establishing Priority for the Eradication of Malaria The demand for adequately trained national and in Continental Europe, which was formulated at the international staff of every speciality, particularly for First European Conference on Malaria Eradication, the African and Western Pacific Regions, continued held at Palermo in 1960. and increased in 1962. The established malaria erad- As the all -out attack phase advances, problems ication training centres at Belgrade(Yugoslavia), emerge here and there.Besides the administrative SaoPaulo(Brazil),Kingston (Jamaica) andin difficulties, due to either organizational deficiencies Venezuela were supplemented by two courses in or financial shortcomings, the technical difficulties in Moscow, one in English and one in French. The new interrupting transmission, sometimes leading to the malaria eradication training centre at Lagos, Nigeria, developmentof so- called" problem areas "(see held its first course in October 1962. Training should section 7.1, page 109), require special local study and begin in Lomé (Togo) during the second half of supplementary attack measures.In one country at 1963 and should recommence in Manila (Philippines) least (El Salvador), malaria transmission in certain about the same date. In 1962, national training centres areas has defied all residual insecticides. A combina- in Ethiopia, India, Indonesia, Pakistan and Sudan tion of physiological resistance and behaviouristic continued their activities. changes has made the vector refractory to the ima- The scheme for exchange of scientific workers gocidal attack, and while a more appropriate, alter- again proved extremely valuable in 1962 in enabling native remedy is being looked for, the malaria incidence senior officials concerned in national malaria eradi- is returning to the original pre -DDT levels.In one cation activities to visit other programmes and related way this failure is a serious and regrettable setback; scientific centres and thus gain additional experience it is also a far -reaching event which amply confirms and solve problems. the foresight of the Eighth World Health Assembly 1 See ninth report of the Expert Committee on Malaria in urging the eradication of malaria on a global (Wld Hlth Org. techn. Rep. Ser., 1962, 243). 94 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
TABLE A. SUMMARY OF STATUS OF MALARIA ERADICATION, BY REGION, AT 31 DECEMBER 1962
Population, in thousands,
of areas where of areas where eradication programmes in progress of areas of areas malaria never of where Region indigenous or malaria where original Total disappeared eradication in the eradication malarious in the in the programmes without specific areas claimed consolida- antimalaria (mainten- tion attack preparatory Total not yet measures ance phase) phase phase phase started
Africa 172 434 14 815 157 619 3 278 1435 1 155 - 2 590 151 751 The Americas . . 429 726 275 835 153 891 59 326 30 436 49 386 13 753 93 575 990 South -East Asia . 634 678 35 238 599 440 1467 162 028 381 060 9 191 552 279 45 694 Europe 698 861 391 937 306 924 245 744 30 026 12 987 - 43 013 18 167 Eastern
Mediterranean. . 212 546 36 419 176 127 1 884 14 486 12 705 10 077 37 268 136 975 Western Pacific (excluding China (mainland), North Korea and North
Viet -Nam) . . . 215 573 137120 78 453 17 367 4 766 3 809 280 8 855 52 231
Total 2 363 818 891 364 1 472 454 329 066 243 177 461 102 33 301 737 580 405 808 (3 058 930)*
* The figure in brackets includes the estimated population (of 695 112 thousand) of China (mainland), North Korea and North Viet -Nam from which no other information is available.
1.2Global Epidemiological Assessment TABLE C. POPULATION OF ORIGINALLY MALARIOUS AREAS IN THE MAINTENANCE AND CONSOLIDATION The global epidemiological assessment isbased PHASES IN 1961 AND 1962 mainly on information received through the WHO - promoted quarterly reports on surveillance operations. Percentage Population of The general adoption of this system would provide Population in areas population the basis for an effective and comprehensive assess- of originallyunder con-of originally Region Year malarious solidation malarious ment.By the end of 1962, the number of countries areas (in and areas under thousands)maintenanceconsolida- submitting quarterly reports on surveillance opera- (in tion and tions had reached thirty -eight (including four coun- thousands)maintenance. tries in the attack phase only). This is fourteen more than in 1961, most of them in the Region of the Africa 1961 152557 4581 3.0 Americas.The situation at the end of 1962 with 1962 157619 4713 3.0 regard to countries wholly or partly in the consoli- The Americas . . 1961 146592 74158 50.6 dation phase can be seen by regions in Table B. 1962 153891 89762 58.4
TABLE B.REPORTING OF SURVEILLANCE South -East Asia . 1961 570759 8073 1.5 OPERATIONS IN 1962 1962 599440 163495 27.2
Europe 1961 302420 270363 89.4 Countries with Countries submitting Region programmes in the quarterly reports 1962 306924 275770 89.8 consolidation phase on surveillance Eastern Mediterranean. 1961 172284 14421 8.4 4 Africa 2 1962 176127 16370 9.3 The Americas . . . . 22 13
South -East Asia . . 5 3 Western Pacific . . 1961 75311 25495* 33.9 9 Europe 7 1962 78453 22133 28.2 Eastern Mediterranean 7 6
Western Pacific . . . 5 3 Total 1961 1 419923 397091 27.7 19621 472454 572243 38.8 By the end of 1962 the population of originally malarious areas that had reached the consolidation * Corrected figure. ANNEX 8 95 and maintenance phases was 11.1 per cent. higher noticeable in some programmes, especially in the than in 1961 -i.e. it had increased from 27.7 to 38.8 organization and supervision of the active surveil- per cent. (see Table C).Of the total population of lance mechanism -as has been evidenced by the 1472 million in the originally malarious areas, there failure to discover rapidly enough sources of infection were at the end of 1962 (as will be seen from Table A) in areas in the consolidation phase before they gave 572 million people in areas in these two phases -an rise to extensive active malaria foci -and also in the actual increase of 44 per cent. over the number, slow progress being made in the participation of 397 million, recorded in 1961.The greatest increase health services in case -detection, owing to the inade- occurred in South -East Asia where withdrawal of quacy of the rural health services.This latter defect spraying on completion of the attack phase in India may well lead to the prolongation of the consolidation covered areas with a population of 153 million.In phase and to delay in achieving eradication. the Americas, areas with thirteenmillion people Adherence to the criteria recommended by the entered the consolidation phase during the year, and Expert Committee on Malaria for withdrawal of malaria is claimed to have been eradicated from areas spraying, and theuse of independent assessment with a further three million.In Europe, areas with teams to help the government authorities to evaluate a further five million and in the Western Pacific areas the achievements, have contributed to the strengthen- with a further million people entered the maintenance ing of epidemiological activities. The assessment phase.In the Eastern Mediterranean areas with a teams scrutinize all the epidemiological data and make further two million were moved from the attack check visits to evaluate the efficiency of the case - to the consolidation phase. detection mechanism and theproficiencyof the The assessment of the qualitative aspect of the laboratory services. global eradication programme is difficult to express, The progressivedepletionof thereservoirof but there are definite signs of the strengthening of malaria infection(as shown in Table D) in areas epidemiologicaloperations,namely,case -detection which have been in the consolidation phase for more mechanisms, laboratory services and entomological than one year is a favourable sign. A marked decline activities. The intensification of training for microsco- in the annual parasite incidence can be noticed in pists and surveillance agents, the organization of most programmes.In a few programmes, where specialized courses in epidemiology and entomology, case -detection and arrangements for administration and the increase in the number of microscopists and of radical cure have not been sufficiently strengthened, of supervisory staff of surveillance operations, are there has been either no change or else an increase all good signs of progress.However, defects are in the parasite rate.
TABLE D. COMPARATIVE EPIDEMIOLOGICAL DATA, 1961 AND 1962, FOR AREAS IN THE CONSOLIDATION PHASE, BY REGION AND COUNTRY (population in thousands)
Population in areas Annual Annual incidence of in consolidation parasite newly transmitted Region and country phase incidence o /oo infections o /oo*
1961 1962 1961 1962 1961 1962
Africa Mauritius 264 263 ... 0.023 ... 0.0075 The Americas Argentina 41 624 0.4 (0.02) 0.25 (0.018) Bolivia 461 759 (0.03) (0.037) (0.002) (0) British Honduras . . . . - 100 - 0.36 - 0.36 Colombia - 3 027 - (0.02) - (0.004) Costa Rica - 230 - 0.43 - 0.3 Guadeloupe 186 66 0 0 0 0 Guatemala - 498 - 0.35 - 0.2 Honduras - 46 - 0.065 - ... Jamaica 761 1 282 0.01 0.001 0.0013 0 Mexico 11 721 15 592 0.23 0.25 0.18 0.2 Nicaragua - 515 - (0.31) - ... Panama Canal Zone . . . 41 44 0.61 (0.41) 0.61 0.41 96 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Population in areas Annual Annual incidence of in consolidation parasite newly transmitted phase incidenceloo infections o /oo* Region and country
1961 1962 1961 1962 1961 1962
Peru 47 864 0.021 0.02 ... 0.002 Surinam 115 125 0 0.008 0 0
Trinidad and Tobago. . . 197 877 0.005 0.001 0 0 Venezuela 173 150 0.63 0.35 0.17 0.09
South -East Asia Afghanistan 86 87 0.035 (0.08) 0 0
Burma 3 500 4 100 (0.035) 0.19 (0.004) ... Ceylon 1 260 1 294 (0.011) 0.003 (0.001) 0 India 1 800 154 887 0.01 0.017 0.007 ... Thailand - 1 660 - 0.95 ** - 0.9 Europe Albania 786 1 053 0.052 0.018 0.032 0 Bulgaria 55 48 0 0 0 0 Greece 2 437 2 167 0.05 0.046 0.024 0.027 Portugal 631 678 (0.027) (0.02) (0.008) (0.004) Romania 5 747 6 326 0.002 0.002 0 0 Spain 294 298 0.06 0.003 0.017 0 Turkey 17 959 18 268 0.05 0.055 0.04 0.038 Union of Soviet Socialist Republics 2 000 890 0.033 0.15 0.025 0.1 Yugoslavia 258 298 0.05 0.003 0 0
Eastern Mediterranean Iran 5 500 6 000 0.13 0.42 0.09 0.3 Iraq 3 300 4 163 0.002 0.097 0 0.086 Israel 1 499 1499 (0.029) (0.024) (0.003) (0.003) Jordan 480 851 0.067 0.28 0 0.22 Lebanon 683 683 0.009 0.28 0 0.14 Libya 14 25 ... 0.72 ** ... 0.68 Syria 1123 1 265 0.021 0.027 0.0035 0.006
Western Pacific China (Taiwan) 800 945 0.14 0.021 0.087 0.001 North Borneo 13 13 0.3 0.23 0 0 Philippines 3 261 3 261 0.69 0.82 ** 0.35 ... Sarawak 571 505 0.32 0.42 0.1 0.29
0 Negative result. - Not applicable. ... No information received. * Incidence of cases grouped under indigenous, introduced and unclassified. ** The annual parasite incidence exceeds the maximum permissible level of 0.5 per thousand population for a consolidation phase area. () Figures in brackets refer to areas where case -detection was inadequate; thus the annual parasite incidence is of limited value.
The progress in continental Europe and the quality most of the countries of Zone I of the Region of the of the epidemiological work performed there has been Americas, namely Venezuela and seven Caribbean impressive.In the whole of Europe, 4518 cases of island administrations (Dominica, Grenada, Guade- malaria were reported during 1962, of which 3594 loupe, Jamaica, Martinique, St Lucia and Trinidad were in Turkey.No indigenous malaria case was and Tobago), promise imminent achievement of reported in Spain in 1962, and none in Bulgaria in 1961 and 1962. eradication in the whole Zone.In the seven island In Venezuela, eradication was certified in 1961 as administrations, no indigenous malaria case due to having been achieved in an area with a population Plasmodium falciparum or P.vivax was reported of 4 325 000, and the excellent results obtained in during 1962. MAP 2.EPIDEMIOLOGICAL ASSESSMENTOF STATUS OF MALARIA, DECEMBER 1962
:1/6,6 11,/i,/1//1//611>11/11/ 1/ ,/1 ,1/1¡/ 1111/1'/11111/11 /1,11,/1,/1i111/11:///%::ii%;:%;:%s%%::%% /11:111111//1/1111'/1/1// 1 ,i/1i111111/11ii1/1:i1/////i// I// /,1 !/ 0/.0,:;:01,//////¡,// r11/,//// " /,,////1///,r/11/11//11/11/// 4:1/1//li/% /11//11/11 4/111 /1,/1,///1/1:11//1111,// 111' ,/,,,,,,/1/1111111//1//111/')/, /,,,l,/,,/' /'/,//¡/,,/ ///,/,,11 /,/ //, sl//////11i11i/1//111/.;ll/11111i/ A';! ! 1/11111//1;1/111>1,J///¡11/1111//11//l'//l'/1i/1/11111/:111////1//1/!11l11/>1,/1/1111/11° '/ ' 11/11/11111//11/111/11;!.1/ / // //// ///> / // /// 1'/11'//11/1/1/11//1/1/i1'/i1//1//1/////111//'//'/1/1//// 111i1///¡i/¡i/1¡11¡/`iï//¡/¡!1¡!1¡/1¡/1'çi/1/11/11'' ifj11%1/11111j1111111111111111111'11l11/11/ %iii1/'y ¡¡1¡¡1'¡' /;%1%,' :,;11111/111111111> '0%!,: 000/0/0/ '"'s'1 ' 1!1/;$/1¡1 1 /',11111/1i'/ f'//Ikt/%!% / '//i11'il'/ 1111 ii/ i1/1:Îi/11fd//, .
i,. JAMAICA alq PUERTO RICO , GUADELOUPE t DOMINICA MARTINIQUE ST. LUCIA
BARBADOS GRENADA TOBAGO TRINI DAD
SÁO TOMÉ - ZANZIBAR COMORO 4:21:10643e.CL'zV
MAURITIUS
REUNION O
SWAZILAND
AREAS IN WHICH MALARIA HAS DISAPPEARED OR NEVER EXISTED
MALARIOUS AREAS NOT YET IN CONSOLIDATION PHASE
AREAS IN CONSOLIDATION PHASE op /. f1 ¡ ¡1 AREAS IN WHICH MALARIA HAS BEEN ERADICATED
COUNTRIES FROM WHICH INFORMATION IS NOT AVAILABLE IN REGARD TO THE PRECISE EXTENT OF THE MALARIOUS AREA AND THE EPIDEMIOLOGICAL STATUS
WHO 3126 MAP I. EPIDEMIOLOGICAL ASSESSMENT OF STATUS OF MALARIA,DECEMBER 1961
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SINGAPORE
l ZANZIBAR -o
MAURITIUS J
REUNION O
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AREAS IN WHICH MALARIA HAS DISAPPEARED OR NEVER EXISTED
MALARIOUS AREAS NOT YET IN CONSOLIDATION PHASE
AREAS IN CONSOLIDATION PHASE cup ? AREAS IN WHICH MALARIA HAS BEEN ERADICATED
COUNTRIES FROM WHICH INFORMATION IS NOT AVAILABLE IN REGARD TO THE PRECISE EXTENT OF THE MALARIOUS AREA AND THE EPIDEMIOLOGICAL STATUS
WHO 2107 ANNEX 8 97
In Ceylon and India the surveillance activities in favourable signs. The strengthening of WHO technical areas in the consolidation phase are satisfactory.In services in the epidemiological field by the establish- India, of the 140 units that entered the consolidation ment of regional posts for epidemiologists during phase in 1962, only two reverted to the attack phase, 1962, the organization of a refresher course on ad- and seventy -eight more units have already been vanced epidemiological methodology in 1963, and the scheduled for withdrawal of spraying in 1963 and it issue by WHO, in December 1962, of a Manual on is expected that the total population under the conso- Epidemiological Evaluation and Surveillance in Malaria lidation phase in India in 1963 will be about 250 Eradication, will certainly contribute to raising the million. standard of all epidemiological activities.Govern- Some active malaria foci occurred during 1962 in ments requesting WHO teams to certify and register areas in the consolidation phase in neighbouring that eradication has been achieved are stimulated to countries of the Eastern Mediterranean Region (Iraq, strengthen their rural health services, since adequate Israel, Jordan, Lebanon, Syria) and, although these coverage by these services and their proficiency in reflected some weakness in the case -detection me- detecting and eliminating malaria infections are among chanism, yet the quality of the epidemiological work the main criteria to be fulfilled.Other favourable carried out to delimit and eliminate the foci was signs are the promotion of the development of a satisfactory. network of rural health services synchronized with the development of the malaria service, as conceived in In the Western Pacific Region, the eradication pro- the planning and execution of pre- eradication pro- gramme in China (Taiwan) suffered a temporary grammes in developing countries, and the efforts to setback, owing to the appearance of active foci of accelerate these programmes in Africa in order to malaria following the importation of malaria infec- shorten the time needed for total malaria eradication. tions from abroad. The visit of the WHO team for In the global malaria eradication programme, once certifying the achievement of eradication, scheduled the spectacular victories associated with the attack for 1963, has had to be deferred until there is an phase are over, progress will appear slower and be improvement in the case -detection mechanism, espe- less obvious.The management of the later parts cially by medical institutions, and by better control of the consolidation phase and dealing with so -called and follow -up of arrivals from overseas. problem areas will certainly be a challenge to malario- Under the assessment of the global malaria eradi- logists and public health workers, but through deeper cation programme it is appropriate to refer to the knowledge of the epidemiology of malaria, through strategy adopted in the planning and implementation intensified research and studies to perfect epidemio- of this programme. The conviction of public health logical operations and, above all, through man's will leaders of the soundness of the eradication policy and determination to achieve the goal, the final and their determination to achieve this goal are very battle against this scourge will be won.
2.TRAINING OF NATIONAL MALARIA ERADICATION STAFF
Throughout the year the Organization has continued tional responsibility the opportunity of comparing to assist in a vitally important aspect of all malaria operating programmes under different epidemiological, eradication programmes -the training of staff.This physical and administrative conditions. Thus, in assistance has been given in a variety of forms, and addition to acquiring a knowledge of basic malaria is aimed at providing enough adequately trained people eradication techniques, these future executives gain at every level. experience of operational and administrative proce- Every effort is made to arrange wherever possible dures which they can later adapt for use in their own for the various categories of personnel -particularly country programmes. non -professional staff -to be trained in their own During the year the Organization has helped to countries.Not only is this more economical than provide these opportunities in a variety of ways. training elsewhere, especially if large numbers are Existing international centres have been maintained involved, but also training adapted to the environment and new ones have been established, or plans for their in which the personnel are employed is of far greater establishment have been well advanced.Assistance value. with training within Member countries has included For limited numbers of staff at the professional advisory staff to help with teaching and management level and for personnel holding the more responsible of national training centres and supplies and equip- positions in large programmes, training abroad may ment.In addition to the award of fellowships to be necessary and desirable :it gives staff with direc- enable staff of national malaria services to attend 98 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I formal malaria eradication training courses and to gathering momentum. The first course at Lagos was visit operating field projects, awards have again been held from October to December 1962.A similar granted under the scheme for the exchange of scien- training centre at Lomé, Togo, to cater for the needs tific workers. of the French -speaking countries, was being planned The training courses held at international training in1962, for inauguration in1963. The training centres in 1962 and the numbers of national malaria centre in the Philippines is expected to be reopened, eradication staff attending them are shown in Table E. with formal courses beginning in late 1963. Those attending the courses came from more than During the year the Organization continued to 55 countries. support in one manner or another thenational training centres established in Ethiopia, India, Iran TABLE E. COURSES AT TRAINING CENTRES and Pakistan. ATTENDED BY STAFF OF NATIONAL MALARIA In the Ethiopian centre at Nazareth, in addition to ERADICATION SERVICES IN 1962 refresher courses, a fifth course for new trainees was held.Twelve of the thirty students were for Type Number Language Number field operations in general, seven were for entomo- Training centre of of of instructionattending course courses logical work, and eleven were microscopists.The centre in India has, as in previous years, trained Belgrade, Senior 1 French 5 students from other countries of the South -East Asia Yugoslavia Junior 2 French 34 Region. The Institute of Malariology and Parasitology in Teheran held special courses on malaria and Cairo, United Senior 1 English 21 Arab Republic Junior 1 English and 30 malaria entomology for general public health per- Arabic sonnel; and a senior course for ten of the malaria eradication staff.There was in addition a course Kingston, Senior 3 English 37 ongeographicalreconnaissance,forthirty -seven Jamaica Junior 1 English 21 students, (for which WHO gave assistance with the
Lagos, Nigeria Junior 1 English 15 teaching); and a course for fifty microscopists. Acti- vities have been stepped up considerably inthe Maracay, Senior 1 Spanish 33 centres in Dacca and Lahore (Pakistan), which were Venezuela first opened in 1961.In addition to the standard
Moscow, Senior 1 English 16 senior and junior courses, special provision was made USSR Senior 1 French 10 for courses for entomologists, malaria supervisors and malaria inspectors, microscopists, entomological São Paulo, Senior 2 Portuguese 28 technicians and insect collectors :inall,over 360 Brazil Entorno- 1 Portuguese 10 logical students were trained in each of these two centres. The Indonesian centre in Tjiloto, for which the Total 16 Total 260 Organizationhas providedamalariologist,gave courses covering a wide variety of disciplines during 1962, including a three -month course for thirty -three As can be seen, the established centres in Belgrade senior technicians, starting in May; a coursefor (Yugoslavia), Cairo (United Arab Republic), Kingston forty -twoadministrativepersonnel from Julyto (Jamaica),Maracay (Venezuela)andSdoPaulo October; and a one -month refreshercoursefor (Brazil) have continued. Although the centre in twenty -six surveillance operators. In addition, a four - Cairo ceased to be termed an international centre month course for thirty -seven sub -zone chiefs and a before the end of the year, it continued, with WHO two -month course for nineteen medical officers had support, to provide training for all levels of local started before the end of the year.This is by no personnel and for the malaria eradication staff of means the only training carried out in Indonesia, neighbouring countries. where an indication of the needs for field staff can Two senior courses, one in English and one in be gathered from the following provisional estimate French, were held in Moscow from March to June of requirements : sector chiefs, 450; chiefs of opera- and from July to October respectively, and in both tion, 600; chief canvassers, 2700; canvassers, 8000; cases the associated field training was undertaken in squad chiefs, 7000; microscopists, 1100; and chief Turkey and Syria.A new international training evaluators, 600.In Bali, there have been courses centre(English language) was openedatLagos, for sector chiefs, microscopists, medical officers, sub - Nigeria -one of two planned to meet the growing chiefs and administrative officers; altogether some needs of the programme in Africa, which is now 500 people were trained.In Bandung, too, training ANNEX 8 99 has been given special emphasis and 609 of the staff have been made available to give specific teaching were trained, including chiefs of sectors and their assistance. In Afghanistan, for example, courses deputies, microscopists and other field operational were held throughout the year for junior and senior staff. Two new training centres are planned for malariainspectors,and some150 were trained. Sumatra. In Nepal, too, several training courses, lasting from In Sudan the WHO- assisted centre was completed one week to three months, have given training to an towards the end of the year and courses are expected additional 190 personnel. to begin in 1963. Brief reference has been made above to the teaching Apart from thespecificallydesignated malaria of malaria to public health personnel not directly eradication training centres referred to above, the associated with the malaria programme. It is presumed Organization has assisted, wherever possible, with the that such people will indirectly support the programme training aspects of individual country programmes, by their association, for example, with the develop- large and small. In some instances the assistance has ment of a country's health infrastructure.Allied to been the actual organization of a specific course of these are the voluntary collaborators whose services study, such as that held for senior technicians in are utilized extensively in many countries in surveil- China (Taiwan) for the benefit of the countries in lance activities and for whose training no little effort the Western Pacific Region. A similar type of course has been made.Indication of this effort can be was held in the Philippines for field operational gauged from the fact that in Haiti alone 500 of staff at the senior squad or sector chief level.Early these people received training in one month. in 1963 a special course for entomologists took place The WHO advisory staff,in addition to giving at Kuala Lumpur for personnel in the Western direct aid in the preparation and presentation of Pacific Region.In other cases, WHO assistance has specific courses, have helped national staff to prepare been given through the advisory service staff attached teaching media. The use of such manuals and teaching to specific projects, or regional or headquarters staff aids is strongly advocated by the Organization.
3. WHO TECHNICAL SERVICES IN THE FIELD OF MALARIA ERADICATION
To keep pace with the expanding global eradication post to maintain adequate liaison with the WHO programme, e very effort has been made during 1962 country malaria advisers, and a meeting was held of toprovidethebestavailabletechnicalservices. all these advisers, together with the regional office Without an adequate number of well- trained advisory and country WHO public health advisory staff who personnel itisnot possible to give the required are intimately concerned with development of the assistance in planning and carrying -out, at the neces- healthinfrastructureforthepre- eradication pro- sary high standard, the wide range of activities that gramme -the principal item discussed at the meeting. collectively comprise an eradication programme During the year, eleven of the more senior field Besides the advisory services at country level, the projectstaff from differentregionsvisitedother Organization maintains technical personnel at the operating projects under the programme of study regional offices and at headquarters. These three tours for advisers. echelons are interdependent, the responsibility for The serious shortage of sufficiently experienced advising the Director -General on over -all planning personnelavailableforrecruitment has madeit and co- ordination resting with the Division of Malaria necessary for the Organization to continue its pro- Eradication at Geneva.In a similar manner the gramme of selecting staff as trainees and arranging malaria staff at regional offices assist their regional specific intensive training courses for them. The directorsin the provision of technical advice to needs of pre- eradication programmes in terms of governments and in the promotion of country co- developing a basic rural health infrastructure have ordination. made it desirable wherever possible to select medical The staffing of regional office malaria units during officers with public health experience, adding to this the year has reflected the progress of the programme foundation training in malaria eradication techniques. in individual regions. In two regions additional The numbers and categories of the Organization's medical officers have been assigned to assist in the technical staff engaged in the malaria programme in epidemiological evaluation and assessment of pro- December 1962 are shown in Table F, with the grammes. In the Regional Office for Africa the increase corresponding figures for 1958. in the number of programmes to be initiated has The increase in the number of medical officers, justified the establishment of a third malariologist's engineers, entomologists and sanitarians reflects the 100 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I increase in programme activities, and that of admin- on the various advances of techniques, new discoveries istrative officers the necessity of providing advice to and fresh approaches in malaria eradication. In governments on the administrative aspects of their addition to the Organization's regular publications - malaria eradication programmes.Rapid training of such as reports of the Expert Committee on Malaria, national technicians has enabled the Organization monographs and special issues of the Bulletin devoted to reduce its staff in this category in some regions. to malaria and insecticides -mimeographed documents are issued for limited circulation.These documents, issued in over 1500 copies in English and French, TABLE F.COMPARATIVE FIGURES FOR WHO are circulated to national institutes, senior officials of COUNTRY ADVISORY STAFF, 1958 AND 1962 national malaria eradication programmes and public health and research workers who have a particular interest in malaria.During 1962, forty -four such Category December December 1958 1962 papers were produced, four on general aspects of malaria, five on chemotherapy, fifteen on entomology, eight on insecticides, eight on parasitology and four Medical officers 74 117 on other aspects of malaria eradication. The regional Public health advisers - 1 Engineers 19 40 offices similarly issue documents and newsletters of Entomologists 31 57 regional interest. Sanitarians 68 108 A further activity, already referred to in chapter 2, Technicians 31 30 is the preparation of manuals and guides on various Administrative officers - 26 Others * 21 32 aspects of the malaria eradication programme.In 1962 a Manual on Epidemiological Evaluation and Total 244 411 Surveillance in Malaria Eradication was issued by WHO in Geneva and a Practical Guide for Malaria * Assistant malariologists, parasitologists, statisticians, health educators, Entomologists in the African Region of WHO was etc. issued by the Regional Office for Africa. A further The posts are financed from the regular budget, the Expanded Programme of Technical Assistance, the Malaria Eradication Special Account, and the manual on entomology covering the broader global Special Malaria Fund of the Pan American Health Organization. aspects was in preparation at headquarters for issue in 1963.Regional manuals on geographical recon- The Organization has continued to supply workers naissance have been produced by the Regional Offices in all fields of malaria with up -to -date information for Africa and for the Eastern Mediterranean.
4. GENERAL HEALTH SERVICES AND MALARIA ERADICATION PROGRAMMES
One of the requirements for the satisfactory oper- a state of affairs leads to an expensive and sometimes ation of a malaria eradication programme is the ruinous dispersion and misuse of effort and resources, formation in the country of a national malaria eradi- which could be avoided by proper understanding and cation service. The director of such a service should co- ordination. The Organization is doing its utmost have direct access to the chief officer of the ministry to correct this deviation and is trying to ensure that of health and, if necessary, to the minister, and malaria eradication programmes have the full support should have complete administrative control over the and participation of the general health service of the staff of the eradication service and over the expenditure country from the beginning of the campaign, because of the funds allotted to the programme. it is of the utmost importance that such support and In some countries there has been a tendency for participation be forthcoming unstintingly during the the national malaria eradication service to take too consolidation phase and thatthegeneral public literally the recommendation that the service should health service should be prepared to accept the full have " operational autonomy " and thus there has responsibilityforthe maintenance phase of the developed a segregation, with the result that the programme when the national malaria eradication malaria eradication service has divorced itself from service, having fulfilled its function, is disbanded. other branches of the ministry of health, causing the But good understanding, close collaboration and officials of the general public health service to lose perhaps " integration " will solve the problem, at all contact with it and, what is worse, to lose interest least in those places where the population is actually in a campaign which generally has the first priority " covered " by public health services.In areas where amongst the country's public health endeavours. Such such services are deficient or non -existent, the lacunae ANNEX 8 101 should be filled by the establishment of new health the following :that a proper mental attitude should posts, especially in vulnerable areas, which are those be created throughout the entire health organization having a high potential for transmission and at the towards the malaria eradication programme; that same time a liability to the reintroduction of the public health planning groups and malaria eradication disease.Unfortunately, almost all the rural areas of boards should be established for policy guidance and the countries in the tropics fall into this category. should be attended by staff of both the general It must be understood, therefore, that when the term health services and the malaria eradication service, " public health services " is used in connexion with and that at all levels the chiefs of the respective are malaria eradication," ruralhealthservices " servicesshouldmaintainco- ordinationoftheir meant, and these should be spread with more emphasis activities through frequent and close contact until on geographical coverage than on high technical their services were merged.The Organization is standards.A few model health centres will be of very little help to the malaria eradication campaign. implementing these recommendations. With this In its ninth report 1,the Expert Committee on aim, a seminar for advisers at country level was held Malaria made a number of suggestions to ensure in Ibadan, Nigeria,in October 1962, and other adequate co- ordination at all stages in the development seminars are being planned for the benefit of respon- of the malaria eradication programme. They include sible national authorities.
5. OPERATIONAL ASPECTS
5.1Eradication Programmes often there has been insufficient effort in the prepar- ation and planning of these basic health services, so 5.1.1Planning, Organization and Management that their necessary full and effective participation in Most governments with malaria eradication pro- the relevantactivitiesof the malaria eradication grammes in operation have continuedduring 1962 programmes has been lacking. to recognize the importance of realistic anddetailed Having reviewed the situation in the light of these planning.It has to be noted, however, that in several factors, some governments have decided to aim at major programmes the execution of plans of action eradication by way of a pre- eradication programme, and the organization of operations have been ham- which will enable them gradually to build up the pered in varying degrees by defective management essential health infrastructure and train personnel for practices, particularly with regard to the national the future national malaria eradication service.This financing of these programmes.In many instances has resulted in some cases in the conversion of pre - throughout the year, malaria operations failed to eradicationsurveys and pilotprojectsintopre - reach planned targets because national funds were eradication programmes whichwill enhance the diverted to other government programmes, despite prospects for eventual success of the future pro- the fact that governments had agreed upon and grammes of malaria eradication. appropriated the funds estimated as required in the 5.1.2Spraying Operations plans for the malaria eradication programme. Failure to achieve total coverage in spraying and surveillance Although there has been no important change operations may prolong the time needed to reach during the year in the methodology of spraying eradication and may therefore entail greater financial operations, there has been increasing acceptance of outlays by the government and by participating the need for greater field supervision. There are still, agencies. however, large programmes in which the spraying There has been a growing recognition on the part operations are not the responsibility of special officers, of governments during the year under review that and the desirability of employing engineers for these the practicability of reaching and maintaining eradi- operations is not universally appreciated. cation depends on the existence in their countries of The following figures indicate the vast scale of essential basic health structures and services, and that these spraying operations.More than 50 000 tons without such services success is unlikely.This is of insecticide are used annually in malaria program- particularly relevantinrelationtothe extent of mes.This material is distributed in nearly a million coverage by the basic health servicesneeded to drums to 25 000 spraying squads.It is mixed with support surveillance and vigilance operations.All too 200 million gallons of water (occasionally with kero- sene) and sprayed on the inside walls and ceilings Wld Hlth Org. techn. Rep. Ser., 1962, 243. of 100 million houses at intervals of six to twelve 102 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I months.The insecticide used annually costs some continued to be used as the main antimalarial measure $30 million and the transport and spraying equipment in the consolidation phase of eradication programmes, used -a quarter of which needs to be replaced every with the purpose of eliminating all residual or impor- year- represent an investment of another $30 million. ted infections and thus ensuring eventual complete The value of sound geographical reconnaissance is eradication of the disease. As a precautionary measure, receiving ever -increasing recognition; it is not only a single -dose treatment is usually given to all suspected a necessity for malaria programmes in the attack malaria cases, followed by radical treatment after phase, but is vital if the consolidation phase is to be microscopical confirmation of the infection. The implemented successfully. As a help in tackling this seriousdifficultiesthat are encountered in many difficult problem effectively and economically, espe- programmes in providing for prompt and complete ciallyinareaswithscattered and impermanent radical treatment of all confirmed cases have once habitations, a manual is being prepared, on the basis more emphasized the need for an efficientrural of the field experience of engineers and sanitarians in health service as an essential condition for implement- all regions. ing the consolidation phase.The building -up of New and temporary houses, replastered walls and such a service is one of the main aims of pre- eradi- new roofs, rooms inaccessible for spraying because cation programmes, which are now being adopted by of grain storage, silk -worm culture, or simple refusal an increasing number of countries. to permit spraying, and seasonal and nomadic popu- Mass drug administration, either direct, by tablets, lation movements, make the achievement of total or indirect, by medicated salt, has its main application coverage often difficult and sometimes impossible. in the attack phase of an eradication programme.It These problems are tackled in various ways, depending may be used as an adjuvant measure to house -spraying on the local situation, but with a degree of success in areas where insecticides alone are fully effective that enables most programmes to adhere to a planned in interrupting transmission. In this case, drug admin- schedule. istration is not strictly necessary, but even if it is The insecticide used in by far the greatest number given only at the time of the spraying round, it will of projects is a suspension of DDT water -dispersible contribute to reducing the parasite reservoir and powder.Special circumstances necessitate the use of thereby hastentheinterruptionof transmission. dieldrin in some projects.Kerosene solutions or Moreover, a single -dose treatment given at the time water emulsions of these insecticides are sometimes when house spraying is carried out is often helpful in required.No convincing evidence has been forth- promoting co- operation of the inhabitants with the coming to warrant widespread changes in the existing spray teams. dosages and frequency of application of the insecti- Much more important is the use of mass drug cides in use.In addition to small -scale insecticide administration as a complementary method to house trials in the Americas, a full -scale field trial of mala- spraying in areas where, owing to the habits of the thion has been organized in Uganda and the initial vector or of man, complete interruption of trans- operations, begun at the end of 1962, will continue mission cannot be achieved with insecticides alone. through 1963.The WHO insecticide testing team in As more and more programmes are approaching the Lagos, Nigeria, had completed its investigations with end of the attack phase, a certain number of areas dichlorvos(DDVP)(2,2- dichlorovinyldimethyl have been found where, despite several years of total phosphate) with promising results, and a field trial coverage with insecticides, transmission is still going with this fumigant insecticide is being undertaken in on.With the disclosure of these " problem areas ", Northern Nigeria in 1963. where for various reasons malaria is refractory to There is considerable interest in improvements in insecticides, the need for mass drug administration spraying equipment. The rubber disc flow regulator, as a complementary method to house spraying has which had undergone extensive field tests, has been been accentuated and an increased use of this measure adopted in a number of programmes; when certain is to be expected during the next few years. In certain technical improvements are completed, a wide use problem areas in the central part of the Americas of this device is expected. An expert committee on (Mexico, Guatemala, Nicaragua and El Salvador) insecticides to meet in 1963 will consider, inter alia, regular mass drug treatment as a complementary the revision and extension of specifications for vector method of attack has been introduced. control equipment used in malaria programmes. In areas where house spraying is either ineffective or impracticable and where mass drug administration 5.1.3Drug Administration appears to be the sole possible method of attack, There have been no important changes in the use of interruption of transmission by the use of drugs antimalarial drugs during 1962.Chemotherapy has alone cannot be expected unless complete coverage ANNEX8 103 is achieved.Experience has shown that, however during the incorporation of the drug into the common efficientthedistributionsystem,itispractically salt, and at the end, for the evaluation of the pro- impossible to ensure that a hundred per cent. of a gramme, when itis necessary to ascertain whether population will take a certain number of antimalarial the medicated salt is actually being consumed by the tablets at regular, short intervals over a prolonged whole population and what are the results.Between period. With the drugs at present in use, direct mass these two technical aspects of the programme lies drug administration as the sole method of attack the whole process of the distribution and marketing cannotberecommended,exceptwheremalaria of the product, which is carried out under the control incidence is at a very low level, or where the trans- of other government agencies not necessarily deeply mission season is very short. concerned with the objectives of the programme. In those areas where salt is used as a regular food Other social factors also complicate the operation.It is additive by the entire population, indirect mass drug for these reasons that the projects in Cambodia and administration in the form of medicated salt distri- West New Guinea (West Irian) have been terminated. bution may be the method of choice, provided that Nevertheless, these projects have been of consider- infants and children, whose normal diet contains able value in providing much useful information; little or no salt, are covered by a simultaneous pro- they have revealed and clarified various practical gramme of direct drug administration. problems connected with the use of medicated salt Medicated salt projects have been carried out in in under -developed rural areas, so that this method limited areas in a number of countries.In Brazil, can now be applied much more judiciously and distribution of chloroquinized salt was continued in efficiently than before. the Amazon Basin until the end of 1961, and was One of the objectives of pre- eradication program- then suspended pending the results of a special study mes is the distribution of antimalarial drugs for the of the effectiveness of the project and of the possible general protection of inhabitants of malarious areas. occurrence of chloroquine tolerance or resistance in In its ninth report1the Expert Committee on Malaria the local strains of P. falciparum. In British Guiana, suggested that in pre- eradication programmes anti- a chloroquinized salt programme covering the whole malarial drugs should be used mainly as follows : of the interior was started early in 1961 as the only drug treatment should be readily available toall suitable method of attack in this difficult part of the clinical malaria cases through the network of rural country; the results have been most promising, except healthunits and any othersuitabledistribution in one area where non -medicated salt was available. centres;where regular mass drug administration In Tanganyika a small field trial, in which chloro- aiming at the prevention of clinical symptoms of quinized salt is used, is being carried out; its initial malaria is feasible, priority should be given to(a)par- results are excellent, as shown by the reduction of ticularlyvulnerablepopulationgroupssuchas parasite rates to a very low level, except in children pregnant and nursing women, infants and small below the age of two years (see section 8.2, page 118). children,and (b)groups of epidemiological and In Iran, following encouraging results of a preliminary socio- economic importance. trial with medicated salt among two small tribal 5.1.4EpidemiologicalEvaluationand Surveillance groups, it is planned to implement this method on Operations a larger scale among a predominantly nomadic popu- lation in the Jareh area of Kazerun.In Ghana, The methodology adopted in epidemiological eval- distribution of medicated saltexclusively through uation and surveillance operations, which is based the existing commercial channels could not prevent on the experience gained since the implementation of the entrance of non -medicated salt into the project the global malaria eradication programme, has now area. A new arrangement, in which the normal been presented in the Manual on Epidemiological commercial channels are superseded by government - Evaluation and Surveillance in Malaria Eradication sponsored distribution, was introduced during the and given a wide circulation. last quarter of 1962, and the duration of the project With the application of the methodology in different has been extended until the end of 1963. programmes,fieldmalariologists have takenthe From a purely technical point of view, there is no initiative in developing certain techniques and pro- doubt that medicated salt is highly effective.Never- cedures to bring about a high quality performance. theless, the results of medicated salt projects have Thesehaveincludedimprovementsinsampling frequently not come up toexpectations, mainly techniquesforconducting malariometric surveys, because of the complexity of the operation on a and in the training and supervision of microscopists; large scale.Public health officials have supervision the development of practical schedules for surveil- only at each end of the operation -at the beginning, 1 Wld Hlth Org. techn. Rep. Ser., 1962, 243. 104 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I lance agents and of concomitant and consecutive of radical cure, there has been a very noticeable supervisory techniques; improvements in logistics to rise in the number of slides taken, under passive lessen the time -lag between the taking of slides and case -detection, by medical institutions. The co- the relay of results; and, last but not least, the deve- operation of these health services has been activated lopment of an effective reporting system on the basis in two ways, by attaching some personnel from of the WHO- promoted quarterly surveillance reports. the malaria service to the hospitals and dispensaries All these factors have contributed to the improvement on certain days to take blood films from fever cases, noted in the quality of the work and have made for and also by arranging for the malaria service to greater confidence in the reliability of the epidemio- examine slides submitted by hospitals and dispensaries logical data. and relay the results within forty -eight hours.It is The realization, by those responsible for national gratifying to note that the public health services malaria eradication programmes, of the need to are showing greater interest in and awareness of the achievements of malaria eradication and their own strengthen national epidemiological sections, including role in such a gigantic public health undertaking. the units dealing with surveillance operations, labo- ratory services and entomological activities, has led The concept of a problem area is now accepted, to the organization of specialized courses for both asisthe necessity for detecting such areas early, professional and auxiliary personnel.Units have during the attack phase.The same applies to the been reorganized so that the results of their work conceptof a malaria focus,itsepidemiological can be co- ordinated and focused on interrupting significanceanddynamics,themethodologyof malaria transmission and eliminating the reservoir investigation and the machinery for applying remedial of infection -a major activity of malaria eradication measures quickly. Very commendable work has been programmes at the consolidation phase. In the recorded in many countries in these respects. South -East Asia Region, a regional blood examination In view of the value of entomological contributions centre has been established to provide independent to the overall epidemiological evaluation, a reorienta- cross -checking for blood films from countries in the tion of the malaria entomologist's work has been Region. effected through regional refresher courses for ento- During the year, the development of independent mologists and the development of a manual on ento- mological techniques. assessments by teams not directly connected with the The gearing of the work of entomologists to the needs of an eradication pro- executive part of the malaria eradication programme gramme, has resulted in valuable contributions being in the respective units or zones, and with the participa- tion of members of the public health service (as in made in investigations into the persistence of malaria transmission, both in limited foci and in problem India) has resulted in greater adherence to the WHO areas. epidemiological criteria regarding the interruption of transmission and withdrawal of spraying. From the point of view of quantitative assessment, 5.2Pre -eradication Programmes the increase in the annual blood examination rate can be seen in all programmes in the consolidation The Expert Committee on Malaria in its eighth phase, and even during the last year of the attack report,2 in considering the approach which should phase.The fact that the annual parasite incidence be made to malaria eradication in developing coun- in areas projected for withdrawal of spraying falls tries, noted that : below the permissible rate of 0.5 per thousand in The criteria necessary for the establishment of the presence of an active case -detection mechanism a malaria eradication programme are that eradica- in the last year of the attack phase is a favourable tion should be technically, administratively and sign. Unfortunately, the qualitative aspect of the work practically feasible, and that the programme should -the achievements in covering the total population be planned with the object of eradication on a with an effectivecase -detection mechanism, both country -wide scale. active and passive;theprogressiveparticipation Technical feasibility implies the possibility of of all medical institutions; and the improvements in indicating the processes that would result in an supervisoryarrangements- althoughoutstanding, absoluteinterruptionoftransmissioninany cannot be presented statistically. epidemiological circumstancesthatmightbe As a result of the emphasis placed on adequate encountered. coverage by rural health services and on their participa- tionincase -detection and intheadministration 1 Wld Hlth Org. techn. Rep. Ser., 1961, 205. ANNEX 8 105
Administrative feasibility implies the possibility cases and their adequate treatment and which, during of creating an organization that would deploy the the maintenance phase, should be prepared to assume skills and resources necessary to secure and maintain responsibility for keeping a watch over the area and the interruption of transmission over a sufficient maintaining it permanently free from a re- establish- area and with sufficient uniformity for a sufficiently ment of the disease. At the present stage reached by long period of time. many of the newly developing countries, such a Practical feasibility implies that the mechanism rural network could be staffed entirely by auxiliary required for these processes is within the financial personnel. and material resources available to the government The national malaria service is the organization concerned, and that open communications, freedom which, in due course, will become the national malaria of movement, and the co- operation of the public eradication service, with all the skill and resources will be sufficient to make it possible to ensure necessary to secure the interruption of transmission total coverage in the application of insecticides and and maintain it until eradication is achieved. to secure adequate country -wide surveillance and maintenance in due course. 5.2.1 Planning Taking into account these criteria, which need to A pre- eradication programme is not a " time -limited be met before a country can reasonably undertake a operation " which must adhere to a strict schedule malaria eradication programme, the Expert Com- from month to month and year to year, as is a malaria mittee considered that, from the malaria eradication eradication programme, with its several definite phases point of view, a developing country should be defined leading to a specific goal.It is rather a programme as one " in which the general administration and of orderly and purposeful growth and development, health services have not yet reached a level that aiming at the eventual full preparedness of a country would enable it to undertake a malaria eradication to undertake the very exigent malaria eradication programme, and in which, therefore, the necessary programme which is expected to follow.Whatever foundations for this kind of closely co- ordinated, the level of development in a country, both elements thorough, and time -limited activity have first to be of the pre- eradication programme, namely the health laid ". infrastructure and the malaria service, need to grow The Expert Committee, therefore, proposed a new until they reach the minimum organizational level type of assistance that would be required as a prelude required.The great variation in the initial level of to malaria eradication and would enable a country preparedness of different countries makes it impossible to make good the deficiencies mentioned above. The to lay down any standard plan for pre- eradication complex of preliminary operations has been termed a programmes or to indicate any strict schedule of " pre- eradication programme " which was defined in achievements for the years to come.Plans should, the report to the Fourteenth World Health Assembly 1 therefore, be made for two years at a time, the situa- as follows : tion being carefully reviewed as each renewal is ... apreliminaryoperationundertakenina prepared.The first task during the initial period is country whose general administration and health the investigation and preparation of an inventory of services have not yet reached a level which would allavailablefacilitiesrelated to" the two main enable it to undertake a malaria eradication pro- objectives ". As it is expected that this will take some gramme and in which, therefore, the necessary six months, the first plan of operations should provide basic foundations for this kind of co- ordinated, for the preparation of an addendum at the end of thorough and time -limited activity have first to be laid. this period containing the inventory of available facilities and setting out the detailed plan of action The main purposes of a pre- eradication programme for the remainder of the first two years, with an are the stimulation and concurrent development of indication of the intermediate targets to be aimed at the " necessary basic foundations ", usually referred and the steps to be taken to this end.These will to as " the two main objectives ", namely (a) the include :the establishment of adequate facilities for health infrastructure, and (b) the national malaria training personnel of the various categories needed; service. the assessment of the malaria situation and the further The health infrastructure may be defined as the study of epidemiological conditions; the organization network of rural public health services which, by the of medical aid consisting of diagnostic services and end of the attack phase and through the whole of the distribution of drugs to people living in malarious the consolidation phase, should be able to provide areas; and the study and development of the most efficient collaboration in the detection of malaria suitable approach to ensure the fullest collaboration of 1 Mimeographed document A14 /P &B /2, December 1960. the public in the future malaria eradication programme. 106 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
The keynote of the development of the rural health A health post is a basic constituent of the infra- infrastructureinapre- eradication programmeis structure, and may serve a population of from 2500 " total coverage "; but the type of health network to 20 000.The sizeof the area served depends required for the support of the malaria eradication largely on the prevailing local conditions and 5000 programme which is to follow is of the simplest, for to 10 000 is not an unreasonable average figure for it is not the concern of a pre- eradication programme planning purposes. The primary responsibilities of a to promote the development of administrative and health post are described by the Expert Committee health services to the level required to meet a country's on Malaria in its ninth report1 as simple medical over -all health needs.At the same time it cannot care, detection and prevention of certain communi- be expected that any country will remain content with cable diseases,collection of information on vital the elementary, though total coverage, service required statistics,maternal and child health work, basic in connexion with malaria eradication, and in this environmental sanitation, and health education. way a pre- eradication programme should always be A health post should always have two distinct looked upon as a true public health promotional elements, one stationary and the other mobile, both activity. staffed with auxiliary personnel. The stationary Although there is no rigid limit to the duration of element should have a dispenser or nurse with ele- a pre- eradication programme, the relative timing of mentary training in simple medical care, functioning the achievement of " the two main objectives " is at the health post; the mobile element should have of importance. The national malaria service must be a health auxiliary to make routine visits covering the fully ready to carry out its specialized role, at least entire area assigned to the post, carrying out case - in the first operational zone of the country, before finding, reporting and simple preventive procedures a malaria eradication programme can be launched; for certain communicable diseases.The training of and it is essential that the development of the health such health auxiliariesisvery elementary; in the infrastructure be planned so that it will reach the Moroccan programme, for example, it takes eight minimum level required for the support of surveil- months. lance activities not later than the beginning of the A health post should be able to perform, as one third year of the attack phase.Both in the interests of its normal functions, case -detection for malaria of economy and for the sake of the morale of the both (by -house visits) and staff, the malaria service should not be brought to passive (at the stationary health posts).Eventually, operational strength until the development of the additional functions such as radical treatment, some health infrastructure by the required time can be elementary epidemiological investigations, etc., can definitely assured. also be delegated to the post.The development of the infrastructure should be planned so that the health 5.2.2Health Infrastructure posts reach the minimum standard required not later The importance of the support given by a country's than the third year of the attack phase of a malaria general health servicestoitsmalaria eradication eradication programme, in order to be able to carry programme and of its participation in that programme out case -detection at the beginning of that activity. hasalready beenstressedearlierinthisreport The health infrastructure must be developed to (chapter 4 - General Health Services and Malaria include an effective supervision of the health posts. Eradication Programmes), and in paragraph 5.2.1 The first echelon of field supervisors can consist of above the essential elements of the development health auxiliaries, although they will need tobe of the rural health infrastructure as the firstmain better qualified by training and experience than those objective of a pre- eradication programme have been working at the health posts.A higher echelon of mentioned. professional supervision must also be assured. In a malaria eradication programme, the respon- 5.2.3NationalMalariaServiceandAntimalaria sibilities to be discharged by the health services are Activities connected,forthemostpart,withsurveillance operations, and for this purpose the building -up of The second basic objective of a pre- eradication the peripheral services or " infrastructure " is essential. programme is to develop the national malaria service, Such an infrastructure is a network of health posts which will become, in due course, the " national capable of providing certain basic health services and malaria eradication service ",able to deploy the planned in such a way that an area is totally and skill and resources necessary to secure and to maintain evenly covered by it.It will form the permanent the interruption of transmission until eradication is foundation on which the health services can later achieved. expand according to needs and available resources. 1 Wld Hlth Org. techn. Rep. Ser., 1962, 243. ANNEX 8 107
The national malaria service needs to grow gradually adequate opportunities to assemble the necessary but steadily, gathering information about the extent basic entomological data during complete cycles of and nature of the malaria problem of the country, seasons, preferably covering two years.The main gaining knowledge and experience of its present and vectors have to be determined, as well as their seasonal future responsibilities and developing the ability to incidence in different parts of the malarious area. manage country -wide operations. A fullgeographical and topographical studyto The first country -wide active antimalaria measure obtain this information is important for the eventual which needs to be implemented from the beginning drawing -up of a sound plan of operations and will of a pre- eradication programme is the organization enable the entomologist to suggest the most appro- of a reliable system for the microscopic diagnosis of priate techniques from the wide range now available. malaria and the distribution of antimalarial drugs, In order to ensure the gradual growth of the national mainly for curative purposes, through existing health malariaservicementioned .earlier,practicalfield units, schools, post offices and any other suitable experience hastobe provided foritsincreasing method of distribution.These activities should help number of technical personnel.For this purpose, to create a " malaria consciousness " and must go demonstration and training areas are selected where along with a health education campaign to stimulate the organizational requirements for spraying and and promote the maximum co- operation of the public, surveillance operations and other malaria eradication as well as of private and government agencies.The procedures, and their administrative implications, can direction for such action must come initially from be demonstrated. These operational areas are limited the highest government level, but the continued drive to the size required for demonstration and training and supervision to ensure that the supply of drugs purposes and do not normally cover a population is adequate and that the diagnostic service is satis- greater than 100 000, though in large countries, where factorily developed will be the duty of the national conditions may vary considerably from one part to malaria service in co- operation with the general health another and where these different conditions necessi- service.The Organization may assist with the labo- tate the trial of several organizational requirements, mo- ratory equipment and drugs necessary for this basic re than one such operational area may need to be selec- antimalaria activity in cases where they are not pro- ted and organized. These demonstration areas will also vided from other sources. serve to collect preliminary data on the impact of The next important function of the malaria service attack measures on malaria transmission under local is to collect and study all pre- existing data on the conditions.Where necessary, and within the limits epidemiology of malaria in the country and to carry of its available resources, the Organization is prepared out the surveys necessary to fill any gaps in knowledge, to provide operational supplies and other assistance. so that the extent of the malarious areas may be accurately demarcated and the level of endemicity in 5.2.4Progress in Pre -eradication Programmes differentpartsof the country determined The The progress achieved in the development of pre - resources for carrying out such duties, both parasito- eradication programmes is indicated by the fact that logical and entomological, may be limited at the by the end of 1962 programmes had started or were beginning, but will certainly increase step by step. in the planning stage in twenty -three countries : ten in Theseinvestigationswillcomprisemalariometric the African Region - Cameroon, Ghana, Liberia, surveys(bothspleen and parasite)in randomly Madagascar, Mauritania, Mozambique, Nigeria, Sene- selected areas.In areas in which the impact of era- gal, Togo and Uganda; two in the South -East Asia dication measures is to be tested, priority has to be Region- Indonesia (outer islands) and Nepal (in areas given to parasite rates, especially infant parasite rates, not easily accessible); two in the European Region - as these are the most sensitive. It is also of importance Algeria and Morocco; four in the Eastern Mediter- to have information on the distribution of the different ranean Region - Ethiopia, Saudi Arabia, Somalia and parasite species in the country. Sudan; and five in the Western Pacific Region - For the planning of the future eradication pro- Brunei, Cambodia, Republic of Korea, Republic of gramme, the study of the transmission season or Viet -Nam, and West New Guinea (West Irian). seasons is essential, and itis here that entomology The approach to malaria eradication by way of the has a vital role to play.In the past it has all too pre- eradication programme was fully discussed at the frequently happened that pressure to initiate spraying Third African Malaria Conference held at Yaoundé operations urgently has drastically reduced the time in July 1962, at which ministers of health, directors available for basic entomological survey during the of health and directors of malaria services met with preparatory phaseof an eradication programme. senior officials of the Organization.The technical The pre- eradication programme, however, provides policies and prospects for development of the pre- 108 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I eradication programmes were fully endorsed by the In the European Region a very large training participants and the majority of national represent- scheme for auxiliary health workers is already well atives were anxious to begin planning for pre- eradica- under way in Morocco in twenty -four schools and tion programmes at an early date. An orientation centres.All the personnel needed to staff the infra- seminar for WHO public health and malaria advisers structure at the required level are expected to be of the African Region was held in October, at which available not later than the beginning of 1965.As particular attention was given to the implementation these personnel become available they are being of a pre- eradication programme and the development deployed to carry out basic surveys and geographical of the rural health infrastructure as an integral part of reconnaissance, and to make domiciliary visits for such a programme. general health purposes.The training of micro- In Togo a detailed assessment has been made of the scopists has been practically completed.Although existing basic public health services to permit the pre- the pre- eradication programme proper is still in the paration of a plan for the development of the necessary planning stage in Algeria, the training of auxiliary health infrastructure.Similar action will now be health workers and microscopists has already started. undertaken in other countries in the African Region. All five pre- eradication programmes in operation in Considerable progress has, however, been made in the Western Pacific Region have followed on other the collection of basic data on the epidemiology of antimalaria operations in these countries so that, malaria in a number of countries of the Region. except in Brunei, the basic structure of the national In South -East Asia, before the actual implement- malaria service exists, and extensive field operations ation of a pre- eradication programme in the outer have already been undertaken.Particular attention islands of Indonesia, the national malaria eradication is,therefore, being given to the development of service has already been collecting demographic data adequate health infrastructures. andstudyingthecommunicationsandfacilities While there has been general acceptance by govern- available in the area. ments of the soundness of the pre- eradication approach In the Eastern Mediterranean, the pre- eradication to eventual malaria eradication programmes, some programmes already in operation in Ethiopia and Somalia have facilities for training of health per- have hesitated to shoulder the large commitment that sonnel, and attention is being given to the develop- seems to be involved in undertaking the development ment of the health infrastructure. Antimalaria demon- of country -wide rural health services, even of the most stration and training areas are also in operation. elementary kind.In view of the determination of There are WHO- assisted malaria eradication training the World Health Assembly to reach the accepted goal centres in Ethiopia and Sudan. In Sudan, where the of the global eradication of malaria, and the funda- general health services have been already well de- mental role which the health infrastructure plays in veloped, both in quality and extent, malaria eradication malaria eradication as well as in other health pro- is expected to be undertaken as part of the general grammes, it is hoped that enough financial assistance health programme once sufficient specialized personnel will be obtainable to enable governments to develop have been trained. these necessary services.
6.REGISTRATION OF AREAS WHERE MALARIA HAS BEEN ERADICATED, AND MAINTENANCE OF ACHIEVED ERADICATION
The official register of areas from which malaria has necessary certification.Cyprus has been under main- been eradicated was established by the- Director - tenance since eradication was achieved in 1950 and General at the request of the Thirteenth World Health no indigenous malaria cases have been reported since Assembly (resolution WHA13.55).During 1962, no then.In Grenada and St Lucia malaria has been further country orterritory was entered inthis eliminated after execution of a normal malaria era- register; thus Venezuela is so far the only country dication programme.In both islands no malaria listed in the register ashaving achieved malaria cases have been found for several years, in spite of eradication in large parts of the national territory. elaboratecase -detectionactivities.The islandof However, in addition to various requests for future Grenada is considered to have been under maintenance certification and registration already received,pri- since July 1962, while St Lucia terminated its consoli- marily from countries of the European continent, dation phase at the end of December 1962. Cyprus, Grenada and St Lucia have, during the past Consideration was given during the year to im- year, asked to be included in the register after the proving the methodology of certification.In anti- ANNEX 8 109 cipation of the final certification of malaria eradication especially in the European continent, considerable in the near future in a number of Greek islands and attention was given during1962to the preparation of in Spain, officials of the WHO Regional Office for the health services to undertake vigilance responsi- Europe visited Greece and Spain to advise the Govern- bilities. ments on the methodology for carrying out the certi- A major concern in maintenance areas is to prevent fication during1963. This includes the provision of the reintroduction of malaria.In order to assist evidence that the epidemiological criteria for the national public health services in this task, the Organ- achievement of eradication have been met, and of ization began in1962periodical dissemination of information on the adequacy of the coverage by the information on the epidemiological status of malaria rural health services and their proficiency in malaria in the world through the Weekly Epidemiological case -detection and investigation. Record.This will allow health authorities to appraise In view of the increase in the number of countries the degree of danger of reintroduction of malaria from approaching the end of the consolidation phase, other parts of the world.
7. PROBLEMS FACING MALARIA ERADICATION
7.1Problem Areas habitants seldomsleepout -of- doors,andlabour migrations and other population movements are rare The drive towards malaria eradication in the world in the area.The type of houses, however, may be has brought to light a number of new technical of importance. A survey of housing conditions in the problems, some of them of very definite operational area indicated that positive cases tended to occur in significance.For some time physiological resistance isolated or peripheral dwellings of poor construction, to insecticides has been recognized as an important with lack of walls or discontinuity of walls.In the technical problem in malaria eradication, but during more solidly built houses in the centre of the villages the last two or three years it has been realized that positive cases were rare, but they occurred neverthe- other technical problems may account for the persist- less, indicating that housing conditions alone could not ence of transmission in what are commonly referred explain the persistence of transmission.The ability to as problem areas, that is, areas in which transmis- of the vectors to enter sprayed houses at night, bite sion has not been interrupted in spite of regular the inhabitants inside and escape after little or no spraying and good coverage. contact with the sprayed walls, seemed to be the main In Mexico, after four years of attack phase, it was cause of the persistence of transmission. found that transmission had been interrupted in 77 per An incipient development of DDT resistance in cent. of the originally malarious territory. In approx- A. albimanus appeared to exist in some of the localities imately 10 per cent. of the remaining areas, the persist- studied in Oaxaca, but this was not considered the ence of transmission could be attributed to opera- main reason for the persistence of transmission.In tional problems and administrativeshortcomings, El Salvador, where aerial spraying against cotton but in about13per cent. of the originally malarious pests has produced a very marked DDT resistance in territory, with a population of approximately2 600 000, A. albimanus, a research team from the Regional transmission persisted for technical reasons -in the Office for the Americas found that the degree of Pacific coastal area, where the vector is Anopheles resistance was not correlated with the amount of albimanus, and in inland areas where malaria is carried transmission, and that causes other than physiological by A. pseudopunctipennis.Reasons for the persist- resistance were at play. ence of transmission in a country of such varied In Venezuela, in what are called areas of " refractory topography and climate as Mexico may differ from malaria," which are in fact " problem areas ", the one problem area to another, but from the studies local vector, A. nuñez- tovari, seems to avoid the action undertaken jointly by the Mexican malaria eradica- of DDT, probably because of its exophilic habits. tion service and the WHO team for special epidemio- The use of other insecticides and the increase in the logical studies, it appears that in the State of Oaxaca number of DDT spraying cycles, combined with continued transmission is probably due to the behav- vigorous mass treatment there, has not resulted in the iour of A. albimanus and A. pseudopunctipennis and completeinterruptionoftransmission,probably not to physiological resistance to DDT -at least in because of the continuous influx of fresh infections the case of A. pseudopunctipennis, the main vector in broughtby importedlabour from neighbouring the area.Human ecology, on the other hand, seems Colombia, where the same thorough eradication meas- a comparatively unimportant factor.The local in- ures have not yet been undertaken. 110 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Mass distribution of drugs has been used with lived action, is not recommended in eradication pro- success in Trinidad to overcome the problem of out- grammes, and resistance to pyrimethamine can be door biting A. (Kertezia) bellator.Monthly treat- avoided if this drug is not used alone for treatment of ment with chloroquine and primaquine resulted in a established blood infections.Pyrimethamine should rapid interruption of transmission, no autochthonous be used only for its prophylactic and sporontocidal cases having been found in the island since September action and always in association with adequate doses 1960. of chloroquine or amodiaquine. Larviciding from the ground on a small scale has Since October 1960, drug resistance has attracted been tried in Mexico and El Salvador as a supplemen- renewed attention, following reports of the occurrence tary measure to DDT spraying without clear success, ofa" Plasmodium falciparumstrainwith a high but the more promising large -scale larviciding from the degree of tolerancetochloroquine.Thisstrain, air is now being tried in El Salvador. In this and other which seems to have originated in Colombia, was Central American countries the possibility of using isolated from a non -immune patient who had worked for residual spraying insecticides other than chlori- in Colombia and had suffered from frequent malaria nated hydrocarbons is being considered.In El Sal- attacks in spite of repeated treatment with chloroquine. vador and Nicaragua malathion was tried recently, The strain was investigated in the National Institutes without conclusive results, perhaps because the sprayed of Health in the United States of America and was areas were too small. found to have a high tolerance, not only to chloro- Outside the Region of the Americas the delimitation quine, but also to other 4- aminoquinolines.In view and study of problem areas is less advanced, probably of these findings, a number of field epidemiological because the eradication programmes have not pro- surveys have been carried out in the areas of the pos- gressed at the same pace as in the Americas.There sible origin of this strain, as well as in various areas are nevertheless some well -known problem areas, such of Brazil from which "chloroquine- resistant" P. falci- as the A. stephensi areas in Iran, where this vector parum infections had been reported.These surveys, has developed insecticide resistance to both the DDT which began in early 1961, are still continuing, but so and dieldrin groups of chlorinated hydrocarbons. far no evidence has been found of any occurrence of Also in the area of distribution of A. 1. balabacensis, chloroquine- resistantstrainsintheseareas.The particularly in Thailand, Cambodia and Viet -Nam, resistant strain from Colombia thus appears to be an problemsof behaviourrather thanphysiological isolated case and has probably not spread in the field. resistance seem to account for the failure to interrupt More recently, observations have been reported transmission, but here it has not yet been possible to that falciparum infections in non -immune patients, separate entirely the technical problems from admin- who had acquired the infection in Thailand, Cambodia istrative and operational shortcomings, the two often or Malaya, did not respond " normally " to the usual overlapping. standard treatment with chloroquine, or that early To face the threat posed by the persistence of trans- relapses occurred.These cases are still under investi- mission in problem areas, the Organization has in the gation. first place encouraged the investigation of the factors Since chloroquine isat present the most widely that may account for this failure.A team for special used drug in eradication programmes, it is obvious epidemiological studies was set up to help in investi- that widespread resistance to this and similar drugs gating some of the problem areas of the world and also would present a serious problem in malaria eradication. in developing an adequate methodology.The Organ- It is therefore necessary to maintain a close watch ization has also established a scheme for screening and on the situation and to analyse carefully any reports vetting new insecticides that could be used against of alleged drug resistance in the field.The occur- malaria and other insect -borne diseases; with the rence of drug resistance should be considered only co- operation of the Governments of Uganda and after all possibilities of inadequate treatment or of drug Nigeria it is now carrying out field trials in Africa failure have been ruled out. with malathion and DDVP, which represent the last Drug failure, which is a much more common event stage in this screening and testing scheme. than drug resistance, may be due to many causes, and most often to the fact that the prescribed doses of the 7.2Resistance of Malaria Parasites to Drugs drug have not actually been taken. To date, drug resistance had nowhere become a grave problem in malaria eradication.The only 7.3Vector Reactions to Insecticides drugs to which definite resistance of malaria parasites When the original concept of malaria eradication, has occurred on a significant scale are proguanil and based primarily on the use of insecticides against the pyrimethamine.Proguanil, on account of its short- vector, was formulated it was realized that physio- ANNEX8 lIl logical resistance to DDT and other residual insecti- vectors from entering treated houses, or may drive cides might develop and constitute a serious obstacle them out of the house before they have had on oppor- to the malaria eradication programme. The fact that tunity to feed.In the latter event the vital contact resistance to DDT had already been reported in one with man may be disrupted to such an extent that or two countries in the course of malaria control interruption of transmission is achieved. operations provided an added incentive to establish With the increasing attention being paid to problem a world -wide information service about the suscepti- areas (see section 7.1), it is clear that, when DDT is bility status of all major vectors of malaria. By means the insecticide concerned, this behaviour aspect may of the WHO susceptibility test, all this information be the principal factor involved, even in some of the has been obtained and recorded in a standardized areas where recorded resistance to DDT might appear manner, the results being summarized periodically by to offer the obvious explanation for failure to achieve the Organization and widely circulated.From the control. The study of these behaviour reactions of the considerable information now available certain facts vector in the presence of insecticide is still at an early are emerging which are of some importance, in that stage, and further investigations may reveal that they indicate that the practical significance of resistance irritability is not the only aspect to be considered. The to insecticides depends largely on which of the two possibility that other aspects of vector behaviour may main insecticides -DDT or dieldrin -is implicated. play a major role in determining the success or other- As far as dieldrin resistance is concerned, the situa- wise of insecticide treatment is being kept in mind, tion is fairly well defined.When dieldrin resistance particularly with regard to the new organophosphorus develops it usually progresses rapidly to the point and carbamate insecticides now becoming available where a highly resistant mosquito population is for field use. selected out, and the insecticide ceases to be of further With regard to the information on the resistance operational value.In this connexion the dieldrin status of vectors, summarized in Table G, the fol- susceptibility test data can provide a valuable early lowing features call for special comment.The con- warning about impending breakdowns in the field. siderable amount of information now available about The position with regard to DDT resistance of the susceptibility or resistance of the main malaria vectors is very different, and there is increasing evi- vectors to the two principal insecticides in use -DDT dence that DDT may still be of operational value in and dieldrin- indicates that the general situation is several of the species which have developed " resist- becoming more stabilized.In many countries in ance ",or" increasedtolerance "to DDT, for which physiological resistance to dieldrin was pre- example, A. sachavori, A. culicifacies and, possibly, viously reported, the switch -over to DDT has been A. pharoensis. accomplished without giving rise to new problems of In contrast to the cases mentioned above, where dual resistance.The comparatively few new records DDT has continued to be of operational value despite of resistance to dieldrin may be attributed in part to the development of resistance, there are now several the fact that the use of this insecticide is promptly well established instances where DDT after several suspended as soon as resistance is detected, and in years of application is still failing to interrupt malaria part toageneral decrease in the use of dieldrin in transmission completely, despite the fact that the malaria eradication programmes wherever there is a standard physiological tests show that the vectors possibility of resistance developing. have not developed any resistance or tolerance.An The wide -scale use of the WHO susceptibility test outstanding example of this is provided by A. gambiae has confirmed that dieldrin resistance on the part of in the savannah areas of West Africa, where dieldrin A. gambiae isfairly widespread over the western is contra -indicated because of established resistance, countries of tropical Africa between a northern limit and where DDT, now being used, has failed to bring of Upper Volta and Northern Nigeria, and a southern about complete interruption of transmission, despite limit of the Congo (Brazzaville).In the countries of the continued normal susceptibility of the vector. eastern and south -eastern Africa, however, no dieldrin It now appears that the explanation of this apparent resistance has been recorded despite the use of insecti- anomaly must lie in the behaviour characteristics of cides of the dieldrin /BHC group for many years in the vectors concerned, particularly their reactions to parts of Tanganyika, Southern Rhodesia and Swazi- the well -known irritant quality of DDT deposits. land.Throughout the whole of its area of distribu- Some vector species can continue to enter treated tion A. gambiae continues to be susceptible to DDT. houses and feed on the occupants, but leave the house With regard to the recently reported resistance of without having settled long enough on the irritant A. minimus flavirostris to dieldrin in East Java, it is insecticide deposits to absorb a lethal dose.In other still too early to judge its significance. The importance cases the irritant effect of DDT may discourage the of this species as a malaria vector in the Philippines 112 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I has long been established, but, although infected spe- have been sufficiently pronounced to enable this insecti- cimens have previously been reported in Java, this cide to be used effectively once more -for a few species has never been regarded as a vector of major months at least -in the treatment of focal areas in the importance there.The resistance of A. rangeli to consolidation phase.After a further few months' dieldrin in Venezuela is of dubious significance, since exposure increasing resistance of the vector again it is not yet confirmed as a vector species. becomes evident. The recent report of the " resistance " of A. aconitus Although the resistancesituationingeneralis to DDT in parts of Java, where that species is already perhaps giving rather less cause for concern than was resistant to dieldrin, has not yet been followed by visualized at an earlier stage in the overall malaria any evidence of breakdown in control during the eradication programme, nevertheless a high degree of several months since resistance was first recorded. double resistance to both groups of currently used In Indonesia the double resistance of A. sundaicus insecticides -DDT anddieldrin /BHC -couldstill (to dieldrin on the south coast of Java and to DDT constitute a serious setback in some programmes. on the north coast) has not given rise to the opera- With this in mind, the use of alternative groups of tionaldifficultiesexpected.On thesouthcoast insecticides, particularly the organophosphorus com- dieldrin has been replaced successfully by DDT, to pounds and the carbamates, is being fully explored at which A. sundaicus remains susceptible. The with- all levels of testing from initial laboratory screening drawal of dieldrin pressure in that area has also to final field trials (see also section 8.6, page 120). resulted in a decrease in resistance levels to that Two of these organophosphorus compounds, mala- insecticide.On the north coast dieldrin continues to thion and dichlorvos (DDVP), have already been be used with such success that A. sundaicus has almost selected as suitable insecticides for final epidemio- disappeared from many of its former haunts. logical evaluation in field trials in Uganda and Nigeria Following the withdrawal of spraying, or the with- respectively. A third promising insecticide -a methyl drawal of DDT at least, there are two interesting carbamate -has recently been cleared and recom- records of an increase in susceptibility on the part of mended for final epidemiological assessment in field vectors which were formerly resistant to DDT.In the western states of India there are areas where the trials.Three additional compounds, two carbamates discontinuation of DDT spraying, either in areas and one organophosphorus, have passed the initial entering the consolidation phase or in localities where stages successfully and are at present being tested out DDT has been temporarily replaced by BHC, has at hut and village level in Africa, prior to selection resulted in a measurable decrease in tolerance on the and recommendation for extended field trials. part of A. culicifacies.Similar changes in suscepti- With these rapid developments, it appears that there bility levels of A. stephensi in Iraq have been noted are good prospects within the next year or two of in the years following withdrawal of DDT spraying having at our disposal a choice of several new powerful in 1958.Although this vector was formerly highly insecticides for supplementary use in the malaria resistant to DDT, the recent increases in susceptibility eradication programme.
TABLE G. RESISTANCE TO DDT AND TO DIELDRIN IN MALARIA VECTORS
Date of Species Country Region and Reaction Reaction Date of most recent district to DDT to dieldrin initial evidence confirmation
A. aconitus Indonesia Central Java : Jogjakarta Susceptible Resistant March -April 1960 JResistant Resistant 30 April 1962 Subah Susceptible Resistant Oct. 1959 East Java : Belikanget Susceptible Resistant June 1962 Bogoredjo Susceptible Resistant June 1962 Penambangan - Resistant June 1962 Sukohardjo Susceptible Resistant May 1962 West Java : Tasikmalaja (zone) Susceptible Susceptible June 1962 Tjiandjur (zone) Susceptible Susceptible April 1962 ANNEX 8 113
Date of Region and Reaction Reaction Date of Species Country most recent district to DDT to dieldrin initial evidence confirmation
A. albimanus British Belize Susceptible Resistant Feb. 1959 Honduras Punta Gorda Susceptible Resistant May 1959
Colombia Córdoba Susceptible Resistant Nov. 1959 Norte de Santander Susceptible Resistant Sept. 1960
Costa Rica Puntarenas Susceptible IntermediateOct. 1960
Cuba Camagüey Susceptible Resistant April -May 1960 Oriente Susceptible Resistant June -July 1959 DDT Dec. 1960 DIn March 1960 Dominican Barahona Susceptible IntermediateOct. 1959 Republic Benefactor Susceptible Resistant Aug. 1959 Oct. 1960 Julia Molina Susceptible Resistant July -Sept. 1959 Libertador Susceptible IntermediateMay 1960 Samaná Susceptible Resistant Sept. -Oct. 1959 DDT Oct. 1960 San Rafael Susceptible IntermediateOct. 1959 Santiago Susceptible Resistant Aug. 1959 DDT July 1960 Trujillo Susceptible Resistant Sept. -Nov. 1959 DDT June 1961 Din Feb. 1960
Ecuador El Oro Susceptible Resistant June 1959 July 1961 Esmeraldas IntermediateJuly 1960 March 1961 Guayas Susceptible IntermediateJuly 1959 Feb. 1960 Los Ríos Susceptible Intermediate March -April 1960 Dec. 1960 Manabí Susceptible Resistant April 1960
El Salvador Ahuachapán Intermediate DDT April 1961 Resistant Nov. 1958 Cabañas {Intermediate Nov. 1959 Chalatenango Susceptible Resistant July 1958 La Libertad Resistant Resistant July 1958 DDT June 1959 La Paz Resistant Resistant DDT June 1961 Din July 1958 La Unión Resistant Resistant July 1958 DDT Sept. 1960 Morazán Resistant DDT Sept. 1960 San Miguel Resistant Resistant July 1958 DDT Dec. 1961 San Salvador Resistant Sept. 1959 Santa Ana Intermediate July 1960 San Vicente Resistant Resistant Feb. -Sept. 1959 DDT Oct. 1961 /Intermediate Resistant July 1958 Sonsonate l Resistant April 1961 Aug. 1961 Usulután Resistant Aug. 1959 DDT Nov. 1961
Guatemala Chiquimula Susceptible Resistant April -June 1959 El Progreso Resistant Resistant Sept. 1959 May 1960 Escuintla Resistant Resistant March -July 1959 DDT Oct. 1961 Dln Dec. 1960 Guatemala Susceptible IntermediateJune -July 1959 Aug. 1962 Izabal Intermediate May 1962 {Susceptible IntermediateJuly 1959 Retalhuleu Resistant March 1960 Suchitepéquez Susceptible Resistant July 1959 Oct. 1960 Zacapa Susceptible Resistant Sept. 1958
Haiti Artibonite Susceptible Intermediate Sept. 1960 Grande Saline Susceptible Resistant Sept. -Oct. 1960 Nord Susceptible Resistant Feb. 1960 Ouest Susceptible IntermediateSept. 1960 114 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Reaction Date of Species Country Region and Reaction Date of most recent district to DDT to dieldrin initial evidence confirmation
A. albimanus Honduras Atlántida Intermediate Oct. 1960 (continued) Choluteca Resistant - Nov. 1959 Sept. 1961 Comayagua Resistant Resistant Nov. 1958 DDT Nov. 1960 Cortés Susceptible Resistant Jan. 1959 El Paraíso Intermediate - July 1960 Francisco Mora - zán Resistant Resistant Jan. -April 1959 Oct. 1962 Valle Resistant - Nov. 1961 Jamaica Susceptible Resistant Nov. 1958 Feb. 1959
Mexico Chiapas Susceptible Resistant Dec. 1959 Din Sept. 1960 Guerrero Susceptible IntermediateMay 1960 Michoacán Resistant May 1959 Puebla Susceptible IntermediateOct. 1960
Nicaragua Carazo Intermediate Resistant Nov. 1959 Oct. 1959 Nov. 1961 Chinandega 1 Resistant - Resistant Oct. 1958 May 1960 Chontales Resistant - May 1961 Estelí Resistant Resistant Feb. 1960 Granada Intermediate Resistant Oct. -Nov. 1959 León Resistant Resistant April -Sept. 1959 DDT March 1961 Madriz Resistant - Feb. -March 1961 Managua Resistant Resistant Oct. 1958 Dec., 1960 Masaya Intermediate - July 1959 Nueva Segovia Susceptible Resistant Oct. 1958 Rivas Susceptible Resistant April 1959
A. albitarsis * Colombia Tolima Resistant Resistant April 1961
Venezuela Barinas Susceptible Resistant Sept. 1961
A. aquasalis Brazil Pará Susceptible Resistant March -May 1959
Trinidad and Tobago Trinidad Susceptible Resistant Aug. 1958 Feb. -July 1959
Venezuela Sucre Susceptible Resistant Aug. 1959 Sept. 1961
A. culicifacies India Andhra Pradesh : Krishna Susceptible IntermediateNov. 1960 Gujarat : Ahmedabad Intermediate May 1961 Ahwa Intermediate - 1961 Baroda Intermediate Susceptible Sept. 1959 1961 Broach Intermediate Susceptible 1961 Dangs Intermediate - 1961 Kaira Intermediate Susceptible Dec. 1959 April 1961 Resistant Susceptible Sept. 1959 April 1961 Panch Mahals 1 Resistant - May 1962 Surat Intermediate 1961 Madhya Pradesh Betul Intermediate Jan. 1961 Jan. 1962 Maharashtra : Intermediate 1961 Chanda 1 Resistant Feb. 1962 East Khandesh Resistant Jan. 1961 July and Sept. (Jalgaon) 1962 Thana Susceptible Intermediate Oct. 1958
* Vector status not established. ANNEX 8 115
Reaction Date of Date of Species Country Region and Reaction most recent district to DDT to dieldrin initial evidence confirmation
A. culicifacies India West Khandesh Intermediate - Dec. 1960 (continued) (continued) Mysore : Intermediate Feb. 1961 Mandya - Î Resistant - Sept. 1961 Rajasthan : IntermediateMarch 1959 Udaipur 1 Susceptible t Susceptible - March 1962 Nepal Bara Susceptible Resistant May -June 1960 Parsa - Resistant June 1960 A. funestus Ghana Volta Susceptible - Aug. 1961 Mozambique Catuane Susceptible - 1958 ? Jan. 1961 A. gambiae Cameroon Mbalmayó Susceptible - Oct. 1961 Mfou Susceptible - Oct. 1961 Yaoundé Susceptible Resistant Aug. and Oct. 1961
Congo Djoué Susceptible Resistant Feb. -April 1961 March 1962 (Brazzaville) ( Susceptible Resistant July -Sept. 1960 Ghana Volta Susceptible - April 1961 -March 1962
Mozambique Catuane and Mambone Susceptible Susceptible 1958 ? Jan. 1961
Southern Rhodesia Chirundu Susceptible Susceptible March 1960 Uganda North Kigezi ' Susceptible - Feb. -March 1960 July -Dec. 1961 Zanzibar Zanzibar - Susceptible June 1960 Pemba - Susceptible ? A. labranchiae Algeria Algiers Susceptible Resistant June 1960 Mostaganem Susceptible Resistant Sept. 1960 Oran Susceptible Resistant Aug. 1961
Morocco Rabat Susceptible IntermediateJune -Sept. 1959 July 1961
A. labranchiae atroparvus Romania Bucharest Intermediate Resistant July 1961 Aug. 1962
A. maculipennis Bulgaria Marten Susceptible IntermediateAug. 1960
Turkey Sakarya Intermediate Susceptible Sept. 1962
A. minims Indonesia East Java Susceptible Resistant Sept. 1962 flavirostris Philippines Mindanao Susceptible Resistant July 1959
A. neomaculipalpusColombia Córdoba Susceptible Resistant June 1960
Trinidad and Tobago Trinidad Susceptible Resistant Sept. 1959 July -Aug. 1960
A. nuñez- tovari Venezuela Táchira Intermediate Susceptible Aug. 1961
A. pharoensis Israel Ashkelon Intermediate Resistant Nov. 1959 116 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Region and Reaction Reaction Date of Date of Species Country district to DDT to dieldrin initial evidence most recent confirmation
A. pharoensis Sudan Blue Nile Intermediate Resistant Dec. 1959 Sept. 1962 (continued) United Arab Beheira Intermediate Resistant Sept. 1959 Republic Cairo Intermediate Resistant Aug. 1959 Sept. 1962 Fayum Intermediate Resistant Aug. 1959 Fouadiya Intermediate Resistant Sept. -Oct. 1959 Gharbiya Intermediate Resistant Sept. 1959 Giza Intermediate Resistant Sept. 1959 Ismailia Intermediate Resistant Sept. 1959 Minufiya Intermediate Resistant Sept. 1959 Qalyubiya Intermediate Resistant Sept. 1959 Sharqiya Intermediate Resistant Sept. 1959
A. pseudopuncti- Guatemala Chiquimula Susceptible Resistant April 1959 pennis Mexico Colima - IntermediateApril 1959 July 1959 Jalisco - Resistant July 1959 Mexico - Resistant Aug. 1959 Michoacán Susceptible Resistant May 1961 Morelos Susceptible Resistant Aug. 1961 Puebla - Resistant Oct. 1959 Sonora Susceptible IntermediateAug. 1961
Nicaragua León Intermediate IntermediateMay 1959
Venezuela Aragua Susceptible Resistant June 1961 A. punctimacula Colombia Chocó Intermediate - Feb. 1959 A. quadrirnaculatusMexico Tamaulipas Resistant Resistant July 1959 Aug. 1959
United StatesGeorgia Resistant Resistant Sept. 1959 of America Maryland Resistant Resistant 1958 Mississippi Susceptible Resistant Aug. 1954 June -July 1959
A. rangeli * Venezuela Tachira Susceptible Resistant June 1962
A. sacharovi Greece Central: Aetolia- Akarnania Susceptible Resistant Aug. 1960 July -Aug. 1962 Phthiotis Intermediate Resistant Aug. 1959 July 1962 Macedonia : Drama Intermediate Resistant June 1960 July 1962 Hematheia Intermediate Resistant Sept. 1960 Aug. 1962 Pieria Intermediate - July 1957 Serrai Resistant Resistant June 1962 Thessalonika Resistant Resistant June -July 1960 Aug. 1962 Peloponnesus: Heliae Intermediate IntermediateJuly 1962 Lakonia Resistant Resistant Aug. 1956 May -Aug. 1962 Thrace : Xanthe Resistant - Aug. 1959 Sept. -Oct. 1962 Turkey Aydin Resistant Susceptible Aug. 1961 Sept. 1962 Gazientep Resistant Susceptible Oct. 1962 Içel: Tarsus Resistant Susceptible June 1958 Kayseri Resistant Susceptible Aug. 1959 May 1962 Maras : Maras Resistant Susceptible Aug. -Sept. 1959 July 1962
* Vector status not established. ANNEX 8 117
Date of Region and Reaction Reaction Date of Species Country most recent district to DDT to dieldrin initial evidence confirmation
A. sacharovi Turkey Seyhan : (continued) (continued) Adana Resistant Susceptible June 1958
A.setgenti Jordan Dead Sea Susceptible Resistant Nov. 1958 Feb. 1961
A. stephensi India Madras Salem Resistant Susceptible Sept. 1957 1961
J Resistant Susceptible Oct. 1957 Iran Fars I Resistant Resistant Jan. 1959 June 1961 J Resistant Susceptible Oct. 1957 Kerman l Resistant Resistant Jan. 1959 June 1961 Resistant Susceptible Oct. 1957 Khuzistan Intermediate Resistant Nov. 1960 June 1962
f Resistant Susceptible Oct. 1957 Iraq Basra l Intermediate Resistant Oct. 1961 Oct. 1962 Muntafiq Resistant Susceptible March 1958 J Resistant Susceptible Nov, -Dec. 1955 Saudi ArabiaHasa Intermediate Resistant June -July 1962 J Resistant Susceptible Nov. -Dec. 1955 Qatif IIntermediate Resistant Feb. 1962
A.strodei * Brazil Sao Paulo Intermediate - Sept. 1961
A.sundaicus Indonesia Central Java : Jogjakarta Susceptible Resistant March -April 1960 Nov. 1960 Puworedjo Susceptible IntermediateNov. 1959 Sept. 1961 Semarang Resistant Susceptible June 1955 March 1960 Tjilatjap Susceptible IntermediateMay 1961 East Java : Banjuwangi (zone) Susceptible - Feb. 1962 Djambi (zone) Susceptible Resistant 1962 Probolinggo - Susceptible Sept. 1962 Surabaya Resistant Susceptible June 1956 West Java : Djakarta Resistant Susceptible 1954 Garut (zone) Susceptible Resistant 1962 Tjirebon Resistant Susceptible 1954 June 1956 North BorneoPapar - Resistant Aug. 1962 Sept. 1962
* Vector status not established.
8. RESEARCH
Researchactivitiesinmalaria,stimulated,co- As during previous years, the greatest attention was ordinated and assisted by the Organization, continued given to applied research, but various aspects of during 1962 at an increased pace, thanks to better fundamental research were also covered.Attempts planning and wider contacts with universities, insti- were made to consolidate and summarize the results tutes and other national research units, particularly of incidental research which are valuable by- products in the newer, developing, countries. of operational activity.Alf over -all assessment of In reviewing these research activities, it is conve- research activities in malaria was made with the assist- nient to divide them into separate groups according ance of a short -term consultant.On the basis of this to the fields of interest. review, and the recommendations made therein, steps 118 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I are being taken to channel research efforts along the malaria occur. A research project is being carried most fruitful lines. out on the identification of the species of sporozoites found in the salivary glands of mosquitos. 8.1Parasitology of Malaria 8.2Chemotherapy An investigation is in progress on the growth of exo- A small -scale trial of medicated salt has been set up erythrocytic forms of P. gallinaceuminvitro and in Africa, covering a population of some 3000 living attempts are being made to infect erythrocytes from in a reasonably isolated area.The salt sources and such cultures in vitro.It may be possible to use the intake have been carefully studied and on this basis culturesof exo- erythrocytic formsassourcesof medicated salt containing 0.3 per cent. chloroquine infection of erythrocytes in vitro and as a known and base has been supplied.The medicated salt is sold constant parasite material for chemotherapeutic assay at the same rate as normal salt and is extremely and for the investigation of metabolic pathways of popular. The results thus far obtained in this holo- malaria parasites generally and in relation to some endemic area have been encouraging. specific drugs. For the preparation of medicated salt, compounds A study of the development of the peritrophic mem- of low water solubility, such as chloroquine hydroxy- brane of A. atroparvus, A. gambiae, A. stephensi and naphthoate and chloroquine tannate, would be of Aedes aegypti is in progress; the behaviour of the advantage because they are not subject to " leaching ookinete of P. gallinaceum and P. cynomolgi in rela- out " as are the very soluble chloroquine diphosphate tion to peritrophic membrane development is being and sulfate.When given to children in large single investigated.It has been found that the peritrophic doses, choloroquine hydroxynaphthoate and tannate membrane is quickly secreted and its development were found to be poorly absorbed and therefore completed in thirty hours after the taking of a blood relatively ineffective.It was thought, however, that meal in Aedes aegypti and Anopheles gambiae and in small daily amounts of these drugs, such as could be forty -eight hours after taking a blood meal in A. atro- ingested with medicated salt, might be completely parvus.Ookinetes of P. gallinaceum adherent to iso- absorbed.It was found on investigation that small lated peritrophic membranes of Aedes aegypti have been daily doses of the hydroxynaphthoate, corresponding studied and seen to change position very slowly. to 38 mg of the base and given to children for seven As a result of an observation made in the field, days, cleared asexual parasitaemia due to P. falci- which may be of some importance, the Organization parum.Similar doses of chloroquine tannate proved has supported experimental work on the possible less satisfactory. interaction between Semliki Forest virus and P. galli- At the annual meeting in November 1962 of the naceum in Aedes aegypti. American Society of Tropical Medicine, a new develop- An important field for research in parasitology today ment in the field of malaria chemotherapy was reported is the study of simian malarias.The discovery of a which may provide a valuable addition to the present possible zoonosis involving P. cynomolgi bastianellii range of therapeutic agents.This is a long- acting, has stimulated interest in this field. injectable drug at present called CI -501 and chemically Investigations on simian malaria are at present being consisting of the pamoic acid salt of 4,6- diamino -l- carried out by a joint research group of the United (p-chlorophenyl ) -1,2- dihydro -2,2- dimethyl -s- triazine. States Public Health Service and a national research It is reported that a single dose of CI -501 protected institute.A number of new species of simian malaria monkeys from severe challenges with malaria parasites parasites have been discovered and their natural ano- for an average of thirty -four weeks and that some pheline vectors traced in some cases.However, no were protected for up to fifty weeks.None of the evidence of natural transmission of monkey malaria doses caused local irritation or was systematically to man has been established.As many parallels may toxic.Similar results, though not so long lasting, be drawn from the study of the parasitological, ento- were obtained in human volunteers. If further trials mological and epidemiological aspects of simian mala- with this drug give results as promising as those already ria and those of human malaria, the Organization has obtained, its employment may be considered in certain signed an agreement with a research institute to under- situations in malaria eradication programmes, but it take a study which may assist in explaining some of should not be expected to solve all the problems.As the puzzling epidemiological situations which occur the time has come when a field trial of this drug should at times. be carried out, a research project is being set up by The identification of plasmodial infections found in the Organization for the purpose.This project will some species of Anopheles in the field is of particular also serve for the testing of other potential anti- importance in areas where human malaria and animal malarial drugs under development. ANNEXS 119
A study of the mechanism and dynamics of drug An exceptionally (interestingapplicationof the resistance was undertaken; P. bastianellii and P. cyno- method of fluorescent protein tracing has been deve- molgi were used for this work. loped for the measurement of circulating antibody to Consideration of the chemical structure of meta- plasmodial infections in the African population living bolites of some drugs may foretell the occurrence of in holoendemic areas.Here the antigen was P. falci- cross -resistance between these drugs.Nevertheless, parum, the conjugated serum was anti -human -globulin the appearance of cross -resistance is not always pre- serum and the sera under test were from local in- dictable; thus some proguanil- resistant strains of mala- habitants; these sera were serially diluted to obtain ria parasite seem to be resistant to pyrimethamine, titres at which the test gave a threshold staining re- whereas others are not; but strains made resistant to action.The results showed that the technique can be pyrimethamine by treatment with that drug appear to used satisfactorily as a serological test for malaria be resistant to proguanil.This problem has not been immunity. fully investigated under controlled conditions, and a The work on fluorescent protein tracing carried out study of it has just begun. under semi -laboratory conditions is now ready for A research project was started to study metabolic extension to the field and for assessment of the value of pathways of chloroquine- resistant and chloroquine- thetestformalariacase -detection. Thisfield susceptible strains of rodent and primate malaria para- project on epidemiology is being carried out in West sites, using various substrates labelled with radioactive Africa, where a new phase in the development of carbon.The aim of these studies is to assess the pos- immunology applied to malaria was started with the sible relationship between the phenomenon of drug discovery by a research team of a causal relationship resistance and the permeability barrier. between the gamma -globulin level in the blood and Research covering the synthesis of a series of deriv- acquired immunity tomalaria.Purified gamma - atives of phenyl -diamidine -urea in order to assess their globulin fractions were found to have a definite effect potential value as antimalarial drugs is being stimul- on the course of malaria infection. ated and supported. Among the methods fot the assessment of immune Investigations devoted to the synthesis of compounds response to infection with blood protozoa, the respiro- of 6- aminoquinolines and of pyrocatechols and to the metric test showed much promise, and research on its assessment of their value as antimalarials are now in practical value in mammalian malaria was stimulated progress, and the first results obtained in avian and and assisted by WHO. The test is based on the fact simian malaria are encouraging. that the energy of the malaria parasite is obtained A comparative study of the haemolytic effect of throughoxydativeglycolysis,theoxygenbeing primaquine and quinocide in individuals with glucose - obtained from the oxyhaemoglobin.Parasitized red 6- phosphate dehydrogenase (G- 6 -P.D.) deficiency is blood cells show a considerably increased oxygen being carried out.For this investigation, a prelimi- consumption, anditwas necessary to determine nary survey of a group of West African males was whether the antibody acts against the whole infected completed and it was found that 20 per cent. were red blood cell or only against the parasite itself. deficient in this enzyme.All the G- 6 -P.D. deficient An alternative test, the tanned red cell haemagglutina- individuals exhibited low blood -cell oxygen consump- tion test, was developed and proved to be a sensitive tion but neither G- 6 -P.D. deficiency nor the presence technique for measuring antibodies developed against of abnormal haemoglobins appears to affect the hae- a wide variety of antigens.Recently a modification moglobin concentration.The investigation continues. of this test, employing formolized tanned sheep cells, was used to determine its value for plasmodial infec- 8.3Immunology tions of primates.
One of the problems of practical importance in the 8.4Epidemiology immunology of malaria concerns the development of better techniques for detection of malaria infection Knowledge of the duration of P. falciparum infec- and for quantitative measurement of the degree of tion in subjects with various degrees of acquired im- acquired immunity toit.A research project to munity in the absence of transmission is of obvious investigate these possibilities is being carried out in importance, and a research project aimed at the col- Europe, and another, with a slightly different experi- lection of some reliable data is now being carried out mental approach, in Africa.The methods used for in Europe.At the present time only a small sample these investigations are fluorescent antibody tracing of suitable subjectsis being investigated and the (direct and indirect) and gel diffusion technique for information gathered is of limited value, but more precipitating antibodies. progress is expected before long. 120 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
It has been recognized that a study of this kind addition, strains of A. quadrimaculatus from the United would be easier to carry out in an area closer to the States of America, A. pharoensis from the United source of infection, where suitable subjects would be Arab Republic, A. albimanus from El Salvador, and available in larger numbers. A second investigation A. stephensi from India, are also being investigated. has therefore been sponsored by the Organization in Field investigations closely linked with these inten- an area where there is an influx of workers from mala- sive laboratory studies have been carried out in Indo- rious areas to a non -malarious area.These workers nesia, in association with the national staff, to find should prove to be most suitable subjects, as they are out the effect of different insecticides and combina- likely to remain in the non -malarious area for up to tions of insecticides in delaying or suppressing the five years before returning to their homes.The aim selection of vector strains resistant to dieldrin or to of this project is to study over a period of years the DDT. Those studies, primarily concerned with assist- parasitology and symptomatology of P. falciparum ing in the long -term planning of the Indonesian pro- malaria and effect of treatment in immune and semi - gramme, have already yielded information which may immune mine -workers transferred to a malaria -free be of great significance in the context of malaria area. eradication as a whole. An investigation of the frequency and character of With regard to the behaviour of vectors when malaria infections connected with blood transfusion exposed to insecticide, support is being given to studies has been started. on different aspects of this increasingly important A study of the relationship between malaria infec- subject.Field investigations are being carried out in tion of the placenta and prematurity and perinatal Southern Rhodesia and in Swaziland to explain why death is taking place in East Africa. insecticide treatment -with BHC -in those countries An investigation of the relationship between the appears to have eradicated a man -biting strain of the incidence of cerebral malaria and degree of parasi- vector A. gambiae, leaving behind a strain of this taemia and the presence of abnormal haemoglobin in vector which is mainly attracted to cattle and has West Africans was completed.The results showed little,if any, malarial significance.Supplementary that all cases of fatal cerebral malaria occurred in studies on the behaviour of vectors are also being carriers of AA haemoglobin and not one in carriers of carried out in West Africa, Europe and the Levant. AS haemoglobin.The mean density of parasitaemia Closely concerned with the problems both of resist- was lower in subjects with the sickle -cell trait.The ance and of behaviour is the increasing emphasis presence of AC haemoglobin and the presence of the placed on the existence of different strains of vectors, glucose -6- phosphate dehydrogenase deficiency trait did particularly A. gambiae in Africa.The existence of not seem to have a protective action in malaria infec- such strains has long been suspected, in view of the tion with P. falciparum. fact that the same vector species may differ in reaction to insecticides, or differ in behaviour in different parts 8.5Entomology of Africa.Recent work supported by WHO and Research activities supported by WHO have been based primarily on a careful analysis of crossing mainly concerned with two important aspects of vector experiments involving mosquito colonies of different reaction to insecticide treatment :first, the fact that origin has confirmed the existence of such strains, in certain vector species readily develop resistance to A. gambiae at least.Two main groups of differing insecticides while other species do not; secondly, the behaviour have been defined so far.These groups or fact that different vectors may show different beha- populations are isolated by a sterility barrier and can viour in the presence of insecticide, this behaviour therefore remain distinct even when they exist side by sometimes playing a major role in determining the side in the same area.This work is being continued success or otherwise of spraying operations. on a collaborative basis -supported by WHO -by With regard to the first aspect, a considerable scientists in Africa and in Europe.It is expected that amount of work is being carried but on the genetics these investigations will have an increasingly important of resistance in order to study the mode of inheritance bearing on the question of interpreting the effect on and the factors causing the selection of resistant strains the vector of different malaria eradication measures, inpopulationsrepeatedly exposed toinsecticide as well as providing guidance on the choice of insecti- pressure.This type of work, under an agreement cide in long -term programmes. with WHO, has been particularly actively pursued over the last four years.The most important fields 8.6Developments in Insecticides of study are on the dieldrin- resistant strain of A. gam - The Organization's programme of research, evalua- biae from various parts of West Africa and the DDT - tion and testing of insecticides provides, in the last resistant strain of A. sundaicus from Indonesia.In stage, for the assessment under field conditions of any ANNEX 8 121 new insecticide of potential value, as an alternative or will be studied in a check area.For malathion, the otherwise, to the chlorinated hydrocarbons used in field trial area is located in Uganda, in the Masaka malaria eradication.Following testsof restricted district; malathion is applied at a dosage of 2 g /m2, effectivenessand toxicologicalinvestigations,two at intervals of three to four months.For dichlorvos, products -malathion and dichlorvos (DDVP) -are at the project area is in Northern Nigeria, in the vicinity present being tested in large -scale field trials.Both of Kankiya; in this latter trial two types of dispensers, are organophosphorus insecticides, but the firstis one with solid and one with liquid 20 per cent. for - applied as a residual contact insecticide, while the mulation, will be under test, each type being used for second is strictly a fumigant, producing its effect on half the population in the field trial area.The results mosquitos by vapour concentration. of the village scale trials out so far indicate that on the In order to assess their practical value in malaria average one dispenser per 21 m3 is effective for ten eradication programmes, these insecticides are tested weeks -a cycle and dosage which will be tried initially as regards their capacity to interrupt malaria trans- in the project.Both the malathion and dichlorvos mission in areas with high or moderate endemicity field research projects will be staffed by WHO teams and a long transmission season, with, if possible, little composed of a malariologist, an entomologist, a sani- population movement, minimal outdoorsleeping tarian and a technician. habits of the local population and one or, at the most, Fenthion, another organophosphorus insecticide, two vectors known to transmit malaria indoors. which in preliminary and village scale trials has shown These technical requirements are a sine qua non for a to be promising, requires further investigation on the sound epidemiological evaluation in which malario- toxicological side. metric and entomological indices may be relied upon. Amongst other products tested in the WHO scheme, Two areas responding to the above conditions have a carbamate insecticide has successfully passed through been found, in each of which 20 000 people will be all the preliminary stages and is ready for trial in under protection of the insecticide and another 10 000 field conditions.
9. CO- ORDINATION
Malaria eradication demands the closest possible of the consolidation phase in the various areas and co- operation and the most effective co- ordination at provides for the periodic exchange of epidemiological all levels.Within a country, co- operation and co- information. ordination are required among the general medical In addition to the meetings of directors of national and health services, the malaria service, the public malaria eradication services which take place within services as a whole and the general public.At the regions, there have been several important inter- governmental level, interministerial and interdepart- regional conferences bringing together representatives mental co- ordination must be assured, and for this of countries with common borders.During 1962, purpose stress has been laid on the importance of for example, there were the Second European Con- national co- ordination committees in order to establish ference on Malaria Eradication. in Tangier in March, the concurrent responsibilities of the various minis- theInter -regional Technical Meeting on Malaria departments and agencies involved. Inter - tries, Eradication in Teheran in May, the Third African country co- ordinationisrequired between neigh- bouring countries in order that operations in border Malaria Conference in Yaoundé in July, and the areas may be carried out in the most effective and Fourth Asian Malaria Conference inManila in economical manner; and wider inter -country co- September. Another form of international co- ordina- ordination between larger groups of neighbouring tion is reflected in the visits by senior personnel of countries is needed in order that they may move national programmes to other malaria eradication together towards the goal of eradication and thus services under the scheme for the exchange of scientific reduce the risk of reimportation of the disease. workers. At this inter -country level, considerable progress Every effort has been made to maintain the closest has been made during the year; in the Eastern Mediter- collaboration with thedifferent international and ranean Region, Iraq, Jordan, Lebanon and Syria bilateral agencies which are assisting countries in have agreed to develop a co- ordinated plan similar malaria eradication. During theyear, UNICEF to that previously adopted by the European Region. co- operated with WHO in furnishing material assist- This plan indicates the expected timing of the end ance to thirty -three malaria eradication programmes, 122 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
of which twenty -one were in the Region of the Ameri- of the malaria eradication training centre at Kingston, cas. UNICEF also gave assistance to the pre- eradi- Jamaica.In line with past practice, as a means of cation survey in Sudan. The United States Agency ensuring the greatest possible collaboration between forInternational Development (AID)assisted in AID, UNICEF and WHO, a fifth meeting of an seventeen malaria programmes (ten in the Americas) informal co- ordinating committee of these agencies and co- operated with WHO /PAHO in the operation took place in Washington in December 1962.
10. STATUS OF MALARIA ERADICATION BY REGIONS
10.1African Region within their financial resources, a basic health service for their respective populations and, secondly, their 10.1.1General Progress and Prospects wish, as expressed during the deliberations of the In the concept of malaria eradication in the African World Health Assembly, to embark upon a pro- Region, two basic facts must be considered of para- gramme for malaria eradication. mount importance. First, the newly emerged countries It is fully appreciated that there exist among Member of Africa, with their urgent need of manpower for States in the African Region different levels of pre- economic and social development, can ill afford to paredness for malaria eradication programmes, and continue to pay the heavy toll which malaria mortality also differences in the time -schedules that those States imposes on the young age -groups of the population. can set themselves to reach full preparedness.The Secondly, the campaign in this region forms part co- ordinationofeffortbytheseveralcountries of the global malaria eradication programme; it is, included in the regional co- ordinated plan iscal- therefore, imperative that the Region participate in culated to ensure that no one country or group of this collective effort in order to eliminate the danger countries in the African Region will be lagging too far of reintroducing the disease from tropical Africa to behind in the general progress towards the minimum other continents -a danger which becomes a reality preparedness necessaryforlaunchingafull -scale with present -day travel facilities. malaria eradication programme. The only eradication programmes in the region are those on the islands of Mauritius and the Zanzibar 10.1.2TrainingofNational MalariaEradication Protectorate, and in Swaziland and the Republic Stiff of South Africa.In Mauritius, steady progress has The training of the professional and auxiliary been made towards eradication : in 1961, 955 positive personnel in techniques of malaria eradication has cases were recorded, as compared with only 226 cases shown steady progress. The WHO malaria eradication in 1962.The case -detection mechanism was streng- training centre at Lagos, Nigeria, for English- speaking thened by the reorganization of the malaria eradication students, held its first course from October to Decem- project during April 1962. This included a reorganiza- ber 1962; it was attended by fifteen non -professional tion of the epidemiological zones on the island, trainees from the following countries : Gambia, Ghana, together with improved supervision of active case - Liberia, Mauritius, Nigeria and Sierra Leone. The detection and promotion of a better participation following courses were planned for 1963: a senior of the existing network of rural health service posts. course for professional staff, 7 January to 3 May; In the Zanzibar programme, critical evaluation of a course for senior national laboratory technicians, the spraying operations has shown that total coverage 27 May to 28 August; and a junior course for auxiliary had not been attained in the past -which may explain personnel, 1 October to 17 December. the failure to secure the complete interruption of A second WHO malaria eradication training centre transmission. Geographicalreconnaissancehas, has been planned for French -speaking students at therefore, been instituted and the revised plan of Lomé, Togo.A preliminary agreement has been action includes the spraying of all sprayable surfaces. negotiated with the Government, and construction At its twelfth session the Regional Committee for of the instructional block is due to be completed in Africa endorsed a regional co- ordinated plan for May 1963. The first course at this malaria eradication initiating pre- eradication programmes, envisaging the training centre is expected to be organized before the implementation of seven new projects in 1962, ten in end of 1963. 1963, and seventeen in 1964.Pre -eradication pro- In addition to these training facilities which are grammes meet,first,the universal desire of new being developed in the Region, twenty fellowships Member States to provide as rapidly as possible, were awarded to nationals of various countries for ANNEx 8 123 attendance at malaria eradication training courses at which is under negotiation, this sector will serve as Belgrade, Kingston, Moscow and Sáo Paulo.At an area for demonstration and training and for cost country level, training of more junior categories of analysis of spraying operations in typical areas of national staff destined to serve in the national malaria varying population density.In the western sector of service is undertaken in Cameroon, the Federation the malaria eradication pilot project, the area has been of Rhodesia and Nyasaland, Ghana, Mozambique, used to develop surveillance activities.Here trans- Togo, Uganda and Zanzibar. mission .has beeninterrupted,followingresidual spraying for some three years. 10.1.3Operational Aspects Sprayingoperationswerecarriedoutinthe In Mauritius, which has the most advanced WHO- Yaoundé pilot project of Cameroon from 1954 and assisted eradication programme inthe Region, a were discontinued in February 1960 after an assess- critical reappraisal has resulted in the preparation ment which proved that transmission of malaria had of a new plan of operation ;this was signed by the been interrupted.Surveillance activities were there- Government and WHO in August 1962. For purposes fore initiated; however, by the second half of 1961, of planning the programme, the island was divided and especially during1962,a high incidenceof into three operational zones, delimited on the basis malaria started to reappear in the entire former pilot of the existing malaria situation -a central main- area.This was also confirmed by data from clinics tenance zone, an intermediary consolidation zone and in the project area which, inquiries revealed, were a coastal attack zone.Since the beginning of sur- being attended by a continually increasing number veillance operations in1960,activecase -detection of patients with fever symptoms typical of malaria, has been the principal method used and has produced although in the years up to mid -1961 malaria cases 70 per cent. of the slides collected.Results during were rarely seen there. The failure to keep the project 1962 showed steady progress, the total number of area free from malaria was due not only to the fact positive cases on the island having dropped from 955 that the area is completely surrounded by districts in 1961 to 226 in 1962, of which 932 and 207 res- with hyper- endemic malaria and that it has at its pectively were in the coastal areas.Of the 207 cases centre the capital, Yaoundé, which attracts a con- in the coastal areas in 1962, 119 were in the district of siderablemovement of population,butalsoto Port Louis.Here, active surveillance was not suffi- deficiencies in the surveillance operations. ciently developed and, despite the number of medical Following the acceptance of the policy for pre - unitssituatedinthe suburban area,ithas been eradication programmes in the less developed newly considered necessary to establish total coverage by emerging countries, the Regional Office for Africa was active case -detection. engaged in 1962, at the request of the Governments In the programme in Zanzibar Protectorate, steps concerned, in converting malaria eradication pilot were taken in 1962 to deal with several inherent projects into pre- eradication programmes in Came- difficulties. The main defect discovered was that total roon, Ghana, Mozambique, Northern Nigeria, Togo coverage had not been attained in the past because the andUganda, andinitiatingnew pre -eradication extremely high roofs in parts of the islands had not programmes inLiberia,Madagascar,Mauritania, been treated.Furthermore, preliminary geographical Nigeria (two) and Senegal. Notification of acceptance reconnaissance has demonstrated the need to bring has been received from the Ivory Coast, while requests the existing maps up to date and to complete a full - for additional information have been submitted by scale geographical operation. For this purpose a first theGovernmentsof Dahomey and Tanganyika. group of twenty -four mappers has been trained. There is little doubt that, as a principle on which to Provision has been made to combine the twice -yearly plan for the general development of health services spraying cycles with mass drug administration, using incountries,thepre- eradication programme has combined 4- aminoquiline /primaquine therapy, with found general acceptance in the countries of the the aim of reducing the apparent asymptomatic Region. parasite reservoir; however, the full impact of this As regards the pre- eradication programmes which measure will be assessed only in 1963. have already been started, demonstration and training In Southern Rhodesia, in the eastern sector of the areas are in operation in Ghana covering a population project area, where some spraying operations have of approximately 80 000. The northern section of the been carried out during the past years,residual area has been used primarily for the field training spraying was discontinued from May 1962 in order of national auxiliary personnel who are to serve in a toallowa complete geographical reconnaissance supervisory capacity in the eventual malaria eradi- to be undertaken before the resumption of spraying cation programme.In Cameroon, the results of in 1963. Under the terms of a new plan of operations, epidemiological surveys have made it essential for 124 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I the entire previous Yaoundé pilot project area to be the joint auspices of the Organization and the Com- used as the demonstration and training area for the mission for Technical Co- operation in Africa (CCTA). pre- eradication programme. In Northern Nigeria, It was attended by representatives of 25 countries the demonstration and training area has yet to be in the African Region, by observers from CCTA and delineated but provisions have been made in the plan the United States Agency for International Develop- of operation for it to be within the Western Sokoto ment, and by WHO staff of the African and Eastern mass malaria control area where the Government is Mediterranean Regions and headquarters. committed to maintaining field activities at least at As a sequel to the Yaoundé Conference, a meeting existing levels.In Togo, it was previously planned of WHO malariologists was held in Ibadan, Nigeria, that the demonstration and training area under the in October 1962. This meeting was attended by WHO pre- eradication programme would be in the northern public health and malaria advisers of the Region, part of the country; however, that area does not headquarters and regional office staff, and malaria appear to be suitable for all purposes and another advisers of the Eastern Mediterranean Region from is being considered. For this programme a short -term projects in the north -eastern part of Africa. consultant carriedout,inco- operation with the Togolese and WHO country advisory staff, a survey of the existing health resources of the country, with 10.2Region of the Americas a view to drawing up a plan for the development of the rural health infrastructure, including the phased 10.2.1 General Progress and Prospects training of the personnel required. As in Cameroon, the epidemiological situation in The malaria eradication programme progressed the Kigezi pilot project area in Uganda has made it steadily in 1962.During the year the attack phase necessary to retain that project area for training was completed throughout British Honduras, Jamaica purposes in the pre- eradication programme in Uganda. and Trinidad and Tobago, and these areas entered In Northern Ghana a field trial of medicated salt the consolidation phase. In parts of Argentina, was continued during the year. Distribution of Bolivia, Colombia, Costa Rica, Guadeloupe, Gua- medicated salt was started in July 1961 in the project temala, Honduras, Nicaragua, Panama Canal Zone, area and within two months encouraging results were Peru, Surinam and Venezuela, further areas were also recorded, as shown by a rapid reduction of over -all placed in the consolidation phase.Some twelve and parasite rates from 80 to 6 per cent.However, the a half million more people than in 1961 are now rate of turnover of medicated salt started to decline living in areas in the consolidation phase. in October 1961, and by December 1961 the daily Haiti began total coverage early in January and by consumption of medicated salt per person had fallen the end of the year had completed two cycles of from the 5 g originally estimated to about 1 g. Investi- spraying without encountering serious problems.In gations showed that the actual rate of salt consumption Brazil new areas entered the attack phase and, if had not changed from the original estimates, and it there is no setback in government support, the entire was proved that unmedicated salt was being made malarious area of the country will be in the attack available for sale surreptitiously.Following discus- phase by the end of 1964.In addition to areas of sions with the Government, it was decided to amend Venezuela, the islands of Carriacou, Grenada and the method of salt distribution so that wholesalers St Lucia entered the maintenance phase. These islands would be by- passed, and the retail sale would be are being registered as areas where malaria has been undertaken by government- nominated agents. In eradicated. addition, provisions were made for pre -packaging A summary of the progress made towards eradica- the medicated salt in pennyworth plastic bags in an tion is given below : effort to standardize the cost to the consumer. These new measures became effective from 12 September Population in areas 1962. where malaria in consolidation eradication phase Field trials with malathion are being undertaken in claimed Uganda, and with dichlorvos (DDVP) in Northern 1959 53251000 2156000 Nigeria. 1960 54365000 10010000 1961 56279000 17879000 1962 59326000 30436000 10.1.4Co- ordination The Third African Malaria Conference was held in In addition, out of a total population of 153 891 000 Yaoundé, Cameroon, from 3 to 13 July 1962 under in the originally malarious areas, 49 386 000 are in ANNEX 8 125
areas in the attack phase and 13 753 000 in areas in such as the use of organophosphorus insecticides, the preparatory phase. mass drug administration and larviciding, are being However, progress was not uniform throughout tried out.In Mexico, additional financial support the Region. Administrative and financial deficiencies is being sought to cover the cost of the supplementary were responsible for setbacks in some areas, and for measures needed to achieve interruption of transmis- near stagnation in others. A serious economic crisis sion in the problem areas.Financial difficulties are prevented extension of spraying operations to the also being encountered in Paraguay and Peru. provincesof Chaco and Formosa in Argentina. In Brazil, the attack phase began by stages in 1961 This part of the campaign, therefore, will have to be and it is planned to achieve total coverage by the end considered as again in the preparatory phase, although of 1964. The prospects of success seem assured great achievements have been accomplished in the in the State of Sao Paulo, where the attack phase is past. On the other hand, some countries (Colombia, proceeding well.Cuba is still at the very beginning El Salvador, Mexico, Nicaragua and Peru, among of the attack phase; by the end of 1962, spraying others) require additional funds to supplement their operations had covered only a small area of the programmes inorder to interrupt transmission in country.In Ecuador, DDT has been employed for problem areas. less than two years but there was a substantial reduc- With the progress of the attack phase and the tion of P. falciparum cases during 1962. Total coverage improvement of epidemiological operationsithas of the malarious areas of French Guiana is planned been possible to delimit, with some precision, the for 1963.In Haiti, total coverage started in January areas with definite persistence of transmission in 1962 and there is a good prospect of success of this certain countries. In these areas, in addition to house programme, which is adequately administered and spraying with insecticides, relatively expensive sup- financed. In Panama, total coverage with DDT plementary methods of attack must be applied. twice a year began in May 1962; however, there are financial difficulties with this programme. Experience gained in 1962 shows that eradication of malaria in the Americas within the present decade will depend upon the will of the governments to give 10.2.2Training and Staffing for National Malaria it top priority in planning economic development. Eradication Projects At the end of 1962 the islands of Grenada and During 1962 three training centres continued to Carriacou and St Lucia were in the process of regis- offer regular courses on techniques of malaria era- tration as having achieved malaria eradication. dication. The XVIII International Course on Malaria In Bolivia, British Honduras, Costa Rica, Domi- and Metaxenic Diseases wasgiveninMaracay, nica, Guadeloupe, Guatemala, Honduras, Jamaica, Venezuela; three courses for senior and one for junior Panama Canal Zone, Surinam, Trinidad and Tobago officers were given by the malaria eradication training and Venezuela, progress has been maintained and centre in Kingston, Jamaica, and two courses for complete eradication of malaria seems assured. senior officers and one for entomologists were given In a number of countries the prospects for eradi- by the Faculty of Hygiene and Public Health of the cation appear good, but technical or administrative University of Sao Paulo, Brazil.No formal course difficulties have still to be overcome.For instance, was given in Mexico. inadequate financial support by the Government of Each national malaria eradication service continued Argentina has slowed down the campaign in that to provide training for its own staff.Every campaign country.In British Guiana, transmission has been in the attack phase retrains the spraying personnel almost interrupted in the interior, except in part of inthe interval between the sprayingcycles and the border with Brazil, where the population is using organizes training courses for auxiliary personnel for non -medicatedsalt which can be obtained more epidemiological operations according to needs. cheaply from over the border.Plans are being made to begin spraying operations in this area. Total 10.2.3Operational Aspects coverage has not yet been achieved throughout the Revised plans for malaria eradication were com- entire malarious areas in Colombia, where a reorgani- pleted in Brazil, the Dominican Republic and Panama. zation of the administration of the campaign is necessary. In addition, administrative reorganization was necess- In the Dominican Republic administrative reorganiza- ary in Guatemala, Haiti, Honduras and Nicaragua, tion is also required. In El Salvador and Nicaragua, where the programmes until then were administered technicaldifficultiesarebeing encountered inthe bytheInter -AmericanCo- operativeServiceof interruption of transmission, and additional measures, Public Health (SCISP) which has since been closed. 126 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
In Paraguay, as further epidemiological studies consisted of 600 mg (base) for adults with more than were required to redefine the total malarious area, 60 kg of body weight, and 450 mg (base) for adults the country has reverted to the preparatory phase. and children over twelve years with a body weight Toimprovecase -detectionactivities, Mexico between 40 and 60 kg. Children of nine to twelve years adopted in 1961 a new organizational system.It was (25 -40 kg) received 300 mg, those between four and agreed that the department of spraying operations eight (15 -25 kg) 150 mg, and between six months and was better equipped than the epidemiological depart- four years (7 -15 kg) 75 mg. ment to carry out the case -detection activities; thus the In Mexico, presumptive cases in areas in the con- engineers were made responsible for both the spraying solidation phase were treated with pyrimethamine. and case -detection operations.As a result, instead The dose was two tablets of 25 mg (base) for indivi- of having two competing operations, one of spraying duals over fifteen years of age and one tablet for those and another of epidemiology, each working inde- of fifteen years or less. pendently under the supervision of one inspector not Malaria was eradicated from areas in Trinidad interested in the other's activities, each inspector of infested by A. (Kertezia) bellator, an outdoor daylight a sector of field operations was made responsible for biter, by mass drug treatment of the population all basic malaria eradication activities in his area. involved.In order further to observe methods of The association of attack and evaluation kept the drug distribution and costs, the Organization spon- personnel more interested in the battle they are sored, during 1962, pilot projects of mass treatment fighting and gave them more hope for their own in some of the problem areas of Costa Rica, El future employment. At the Tenth Meeting of Directors Salvador, Guatemala, Mexico and Nicaragua.After of Central America, Panama and Mexico, the par- preliminary observation of a small trial carried out in ticipating countries agreed to adopt the system. El Salvador in 1961, it was established that a combined In order to improve the participation of the local tablet of chloroquine and primaquine would be used. health services in case -detection, especially during the The success of this method of mass medication consolidation and maintenance phases, two seminars depends a great deal upon the effectiveness of the work are planned for the Americas in 1963, one for the during the preparatory phase. Health educators must South American and the other for the Central Ame- survey the area to explain the programme and the rican countries. They will be attended by the national reasons for it to the population.Simultaneously it directors of health, thedirectors of local health is necessary to study the population's habits principally services and the directors of the national malaria to determine where people stay during the various eradication services. hours of the day - for example, old persons and very In 1962 the Communicable Disease Center of the young children are generally found at home, teenagers United States Public Health Service, and the Govern- at school and adults at their place of work. ments of Guatemala and Nicaragua with the assistance The distributionof chloroquinizedsaltinthe of UNICEF and the Organization jointly conducted interior of British Guiana began in January 1961. field trials on the usefulness of a pressure regulator The programme has been well received by the public, disc in the nozzle tip of spray pumps.Results were and the co- operation of the salt dealers has been considered satisfactory enough to justify the adoption excellent. Medicated salt had reached more than of the disc in most house spraying operations with 96 per cent. of the houses in the interior by the end wettable powder insecticides.Experience has shown of 1962. Malaria transmission has been virtually that, in addition to 10 per cent. savings in insecticides, interrupted in the entire population of 35 000 in the the device has contributed to an increased output per interior, except in those living in the Lethem area, man -day of operation. The device cannot, at present, which borders upon Brazil. The problem in this area be used for spraying emulsion or solutions of DDT or has been insufficient coverage of the 1400 inhabitants dieldrin because the chemicals used in these formula- with chloroquinized salt, because non -medicated salt tions attack the synthetic rubber disc that regulates has been readily available on the Brazilian side at the pressure. half the price of the chloroquinized salt.In addition, There was a considerable increase in the use of it has been suspected that there may be a strain of drugs in 1962.This was due to expansion of case - P. falciparum resistant to chloroquine in this area. It is detection activities, an increase in the number of planned to make a careful study of the possibility those given radical treatment, and mass drug treat- of drug resistance in the area.It is also planned to ment in pilot areas. With few exceptions, in all areas spray the houses in the Lethem area as a supplementary in the attack and consolidation phases a " presump- measure and at the same time to request the Brazilian tive " treatment of chloroquine was administered to authorities to intensify their malaria eradication efforts the patients who gave a blood sample.The dose along the border. ANNEX 8 127
Preparations were made for a screening centre for No indigenous cases were found in nine of the the detection of strains of human plasmodia resistant, seventeen countries that reported case -finding activities or highly tolerant to, chloroquine and otheranti- in areas in the consolidation phase. malarial drugs to be opened in the State of Sáo Paulo, Entomological work was greatly intensified in the Brazil, with the support of the Organization, early problem areas. During 1962 an epidemiological study in1963. team continued to work in El Salvador in order to The countries with malaria eradication programmes investigate the causes of persistence of transmission and that have areas where eradication is claimed or in the coastal area. The team found that the vector, has been registered have maintained adequate sur- A. albimanus, in addition to being resistant to dieldrin veillance operations in such areas.All cases detected and DDT, in certain areas has also acquired a highly have been investigated and classified as recommended sensitive repellency to DDT.This excito- repellency by the Organization. The only country which reported is sometimes so high that the mosquitos do not rest indigenous cases in its area in the maintenance phase on the sprayed walls long enough to absorb a lethal was British Guiana.Areas in Venezuela registered dose of the insecticide. Populations that are suscepti- as areas where malaria has been eradicated continued ble and resistant to DDT sometimes behave in the under heavy pressure owing to the arrival of malaria same manner. cases imported from abroad. Argentina also reported A device called the " Excito- Repellency Test Box nine introduced cases and three imported from its (Model PAHO) " was developed during 1962 by the own malarious area in the attack phase.From the personnel of the epidemiological study team for the countries in which malaria was eradicated before 1957 study of Anopheles mosquitos in relation to wall information is scarce, except from the United States surfaces that have been sprayed with DDT.While of America.Every year the United States Public the potentialities of the device have not been fully Health Service publishes a report indicating all cases explored, it has already given some very interesting of malaria that have been detected in the country. information about the variation in excito- repellency During 1962, sixty -six cases were reported, of which of the populations of A. albimanus in different localities six were classified as indigenous, four as relapses, in Central America. forty -six as imported from abroad, and two as induced; An insecticide testing programme has been operating and eight were not classified. during 1962 in both El Salvador and Bolivia.In epidemiological addition to testing insecticides sprayed indoors, the As the attack phase advanced, team began operational research on larviciding, to activities increased; an increase in the number of slides be used in certain areas where house spraying does examined, as compared with 1961, was reported from not halt transmission ; hand spraying or liquid and An indication of the development every campaign. dusting larvicides, as well as aerial dusting, were of case -detection methods over the past four years is tested.Studies of malathion were carried out during given in Table H. the year in El Salvador and Nicaragua. A project to evaluate the fumigant insecticide DDVP in the field TABLE H. DEVELOPMENT OF CASE -DETECTION was started in Haiti, and other trials of Sevin and METHODS, 1959 -1962: REGION OF THE AMERICAS Bayer 39007 will be conducted in that country.
Number and source of slides 10.2.4Co- ordination Year Close co- ordination has continued with the multi- Active detectionPassive detection Total lateral and bilateral agencies collaborating in the malaria eradication programme in the Region of the 1959 1 815 845 869 774 2 685 619 Americas.Some formal meetings were held by the 1960 2 533 709 1 306 936 3 840 645 agencies during the year, and in addition frequent 1961 2 844 099 2 032 953 4 877 052 exchanges of views have taken place. 1962 3 446 735 2 166 353 5 613 088 In May 1962 the Tenth Meeting of the Directors of the National Malaria Service of Central America, Panama and Mexico was held in Honduras.The The trend in 1962 has been towards an increase in the finalreport,inSpanish, was mimeographed and use of active case -detection compared with passive; distributed to all malaria projects of the Region. however, 3.4 per cent. of the slides taken during A seminar was held in Paramaribo, Surinam, from passive case -detection were reported positive, com- 25 to 28 September 1962, with the participation of pared with only 0.9 per cent. during active case - the health authorities of Brazil, British Guiana, French detection. Guiana and Surinam, todiscuss the problem of 128 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I malaria eradication in the rural population of this voluntary agencies in the implementation of the area. This seminar not only resulted in a better operations.It has been planned to continue the understanding of common problems, but also set a spraying operations in 1963 by employing voluntary pattern for future border meetings on the details of labour.Although this programme has no obvious joint activities in these difficult operational areas. technical problems, there are operational difficulties As a consequence of this seminar, border meetings in the way of its successful implementation.The between Brazil and British Guiana, and Brazil and future of the programme is difficult to assess under the French Guiana, took place on 25 November and existing conditions. 10 December 1962 respectively.The final report of Ceylon has the most advanced malaria eradication the seminar, issued in English, Spanish and Portu- programme in South -East Asia.Thirty -one malaria guese, was distributed to all countries of the Region. cases were recorded during the year and only two Other border meetings held in 1962 were :Gua- between July and December; both of these had come temala and Mexico,8 -10February;Brazil and from the Maldive Islands. Paraguay, 21 -23 June; and Colombia and Venezuela, The national malaria eradication programme of 24 -26 October. India entered the fifth year of operations in 1962. There has been an all -round improvement in the 10.3South -East Asia Region performance of the programme. Altogether 390 units, each covering a population of over a million, were in 10.3.1 General Progress and Prospects operation. Both in quality and in coverage, the With the exception of the programmes in Burma spraying operations and surveillance activities have and Thailand, there has been an overall improvement shown a remarkable improvement.In the 140 units, in the malaria eradication programmes in South -East covering a population of 153 million, from which Asia. spraying was withdrawn during the year, 1632 positive In Afghanistan, the total population of the malarious slides were found during surveillance up to the end of areas is 4 501 000, of which 312 000 are in areas in the September.The majority of these cases were dis- preparatory phase, 4 102 000 in the attack phase, tributed in a few foci and prompt remedial measures and 87 000 in the consolidation phase.About a have been taken.It was noted that not a single case quarter of a million more people have been brought has been recorded from fifty -six units out of 140 units under protection by DDT spraying during the year. now in consolidation.The blood examination rate Antilarval measures protecting a population of 500 000 of the population under surveillance during the year in urban areas have been continued.In Nangarhar varied from 4 to 12 per cent. Up to the end of Sep- it is hoped that areas with a population of 445 000 tember a total of 13.6 million slides had been examined will be brought into the consolidation phase during throughout the country.It is expected that during 1963 and areas with a population of just over one 1963 additional areas with a population of approxi- million in the province of Kataghan will be included mately 90 million will pass into the consolidation in the consolidation phase in 1964 -1965. There appear phase. One of the major problems that will face this to be no technical problems to impede the programme programme is the inadequacy of rural health services in Afghanistan. for meeting the needs of the maintenance phase. The In Burma, following an assessment of the pro- Government of India is fully aware of this problem gramme carried out in 1961, new plans have been and concerted efforts are being made to plan the future drawn up, reducing the area of operations to a size course of action for augmenting and expanding rural commensurate with the resources available. The health services. assessment emphasized the need for more effective The programme in Indonesia has shown a marked supervision of operations and recommended delaying improvement, particularly in operational efficiency. activities in areas where such supervision was imprac- During the year, out of forty -two zones in the central ticable on account of insecurity. The Government has islands complex of Java, Bali and South Sumatra, all planned to continue the programme on the general except three have entered the attack phase, and these lines suggested in the assessment but without the three should also become fully operational during assistance of WHO field staff, who were withdrawn the first half of 1963.This programme was assessed at the Government's request by October 1962.Out by a special WHO /AID evaluation team during the of a population of approximately 19 million under last quarter of 1962.The assessment report stressed malaria risk, 10.14 million were protected by residual the operational efficiency of the programme; the chief insecticide spraying. Another 4.5 million were under weakness found was the failure to undertake systematic surveillance.Efforts are being made to secure the investigation and follow -up of positive cases.The co- operationofthegeneralhealthservicesand national malaria eradication headquartersisfully ANNEX 8 129 alive to these problems and a further nineteen medical courses during 1962.Similarly, in Burma, training officers are being trained for work in the malaria is carried out both at the Malaria Institute, Rangoon, eradication service.It is considered that the pro- and at regional centres. In Ceylon, training was given gramme in the present operational areas will achieve at the malaria headquarters at Colombo and at the its goal of eradication, but for the maintenance of four regional centres to 129 trainees in the malaria eradication in these areasitwill be necessary to eradication services, and in addition lectures and eliminate the possibility of reintroduction of malaria demonstrations were given to 100 staff of the general from the neighbouring outer islands. health service. India has a Central Institute for In Nepal, the malaria eradication programme is Communicable Diseases at Delhi for the training of still confined to the central zone, in which a population all senior categories, both for its own programmes of 2 169 000 is being protected by DDT spraying. and for the training of candidates from other countries There has been very little improvement in the per- in the Region.There are six regional co- ordinating formance of spraying operations and supervision organizations which provide training for laboratory still leaves much to be desired in some areas. On the technicians and some of the larger states have separate other hand, there appears to be a general improvement training centres of their own. During 1962, fourteen in case -finding and in entomological activities.With courses were held at the Central Institute for Com- certain exceptions, transmission has been interrupted municable Diseases, the state training centres and in all areas in the attack phase. The urgent need of regional co- ordination organizations, and 330 persons the programme is the development of surveillance received training.In addition, eight seminars were throughout the central zone, where the malariometric held -fourforconsolidationareas,attendedby indices have already reached low levels. The activities 192 medical officers; and four for pre -consolidation of the programme have to be concentrated in this zone areas, attended by 182 medical officers. and expansion to the outer zones should be under- In Indonesia, training continues to be provided in taken only after stabilizing the operations there. headquarters, provincial, zonal and sector training There has been very little progress in the malaria centres.The Tjiloto training centre has been con- eradication programme in Thailand during 1962. A siderably expanded and new laboratories, classrooms draft plan of operations has been prepared, envisaging and dormitories, etc. have been installed. The WHO the development of the programme by stages. During and AID staff assigned to the programme assist the 1963, it is planned to protect an area with a population national director in conducting the courses. Seventeen of 12.8 million, for which insecticides have been qualified doctors entered the national malaria eradi- provided by AID. Surveillance activities have shown cation service on 12 Noyember 1962 (Malaria Day) the prevalence of malaria cases in areas where spraying ceased over five years ago and these areas are scheduled and at present are receiving special training in epi- for spraying again during 1963. The central organiza- demiology at the Tjiloto training centre. tion of the national malaria eradication service, which In Nepal, the national malaria eradication organiza- was reorganized during the latter part of 1961, has tion trained various paramedical personnel in sur- not proved very effective and the Government has veillance, evaluation, entomology, parasitology, health recently effected further changes with a view to educationoperations,administration, cartography improving its efficiency. and transport.A total of 2259 persons, including 1730 spraymen, were trained. 10.3.2Trainingof National MalariaEradication In Thailand, two training centres were established, Staff one in Chiengmai, in Northern Thailand, and the Except in India and Indonesia, the senior personnel other in Prabhudhabad in Central Thailand, under of the national malaria eradication services in the the directionof the Deputy Director of Health Region are trained in international training centres. Education and Training. Forty technicians completed For example, Afghanistan received five WHO fellow- a one - and -a -half years' course in public health with ships for the training of medical officers, and three emphasis on malaria eradication. Twenty micro- study tours were arranged by the Organization. Nepal scopists also received training for two months in received three WHO and four AID fellowships for Bangkok. In- servicetraining of forty -four zone the training of its senior staff abroad. chiefs, 218 sector chiefs, 896 squad chiefs, eighty -five The training of paramedical personnel in Afghan- microscopists, 1540 house visitors and twenty -nine istan is carried out at the Malaria Institute, Kabul, spraymen was carried out at regional and head- and at regional centres.A total of 226 inspectors, quarters centres.During the year, sixteen medical microscopists and entomological assistants attended officers received further training on AID fellowships. 130 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
10.3.3Operational Aspects fresh instances of resistance to the insecticides, the The malaria eradication programme in Afghanistan latter for thefirsttime showing an intermediate is under a semi -autonomous body with full authority resistance to DDT. for technical and administrative directionof the Routine mass drug administration is not practised programme and for incurring all expenditure necessary in any of the countries in the Region. In a few areas for it out of the funds provided for the purpose. in Thailand and in Indonesia, mass drug administra- The national malaria eradication programme in tion, using 600 mg chloroquine base and 50 mg pyrimethamine India is an integral part of the normal health organiza- (adultdose),wasemployedfor tion of the country. The direction of the programme combating localized outbreaks of malaria.In Afgha- is vested in the Director, National Malaria Eradication nistan, Burma, Ceylon, India, Indonesia and Nepal, Programme, who functionsundertheDirector - presumptive treatment was given as part of surveillance General of Health Services of India. The responsibility activities to fever cases and to those with a history for implementation of the programme rests with the of fever. For this purpose, one of the 4- aminoquinoline state governments.In each state the programme is drugs together with pyrimethamine was used. In pre- controlled by the Director of Health Services, through consolidationandconsolidationareasthiswas the state malariologist.There is, however, complete followed with primaquine for the radical treatment co- ordination between the centre and the state and the of P. vivax and P. malariae infections.In India, the organization is considered adequate and satisfactory. standard radical treatment consists of 600 mg chloro- A high -powered special working committee exists at quine and afive -day courseof primaquine. In Indonesia the more commonly accepted fourteen -day thecentrallevel under the chairmanship of the Director -General of Health Services, and this com- course of primaquine is employed. mittee decides all important matters.The Director, In Burma, during 1962, a population of 5.86 million National Malaria Eradication Programme, is secretary was under surveillance, each house being visited once to this committee.The country is divided into six a month. In this programme epidemiological investi- regions, and for purposes of co- ordination of eradi- gation and follow -up of cases and the supervision of cation activities and for rendering advisory assistance, surveillance activities need considerable improvement. each region is provided with a regional co- ordination Out of the 390 units in India, 364.5 undertake sur- veillance activities, domiciliary visits for case -detection organizationwhich functionsdirectlyunderthe Director, National Malaria Eradication Programme. being carried out at fortnightly intervals. The remain- ing 25.5 are either border areas or are units where The Indian programme is massive; over 41 million the parasite prevalence is still high.In the 140 units houses were sprayed in 1962 and over 40 000 spraymen (153 million population) from which spraying has were utilized for spraying operations.In some states, been withdrawn, the annual parasite incidence works diazinon has been incorporated with DDT in order out at 0.01 per thousand. In the earlier stages of the to overcome refusals to permit spraying because of programme, there was a gross under -estimate of the theprevalenceof bed -bugs which have become number of blood slides that would be collected during resistant to DDT. surveillance.Originally, therefore, only two micro- Existing hospitals, dispensaries and health units scopists per unit were provided.Since then, the participate in the passive detection of cases. In number of microscopists per unit has been raised to hospitals and dispensarieswith largeout -patient eight.There was also an acute shortage of micro- attendance, the malaria eradication programme pro- scopes,resulting in the microscopists working in vides a blood -taker for collecting blood slides from double shifts to deal with the work load; but the all fever cases.The participation of the general Government has arranged to procure 800 microscopes health services in passive case -detection has shown and WHO has agreed to supply an additional 600. a great improvement during 1962. In Indonesia, voluntary collaborators have been In certain areas in India, A. culicifacies, which has engaged, with varying results ;in one area over a for some years shown resistance to dieldrin, is also thousand such workers have been reported as working showing resistance to DDT. In one district of Gujarat well, whereas in another all the 380 voluntary workers State, although such double resistance occurs, there engaged had to be discharged because of inefficiency. is no evidence of any indigenous transmission of Attempts will continue to be made to enlist the malaria, but in other areas a low -grade transmission services of voluntary workers. During 1962 the main is taking place and BHC has been substituted for epidemiological problems consisted of importation DDT, with an immediate improvement in the trans- of cases from unsprayed into sprayed areas. mission rates.In Indonesia, during the year, both Surveillance operations only started in Nepal in vectors, A. sundaicus and A. aconitus, have presented 1962. Until July 1962, epidemiological evaluation ANNEX 8 131 was carried out by assessment of infant and child During this conference, WHO and AID advisers and parasite rates in index villages, and entomological Indonesian officials discussed border malaria problems assessment by routine checking in fixed observation with malariologists and government officials from posts. In the second half of 1962, it became apparent Brunei,North Borneo, Sarawak and West New that the infant and child parasite rates were no longer Guinea (West Irían).Discussions were also held with sensitive indices, and these were replaced by mass participants from Cambodia, Laos, the Federation of blood surveys. There was more emphasis in 1962 on Malaya, the Republic of Viet -Nam, and Thailand on epidemiological evaluation. problemsaffectinginter -countryco- ordinationof Ceylon is expected to request certification of era- antimalaria activities. dication of malaria at the end of the maintenance period in 1966. 10.4European Region 10.3.4Co- ordination 10.4.1 General Progress and Prospects Five countries in the Region receive substantial Noteworthy progress towards malaria eradication assistance from AID - Ceylon, India, Indonesia, Nepal has been reported in 1962 in the European Region. and Thailand; and UNICEF provides supplies to In continental Europe, the eight countries (Albania, Afghanistan. Bulgaria,Greece, Portugal, Romania,Spain,the Theunequaldevelopmentof programmesin Union of Soviet Socialist Republics and Yugoslavia) adjacent countries has presented problems caused by coveredbythe" Co- ordinatedPlanestablishing imported cases of malaria. This applies to the borders Priority for the Eradication of Malaria in Continental between India and Pakistan, India and Nepal, and Europe " have achieved the objectives laid down in Afghanistan and Pakistan. There is also the problem the plan, i.e., the last areas in the attack phase which of export of malaria from Kalimantan to Sarawak still existed in those countries moved into the conso- and North Borneo.An inter -country antimalaria lidation phase at the end of 1962, except in the USSR, co- ordination meeting was held in Lahore in Novem- where there is a zone with a population of 40 000 ber 1962 with participants from Burma, India and inhabitants still in the attack phase. As much of the Pakistan.A similar conference between India and actual change from consolidation to maintenance Nepal had to be postponed to 1963. An inter -regional and from attack to consolidation did not take place technical conference was held in Teheran, in which until 1 January1963,thedetailedstatementin India and Afghanistan participated. Appendix 1 (page 149) does not fully show the present The Fourth Asian Malaria Conference was held situation in continental Europe.This is summarized in Manila from 27 September to 3 October 1962. in Table 1, together with the figures for 1961 and 1962.
TABLE I.SUMMARY OF GENERAL DEVELOPMENT OF THE MALARIA ERADICATION PROGRAMME IN CONTINENTAL EUROPE
End of 1961 End of 1962 Beginning of 1963
Areas % of population % of population % of population Population of originally Population of originally Population of originally (in thousands) malarious (in thousands) malarious (in thousands) malarious areas areas areas
In which eradication achieved * . . . 240196 93.9 245 744 94.4 252 451 96.90 In consolidation phase 12 208 4.8 11 758 4.5 7 959 3.08 In attack phase 3 349 1.3 2 948 1.1 40 0.02 Without eradication programme . . - - - -
100.0 100.0 100.0
Originally malarious 255 753 260 450 260 450
* Including the Byelorussian SSR, Czechoslovakia, France (Corsica), Hungary, Italy, the Netherlands, Poland and the Ukrainian SSR, which have already achieved eradication throughout the national territory. 132 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
There are no technical or administrative problems epidemics that may arise in 1963 and on the launching in any of these countries that are likely to prevent of a pre- eradication programme with WHO assistance. elimination of the residual foci.All these countries As partof thepre- eradication programme, two possess an excellent public health infrastructure which demonstration and trainingareasareenvisaged, promises well for the quality of vigilance operations. but these will not be developed before the end of 1963. It can be assumed without undue optimism that the It is hoped to start the eradication programme in maintenance phase will be achieved everywhere by 1967. the end of 1966. The implementation of the Co- ordinated Plan In Albania by the end of 1962 all zones were in the establishing Priority for the Eradication of Malaria consolidation phase and the whole of the formerly in Continental Europe has given a powerful impetus malarious area should move into the maintenance totheexchange of epidemiological information. phase at the end of 1965.In Bulgaria the last zone The WHO system of quarterly reports on surveillance passed into the maintenance phase at the end of 1962. operations has been adopted by almost all countries. In Greece it is expected that all the originally malarious Of the eight countries participating in the plan, areas will have passed into the maintenance phase by transmission has practically ceased throughout the the end of 1965. In Romania the attack phase opera- area, except for a few scattered residual foci in Greece tions were completed by the end of 1962 and the whole and the USSR.The reduction in the size of the country should, by the end of 1965, have passed into parasite reservoir in these zones in the consolidation the maintenance phase.In the USSR 99.4 per cent. phase is demonstrated by thefallin the annual of the population of the originally malarious areas parasite rate and its low level by the end of 1962 (see had moved into the maintenance phase by the end of Table J). 1962, only 0.57 per cent. were still in the consolidation phase and 0.03 per cent. in the attack phase.In TABLE J. PARASITE RATE IN CONTINENTAL Portugal, only one indigenous case was detected EUROPE, 1961 AND 1962 during 1962.Several other imported cases (mainly Annual parasite rate from Africa) were detected and treated by the epi- per thousand of the population demiological vigilance service.There has been no Country change in the population of the zones in the consoli- End of 1961 End of 1962 dation phase in 1962 compared with 1961, except for the normal demographic increase.In Yugoslavia Albania 0.052 ... attack phase operations ended in the last zone (Mace- Bulgaria 0 0 donia) in 1962.At the beginning of 1963, nearly Greece 0.05 0.046 two -fifths of the population of the originally malarious Portugal 0.018 0.014 zones were in areas in the consolidation phase, the Romania 0.002 0.001 Spain ...... 0.08 0.003 remainder being in the maintenance phase, and the UnionofSovietSocialist last areas of the country should reach this final phase Republics 0.032 0.013 by the end of 1965. Yugoslavia 0.05 0.01 There are, in the Region, three countries where the eradication programme isless advanced :Algeria, Morocco and Turkey.In Turkey the attack phase In Turkey, which is not in continental Europe, the operations still covered 35.5 per cent. of the population annual parasite rate fell from 0.06 per thousand in in the originally malarious zones at the end of 1962, 1961 to 0.055 per thousand at the end of 1962 in the but all the originally malarious areas should have areas in the consolidation phase. Relatively numerous moved into the consolidation phase by the end of foci of transmission have been discovered in those 1965 and into the maintenance phase by the end of areas.None of these foci is really critical, and they 1968. In Morocco the pre- eradication programme are eliminated as they are discovered. Their discovery launched in 1961 was continued in 1962. During 1962 is usually due to an improvement in the surveillance the emphasis was laid on the training and assignment system, and theirexistenceeithertooperational to posts of the staff of the rural health infrastructure. shortcomings or to problems of human ecology. It is planned to establish three demonstration and training areas in 1963, covering a total of 300 000 10.4.2Trainingof National MalariaEradication persons.It is thought that the preparatory phase Staff could begin in 1964 and the attack phase in 1965.In At the national level, the countries in the Region Algeria, discussions with the Government are still in that still need to train personnel for their malaria progress on methods of meeting the dangers of eradication campaigns have organized courses with ANNEX 8 133
WHO assistance.In Turkey, with the collaboration the Ministry of Health with very little liaison with the of the WHO malaria team, courses for doctors, general public health services, and there has been microscopists and health workers were arranged at littleparticipation of theselatterservicesinthe the Malariology Institute in Adana. In 1962, twenty - programme.However, the Government has under- seven microscopists and fifty -seven health workers taken a policy of decentralization and integration of to act as assistants to zone chiefs were trained. There the special services, and in 1963 two pilot integration is still, however, a deficit of 30 per cent. in the number zones will be established in areas where malaria of doctors and of 20 per cent. in the number of micro- transmission ceased some years ago.In Morocco the scopists.In Morocco 414 assistant health workers progress made with the pre- eradication programme (out of 1751 needed), 220 qualified nurses who will has been satisfactory.The training in public health act as sector chiefs (out of 570) and ninety -two rural and malariology of qualifiednurses and mobile doctors (out of 180) have been trained. A training assistant health workers is progressing normally in course for the 104 technical workers required as zone the nineteen schools and five field training centres. chiefs was planned for 1963. The training of micro- It is estimated that all the subordinate field staff scopists and their assignment to the provinces has needed for the eradication campaign will be assigned almost been completed, following courses held in to that campaign by the beginning of 1965 at the 1961 and 1962. latest. In addition tothe courses at national training Except in Portugal, the population coverage by centres, international training courses were held at the surveillance operations has been quantitatively ade- training centres in Belgrade and in Moscow. In the quate, as may be seen in Table K. former establishment three courses in French were held in 1962: a senior course with seven participants and two junior courses with a total of forty -two TABLE K. ANNUAL RATES OF BLOOD participants. In Moscow two senior courses were held, EXAMINATIONS IN THE EUROPEAN REGION: one in French with sixteen participants and one in 1961 AND 1962 English with eighteen participants. Eight awards under the scheme for the exchange of Population coverage in areas in scientific workers were made for studies connected with malaria eradication, and one fellowship was Country attack phase consolidation phase awarded to a Turkish statistician. 1961 1962 1961 1962 10.4.3Operational Aspects In continental Europe the eight countries with active programmes possess highly developed rural Albania . . . 8.85 10.23 * 12.70 5.97 * health infrastructures which should be capable of Bulgaria . . . - - 17.02 26.61 providing thenecessarysupportforsurveillance Greece . . . . - - 6.74 5.51 Portugal . . . 0.13 0.17 operations and later for vigilance measures. Of these Romania . . . 5.94 7.66 6.14 6.52 countries,Spain and Bulgaria have reached the Spain . . . . - - 3.00 5.87 maintenance phase and the high density of their Turkey . . 7.87 7.68 5.90 5.41 public health network will enable them to undertake Yugoslavia . . 7.46 8.42 8.97 4.31 appropriate vigilance measures.In Greece also the situation is very favourable; there the network of rural * For six months only. clinics is playing an active part in surveillance and ensuring a very high degree of vigilance.In Yugo- slavia, although a good rural health infrastructure The efficiency of case -detection varies from country exists, its participation in surveillance is still inadequate. to country.Emphasis is being placed on the use of An effort to integrate surveillance operations with the passive case -detectionas opposed toactivecase - help of the social welfare authorities has, however, detection as the programme draws near its final goal begun.In Albania, Romania and the USSR the but, as may be seen from Table L, further efforts along high level of participation of the health system in these lines will be needed in a number of countries. surveillance operations, which has been in evidence In Turkey, in the absence of a highly developed since the beginning of the campaign, is continuing publichealthinfrastructure,emphasishasbeen with success. laid on establishing posts of voluntary workers; the In Turkey, the national malaria eradication service number of these rose from 3988 in 1961 to 7644 at has hitherto been autonomous, working directly under the end of 1962. 134 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
TABLE L.CASE -DETECTION IN AREAS IN THE represent of are- establishment of malaria trans- CONSOLIDATION PHASE IN THE EUROPEAN REGION mission. IN 1962 Greece has requested the certification of eradication of malaria in respect of Crete, the Dodecanese and Passive case -detection Active case -detection the Cyclades, where eradication was achieved before Country 1957, and also the certification of the islands of Positive Positive Slides findings Slides findings Lesbos, Chios, Samos and Euboea.Spain has asked for certification of eradication in 1963 for the whole / % national territory. Steps have been taken for an evaluation team in 1963 to meet these requests and Albania . . . 66.35 0.02 33.65 0.02
Bulgaria . . . 33.24 0 6.47 0 any others that may be made later.
Greece . . . 41.61 0.10 34.90 0.11 Despite the very real danger of malaria being Portugal . . . 99.13 0.37 0 0 imported, so far no instance of re- establishment of Romania . . . 56.31 0 38.82 0 transmission following importation of acaseof Spain . . . . 15.95 0.03 79.75 0 malaria has been reported from the countries of Turkey . . . . 2.56 0.18 88.16 0.12 Yugoslavia . . 3.57 0.007 80.32 0 continental Europe which have eradicated malaria. 10.4.4Co- ordination One problem is the persistence of a few cases due to The success of the Co- ordinated Plan establishing P. malariae, which occur mainly as a result of blood Priority for the Eradication of Malaria in Continental transfusions. A study on this subject is in progress in Europe provides an excellent example of inter -country Romania and Yugoslavia. On the basis of a sample co- ordination in Europe. survey, it has been calculated, for example, that in The Second European Conference on Malaria Yugoslavia, in the Macedonian Republic alone, there Eradication was held in Tangier from 1 to 8 March are probably some 550 cases of symptomless P. mala- 1962.The following countries took part :Bulgaria, riae carriers among a population of 1 400 000. As a France, Greece,Italy, Morocco, the Nétherlands, result of this situation, an indigenous but isolated Portugal,Romania,Spain,Turkey, USSR and case due to P. malariae occurs from time to time in Yugoslavia.Turkey and the USSR took part in an certain countries in the Region. inter -regionaltechnicalmeeting heldatTeheran Difficulties have been encountered in eradicating (Iran) in May 1962.A technical conference of the residual foci in Greece, the Soviet Union and Turkey. countries of North Africa is planned for 1963. In Greece, three small foci of transmission still exist In countries in the Region a number of meetings in the districts of Elis, Pieria and Serrai. In the Soviet of the staff of the national malaria eradication services Union, the two foci of transmission in Azerbaidzan have been held; for example, in Turkey quarterly and Tadzikistan are disappearing as a result of the conferences have brought together the professional measures taken after the occurrence of a local epidemic personnel responsible for malaria eradication opera- in 1961.In Turkey, epidemiological problems have tions; in Yugoslavia there was a meeting of the annual given rise to special inquiries.In a sector in the east conference of the medical personnel directing the of Turkey, an entomological team has elucidated the antimalaria operations in each of the republics; and part played by A. claviger, an exophilic biting species, in Morocco the doctors from the health districts in the persistence of transmission.In certain zones have been invited to " information days " on malaria in the west of the country (Denizli, Aydin, Antalya eradication. The annual border meeting between and Kutahya) there is now every reason to suppose Portugal and Spain was held in 1962. that the persistence of transmission in certain foci is UNICEF continued to give assistance to the pro- mainly due to the exophilic habits of A. superpictus. gramme in Turkey in 1962. The Second European Conference on Malaria The Regional Office has continued to issue every Eradication discussed ways of transferring there- six months an information bulletin on the develop- sponsibility for malaria eradication to the general ment of malaria eradication programmes inthe health services of a country moving into the main- European Region; this bulletin, issued in French in tenance phase, and the organization and improvement over 300 copies, has a wide distribution. of services intended to prevent the reintroduction of 10.5Eastern Mediterranean Region malaria into areas from which it had been eliminated. A questionnaire has been sent out to countries in the 10.5.1General Progress and Prospects Region with a view toassessing the number of Of the twenty -five countries or territories in the imported cases of malaria and the danger which they Region, one -Kuwait -is naturally free from malaria; ANNEX8 135 four -Aden Colony, Cyprus, French Somaliland and solidation phase altogether, mostly in northern and theGazaStrip -have reachedthemaintenance western provinces; 49 per cent. are under attack phase; Israel has areas in both the maintenance and and 11 per cent. in the preparatory phase in the extreme the consolidation phases, Lebanon is in the phase of south.The programme in the north is progressing advanced consolidation;five -Iran,Iraq,Jordan, satisfactorily and solutions to the special problems of Libya and Syria -are in the consolidation and attack the south are being sought through pilot projects; phases; and one -Pakistan -is in the attack phase measures such as drug distribution and spraying with only; two countries -Ethiopia and Somalia -have newer insecticides, etc., are being tried out singly or pre- eradication programmes in operation and three in combination, to find the best approach.At the others -Saudi Arabia, Sudan and Yemen -are devel- same time, the development of health services is being oping similar programmes, following, in the cases accelerated through the new health development plan of Saudi Arabia and Sudan, completion of pre - and operational facilities are being built up by the eradication surveys; and Tunisia and the United Arab malaria eradicationserviceasfundamentalsteps Republicareconductingextensivecontrolpro- towards the ultimate eradication of malaria from grammes and are meanwhile developing their basic these areas. health infrastructure with a view to implementing The programme in Iraq is at an advanced stage. malaria eradication through these services. During 1962, 90.5 per cent. of the total population On the whole, the progress made during 1962 is under malaria risk were in areas in the consolidation very encouraging and strengthens the conviction that phase and only 9.5 per cent. in areas in the attack the eradication of malariaisvery near in many phase -riverain tracts and valleys in the north. In the countries of the Region and that, although in other latter areas, total coverage spraying was not achieved countries it will take longer, they are also expected owing to administrative difficulties, and consequently to achieve eradication within the planned time. transmission continued to persist.In the southern Aden Colony, Cyprus, French Somaliland and region, the doubly resistant vector, A.stephensi,long Gaza Strip will shortly be eligible for certification absent, has reappeared. However, inthis region, that malaria has been eradicated, after the necessary in addition to active surveillance, a system of passive assessment has been made. Of these countries, surveillance has been organized which functioned agreement has been reached with the Government quite efficiently during 1962.Steps are being taken of Cyprus for an assessment of the malaria situation to prevent malaria from being reintroduced into the in 1963 with a view to certifying that malaria eradi- free areas from the part of Iraq still in the attack phase cation has been achieved. and from neighbouringcountries;an important One -third of the total population of Israel is in part is played by the co- ordination of programmes areas in the maintenance phase and the remaining along the borders with Iran through periodic meetings. two -thirds in areas in the advanced consolidation No reduction in the present area under attack is phase.Only five indigenous cases were discovered planned for 1963. in 1962 in the consolidation area.Thanks to the In Jordan, steady progress was maintained in 1962. country's comprehensive health services and to the The areas under consolidation were extended to cover developmentof anefficientpassivesurveillance almost 94 per cent. of the total population at risk; system in the areas in the consolidation phase, the the areas inhabited by the remainder -the Jordan prospects of achieving eradication in the remaining Valley and parts of the east of the country -were areas in the near future are extremely bright. still in the attack phase. Some of these will be shifted In Lebanon, the transfer of the entire area to the to consolidation in 1963, whereas part of the areas at maintenance phase is expected to take place in 1964. present in consolidation will be put in the maintenance A small outbreak of malaria at the end of 1962, which phase.With the completion of an extensive geo- was promptly discovered, was caused by the arrival of graphical reconnaissance, the surveillance operations carriers from abroad.The planning and the imple- coverage achieved a highly satisfactory level. mentation of measures to prevent the reintroduction Although the programme in Libya clearly made some of malaria from abroad are, in fact, the only major progress during the year, administrative shortcomings, problems to be solved before final success is achieved. caused by the mistaken assumption that malaria had In Iran, about five per cent. of the total population become a minor problem, have considerably slowed under malaria risk are now at the end of the consol- down the advance. idation phase, but the rural health infrastructure has In Syria, four -fifths of the total population under not yet beensufficiently developed to take over malaria risk are now in areas in the consolidation vigilance responsibilities. Almost 40 per cent. (includ- phase; the remaining one -fifth is still in areas covered ing the above five per cent.)are in areas in the con- by attack operations, but these will move into the 136 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I consolidation phase in 1963, except for a few foci cent. of all slides taken).The total annual blood which will be kept under insecticide coverage.No examination rate in the consolidation phase areas technical problems are present, and an extensive reached the very satisfactory rate of 11.3 per cent., surveillance system, including both active and passive and the annual parasite rate proved to be 0.226 per case -detection, has been established.The successful thousand. Of the above blood -examination rate, completion of the programme in the near future may one -ninth pertained to the slides collected through be expected. passive case -detection and seven -ninths to the slides The programme in Pakistan has progressed, in its collected through active case -detection. The remaining second operational year, according to the planned ninth consisted of slides collected through other means schedule. The attack operations have been extended such as epidemiological surveys, mass blood examin- to protect a population of 4 400 000 - 1 800 000 in ation, etc.Epidemiological investigations of positive East Pakistan and 2 600 000 in West Pakistan.The cases were intensified during the year and, in most of preparatory phase activities have covered another the programmes, a large proportion of positive cases 8 388 000 in the two parts of the country. Adequate found in the consolidation areas were investigated financial provision has been made by the Government and classified. to meet the local and most of the external expenditure; the balance of the latter was financed by WHO, as 10.5.2Training of national malaria eradication staff in the previous year. AID has recently granted a loan Besides the regional malaria eradication training which will cover all the external expenditure for the centre in Cairo, there were during 1962 three fully financialyears1962 -1963and1963 -1964. The establishednationalmalariaeradicationtraining organization of the programme has generally improved centres in the Region, assisted by the Organization. at all levels. Of these, two are in Pakistan, one in East Pakistan, In both Tunisia and the United Arab Republic, the other in West Pakistan.They provide training emphasis is being laid on extending the network of for both senior and junior personnel in conformity rural health services, its efficient organization being with the accepted international standards. They considered by the two Governments as the essential alsoconduct specialcoursesforotherauxiliary requirement for the launching of an eradication malaria eradication personnel. The third, the malaria programme. The acceleration of this activity has been eradication training centre at Nazareth (Ethiopia), encouraged with a view to co- ordinating its develop- provides junior courses, the second part of the curri- ment with the requirements of the malaria eradication culum varying according to the speciality of the programme. Inthemeantime, malariacontrol different personnel being trained. This training centre activities are being extensively conducted in both is under the supervision of the Ministry of Health, countries. withaco- ordinationcommitteeon whichare Technical and operational problems played an represented the malaria service and the international important role in the persistence of transmission in and bilateral agencies concerned. In all, sixteen certain attack areas.In southern Iran, resistance of courses were held during the year in these four centres A. stephensi to both DDT and dieldrin, the special and 384 trainees attended.In addition to these, the characteristics of A. fluviatilis, and movements of Institute of Parasitology and Malariology, University population in the area, added to operational diffi- of Teheran, provided training for the various categories culties, have resulted in the re- establishment of malaria of personnel employed in the national malaria era- in almost the whole of the zone.In East and West dication programme. Pakistan also, there are signs of persistence of trans- Besides the above -mentioned, junior and special mission in certain areas in the attack phase.Here, or refresher courses were organized within the malaria however, the problem is under careful study and eradication projects in a number of countries, includ- measures are being taken to improve operational ing Israel, Jordan, Lebanon, Saudi Arabia, Somalia, efficiency and investigation of the technical problems Sudan and Syria. In both Pakistan and Saudi Arabia, involved. In spite of all these problems, further areas there are peripheral training centres at zonal or pro- intheRegion,inhabited by approximately two vincial level for the training of lower categories of million people, were moved from the attack into the personnel. consolidation phase in 1962. In addition, twenty -one fellows from the Region Consolidation phase operations in all areas pro- attended coursesheldatBelgrade, Jamaica and gressed satisfactorily during theyear. Emphasis Moscow, and seven senior officers of national malaria has been laid increasingly on passive case -detection, eradication services took part in study tours. with the result that 220 761 slides examined during The regional malaria eradication training centre the year came from this source (representing 9.3 per in Cairo concluded its activities as such at the end of ANNEX8 137
1962 after four years of existence, during which available in time for the operation of the project.In period it provided training to 135 professional and West Pakistan, delay in the provision of the budget 173 auxiliary staff, in four senior and seven junior resulted in a postponement of expansion of operations courses respectively.'However, the Cairo training in 1963. centre is to continue during the coming years as a Health education was given serious attention during national centre providing training for the malaria the year.Iran now has a section of health education workers of the future malaria eradication programme at the headquarters division of operations, with two of the United Arab Republic. health educators, and a further eleven health educators in the provinces, fully equipped with audiovisual 10.5.3Operational Aspects mobile units and other necessary equipment and In the Iran programme a planning and evaluation transport.Main activities were 598 film shows with sub -committee was set up, attached to the Scientific an attendance of 322 000 persons in the villages, 241 Council and consisting of staff of the malaria erad- village conferences for 191 000 persons, and twenty -six ication service and of the Institute of Parasitology health education training courses, totalling seventy and Malariology. From its inception the sub- commit- hours of lectures, for 150 000 village teachers, field tee has made a considerable contribution to the work workers and agriculture extension agents. In Pakistan, and has proved most valuable. It meets periodically health education was carried out by the zone eval- and reviews the progress made in the field and advises uators, but the results hoped for were not fully on any changes that may be needed in the operation obtained because of the lack of professional health of the programmeIts main function is to review educators. The necessary staff have now been recruited at the end of the year the plans of action prepared by and are being trained.In other programmes, health zone offices and to draw up a master plan covering education is carried out by the malaria eradication the entire country for consideration and approval staff as part of the routine work. by the Scientific Council. Efforts were made, with little success, to recruit In a number of programmes, such as those in Iraq, more engineers for malaria eradication programmes Jordan and Syria, where attack operations have been in the attack phase.In Pakistan, although coverage nearly concluded or greatly reduced, measures are by attack operations is increasing impressively, no being taken to simplify field operations and spraying national engineer has so far been appointed to the toa minimum required for emergencies. This staff of the malaria eradication service.Two inter- reorganization will be carried out gradually as the nationally- recruited engineers and two sanitarians areas enter into the consolidation phase, and care will are at present serving in this programme. The situation be taken to use the malaria eradication staff to is very much the same in other programmes, except strengthen and develop the health services of these in Iran and Saudi Arabia.In Iran, twenty -seven areas. engineers are at present working in the field operation It should be mentioned that in some countries, division at headquarters, regional and zone levels. where programmes are far advanced, governments Mass drug administration has been practised in tend to integrate the malaria eradication services pre- some countries of the Region as a supplementary maturely and too suddenly into the general health measure in areas where spraying operations alone services.Efforts were made to dissuade them from were not enough to interrupt the transmission of taking such precipitate action and instead a gradual malaria. Thus, in Iran mass drug administration has integration process was advised. been carried out by two methods.In the Sarakhs In Pakistan, .where full autonomous status has been area of Khorassan, where transmission persists due given to the national malaria eradication service, there to the exophily of A. superpictus, the fortnightly were a number of problems in the early stages, such distribution of drugs was carried out by surveillance as difficulties in establishing salary and allowance agents during the transmission season (mid -June to scales and in formulating financial rules and regulations. mid -September). In the area where persistence of However, these have now mostly been straightened transmission is caused by double resistance of A. ste- out and the autonomy is showing its full benefits. phensi, single -dose treatment has been carried out by In Iran, the malaria eradication service has been clinics, dispensaries and hospitals.In the Sarakhs separated from thatdealingwith environmental area, the adequacy of the drugs used, their dosage sanitation and its responsibilities are now confined and frequency of distribution, has been proved by the to malaria eradication alone. absence of positive cases.In the other area, the drug The financial situation in most of the programmes distribution was irregular and contributed only to has up to now been satisfactory, although occasional keeping down the level of endemicity.In Iraq, 5000 delays have occurredin making sufficient funds inhabitants were protected by mass drug administra- 138 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
tion in three communities in which malaria epidemics two -thirds of all cases detected during 1962 occurred occurred in1962. The drugs were administered in the Balqa district. Out of 217 cases in that district, fortnightly from September to November and as 214 have been proved to be P. vivax infections. evidenced by active case -detection were successful in Table M shows that there aire defects in the present stopping transmission. InSyria, 236 inhabitants case -detection systems in certain countries in the along the Yarmuk river and the military personnel Region. of Kuneitra area were protected by weekly adminis- tration of 25 mg of pyrimethamine for adults. TABLE M. CASE DETECTION IN THE EASTERN A medicated salt pilot project was organized by the MEDITERRANEAN REGION Instituteof Parasitology and Malariology,Iran, covering a small tribal population in the Bagdeli sect Positive cases found by of the Ghashgai tribe.The experiment has given satisfactory results and it is intended to continue the Country idemgical other passive active a p loio- surveys experiment on a larger scale in 1963, to protect a case- case- (including survey and detection detection follow -up mass blood population of 22 000 by chloroquinized salt. survey) Surveillance operations have been systematically implemented in a number of countries of the Region (in some countries as early as from the second year of attack phase).Both active and passive methods of Iran 28.9 54.1 17.0 - Iraq 37.1 19.3 case -detection, as well as epidemiological surveys, 15.7 27.9 Israel . . . 52.5 45.0 2.5 - follow -up and other surveys, were carried out.A Jordan . . . 39.4 26.5 10.7 23.4 comparison of the data on surveillance activities for Lebanon . . 25.0 8.0 19.0 48.0 1962 with those for 1961 shows clearly, by the increase Syria 39.7 29.1 18.2 13.0 in the number of slides collected, that there has been a remarkable improvement in population coverage. In 1962, 2 358 165 slides were taken and examined, 10.5.4Co- ordination as compared with only 1 663 125 in 1961. The number To develop and maintain co- ordination among the of positive cases found by passive case -detection is workers engaged in the field of malaria eradication -in small compared with the number of positives detected national services as well as in those of WHO and of by active case -detection, owing to the insufficient bilateral organizations- various meetings were organ- coverage of rural areas by the health services in most ized in theRegion, which afforded opportunities of the countries of the Region. for an exchange of information. On the other hand, the number of positive cases An Inter -regional Technical Meeting on Malaria detected by epidemiological and other surveys is Eradication was held at Teheran (Iran) from 1 to high in relation to the positives detected by active 6 May 1962, with participants from Afghanistan, case -detection,which shows thatthequalityof India, Iran, Iraq, Pakistan, Syria, Turkey and the active case -detection has not reached the required USSR. In addition, there were observers from level, even though there was a substantial improve- UNICEF, AID and the United Nations Technical ment in 1962. A certain number of cases have been Assistance Bureau. detected by follow -up of previously confirmed cases, The Third Burma /India /Pakistan Border Malaria such cases presumably being the consequence of EradicationCo- ordinationMeeting was heldat incomplete radical treatment. Lahore (Pakistan) from 28 to 30 November. During 1962, small epidemics were observed in some The Second and Third Iran /Iraq Border Malaria countries in which malaria eradication programmes Eradication Co- ordination Meetings were held at are in an advanced stage.Thus, in Syria, in the Basra (Iraq) and at Hamadan (Iran) from 28 to 29 Kuneitra area, there was an outbreak of malaria March and 28 to 30 October 1962, respectively. There mainly involving military personnel, and although is a proposal to broaden the scope of these meetings the total number of cases detected was small, it showed to include two bordering States -Turkey and Syria. a typical epidemic trend. In the same country, another The Second Jordan /Syria Border Malaria Eradi- focus of fresh transmission with some sixty indigenous cation Co- ordination Meeting was held in Irbed during cases was detected in the Al- Rashid district.Both March 1962.The main subject discussed was the epidemics were caused by P. vivax.In Lebanon, a co- ordination of the plan of action for 1962 along the small epidemic, also caused by P. vivax, occurred late Yarmuk Valley and information was exchanged in 1962 in the Nahr -Beirut district; eighty -six indi- regarding the malaria situation on both sides of the genous cases were detected.In Jordan, more than border. ANNEX 8 139
A meeting of malaria personnel of Lebanon and ment.The previous shortcomings in these respects Syria was held in May 1962, at a border site in Syrian were due mainly to the lack of adequately trained territory. personnel. WHO provided a short -term consultant Close liaison and co- ordination have been main- in 1962 to assist in this project, and also five WHO tained with AID and UNICEF, in the field and at the fellowships were granted to the national workers for regional level.The projects assisted by AID in the study in China (Taiwan).With the implementation field of malaria in the Region are in Ethiopia, Iran, of thereorganized programme, theprospectsof Jordan, Libya and Pakistan.UNICEF assistance achieving eradication soon are good. was given to the malaria eradication programmes in In Sarawak the eradication programme is in an Iran, Iraq, Jordan, Lebanon and Syria. advanced stage and, of the 660 000 people in the originally malarious areas, 505 000 were in areas in 10.6Western Pacific Region the consolidation phase and 155 000 in areas in the 10.6.1 General Progress and Prospects attack phase in 1962.However, the campaign has met with the difficult problem of the importation of In the Western Pacific Region, about one -third malaria from the unsprayed areas of Kalimantan of the 78 million people in the originally malarious across the border. Nearly half of Sarawak is affected areas(excluding China (mainland), North Korea by this problem, which requires intensive surveillance and North Viet -Nam) are now covered by the erad- operations in areas in both the attack and the ication programme. consolidation phases and the spraying of a band of The WHO -assisted malaria projects in the Region country about ten miles wide along the border must may be classified as follows : be carried out until a spraying programme starts in (a)Therearefivecountries,namely,China Kalimantan. (Taiwan), North Borneo, the Ryukyu Islands, Sara- Some progress was made in the malaria eradication wak and the Philippines, with full eradication pro- programme in the Philippines.In addition to the grammes. administrative difficulties resulting from the change- The eradication programme in China (Taiwan) is over from a centralized to a decentralized scheme, the most advanced in the Region. However, three well certain technical problems, including the development defined small foci of transmission were discovered of resistance to dieldrin in A. minimus flavirostris and during 1962 and also the reactivation of transmission population movement from the malaria -free coastal was found in an old focus.Nevertheless, the total plains to the hinterlands, have favoured continuation incidence of malaria remained low during the year; of transmission. A new comprehensive plan of of nearly one million persons examined during this operation has been completed recently.It is expected period, through various case -detection measures, only that an extensive reorganization of the project will sixty -seven parasite carriers were found.Reappraisal be carried out from 1963 in line with the new plan. of the surveillance system is now being undertaken with a view to strengthening the passive case -detection All these five malaria eradication programmes have system throughout the country, in order that informa- adopted the WHO quarterly surveillance reporting tion may be obtained for the certification of eradica- system. The calculation of the annual parasite incidence in most of these countries is based on an tion. Reintroduction of malaria cases, mainly through mass immigration from abroad, is a threat to the adequate number of blood samples collected through routine case -detection procedures; the annual parasite success of malaria eradication. However, well planned counter -measures have been implemented to cope incidence is well below 0.5 per thousand in China (Taiwan), North Borneo and the Ryukyu Islands; in with the problem. In the programme in North Borneo, spraying was Sarawak it is just below this figure; but in the Phi- lippines the incidence in the area in the consolidation carried out in 1962 in all malarious areas, and a small phase is still above the maximum permissible level. sector is in the consolidation phase. The programme has good operational facilities, including staff and In North Borneo, as a result of epidemiological assessment, the plans of action of the programme were logistic support.Periodical assessment was carried out and results so far indicate good prospects of revised and the premature advancement of areas from achieving eradication, provided that the development the attack phase to the consolidation phase was prevented. of the rural health infrastructure and its participation in the eradication efforts are expeditiously implemented (b)In two countries, the Federation of Malaya as planned. and the British Solomon Islands Protectorate, malaria In the Ryukyu Islands efforts were made to improve eradication pilot projects are in operation. In Malaya, the surveillance activities and epidemiological assess- the pilot project entered its third year of operation in 140 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
1962; progress during the year has been encouraging. tion programme proceeded satisfactorily, and progress An intensive surveillance mechanism has been estab- during 1962 was noted particularly in training and the lished in areas in the late attack phase, and the results building -up of the malaria service. Of 450 000 people of epidemiological assessment indicate that transmis- in the originally malarious areas, 260 000 were under sion has stopped completely since August 1962.It protection.However, the conditions in West New is expected that this project will be concluded by Guinea (West Irian) are such that the launching of a June 1964. The pilot project in the British Solomon country -wide eradication programme eventually will IslandsProtectorate became operational only in depend on the general development of the territory and March 1962, spraying operations beginning in October the extension of administrative control toall the 1962. The project area covers the islands of Guadal- inhabited areas. canal and the New Georgia group, with a total popu- (d)Antimalaria activities in other countries and lation of about 30 000, where malaria, transmitted territories of the Region may be mentioned briefly. by vectors of the A. punctulatus group, is the largest The situation in Japan may be considered, in view of single cause of hospital attendance. the very small number of cases reported in recent years, as one in which malaria has gradually dis- (c)In Brunei, Cambodia, the Republic of Korea, appeared without specific control measures. The the Republic of Viet -Nam, and West New Guinea Japanese authorities are enforcing a passive case - (West Irian), pre- eradication programmes will have to detection scheme and the epidemiological investigation precede the implementation of full eradication pro- of reported cases.In Laos, malaria is widespread. grammes.A WHO malariologist was assigned to Certain possibilities are being studied with a view to Brunei in mid -1962. It was originally expected that the reorganizing as soon aspossible the antimalaria pre -eradication programme would be completed by activities, which were suspended in 1961 because of the end of 1963, at which time a comprehensive plan unsettled conditions.In the Territory of Papua and of operation for a full malaria eradication programme New Guinea, large -scale antimalaria measures are might be obtained. However, owing to the conditions being carried out. Preliminary negotiations have prevailing in that country at the end of 1962, the begun with the authorities of the New Hebrides original expectation may not be fulfilled In Cambodia, Condominium, witha viewtoimplementinga owing to a number of administrative difficulties, there malaria eradication project in the Condominium at was little progress in the pre- eradication programme an early date. during 1962.The project is being reviewed in order to improve the situation. In the Republic of Korea, the 10.6.2Training of National Malaria Eradication Staff formerpre- eradicationsurveyprojecthasbeen converted intoapre- eradication programme and National facilities for malaria training, including the during 1962 emphasis was laid on strengthening the instructional staff and physical facilities, are available rural health infrastructure and on arousing interest in the malaria projects in China (Taiwan), the Federa- in the malaria project.An excellent passive case - tion of Malaya, North Borneo, Papua and New detection system has been gradually developed, with Guinea, the Philippines, the Republic of Viet -Nam, the co- operation of all rural health units throughout and West New Guinea (West Irian).In the British the country.It has been shown that malaria is wide- Solomon Islands Protectorate, Cambodia, the Repu- spread, with definite foci of transmission, although blic of Korea, and the Ryukyu Islands, however, the incidence islow.Itisplannedtocontinue the training of the national staff was carried out by the the pre- eradication programme through 1963. In WHO advisers to the projects, by staff of the malaria the Republic of Viet -Nam the malaria programme is unit of the Regional Office, and, where necessary, by complicated by the existence of inaccessible areas. WHO short -term consultants. In most of the above - The pre- eradication programme was started in 1962 mentioned countries the malaria training courses in order to define the problem and establish the were held as and when the need arose. These courses necessary administrative and operationalfacilities were for the non -professional staff -laboratory techni- before an eradication programme can be implemented. cians, entomological technicians,fieldsupervisors, On the other hand, large -scale field operations were spray squad leaders, etc.In addition, a course for carried out during 1962, which included spraying in entomologists was held in the Federation of Malaya areas with a population of 6.5 millionThe imple- in January 1963. mentation of a fully developed malaria eradication Besides the regular training courses for the super- programme depends largely on the question of internal visors, microscopists and full -time surveillance can- security. vassers, etc., an interesting feature of the programme In West New Guinea (West Irian) the pre-eradica- in China (Taiwan) during 1962 was the training of ANNEX 8 141
2390 school nurses and teachers and 1920 voluntary Mass drug administration is employed in the elim- collaborators inclinical symptoms and treatment ination of small residual foci of infection found in of malaria, as well as in the techniques of blood -slide the consolidation phase areas in China (Taiwan). taking and mailing procedures.All of them have Radical treatment is given to confirmed cases and, participatedinpassivecase -detection, sincetheir whenever thought necessary, weekly single doses of training. chloroquine and primaquine (adult dose 300 mg and Efforts to re- establish a training centre in Manila 30 mg respectively) for eight weeks are also distributed have been made in collaboration with the Govern- to the population in the focus. In the areas of North ment of the Philippines and AID.It is planned to Borneo in the attack phase drugs are given as an open the new centre in 1963. adjuvant measure to house spraying; a single dose During 1962, WHO fellowships were awarded to treatment (adult dose 600 mg of chloroquine base nineteen national staff from the Region (two from and 50 mg of pyrimethamine) is given to the whole North Borneo, two from the Philippines, seven from population when house spraying is carried out.In the Republic of Korea, four from the Republic of some parts of West New Guinea (West Irian), mass Viet -Nam, three from the Ryukyu Islands and one drug administrationisused asa complementary from Sarawak) to attend regular or special courses method to house spraying. Two medicated salt in malaria eradication.Grants of limited duration projects were in operation during 1962 -in Cambodia were also made to four senior officers of national and West New Guinea (West Irian); both were programmes (one from the British Solomon Islands terminated by the end of the year (see section 5.1.3, Protectorate, one from China (Taiwan), one from page 103). North Borneo and one from Sarawak) for observation The surveillance operations in areas in the con- tours in selected malaria eradication programmes. solidation phase inthe malaria eradication pro- grammes in China (Taiwan), North Borneo and 10.6.3Operational Aspects Sarawak have made further progress in 1962, both There has been a growing realization on the part qualitatively and quantitatively.The collection of of governments during the year under review that the data in the field by active and passive case -detection possibility of reaching eradication and the maintenance measures, the assessment of the data, and the initiation of areas from which malaria- has been eradicated of consequent remedial action, have been improved. depend on the existence in the country of essential The surveillance operations in the other two eradica- basic health structures and services, and that without tion programmes, in the Philippines and the Ryukyu them success is unlikely. This is particularly relevant Islands, however, need to be strengthened; for that in relation to the extent of coverage by the basic health reason the services of a short -term consultant were services necessary to support surveillance and vigilance provided to the latter project, and in the Philippines operations. the plan of action has been completely reviewed and The eradication programme of Sarawak is prac- a new one has been established. tically integrated into the general health services, The annual blood examination rate in 1962 showed while in the Philippines the implementation of malaria satisfactory coverage of the population concerned eradication is now the responsibility of the regional in the programmes in China (Taiwan), North Borneo, health directors, each of whom is responsible for the Ryukyu Islands and Sarawak.The annual blood medical and health administration in one of the eight examination rate for the five eradication programmes regions into which the whole country is divided.In in 1962 is shown in Table N. China (Taiwan), a specialized malaria service is in charge of the eradication programme, but there is also a well developed network of rural health services TABLE N. ANNUAL BLOOD EXAMINATION RATE IN reaching all parts of the island.This excellent rural THE WESTERN PACIFIC REGION IN 1962 health service system, which comprises a network Population in Number of Annual blood of twenty -two county health centres, 360 township Country areas in con- slides examination or district health stations and 197 health sub -stations, solidation phase examined rate has rendered indispensable assistance to the malaria eradication programme. At eachhealthcentre China . county health supervisors, and at each health station (Taiwan) . . 941000 963000 102 or sub -station health technicians spend seven to ten North Borneo . 13000 22600 174 Philippines . . 3261000 184000 5.6 days each month on malaria surveillance activities - Ryukyu Islands 42000 8000 19.0 active case -detection, radical treatment of the con- Sarawak . . . 505000 172300 34.1 firmed cases, follow -up investigations, etc. 142 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
During 1962 considerable progress was made in concern in some eradication projects, particularly China (Taiwan) in the development of the passive in the Federation of Malaya and in North Borneo. case -detection scheme.At present there are 2390 The attap roofs are generally infested with various school nurses and teachers,4611privateclinics, caterpillars(Herculianigrivitta,Simplicia caemen- 761 public health units, 257 military medical units salis) ;in Malaya, Herculia is naturally kept under and 2197 voluntary collaborators,organized into control by the chalcid fly. But this fly is susceptible to several hundred malaria working groups, participat- DDT, and the caterpillar is resistant; therefore, after ing in passive case -detection.In Sarawak a new spraying the caterpillars vastly increase in number experiment is under way to utilize the " home helps " and destroy the roof.This gives rise to refusals to (village people with first -aid training) in passive case - allow house spraying. detection. The five pre- eradication programmes started in 1962 The prevention of introduced infection from imported in the Western Pacific Region -in Brunei, Cambodia, malaria has become of growing importance in the the Republic of Korea, the Republic of Viet -Nam, and malaria eradication programme in China (Taiwan), West New Guinea (West Irian)were all converted North Borneo and Sarawak.In China (Taiwan), from previous antimalaria projects, some of which among 4392 persons from the Sino- Burmese border were assisted by WHO. Consideration is being given to who were evacuated to Taiwan in March 1961, establishing a demonstration and training area in the seventy -two cases of relapsing vivax infection were pre- eradication programme in the Republic of Korea, found during 1962 through follow -up investigations, where spraying will also be carried out.The rural while at least one transmission focus was suspected to health infrastructure is being developed and strength- originate from these imported parasite carriers. Also, ened. At present, 182 county health centres and 672 a number of refugee groups from China (mainland) district medical units are established. The mobilization arrived in Taiwan during 1962 and there was the of this health network to participate in the pre- constant danger of parasite carriers being introduced eradication programme has been undertaken.In the into the malaria -free areas of Taiwan. Similar prob- Republic of Viet -Nam the backbone of the rural health lems faced Sarawak and North Borneo, where the programme is the village health station, of which importation of malaria from neighbouring unsprayed there are more than 7000, and it is anticipated that the Kalimantan is a constant threat to the success of the goal of 10 000 will be realized by the end of 1963. two programmes.In Sarawak nearly half of the Supplementing and supervising the village level health country is constantly exposed to the danger of import- facilities there are, at the present time, 210 district ed malaria from any part of the 700 -kilometre -long health centres.Close co- operation between the rural border with Kalimantan. health infrastructure and the malaria service has been In August 1962, A. sundaicus, one of the malaria gradually established.In West New Guinea (West vectors in North Borneo, was discovered to be resist- Irian) considerable progress has been made in recent ant to dieldrin in the Papar area, where dieldrin was years in establishing a network of the rural health sprayed once in July 1961.Fortunately, a plan was services throughout the territory. made at the beginning of 1962 to replace this insecticide It is expected that the certification and registration with DDT, the first spraying of which was undertaken of malaria eradication from China (Taiwan) may be in July 1962.A. balabacensis in Cambodia (and requested by the Government in 1964.Towards this probably also in the Republic of Viet -Nam) causes a objective the surveillance operations in the areas in technical problem.The interruption of malaria trans- the consolidation and maintenance phases are being mission by DDT spraying has not been achieved so strengthened to obtain adequate data.Prospects of far, owing to the exophilic habits of A. balabacensis and registration of the achievement of eradication in the also on account of the primitive construction of farm near future in Japan and the Ryukyu Islands are good. huts, which usually have no walls.A plan is being considered to carry out studies on this problem in 10.6.4Co- ordination Cambodia.Field trials on the optimum number of cycles and dosage of insecticide were undertaken in Most of the malarious countries in the Region hold North Borneo and West New Guinea (West Irian). regular meetings for the purpose of co- ordination and Results so far obtained indicate that it is necessary co- operation; these include the meetings of the Anti - to spray DDT at 2 g per square metre twice a year malaria Co- ordination Board serving Cambodia, the against A. balabacensis, A. barbirostris and A. sundaicus Federation of Malaya, Laos and the Republic of Viet - in the former country, and against A. farauti and A. Nam, together with Burma and Thailand from the koliensis in the latter.The damage to attap (thatch) South -East Asia Region; the Inter -territorial Malaria roofing by insecticide resistant caterpillars is causing Conferences for the South -West Pacific, grouping ANNEX8 143
West New Guinea (West Irian), the Territory of Western Pacific Regions, as well as from Pakistan in Papua and New Guinea, the British Solomon Islands the Eastern Mediterranean Region. Protectorate and the New Hebrides Condominium; Close co- ordination is being maintained with the and the Borneo Malaria Conferences, serving Brunei, United States Agency for International Development Indonesia, North Borneo and Sarawak. (AID) which supports malaria eradication programmes Participants at the Fourth Asian Malaria Con- in Cambodia, China (Taiwan), Laos, the Philippines ference, which took place in Manila from 27 September and the Republic of Viet -Nam, and with UNICEF, to3 October 1962, included representatives from which supports programmes in North Borneo and countries and territories of the South -East Asia and West New Guinea (West Irian). Appendix 1
DETAILED STATUS OF MALARIA ERADICATION AS AT 31 DECEMBER 1962
AFRICAN REGION
(population in thousands)
Population * in areas
where malaria with eradication programmes Other never indi- where malaria Total eradication Country or other political unit * genous or malaria where disappeared which were eradication eradication projects in without originally claimed in the in the programme operation consoli- in the prepara- specificP malarious (maintenance attack Total not yetY antimalaria phase) dation phase tory started measures phase phase
Basutoland . . . 708 708 ------Bechuanaland 289 - 289 - - - - - 289 - Burundi 2 700 100 2 600 - - - - - 2 600 - Cameroon 4 249 - 4 249 - - - 4 249 PEP Central African Republic 1 267 - 1 267 -- - - - 1 267 - Chad 2 729 - 2 729 -- - - - 2 729 - Comoro Archipelago 188 - 188 -- - -- 188 - Congo (Brazzaville) 865 - 865 -- - - - 865 - Congo (Leopoldville) 14 779 - 14 779 - - - - - 14 779 - Dahomey 2 107 - 2 107 - - - - - 2 107 - Federation of Rhodesia and Nyasaland . . . . 8 510 99 8 411 - 138 181 - 319 8 092 - Gabon 450 - 450 - - - - - 450 - Gambia 301 - 301 - - - - - 301 - Ghana 6 726 - 6 726 - - - - - 6 726 FRP, PEP Guinea 3 263 - 3 263 - 3 263 Ivory Coast 3 445 - 3 445 - - - - - 3 445 - Kenya 7 455 373 7 082 - -- 7 082 - Liberia 1 290 - 1 290 - - - - - 1 290 - Madagascar 5 677 - 5 677 - - - - - 5 677 - Mali 4 274 - 4 274 - - - - - 4 274 - Mauritania 676 - 676 - 676 PEP Mauritius 652 - 652 253 136 263 - 399 -- Niger 2 870 - 2 870 - - - - - 2 870 - PEP Nigeria 36 431 36 431 36 431 Portugal : Angola 4 753 4 753 4 753 Cape Verde Islands 208 208 24 94 94 90 PEP Mozambique 6 665 6 665 6 665 Portuguese Guinea 584 584 584 São Tomé and Principe 66 66 66 Réunion 359 359 359 Rwanda 2 201 180 2 021 2 021 Senegal 2 980 2 980 2 980 Seychelles 42 42 Sierra Leone 2 450 2 450 2 450 South Africa 16 122 11931 4 191 2886 1012 293 1305 South West Africa 522 320 202 202 Spain : Sidi Ifni 54 54 Spanish Guinea 246 246 246 Spanish Sahara 146 127 19 19 St Helena 5 5 Swaziland 274 274 115 149 10 159 Tanganyika 9 573 876 8 697 8 697 PEP Togo 1 553 1 553 1 553 Uganda 7 016 7 016 7 016 PEP Upper Volta 4 400 4 400 4 400 Zanzibar 314 314 314 314
TOTALS 172 434 14815 157 619 3278 1435 ' 1155 2590 151 751
'Latest available figures. FRP Field research project. - Not applicable or none. PEPPre- eradication programme.
1 Since the terms " preparatory ", " attack " and " consolidation " are applied specifically to malariaeradication programmes, the figures shown in the relevant parts of this table do not include the antimalaria activities, often considerable, of countries and other political unitsin which eradication programmes as such have not yet been implemented. - REGION OF THE AMERICAS
(population in thousands)
. Population * in areas
where malaria with eradication programmes Other never indi- where malaria Country or other political unit Total population* genous or which were malaria where eradication disappeared originally eradication eradication projects in without malarious claimed in the in the in the programme operation specific (maintenance consoli- attack prepara- Total not yet antimalaria phase) dation phase tory started measures phase phase
Antigua 63 63 ------Argentina 22 216 19 571 2 645 987 624 298 - 922 736 - Bahamas 110 110 ------Barbados 242 4 238 238 ------Bermuda 44 44 ------Bolivia 3 556 2 269 1 287 - 759 528 - 1 287 -- Brazil 75 996 36 100 39 896 3 902 5 597 18 156 12 241 35 994 British Guiana 592 - 592 530 26 36 - 62 -- British Honduras 100 - 100 - 100 - - 100 -- Canada 18 600 18 600 - - - - Chile 7 917 7 790 127 127 ------Colombia 14 768 5 464 9 304 - 3 027 6 027 - 9 054 250 - Costa Rica 1 274 862 412 - 230 182 - 412 -- Cuba 7 022 5 148 1 874 - - 1 874 - 1 874 -- Dominica 60 46 14 - 14 - - 14 -- Dominican Republic 3 228 581 2 647 - - 2 647 - 2 647 -- Ecuador 4 455 1 983 2 472 - - 2 472 - 2 472 -- El Salvador 2 600 780 1 820 - - 1 820 - 1 820 -- Falkland Islands 2 2 - - -- French Guiana 34 - 34 - - 30 - 30 4 - Grenada and Carriacou 89 52 37 37 a ------Guadeloupe 281 28 253 187 66 - - 66 Guatemala 4 014 2 232 1 782 - 498 1 284 - 1 782 -- Haiti 4 134 1 054 3 080 - - 3 080 - 3 080 -- Honduras 1950 389 1 561 - 46 1 515 - 1 561 -- Jamaica 1 650 368 1 282 - 1 282 - - 1 282 -- Martinique 277 101 176 176 ------Mexico 37 170 16 951 20 219 - 15 592 4 627 - 20 219 -- Montserrat 13 13 ------Netherlands Antilles 194 194 ------Nicaragua 1 637 66 1 571 - 515 1 056 - 1 571 Panama 1118 27 1091 - - 1091 - 1091 - Panama Canal Zone - 45 - 45 - 44 1 - 45 -- Paraguay 1 817 305 1 512 - - - 1 512 1 512 -- Peru 10742 7553 3189 864 2325 3189 Puerto Rico 2406 15 2391 2391 St Kitts, Nevis, Anguilla 59 59 - St Lucia 97 15 82 82 St Pierre and Miquelon 5 5 - St Vincent 81 81 - Surinam 300 115 185 125 60 185 Trinidad and Tobago 877 - 877 877 877 United States of America 187400 142000 45400 45400 Uruguay 2846 2846 -- Venezuela 7604 1908 5696 5269b 150 277 427 Virgin Islands (United Kingdom) 7 7 - Virgin Islands (United States of America) 34 34
TOTALS 429726 275835 153891 59326 30436 49386 13753 93575 990
* Latest available figures. b Including 4 325 177 in area from which malaria has been eradicated, registered with PAHO a Entire area registered by PAHO as one from which malaria has been eradicated. - Not applicable or none. SOUTH -EAST ASIA REGION
(population in thousands)
Population * in areas
where malaria with eradication programmes' Oth- Total never indi- where malaria Country or other political unit genous or malaria where eradication populationo * which were eradication disappeared eradication programme projects in without originally claimed in the in the operation malarious consoli- in the P re ara- not yet specific (maintenance attack tory Total started antimalaria phase) dation phase measures phase phase
Afghanistan 14 380 9 879 4 501 - 87 4 102 312 4 501 -- Bhutan 670 560 110 - -- - - 110 - Burma 21 640 1 053 20 587 - 4 100 10 155 - 14 255 6 332 - Ceylon 10 061 3 518 6 543 1 447 1 294 3 802 - 5 096 -- India 453 045 14 465 438 580 20 154 887 283 579 - 438 466 94 - Indonesia 97 085 - 97 085 - - 64 253 - 64 253 32 832 - Maldive Islands 89 12 77 - - - - - 77 - Mongolia 1 000 1 000 ------Nepal 9 407 4 751 4 656 - - 2 169 1 739 3 908 748 - Thailand 27 301 - 27 301 - 1 660 13 000 a 7 140 21 800 5 501 -
TOTALS 634 678 35 238 599 440 1 467 162 028 381 060 9 191 552 279 45 694
* Latest available figures. - Not applicable or none. a Including 3000 in municipal areas not sprayed. EUROPEAN REGION
(population in thousands)
Population * in areas
where malaria with eradication programmes Other never indi- where malaria Total where eradication Country or other political unit population * genous or malaria eradication disappeared which were eradication projects in originally in the in the programme operation without claimed in the not yet malarious (maintenance consoli- prepara- specific dation attack tory Total started antimalaria phase) phase phase phase measures
Albania 1 625 225 1 400 300 1 053 47 - 1 100 -- Algeria 11 020 1 301 9 719 - -- - - 9 719 - Andorra 8 8 - - - - Austria 7 067 7 067 - - - - - Belgium 9 153 9 153 ------Bulgaria 7 867 6 143 1 724 1 676 48 - - 48 Byelorussian SSR 8 316 10 8 306 8 306 ------Czechoslovakia 13 776 13 626 150 150 ------Denmark 4 581 4 581 ------Finland 4 467 4 467 - - France 45 960 45 815 145 145 ------Germany, Democratic Republic 18 368 18 368 ------Germany, Federal Republic 54 450 54 450 ------Gibraltar 27 27 ------Greece 8 389 3 918 4 471 2 304 2 167 - - 2 167 -- Hungary 10 028 8 528 1 500 1 500 - Iceland 176 176 ------Ireland 2 815 2 815 ------Italy 49 549 45 549 4 000 4 000 - -- Liechtenstein 16 16 ------Luxembourg 314 314 ------Malta and Gozo 329 329 - - - -- Monaco 22 22 ------Morocco 11 626 3 178 8 448 - - - - - 8 448 PEP Netherlands 11 637 9 790 1 847 1 847 ------Norway 3 611 3 611 ------Poland 29 965 29 860 105 105 ------Portugal 9 196 6 958 2 238 1 560 678 - - 678 -- Romania 18 680 11 202 7 478 - 6 326 1 152 7 478 -- San Marino 17 17 ------Spain 31 500 9 400 22 100 21 802 298 - - 298 -- Sweden 7 520 7 520 ------Switzerland 5 470 5 470 ------. Population * in areas
where malaria with eradication programmes Other malaria Total never indi- where Country or other political unit population * genous or malaria where eradication disappeared which were eradication eradication projects in originally in the without claimed in the programme operation malarious consoli- in the specific (maintenance attack prepara- Total not yet antimalaria phase) dation phase tory started measures phase phase
Turkey 28 307 - 28 307 - 18 268 10 039 - 28 307 -- Ukrainian SSR 43 527 3 43 524 43 524 ------Union of Soviet Socialist Republics 167 902 11 621 156 281 155 351 890 40 - 930 -- United Kingdom of Great Britain and Northern Ireland 52 925 52 925 ------Yugoslavia 18 655 13 474 5 181 3 174 298 1 709 - 2 007 --
TOTALS 698 861 391 937 306 924 245 744 30 026 12 987 - 43 013 18 167
Latest available figures. PEP Pre -eradication programme. - Not applicable or none. EASTERN MEDITERRANEAN REGION
(population in thousands)
Population' in areas
where malaria with eradication programmes Other Total never indi- where malaria Country or other political unit population * genous or malaria where eradication which were projects in disappeared originally eradication eradication without claimed in the in the in the programme operation malarious consoli- prepara- specific (maintenance( attack Total not yetY antimalaria phase) dation phase tory started measures phase phase
Aden Colony 155 - 155 155 ------Aden Protectorate 758 - 758 - - -- - 758 - Bahrain 152 - 152 - - - -- 152 - Cyprus 581 - 581 581 ------Ethiopia 20 000 10 000 10 000 - - - - - 10 000 PEP French Somaliland 70 - 70 70 ------Gaza Strip 377 - 377 377 ------Iran 21 500 6 327 15 173 - 6 000 7 484 1 689 15 173 -- Iraq 7 085 2 485 4 600 4 163 437 - 4 600 -- Israel 2 200 - 2 200 701 1 499 - - 1 499 -- Jordan 1 700 794 906 - 851 55 - 906 -- Kuwait 219 219 ------Lebanon 1 880 1 197 683 - 683 - - 683 -- Libya 1 250 1 219 31 - 25 6 - 31 -- Muscat and Oman 560 - 560 -- -- - 560 - Pakistan 94 601 - 94 601 -- 4 400 8 388 12 788 81 813 - Qatar 55 7 48 -- - - - 48 - Saudi Arabia 5 000 a 1 000 a 4 000 -- - - - 4 000 - Somalia 2 030 254 1 776 -- - - - 1 776 PEP Sudan 12 109 - 12 109 - - - - - 12 109 PES Syria 4 930 3 342 1 588 - 1 265 323 - 1 588 -- Trucial Oman 86 - 86 - - - - - 86 - Tunisia 4 168 2 254 1 914 -- -- - 1 914 - United Arab Republic (Egypt) 26 080 5 821 20 259 -- -- - 20 259 - Yemen 5 000 1 500 3 500 -- - - - 3 500 -
TOTALS 212 546 36 419 176 127 1 884 14 486 12 705 10 077 37 268 136 975
Latest available figures. PEP Pre -eradication programme. aGovernment estimate. PES Pre- eradication survey. - Not applicable or none. WESTERN PACIFIC REGION
(population in thousands)
Population * in areas
where malaria with eradication programmes Other never indi- where malaria Country or other political unit Total where eradication population* genous or which were malaria eradication disappeared eradication projects in without originally claimed in the in the programme operation in the not yet specific (maintenance consoli- attack prepara- Total antimalaria phase) dation phase tory started measures phase phase
American Samoa 21 21 ------Australia 11292 11 282 10 - - - - - 10 - Bonin Islands ** ** - - - - British Solomon Islands Protectorate 135 - 135 - 135 PP Brunei 90 30 60 - - - 60 PEP Cambodia 5 197 4 147 1 050 - - - - - 1 050 PEP, FRP Canton and Enderbury Islands ** ** ------China (Taiwan) 11 171 - 11 171 10 226 945 - - 945 - - Christmas Island 3 3 ------Cocos Islands 1 1 ------Cook Islands 18 18 ------Fiji 394 394 ------French Polynesia 80 80 ------Gilbert and Ellice Islands 46 46 ------Guam 67 67 ------Hawaii 613 613 ------Hong Kong 3 128 - 3 128 2 728 - - - - 400 - Japan 94 285 94 285 ------Korea, Republic of 24 994 - 24 994 - - - - - 24 994 PEP Laos 1 850 - 1 850 - - - - - 1850 - Macao 207 7 200 - - - - - 200 - Malaya, Federation of 7 271 - 7 271 - - - - - 7 271 PP Midway Islands 2 2 ------Nauru 4 4 - - - - - New Caledonia 77 77 ------New Hebrides 61 - 61 - - - 61 - New Zealand 2 420 2 420 ------Niue 5 5 ------Norfolk Island 1 1 ------North Borneo 487 70 417 - 13 404 - 417 -- Pacific Islands 78 78 ------Papua and New Guinea 2 000 - 2 000 - - - - - 2 000 - Philippines 29 578 20 402 9 176 1 967 3 261 3 250 280 6 791 418 - Pitcairn Island ** ** ------Portuguese Timor 502 100 402 402 Ryukyu Islands 904 103 801 759 42 42 Sarawak 782 122 660 505 155 660 Singapore 1687 - 1687 1 687 Tokelau Islands 2 2 - Tonga 63 63 - Viet -Nam, Republic of 15 197 2 267 12 930 12 930 PEP Wake Island ** ** West New Guinea (West Irian) 750 300 450 450 PEP Western Samoa 110 110 -
TOTALS 215 573 137 120 78 453 17 367 4 766 3 809 280 8 855 52 231
China (mainland) 669 000 North Korea 10 197 No information available. North Viet -Nam 15 915
TOTALS 910 685
* Latest available figures. FRP Field research project. ** Under 500. PEP Pre- eradication programme. - Not applicable or none. PPPilot project. 154 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Appendix 2 PROFESSIONAL STAFF EMPLOYED IN NATIONAL MALARIA ERADICATION SERVICES AS AT 31 DECEMBER 1962
AFRICAN REGION
Country or other Total professional Physicians Engineers Entomologists Other political unit personnel
Cameroon 2 - Federation of Rhodesia and
Nyasaland 3 (I) 1 (1) 1 Parasitologist
Ghana I - 1 Health education officer Mauritius 1 - 1 - Portuguese African Provinces : Mozambique 3 - 1 1 South Africa 3 - 2 - Togo 1 (1) 1 (1) Uganda (1) (1) Zanzibar - (1) (1)
TOTAL 14 (4) 7 (4) 1 4 2
Figures in brackets indicate number of staff employed part -time.
REGION OF THE AMERICAS
Country or other Total professional Physicians Engineers Entomologists Other political unit personnel
1 - Statistician Argentina 11 (4) 6 (2) 2 - I 1 (2) Biochemists 1 - Statistician Bolivia 21 9 - 5 - 5 1 - Health education officer ( 6 - Health education officers Brazil (excluding Sao Paulo). . 82 40 - 23 8 - 1 3 - Pharmacists 2 - Veterinarians Brazil (Sao Paulo) 28 (2) 12 - 8 1 - 7 (2) Health education officers British Guiana - (2) - (1) - - (1) - British Honduras - (2) - (1) - (1) Health education officer 4 - Health education officers Colombia 48 32 - 7 t4 - Statisticians Costa Rica 3 1 - 1 1 - Bacteriologist Cuba 10 8 - 1 1 Dominica (1) (1) - Dominican Republic 6 3 - 3 f 1 - Health education officer Ecuador 20 10 7 1 - l1 - Veterinarian El Salvador 7 3 1 3 - Statisticians French Guiana (4) (4) - Grenada (1) (1) Guadeloupe 2 - 1 1 J 1 - Health education officer Guatemala 9 - 3 2 - 1 2 - Statisticians 1 - Statistician Haiti 16 8 - 5 1 1 1 - Health education officer Honduras 7 2 - 1 4 - Statisticians
Figures in brackets indicate number of staff employed part -time. ANNEX 8 155
Country or other Total political unit professional Physicians Engineers Entomologists Other personnel
Jamaica 1 15 - Health education officers 2 - Statisticians Mexico 191 89 - 49 31 2 - Biochemists 3 - Lawyers Nicaragua 7 4 l - 1 -- Health education officer Panama 3 1 1 - 1 - Health education officer Panama Canal Zone (12) (10) - (1) - (1) Paraguay II 7 3 - I - Biochemist 1 - Statistician Peru 31 14 5 - 5 - 6 - Accountants St Lucia (2) (1) - (1) Surinam 3 (1) (1) 1 2 - Health education officers Trinidad and Tobago 4 2 2 - Statisticians
Venezuela 18 15 1 2
TOTAL539 (31) 271 (22) 124 (2) 63 (2) 81 (5)
Figures in brackets indicate number of staff employed part -time.
SOUTH -EAST ASIA REGION
Country or other Total professional Physicians Engineers Entomologists Other political unit personnel
Afghanistan 23 21a - 2 Burma 13 8 - 5 Ceylon 5 4 - 1 India 542 426 I 115 Indonesia 12 7 - 5 Nepal' 18 9 - 9 I 2 Health education officers Thailand 20 17 - I 1 Public relations officer
TOTAL 633 492 1 137 3
aIncluding five in the process of recruitment. EUROPEAN REGION
Country or other Total political unit professional Physicians Engineers Entomologists Other personnel
Albania
Bulgaria 5 (43) (30) - (1) - (12) 5 (not specified) Greece - (1144) (1144) Morocco 3 (108) 1 (107) - (1) 2 Portugal 16 (3) 16(3) Romania 54 - 26 - 28 Spain 8 (213) 8 (213) Turkey 77 - 68 - 9 Union of Soviet Socialist Republics
Yugoslavia 20(112) 17(109) 1 2 (3)
TOTAL 183 (1623) 136(1606) 1 (2) 41 (15) 5
Figures in brackets indicate number of staff employed part -time. ... Information not available. 156 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
EASTERN MEDITERRANEAN REGION
Country or other Total professional Physicians Engineers Entomologists Other political unit personnel
Ethiopia 2 - 1 - - 1 - Iran 73 - 38 - 27 8 - Iraq 2 (7) 1 (7) - 1 - Israel 2 (16) 1 (16) - 1 - Jordan 1 - 1 - - - - Lebanon 2 --- 1 1 - Libya ------Pakistan 28 - 28 - - - - Saudi Arabia 15 - 5 - 6 4 - Somalia ------Sudan 2 - 1 - - 1 Syria 5 - 4 - - 1 Tunisia ... .. United Arab Republic ' 22 - 18 - - 4 - TOTAL154 (23) 98 (23) 34 22 -
Figures in brackets indicate number of staff employed part -time. ... Information not available.
WESTERN PACIFIC REGION
Total Country or other professional Physicians Engineers Entomologists Other political unit personnel
British Solomon Islands . . . . 1 (1) - (1) - 1 Health education officer Brunei - (1) - (1) - --- Cambodia 5 - 5 -- --- i 1Biologist China (Taiwan) 9 - 4 - 1 2 - 1 Health education officer Hong Kong 1 - 1 -- --- Korea, Republic of 3 (1) 2 (1) - 1 -- Laos 4 - 4 - -- Malaya, Federation of 4 - 1 - 1 1 - 1 Health education officer North Borneo 1 (1) 1 (1) - --- Papua and New Guinea 5 (1) 3 -- 2 (1) - Philippines 65 - 38 - 12 15 -- Ryukyu Islands 1 - 1 - - --- Sarawak - (5) - (5) - --- Viet-Nam, Republic of 14 - 13 -- 1 -- West New Guinea (West Irian) 4 - 3 -- 1 --
TOTAL 117 (10) 76 (9) 14 23 (1) 4
Figures in brackets indicate number of staff employed part -time. ANNEX 9 157
Annex 9
REVIEW AND APPROVAL OF THE PROGRAMME AND BUDGET ESTIMATES FOR 1964 1
1. REPORT OF THE AD Hoc COMMITTEE OF THE EXECUTIVE BOARD
[A16 /P &B /12 Add.1, A16 /AFL /9 Add.1 Rev.l - 9 May 1963]
1. The Executive Board, at its thirty -first session, 5.With regard to the continuing costs of a discretion- " having examined indetailthe programme and ary nature, the Committee noted that the Director - budget estimates for 1964 2 prepared and submitted General proposed the inclusion of the same minimal by theDirector -Generalinaccordance with the amount of $40 000 as in the supplementary budget provisions of Article 55 of the Constitution " recom- estimates for 1963 for the purpose of meeting requests mended " to the Health Assembly that it approve for services from new Members and Associate Mem- an effective working budget for 1964 in the amount bers as well as from Members resuming active parti- of $33 716 000, as proposed by the Director -General " cipation in the work of the Organization (see part 2, " subject to minor adjustments in cost estimates, paragraph 4). to be reported by the Director -General to the Sixteenth World Health Assembly, through the Ad Hoc Com- 6.The steps which the Director- General proposes mittee of the Executive Board ".3 be taken in 1964 to assist in meeting some of the additional costs of the headquarters building and 2.In accordance with resolution EB31.R52, the which are similar to those proposed in the supplement- Ad Hoc Committee established by the Executive ary estimates for 1963 (see part 2, paragraph 2) were Board and consisting of Dr M. K. Afridi, Professor considered by the Committee to be sounds E. Aujaleu and Dr A. Nabulsi, met on 6 May 1963 in the Palais des Nations, Geneva. Dr Afridi was 7. Initsreport to theSixteenth World Health elected Chairman. Assembly on accommodation for the Regional Office for Africa, the Committee endorsed the Director - 3.In considering the adjustments in the cost estimates General's view that no adjustment need be made of the proposed programme and budget estimates for with regard to Appropriation Section 12 " Reimburse- 1964 reported by the Director -General (see part 2 of ment of the Working Capital Fund ", in the proposed this annex), the Committee noted that these were programme and budget estimates for 1964.8 in part consequential to and in part in line with the additional requirements included in the supplementary 8.As a result of its examination of the proposed budget estimates for 1963 and recommended by the adjustments to the programme and budget estimates Executive Board for approval by the Sixteenth World for 1964, the Committee, on behalf of the Board, Health Assembly.4 recommends to the Sixteenth World Health Assembly that it approve the inclusion of the following pro- 4.Thus the Committee found that the continuing costs of the increases relating to the salary scales visions : for general services staff (in Geneva, Copenhagen and us s (a)Increases in the salary scales for general services New Delhi) and in the payments to the pensioners staff and in the payments of OIHP pensioners 192100 oftheOfficeInternationald'HygiènePublique (OIHP) amounting to $192 100 (see part 2 of this (b)Provision for servicesto new Members and Members resuming active participation . . . 40000 annex, paragraph 5) were of a mandatory nature, (c)Headquarters Building Fund (apart from revising and as a result of its examination the Committee was the title of Appropriation Section 10 to read of the opinion that these estimates were satisfactory. " Headquarters Building Fund ") 117000
See resolution WHA16.28. 349100 2 Off.Rec. Wld Huth Org.121. 3 Resolution EB31.R30 and footnote, OJf.Rec. Wld Huth Org.124, 18. 5 See also Annex 3, part 1. See Annex 3, part 2. 6 See Annex 4. 158 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
9.Inconsideringthe manner of financingthe by using $849 100 of casual income to help finance additional expenditure of $349 100 proposed to be the proposed adjusted effective working budget of added to the effective working budget level, as recom- $34 065 100 for 1964, no increase in the total assess- mended by the Executive Board, the Committee fully ments on Members will be necessary as compared to endorsestheDirector -General'sproposaltouse the total assessments for the effective working budget availablecasual income tomeet thisadditional level of $33 716 000 proposed by the Executive Board The Committee calls the attention of expenditure. at its thirty -first session (see part 2, Appendix 2). the Sixteenth World Health Assembly to the fact that,
2. REPORT BY THE DIRECTOR- GENERAL
[A16 /P &B /12, A16 /AFL /9 - 3 May 1963] 1.Introduction 2.Appropriation Section 10 : Headquarters Building : Repayment of Loans 1.1The Executive Board, at its thirty -first session, " having examined indetailthe programme and 2.1 Under agenda item 3.11, the Director -General budget estimates for 19641 prepared and submitted issubmitting a progressreport on headquarters by theDirector -Generalinaccordancewiththe accommodation,4 and as explained in the Director - provisions of Article 55 of the Constitution ", recom- General's report on the supplementary budget estim- mended to the Sixteenth World Health Assembly ates for 1963 5 (agenda item 3.3), the Director - General " that it approve an effective working budget for 1964 considers that the increase in cost of the headquarters in the amount of $33 716 000, as proposed by the building will require a number of steps to be taken. Director -General "..." subject to minor adjust- Of the two steps which he believes can now be taken, ments in cost estimates, to be reported by the Director - the first envisages that the amount of US $387 000 General to the Sixteenth World Health Assembly, appropriated by the Fifteenth World Health Assembly through the Ad Hoc Committee of the Executive underAppropriationSection 10" Headquarters Board ",2 meeting on 6 May 1963. Building :Repayment of Loans ", of the Appropria- tionResolutionforthefinancialyear 1963 1.2 When the Executive Board examined the estim- (WHA15.42), be used for a credit to the Headquarters ates it was informed that adjustments might become Building Fund, the title of Appropriation Section 10 necessary, specifically in the amounts included under beingchangedtoread" HeadquartersBuilding Appropriation Sections 10 " Headquarters Building : Fund "; and the second envisages that the amount Repayment of Loans " and 12 " Reimbursement of of US $387 000 be increased to US $500 000 by the the Working Capital Fund ".Accordingly, as stated inclusion in the supplementary estimates for 1963 of in paragraphs 204 and 206 of Chapter IV of its report 3 an additional amount of US $113 000. on its examination of the proposed programme and budget estimates for 1964, the Board decided that 2.2The Director -General proposes, as he did for these provisions should be referred to its Ad Hoc 1963, that the amount of US $383 000 included in the Committee for review. Since the session of the Board, proposed estimates for1964 under Appropriation developments have occurred which make necessary Section 10 " Headquarters Building :Repayment of adjustments in the estimates (i) to provide services Loans " be increased by US $117 000 to US $500 000, to new Members and Associate Members and to to be credited to the Headquarters Building Fund; Members resuming active participation in the work and that the title of Appropriation Section 10 be of the Organization (see paragraph 4 below), (ii) to changed accordingly. meet increases in the salary scales for general services staff in certain locations (see paragraph 5) and (iii) to 3.Appropriation Section 12: Reimbursement of the meet increases in the payments to pensioners of the Working Capital Fund Office International d'Hygiène Publique (OIHP) (see paragraph 5);none of these increased costs was For the reasons explained in the Director -General's foreseen at the time. report on accommodation for the Regional Office for Africa 6(agenda item 3.12),theDirector- General 1 Off Rec. Wld H1th Org. 121. 2 Resolution EB31.R30 and footnote, Off Rec. Wld Hlth Org. 4 See Annex 7, part 2. 124, 18. 5 See Annex 3, part 2. 3 Off. Rec. Wld Huth Org. 125, 58. 6 See Annex 4, part 2. ANNEX9 159
does not consider any adjustment necessary in the 1964 as presented inOfficial RecordsNo. 121, the amount provided under this appropriation section. amounts required to be added, and the resulting total estimates proposed for 1964.The two statements also reflect the adjustments required to be made as 4. ProvisionforServicesto New Members and between AppropriationSections6(Expert Com- Members resuming Active Participation mittees) and 4 (Programme Activities) should the As explained in the Director -General's report on Sixteenth World Health Assembly adopt the Director - the supplementary budget estimates for1963,' the General's recommendation that a study group rather than an expert committee be convened on special Director -Generalproposedthat anamountof courses for national staff with higher administrative US $40 000 be included in the supplementary estimates for 1963 for the purpose of meeting requests from new responsibilities in the health services. Members and Associate Members as well as from Members resuming active participation in the work of the Organization. The Director -General proposes 7.Method of Financing the Additional Requirements that a similar amount of US $40 000 be added to the proposed programme and budget estimates for 1964 As indicated in the Summary of Budget Estimates 3 for the same purpose. and in the Summary Table showing Total Budget, Income, Assessments and Effective Working Budget,4 the Director -General recommended that casual income 5.Increases in the Salary Scales for General Services available in the amount of US $500 000 be used to Staff and in the Payments to OIHP Pensioners help finance the proposed programme and budget estimates for 1964 as presented inOfficial Records As explained in the Director -General's report on No. 121.This recommendation was endorsed by the the supplementary budget estimates for 1963,1 the Executive Board in its report on its examination of Director -General has found it necessary to include theproposed programme andbudgetestimates provision in the supplementary estimates for 1963 for 1964.5 to meet additional expenditure resulting from increases As sufficient casual income is available, over and in (a) the salary scales for general services staff in above the amount of US $438 100 recommended to Geneva, Copenhagen and New Delhi, and(b)the be used to help finance the supplementary budget payments to OIHP pensioners.At the timethe estimates for 1963,' to cover the increased require- proposed programme and budget estimates for 1964 ments for 1964 as described in paragraphs 2, 4 and 5 were prepared these increases were not foreseen and above, the Director -General recommends that these the Director -General now reports that the additional additional requirements be financed by using available expenditure for 1964 in respect of these requirements casual income in the amount of US $349 100.The totals US $192 100, as follows : total amount of casual income which the Director- US General recommends be used to help finance the 1964 (a)Increased costs resulting from increases in the budget is therefore US $849 100, made up as follows : salary scales for general services staff in Geneva, Copenhagen and New Delhi 189700 uss (b)increased payments to OIHP pensioners . . . 2400 Assessments on new Members from previous years 98 860 192100 Miscellaneous income 454 733 Available by transfer from the cash portion of the Assembly Suspense Account 295 507
6.Total Adjusted Estimates for 1964 849100 The Director -General submits a statement 2 showing, by appropriation section and by purpose-of- expendi- ture code, the amounts required to be added to the The adjustments that will have to be made to the estimates for 1964 to take account of the above - 1964 column of the Summary Table on page 11 of mentioned increased requirements.He also submits Official RecordsNo. 121 in order to reflect the above a statement (see Appendix1,page 160 (showing, proposals are shown in Appendix 2. by appropriation section, the proposed estimates for 3 Off. Rec. Wld HIM Org.121, 9. 1 See Annex 3, part 2. 'Off. Rec. Wud HO Org.121, 11. Unpublished. 5 Off Rec. Wld Huth Org.125, 84. 160 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Appendix 1 PROPOSED ESTIMATES OF EXPENDITURE FOR 1964 UNDER THE REGULAR BUDGET Proposed estimates of Total expenditure, Proposed adjusted Appropriation Purpose of Appropriation as shown in adjustments estimates of Section Official expenditure Records No. 121 US$ US$ US$ PART I: ORGANIZATIONAL MEETINGS 1.World Health Assembly 317210 317210 2.Executive Board and its Committees 189090 189090 3.Regional Committees 100530 100530
Total - Part I 606830 606830
PART II : OPERATING PROGRAMME 4.Programme Activities 16299369 140450 16439819 5.Regional Offices 2639006 24700 2663706 6.Expert Committees 236500 (9900) 226600 7. Other Statutory Staff Costs 5501580 19700 5521280
Total - Part II 24676455 174950 24851405
PART III: ADMINISTRATIVE SERVICES 8.Administrative Services 1876632 48550 1925182 9.Other Statutory Staff Costs 610083 8600 618683
Total - Part III 2486715 57150 2543865
PART IV: OTHER PURPOSES 10.Headquarters Building Fund 383000 117000 500000 11.Transfer to the Malaria Eradication Special Account 5363000 - 5363000 12.Reimbursement of the Working Capital Fund 200000 - 200000
Total - Part IV 5946000 117000 6063000
Sub -total - Parts I, II, III and IV 33716000 349100 34065100
PART V : RESERVE 13.Undistributed Reserve 2230540 - 2230540
Total - Part V 2230540 2230540
TOTAL - ALL PARTS 35946540 349100 36295640
Appendix 2 SUMMARY TABLE SHOWING TOTAL BUDGET, INCOME, ASSESSMENTS AND EFFECTIVE WORKING BUDGET FOR 1964 As per Official Records Adjustments Total No. 121 asadjusted page 11 US$ US$ US$ Total budget 35946 540 a 349100 36295640 a Deductions 1256 990 349100 1606090
Assessments on Members 34689 550 a 34689550 a Less: Amount of Undistributed Reserve 2230 540 a, b 2230540 a, b Assessments on Members for the effective working budget 32459 010 - 32459010 a These amounts will be subject to adjustment if one or more Members resume active participation in the work of WHO, or if the membership of WHO increases by the time of the Sixteenth World Health Assembly. b Equalling the assessments on inactive Members (at the time these estimates were prepared, the Byelorussian SSR and the Ukrainian SSR) and on China. ANNEX 10 161
As per Official Records Adjustments Total No. 121 as adjusted page II US$ US$ US $ Add: (i)Amount reimbursable from the Special Account for the Expanded Programme of Technical Assistance 756990 756990 (ii)Casual income 500000 349100 849100
Total effective working budget 33716000 349100 34065100
Annex 10 SUMMARY OF BUDGET ESTIMATES FOR THE FINANCIAL YEAR 1 JANUARY - 31 DECEMBER 1964
As approved by the Sixteenth World Health Assembly 1
1964 1964 Estimated Estimated expenditure expenditure US S US $ PART I: ORGANIZATIONAL MEETINGS Chapter 60Fixed Charges and Claims 62 Insurance 60 SECTION 1 :WORLD HEALTH ASSEMBLY
Chapter 00Personal Services Total - Chapter 60 60 01 Salaries and wages (temporary staff) 54 000
02Short -term consultants' fees . . . . 900 Chapter 80Acquisition of Capital Assets 82 Equipment 1 500 Total - Chapter 00 54 900 Total - Chapter 80 1 500 Chapter 20Travel and Transportation TOTAL - SECTION 1 317 210 21 Duty travel 12 500 22Travel of short -term consultants . 1 200 25 Travel of delegates 98000 SECTION 2:EXECUTIVE BOARD AND ITS 26Travel and subsistence of temporary COMMITTEES staff 15 500 Chapter 00Personal Services 01 Salaries and wages (temporary staff) 47 800 Total - Chapter 20 127 200 Total - Chapter 00 47 800 Chapter 30Space and Equipment Services 31 Rental and maintenance of premises 6 800 Chapter 20Travel and Transportation 32 Rental and maintenance of equipment 2200 21 Duty travel 13 300 25 Travel and subsistence of members 61 500 Total - Chapter 30 9 000 26 Travel and subsistence of temporary staff 13 400 Chapter 40Other Services 88 200 43Other contractual services 22 300 Total - Chapter 20 44Freight and other transportation costs 2 100 Chapter 30Space and Equipment Services Total - Chapter 40 24 400 31 Rental and maintenance of premises 4 840 32 Rental and maintenance of equipment 1 100 Chapter 50Supplies and Materials Total - Chapter 30 5 940 51 Printing 96 250 52Visual material 1 500 Chapter 40Other Services 53 Supplies 2 400 43Other contractual services 18 150 44Freight and other transportation costs 800 Total - Chapter 50 100 150 Total - Chapter 40 18 950 1 See resolution WHA16.28. 162 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
1964 1964 Estimated Estimated expenditure expenditure US $ US $ Chapter 50Supplies and Materials Chapter 20Travel and Transportation 51 Printing 26700 21Duty travel 711550 53 Supplies 800 22Travel of short -term consultants 542800
25Travel of temporary advisers . 100532 Total - Chapter 50 27500 26Travel of temporary staff 72064
Chapter 60Fixed Charges and Claims Total - Chapter 20 1426946 62Insurance 700 Chapter 30Space and Equipment Services Total - Chapter 60 700 31 Rental and maintenance of premises 211986 32Rental and maintenance of equipment 54484 TOTAL - SECTION 2 189090 Total Chapter 30 266470
Chapter 40Other Services SECTION 3:REGIONAL COMMITTEES 41 Communications 176620 Chapter 00Personal Services 42Hospitality 10350 43Other contractual services 542 01 Salaries and wages (temporary staff) 23280 628 44Freight and other transportation costs 69204 Total - Chapter 00 23280 Total - Chapter 40 798802
Chapter 20Travel and Transportation Chapter 50Supplies and Materials 21 Duty travel 28990 51 Printing 384263 26Travel and subsistence of temporary 53 Supplies 278094 staff 25010 Total - Chapter 50 662357 Total - Chapter 20 54000 Chapter 60Fixed Charges and Claims Chapter 30Space and Equipment Services 62Insurance 20750 32Rental and maintenance of equipment 530 Total - Chapter 60 20750 Total - Chapter 30 530 Chapter 70Grants, Contractual Technical Services Chapter 40Other Services and Training Activities
71 Fellowships 1 584624 41 Communications 1420 72Grantsandcontractualtechnical 43Other contractual services 8300 44Freight and other transportation costs 2050 services 1 441280 73Participants in seminars and other educational meetings 452234 Total - Chapter 40 11770 74Staff training 60000 75Research training 150000 Chapter 50Supplies and Materials 53 Supplies 10950 Total - Chapter 70 3688138
Total - Chapter 50 10950 Chapter 80Acquisition of Capital Assets 81 Library books 30229 TOTAL - SECTION 3 100530 82Equipment 281976
TOTAL - PART I 606830 Total - Chapter 80 312205
Contingency provision 40000
PART H : OPERATING PROGRAMME TOTAL - SECTION 4 16439819
SECTION 4:PROGRAMME ACTIVITIES Chapter 00Personal Services SECTION 5:REGIONAL OFFICES 01 Salaries and wages 8681351 Chapter 00Personal Services
02Short -term consultants' fees . . . . 542800 01Salaries and wages 2040442
Total - Chapter 00 9224151 Total - Chapter 00 2040442 ANNEX 10 163
1964 1964 Estimated Estimated expenditure expenditure USs US s Chapter 20Travel and Transportation Chapter 60Fixed Charges and Claims 21 Duty travel 94 970 62 Insurance 2640
Total - Chapter 20 94 970 Total - Chapter 60 2640
Chapter 30Space and Equipment Services TOTAL - SECTION6 226600 31 Rental and maintenance of premises 113 514 32 Rental and maintenance of equipment 30 139 SECTION7:OTHER STATUTORY STAFF COSTS Total - Chapter 30 143.653 Chapter 10Personal Allowances Chapter 40Other Services 11 Repatriation grant 35269
41 Communications 101 397 12 Pension fund 1186653 42Hospitality 9 000 13 Staff insurance 230164 43 Other contractual services 36 489 14 Representation allowance 23400 44 Freight and other transportation costs 32 991 15 Other allowances 2861202
Total - Chapter 40 179 877 Total - Chapter 10 4336688
Chapter 50Supplies and Materials Chapter 20Travel and Transportation 51 Printing 16 960 23 Traveloninitialrecruitment and 52Visual materials 44 191 repatriation 207457 53 Supplies 54 412 24Travel on home leave 764919 27 Transportation of personal effects 46751 Total - Chapter 50 115 563 28 Installation per diem 72604 Chapter 60Fixed Charges and Claims Total - Chapter 20 1091731 62 Insurance 13410
Total - Chapter 60 13 410 Chapter 60Fixed Charges and Claims
61 Reimbursement of income tax . . . 92861 Chapter 80Acquisition of Capital Assets 81 Library books 7 038 Total - Chapter 60 92861 82 Equipment 68 753 TOTAL -- SECTION7 5521280 Total -- Chapter 80 75 791 TOTAL - PART I I 24851405 TOTAL - SECTION5 2663 706
PART III: ADMINISTRATIVE SERVICES SECTION6:EXPERT COMMITTEES Chapter 00Personal Services SECTION8:ADMINISTRATIVE SERVICES 01 Salaries and wages (temporary staff) 34 760 Chapter 00Personal Services
01 Salaries and wages 1 448553 Total - Chapter 00 34 760 02 Short -term consultants' fees . . . 15200 Chapter 20Travel and Transportation Total - Chapter 00 1463753 25 Travel and subsistence of members 132 000 Chapter 20Travel and Transportation Total - Chapter 20 1.32 000 21 Duty travel 74300
Chapter 40Other Services 22Travel of short -term consultants . 15200 43 Other contractual services 19 800 Total - Chapter 20 89500 Total - Chapter 40 19 800 Chapter 30Space and Equipment Services Chapter 50Supplies and Materials 31 Rental and maintenance of premises 68546 51 Printing 37 400 32Rental and maintenance of equipment 17391
Total - Chapter 50 37 400 Total - Chapter 30 85937 164 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
1964 1964 Estimated Estimated expenditure expenditure US $ US $ Chapter 40Other Services PART IV:OTHER PURPOSES 41 Communications 52 098 42Hospitality 4 650 SECTION 10: HEADQUARTERS BUILDING FUND 43Other contractual services 74 451 Chapter 80Acquisition of Capital Assets 44Freight and other transportation costs 17 365 83Land and buildings 500 000 Total - Chapter 40 148 564 Total - Chapter 80 500 000
Chapter 50Supplies and Materials TOTAL - SECTION 10 500 000 51 Printing 939 52Visual material 59 900 53 Supplies 20 520 SECTION 11 :TRANSFER TO THE MALARIA ERADICATION SPECIAL ACCOUNT Total - Chapter 50 81 359 Chapter 70Grants, Contractual Technical Services and Training Activities Chapter 60Fixed Charges and Claims 72Grantsandcontractualtechnical 62Insurance 5 239 services 5 363 000
Total - Chapter 60 5 239 Total - Chapter 70 5 363 000
TOTAL - SECTION 11. 5 363 000 Chapter 80Acquisition of Capital Assets 82Equipment 50 830 SECTION 12: REIMBURSEMENT OF THE WORKING Total - Chapter 80 50 830 CAPITAL FUND 200 000
TOTAL - SECTION 8 1 925 182 TOTAL - SECTION 12 200 000
TOTAL - PART IV 6063 000
SECTION 9:OTHER STATUTORY STAFF COSTS SUB -TOTAL -- PARTS I, 11, III AND IV34065 100 Chapter 10Personal Allowances 11 Repatriation grant 7 505 12Pension fund 192 487 PART V :RESERVE 13 Staff insurance 32 264 14Representation allowance 15 600 SECTION 13: UNDISTRIBUTED RESERVE 2223 130 15Other allowances 261 521 TOTAL - PART V 2 223 130 Total - Chapter 10 509 377 TOTAL - ALL PARTS36 288 230 Chapter 20Travel and Transportation 23 Travel oninitialrecruitment and Less: repatriation 16 539 Reimbursement from the Special Account of the 24Travel on home leave 54 692 Expanded Programme of Technical Assistance 756 990 27Transportation of personal effects 9 039 28Installation per diem 4 755 Less: Casual Income Assessments on new Members from previous Total - Chapter 20 85 025 years 98 860 Miscellaneous income 454 733 Chapter 60Fixed Charges and Claims Available by transfer from the cash portion of the Assembly Suspense Account 295 507 61Reimbursement of income tax . . . 24 281
Total - Chapter 60 24 281 TOTAL - CASUAL INCOME 849 100
TOTAL - SECTION 9 618 683 TOTAL - DEDUCTIONS 1 606 090
TOTAL - PART III 2 543 865 TOTAL - ASSESSMENTS ON MEMBERS34 682 140 ANNEX 11 165
Annex 11
DECISIONS OF THE UNITED NATIONS, SPECIALIZED AGENCIES AND THE INTERNATIONAL ATOMIC ENERGY AGENCY AFFECTING WHO'S ACTIVITIES (ADMINISTRATIVE, BUDGETARY AND FINANCIAL MATTERS) 1
[A16 /AFL /21 - 15 May 1963]
REPORT BY THE DIRECTOR -GENERAL
1. The Director -General reported to the Executive present responsibility for advising on recruitment and Board at its thirty -first session on decisions of the personnel policies, the importance of which would United Nations, specialized agencies and the Interna- not be diminished by the additional functions. Work- tionalAtomic Energy Agencyaffecting WHO's ing arrangements, and the size of the Board, may activities in administrative, budgetary and financial need to be modified, both to enable it to verify the matters.2The Executive Board, initsresolution facts on particular questions and to deal with urgent EB31.R43, noted the report and noted " with approval matters which might arise between its regular sessions. the position taken by the Director -General when the The Board's views, with ACC's definitive proposals, Administrative Committee on Co- ordination con- will be reported to legislative bodies in due course. sidered the extension of central and independent facilities for dealing with salary and allowance ques- 3.Revised terms of reference have been suggested tions ".The Board also confirmed " its continuing by ACC for consideration by the International Civil confidence in the International Civil Service Advisory Service Advisory Board, when it meets on 20 May Board as a body of independent experts in public 1963. The Director -General believes that if the new administration whose competence and objectivity have terms of reference and authorities are approved by been amply demonstrated " and expressed" the all concerned, this step will become one of the most important yet taken to improve co- ordination on hope thattheDirector -Generalwill pursue this matter in the Administrative Committee on Co- administrative matters. ordination and that an early and definitive conclusion 4. ACC has also revised and amplified the inter - will be reached ". organization agreement on the transfer, secondment or loan of staff from one organization to another; 2.The Administrative Committee on Co- ordination (ACC), at its meeting on 2 and 3 May 1963, agreed the new agreement will enter into force on 1 January upon the basis on which, subject to the views of the 1964. Board itself, the International Civil Service Advisory 5.ACC has agreed to continue for a further year, Board might serve as an independent inter- organiza- to 31 December 1964, the present cost -sharing arrange- tion body to make recommendations, through ACC, ments by which the various organizations meet the to all organizations on problems arising in the admin- expenditures on certain joint administrative activities, istrationof the common system of salaries and such as those relating to the International Civil allowances.The Committee's intention to consult Service Advisory Board, the Expert Committee on the International Civil Service Advisory Board on Post Adjustments and the Consultative Committee this matter was reported to the General Assembly in on Administrative Questions. October 1962, and noted with approval by the General Assembly in resolution 1869 (XVII).Primarily, the 6.ACC has also agreed upon arrangements to change would mean broadening the terms of reference facilitate the exchange of information regarding the of the Board to include responsibility for reviewing scheduling of conferences by the various organizations. (when necessary) conditions of service and divergencies There is, however, a limit to the usefulness of such as between organizations in the application of the inter- secretariat attempts to co- ordinate conference common system. Final authority would, for constitu- schedules, unless the government representatives in tional reasons, remain with the appropriate authorities the various bodies are prepared to take account of of each organization.The Board would retain its established, recurring requirements of other bodies. In this connexion, the physical accommodation in 1 See resolutions WHA16.32 and WHA16.33. thePalaisdes Nationsisbecoming increasingly 2 Off.Rec. Wid HlthOrg. 124, Annex 20. inadequate.In fact, statutory meetings, particularly 166 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I the World Health Assembly and the Conference of operations of the organizations concerned.Further- theInternational Labour Organisation,are now more, the costs of dislocating the meetings of estab- jeopardized by the scheduling of ad hoc and other lished bodies result in an unnecessary expense to govern- meetings in the Palais des Nations which conflict ments. In view of some of the impending decisions by with traditional, long- established dates.The timing the Economic and Social Council and others, for of such statutory meetings is extremely important to example, on the 1964 Trade Conference, this is a governments and determinesthe whole cycleof matter of immediate and urgent concern.
Annex 12
CLINICAL AND PHARMACOLOGICAL EVALUATION OF DRUGS 1
[A16 /P &B /4 - 3 April 1963] REPORT BY THE DIRECTOR - GENERAL
1.Previous Resolutions of the Health Assembly and Health Assembly resolution; the Executive Board the Executive Board then requested the Director -General:
1.1 TheFifteenthWorldHealthAssembly,in (i)toreporttotheSixteenth World Health resolution WHA15.41, requested : Assembly on the outcome of the discussions in the forthcoming meeting of the scientific group [on 1....the Director -General to pursue, with the the evaluation of the safety and efficacy of drugs]; assistance of the Advisory Committee on Medical (ii)to explore meanwhile ways and means of Research, the study of the scientific aspects of the compiling information on serious adverse drug clinical and pharmacological evaluation of phar- reactions and of supplying this information to maceutical preparations; national health administrations in order to enable 2. ... the Executive Board and the Director -General them to take appropriate action ; to study the feasibility or otherwise, on the part Further, in paragraph 2 of resolution EB31.R6, the of WHO, of Executive Board recommended to the Sixteenth World (a)establishing minimum basicrequirements Health Assembly to invite Member States : and recommending standard methods for the (i)to seek agreement, in co- operation with WHO, clinical and pharmacological evaluation of phar- on basic principles and minimum requirements maceutical preparations; applicable to the toxicological, pharmacological and (b)securing regular exchange of information on clinical evaluation of drugs; and the safety and efficacy of pharmaceutical prepara- (ii)to make available to WHO, for rapid dissem- tions; and, in particular, ination to Member States, informationof any action taken to prohibit or limit the use of a drug (c)securing prompt transmission to national as a result of adverse reactions and of the evidence health authorities of new information on serious which led to this action. side- effects of pharmaceutical preparations;
and toreport totheSixteenth World Health 2.Observations by the Director - General Assembly on the progress of this study. 2.1 As a first step towards the implementation of 1.2In resolution EB31.R6, adopted at its thirty -first these resolutions, a Scientific Group on the Evaluation session, the Executive Board emphasized the need of the Safety and Efficacy of Drugs was convened. for early action in regard to rapid dissemination of It was composed of thirteen clinicians and pharma- information on adverse drug reactions and considered cologists from nine countries, many of them having thatinternationalco- operationwasessentialto also great experience in the administrative aspects of achieve the objectives of the above -mentioned World the problem. The mandate of this group, which met from 4 to 8 March 1963, in Geneva, was to advise the 1 See resolution WHA16.36. Director -General on the way in which the Organiza- ANNEX 12 167 tion could develop a programme relatedtothe question of withdrawal (prohibition)of drugsis toxicological, pharmacological and clinical evaluation dealt with also in section 2.4 below. of drugs. The Group recognized that information in connexion Considering that the problems in this new field of withrejection, though veryvaluable,would not activity for WHO were urgent and important from always be available. As for information on approved the point of view of the protection of public health, drugs, the Group realized that the criteria used for the Group held that the programme as outlined by approval vary greatly from country to country -an the Fifteenth World Health Assembly and specified additional reason why it is desirable for WHO to by the Executive Board was within the Organization's promote generally agreed criteria for drug evalua- technical capacity.The Group discussed, on the tion, as suggested in section 2.2 above. basis of present scientific knowledge and taking into 2.4 A service of information on serious adverse drug account relevant activities being planned or pursued reactions was, in the opinion of the Scientific Group in several countries, the feasibility of several contribu- on the Evaluation of the Safety and Efficacy of Drugs, tions that WHO might make towards an improvement, a matter of urgency. The Group considered that the where desirable, of the present situation in regard to rapid exchange of information, through WHO, on the assessment of the safety and the efficacy of drugs. action taken to prohibit or limit the use of a drug as The report of the Scientific Group will be submitted a result of adverse reactions was essential as a first to the Advisory Committee on Medical Research at step, but that such a service should be extended as its fifth session in June 1963. indicated below so as to allow for preventive measures A summary is given below of the Group's sugges- to be taken as early as possible. tions and recommendations as they refer to the The Group considered the practical implications objectives of resolutions WHA15.41 and EB31.R6. of the inclusion of cases of " limitation of use " in such an information service. It found that the question 2.2The feasibility of formulating basic principles of " limitation of use " of a drug or a group of drugs and requirements applicable to the evaluation of was so complex, and was dealt with so differently in drugs at the various stages was explored carefully by the various countries, that it could not formulate the Scientific Group. It considered that the preclinical general conclusions as to the opportuneness of includ- studies (i.e. toxicological and pharmacological animal ing relevant data in a regular system of information. experiments) as well as large -scale clinical trials are now It should be possible for WHO to organize a more sufficiently advanced, as regards the methods applied comprehensive service of information on adverse drug and experience gained, to allow essential criteria for reactions, having due regard to the need for preven- their proper conduct to be formulated. The Group, tion; but this would be feasible only if a sufficient therefore, recommended that such criteria be estab- number of Member States undertook to supply WHO lished by WHO for preclinical studies as well as for with the necessary information. To this end, Member clinical trials, with a view to obtaining international States might be encouraged to devise a system for agreement thereon. collecting such information, in particular, after the It would be for further scientific groups to study general release of new drugs.It would be for WHO the matter, with the guidance of the Advisory Com- to classify and assess the incoming information with mittee on Medical Research, and to formulate adequate a view to (a) publishing regularly a survey together criteria and requirements. with a critical analysis; and (b) in severe cases of great urgency,issuing immediately a warning to 2.3The question of securing regular exchange of information on the safety and efficacy of drugs, as national health authorities, or a cautionary statement, after having sought and obtained appropriate expert recommended by the Fifteenth World Health Assembly advice in both instances. for the study by the Executive Board and the Director - General, was also examined by the Scientific Group. 2.5A programme for action as outlined in the The Group suggested that, in view of the vast amount preceding sections 2.2 to 2.4 might well be supple- of relevant evidence continuously being produced, mented by contributions in the form of research the collection of such information from, and dissemi- grants, fellowships, lectureships, and seminars for the nationto,national healthauthorities should be purpose of improving the methodology of drug testing limited to data which WHO receives from Member and its proper application. Furthermore, the Scientific States in relation to drugs approved or rejected, or Group recommended a number of relevant problems for which approval has been withdrawn. An invitation for study by meetings of groups of specialists, which to Member States to furnish such data to the Organiza- would be arranged under the medical research pro- tion might be appropriate.It will be noted that the gramme of WHO. 168 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
3.Conclusions connexion with the dissemination by WHO of certain types of information referred to in sections 2.3 and 2.4 3.1 It is the intention of the Director- General to study the technical and administrative aspects of the of this report. suggestions and recommendations of the Scientific Group, as reported in sections 2.2 to 2.5 above. 3.2For further action, the Assembly may wish to In planning and implementing relevant activities he take into account the observations formulated in the willtake into consideration the advice of the Advisory light of the report of the Scientific Group on the Committee on Medical Research.Possible implica- Evaluation of the Safety and Efficacy of Drugs and tions of a legal nature may have to be studied in submitted herewith for its consideration.
Annex 13
UNITED NATIONS DEVELOPMENT DECADE [A16 /P &B /6 and Add. 1 - 5 April and20May1963]
REPORT BY THE DIRECTOR -GENERAL
The Director -General has the honour to transmit to the Sixteenth World Health Assembly the report on the United Nations Development Decade which he submitted to the Executive Board at its thirty -first session. (See report below, with Appendices 1 to 5.) After considering this report, the Executive Board adopted resolutionEB31.R50.2 The Special Committee on Co- ordination, referred to in paragraph 4 of the Executive Board's resolution, held its first meeting in New York from 25 to 28 February 1963. It decided to consider at its next meetings, beginning on 13 May 1963, its preliminary findings as regards priority areas relating to the objectives of the United Nations Develop- ment Decade and to prepare, in consultation with the agencies concerned, recommenda- tions thereon, which would be submitted to the Economic and Social Council. To complete the information contained in his report to the Executive Board at its thirty -first session on the United Nations Development Decade, the Director - General also transmits to the Health Assembly an excerpt from the twenty- eighth report of the Administrative Committee on Co- ordination to the Economic and Social Council (see Appendix 6, page 179).
REPORT TO THE EXECUTIVE BOARD AT ITS THIRTY -FIRST SESSION, JANUARY 1963
[EB31/28 - 12Dec.1962]
1. The Director - General reported to the Executive Executive Board, at its twenty -ninth session in its Board,atitstwenty -ninthsession,onGeneral resolution EB29.R44. The Fifteenth World Health Assembly resolution 1710 (XVI) which designated Assembly, in its resolution WHA15.57, endorsed the the current decade as the United Nations Development Executive Board's recommendation that governments Decade.In May 1962, he reported to the Fifteenth undertake a ten -year public health programme, with World Health Assembly3 on the action taken by the the assistance of WHO, if they so wish, with certain specific objectives and targets designed to raise the standards of the health of the peoples, such as the 1See resolution WHA16.40. 2 Off. Rec. Wld Hlth Org. 124, 27. preparation of national plans for the development of
3 Off. Rec. Wld Huth Org. 118,Annex3. publichealth programmes; concentration on the ANNEX 13 169 education and training of professional and auxiliary made arrangements for the preparation of detailed staffforstrengtheningtheirhealthservices;the proposals. The contribution of WHO to the United establishment as baselines of certain indices of their Nations paper on " A programme consisting of detailed current health situation; and the devotion of increased phased proposals for action with respect to the basic national resources to the control of disease and the facts of economic growth ", for presentation to the improvement of health. This resolution was brought thirty -sixthsessionof the Economic andSocial totheattention of the United Nations General Council, is given in Appendix 3. Assembly, the Economic and Social Council, the 5. Following the review of programme development Technical Assistance Committee and the Governing and co- ordination, the Economic and Social Council Council of the Special Fund. decided, in its resolution 920 (XXXIV), reproduced 2. The Secretary -General of the United Nations in Appendix 4, to set up a Special Committee on consultedthespecializedagenciesregardinghis Co- ordination,withparticularemphasisonthe proposals for action during the Decade, which he United Nations Development Decade, consisting of had been requested in resolution 1710 (XVI) to submit representativesof elevenStates members of the to the Economic and Social Council at its thirty - CouncilortheTechnicalAssistance Committee. fourth session in July 1962. The programme which The Special Committee is to keep under review the was approved by the Executive Board, at its twenty - activities of the United Nations and its agencies in the ninth session, and by the Fifteenth World Health economic, social, human rights and related fields; Assembly, was summarized in the document containing to consider, wherever appropriate, in consultation the Secretary -General's proposalsand set out in with the agencies concerned, priority areas or projects full in an addendum to that document.2In presenting relating to the objectives of the Decade, and to submit hisreport totheCouncil, theSecretary -General recommendations on these matters to the Council. specifically referred to the fight against malnutrition It will also assume certain functions of the ad hoc and disease and suggested that expenditure on health Working Group on Co- ordination, established by services might be doubled.The Director- General Economic and Social Council resolution 798 (XXX), of WHO also took part in the debate of the Economic and will submit to the Council, for consideration, a and Social Council on the Development Decade, and concise statement of the issues and problems in the informed it of the action taken by WHO. His state- field of co- ordination, which call for special attention. ment to the Council is reproduced in Appendix 1 to The first meeting of the Special Committee is to be this report. held in February 1963. SocialCounciladopted 3.The Economic and 6. The Director -General of WHO took part in the resolution 916 (XXXIV) (see Appendix 2), further debate on this proposal in the Economic and Social defining the objectives of the Decade, most of which Council and all specialized agencies agreed that no relate to trade. However, one area of work to which new machinery for co- ordination was required. The the Council called particular attention was " the Economic and Social Council underlined the fact development of human resources through adequate that the new Committee was a subordinate body of programmes for education and vocational training, the Council and should' not be regarded as a new nutrition, health, sound public administration, hous- piece of machinery since it continued the work of the ing, urban and rural development ... and effective Council's ad hoc Working Group on Co- ordination. land reform, with particular emphasis on their contri- The Council invited ACC to express its views, and the bution to overall development objectives and with ACC, at its thirty -fifth session, agreed to a statement the co- operation where appropriate of trade unions (reproduced in Appendix 5), drawing attention to the and other non -governmental organizations in con- importance of the participation by the representatives sultativestatus ". This . resolutionrequestedthe of the specialized agencies in the deliberations of the Secretary- General, in co- operation with the specialized Council and its committees. It hoped that the existing agencies and others, to submit in July 1963 " a pro- instruments at the disposal of the agencies for assisting gramme consisting of detailed phased proposals for developing countries in making the Decade a success action ". would be fully utilized. On the basis of the statement 4.In compliance with this request, the Administra- and reservations made by ACC, the executive heads tive Committee on Co- ordination, in October 1962, of agencies expressed their willingness to recommend co- operation with theSpecial Committee on Co- i United Nations (1962) TheUnited Nations Development ordination to their governing bodies. The ACC also Decade: proposals for action, New York.(United Nations document E/3613). suggested that the budgets of the Expanded Pro- 2 United Nations document E/3613 Add. 1. gramme of Technical Assistance, the Special Fund 170 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I and the World Food Programme, as well as the particularly of the less developed countries, for the regular budgets of the specialized agencies, should be stability of the world economy and the maintenance adjusted to the targets of the Development Decade. of international peace and security.' 7. In a further resolution on trade and the Develop- 8.The General Assembly of the United Nations is ment Decade, the Economic and Social Council considering at its seventeenth session the report of the approved the convening of a United Nations Con- Economic and Social Council on the Development ference on Trade and Development and called atten- Decade.Such decisions asit may make will be tion to the importance of economic development, reported to the Executive Board.
Appendix 1
ADDRESS BY THE DIRECTOR -GENERAL OF THE WORLD HEALTH ORGANIZATION TO THE ECONOMIC AND SOCIAL COUNCIL AT ITS THIRTY -FOURTH SESSION Geneva, 11 July 1962
The spirit in which the General Assembly initiated the United ment, they are also among its major objectives ". We must Nations Development Decade and the goals it formulated led the bear constantly in mind that economic and social development World Health Assembly to adopt its resolution WHA15.57, is required for man, that human beings are the means of achieving which is before this Council in document E/3611, Addendum 1. that development and that they are to be its beneficiaries. The Health Assembly, " Cognizant of the profound effect Health means more than individual care for the sick, more health standards of families, communities and nations have on than the nation -wide or even international attacks on the causes their social advancement and economic progress, particularly of disease in which most countries are now engaged. It means, in the developing areas of the world " and " aware of the in every country, heightening the vitality of the people so that benefits accruing to health from the accelerated national pro- they have fewer casualties to care for, their work becomes more grammes for general socio- economic development ", recom- productive and -what is just as important -they have the mended that " in so far as the health aspects of accelerated energy to learn the new skills and to adjust to the new patterns economic and social development are concerned, governments of living that constitute economic and social progress. Thus, participate in these programmes, with the assistance of the improvement of the people's health contributes to progress in World Health Organization if they so wish, by undertaking a practically every other sector of the development programme, ten -year public health programme with the objective of raising just as advances in these other sectors can bring important the standards of the health of the peoples " by a few closely benefits to health. related actions. It is clear, too, that economic and social development is not The Development Decade gives the World Health Organiza- something which can be given to people -it is, instead, something tion an opportunity and a responsibility to expand health which they can only achieve for themselves. And the strength programmes and to review their focus as part of the common of people to produce, their receptiveness to training, their will effort to speed the pace of development during these ten years. to work for their own betterment, require a healthy mind in a I appreciate this opportunity to bring to this Council some of healthy body. the details of the contribution which my organization hopes When the Fifteenth World Health Assembly considered the to make in this co- operative effort.In this effort, health is General Assembly's resolution, one of its main conclusions important not only for its own sake, but because it is essential was that " in developing countries, the creation of a network for economic development. For the newly independent countries, of minimum basic health services must be regarded as an essential independence may mean a breakdown of the barest minimum pre- investmentoperation,without whichagriculturaland of health services. The absence of health is one of the most industrial development would be hazardous, slow and un- important contributing factors to instability of the individual, economic".2It is axiomatic that, if a country is to achieve self - the family and of the entire community. The health problems sustaining development, it must have an adequate infrastructure. of newly independent and emerging countries must be faced. It is also obvious that the infrastructure, to be complete, must Indeed, economic values are not fully applicable to the saving include a sufficient health component to provide the minimum of human life and the alleviation of suffering of people, for health services for the country. These health services must be these cannot wait and are not determined by economic factors competent toidentify problems, to provide the minimum alone. preventive and curative services, to plan the further development The Acting Secretary -General, in his statement the day before of health services in the context of economic and social develop- yesterday, emphasized clearly the overriding importance of the ment and to avoid the health hazards which too often are the human factor in the entire development process. In the introduc- concomitant of economic development.Thus, training for tion to his report, which is before this Council, containing his the provision of the minimum health services is an essential proposals for action in the United Nations Development Decade, pre- investment activity. he also stated, " The widening of man's horizons through education and training and the lifting of his vitality through ECOSOC resolution 917 (XXXIV). better health, are not only essential pre -conditions for develop- 2Resolution WHA15.57. ANNEX 13 171
The Health Assembly made specific recommendations to a high prevalence of communicable diseases represents a hazard governments in connexion with t he Development Decade. which resultsin continued lower standards of living.The Of basic importance is the establishment of a national health experience of the Organization has demonstrated that the circle plan for each country, co- ordinated with its plans for work in of disease, low productivity and poverty, to which so many other sectors. A realistic and technically sound health plan delegations have referred, can successfully be broken by a would take epidemiological and other technical data into concentrated attack onitsbiological components through consideration, and would relate them directly to basic economic sustained and mass campaigns against the most prevalent facts, such as resources and costs, and also to the degree of communicable diseases. As targets for the Decade, therefore, benefit that can be expected. the World Health Assembly has proposed that certain of the Preparation of a sound plan will promote the establishment and development of a basic health organization as the sine qua most prevalent communicable diseases be attacked in a .more non for providing minimum health services to the people. concentrated fashion with a view to achieving their eradication, These plans must include provision for concentration on or reduction to the point where they cease to be of serious education and training, so that countries can staff their health public health or economic importance. In the Decade increased services with their own professional and auxiliary workers, effort must be made to prevent premature death and to increase and can build up as early as possible their own training institu- life expectancy, thereby achieving a more favourable age com- tions for health staff. To this end, measurable targets must be position. The infant mortality rate, the most sensitive of social set for expanding each category of staff according to the pre- indicators, must be lowered during the Decade. Malnutrition, determined needs. as has been pointed out by my colleague, Mr Sen, represents It may help the Council in its deliberations to be aware of an immediate challenge during the Decade. In co- operation the order of magnitude of the problem. The minimum require- with FAO and other organizations, WHO will intensify the ments for basic health services are considered to be: programme in the health aspects of malnutrition. Finally, a 1 physician per 10 000 population, direct attack on the environment through, in the first instance, 1 nurse per 5000 population, a dynamic and intensified community water supply programme, will be undertaken. 1 sanitarian per 15 000 population, 1 sanitary engineer per 250 000 population. The Health Assembly further recommended that countries The difficulties in achieving such a goal in the developing devote increased resources to the control of disease and the countries will vary, for example, according to the proportion of improvement of health. U Thant, in his speech the day before physicians graduating in different areas of the world.Thus, yesterday, stated that, in the less developed areas, expenditure according to estimates based on 1955 -1956 figures, while in for public health services must double over the period, and we Europe an average 6 or 7 physicians graduate every year in WHO hope earnestly for the achievement of this modest goal. per 100 000 population, in the Americas and Oceania the During the past decade many new nations have obtained proportion varies between 3.5 and 5 per 100 000 population, their political freedom.They seek now their technical inde- and those in Asia and in Africa are 0.8 and 0.5 per 100 000 pendence so that they will, themselves, be equipped to work respectively. We speak today of a Development Decade, but the man on effectively for the emancipation of their peoples from the whom health work basically depends -the physician- requires scourges of ill- health, poverty and ignorance. To these ends after full secondary education six to seven years in which to be the Development Decade can, as the words which created it trained; in some countries without their own doctors, or with a are translated into action, make a crucial contribution. few, the Decade will be two- thirds completed before even a very Experience during the fourteen years of the existence of the small part of the basic national staff can be graduated from World Health Organization, in providing assistance to govern- medical schools. This underlines the urgency to provide every ments, at their request, to strengthen their health services, will possible assistance to the developing countries not only in be invaluable in carrying our share of the responsibility of the training individuals as rapidly as possible, but also in the early Development Decade. The Health Assembly has agreed upon establishment of training institutions. The Health Assembly also recommended that governments a programme of action which would enable the Organization establish as baselines certain indices of their current health to become an active partner in this enterprise. We have the situation, so that they can gauge progress towards their own structure, the machinery, the techniques. We need the additional targets for the Decade.' Those targets, of course, would be resources -human as well as financial -to carry out fully the defined in the national health plans. objectives of the Decade for the improvement of the well -being In many of the under- developed countries of the world today, of people everywhere.
Appendix 2
ECONOMIC AND SOCIAL COUNCIL RESOLUTION 916 (XXXIV)
United Nations Development Decade Nations Development Decade ", in which Member States and The Economic and Social Council, their peoples will intensify their efforts to mobilize and to sustain support for the measures required on the part of both RecallingGeneralAssemblyresolution1710(XVI)of 19 December 1961 designating the current decade as the " United developed and developing countries inorder to accelerate progress towards self -sustaining growth of the economies of 1 Resolution WHA15.57. the individual nations and their social advancement so as to 172 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I attain in each under -developed country a substantial increase (c)Appropriate measures, such as international commodity in the rate of growth, with each country setting its own target, arrangements, to stabilize at remunerative levels the prices of taking as the objective a minimum annual rate of growth of primary commodities on international markets, and also sound aggregate national income of 5 per cent. at the end of the Decade, compensatory arrangements designedtomitigateexcessive fluctuations in the export receipts of primary producing countries Consideringthat the economic and social development of the and to compensate for the harmful effects thereof; economically less developed countries is not only of primary importance to those countries, but is also basic to the attainment (d)The pursuance by regional and sub -regional economic of international peace and security and to a faster and mutually groupings of economic policies which avoid the introduction beneficial increase in world prosperity, and facilitate the elimination of obstacles and restrictions which might hamper the necessary expansion of the trade of the Recognizingthat, in spite of a variety of efforts, policies, and developing and under -developed countries or might discourage measures designed to assist the developing countries in their the indispensable growth of their economies; efforts to achieve economic growth through which much has been accomplished, the rate of economic and social progress (e) A substantially increasing in -flow of long -term develop- in these countries isstill far from adequate, ment capital, public and private, for financing their economic development programmes on terms which take into account Notingthe essentiality of strengthening the economic inde- the special requirements and conditions of the developing pendence of the less developed countries, countries so as to benefit them; and for this purpose the continuing Bearing in mindthat new problems affecting particularly the need for measures in both developing and developed countries developing countries and hampering and delaying their economic designed to facilitate and encourage its flow to the less developed and social development, have arisen in international economic countries; relations in the course of the past years, (f)The development of human resources through adequate Having before itthe report prepared by the Secretary- General 1 programmes for education and vocational training, nutrition, presenting proposals for intensified national and international health, sound public administration, housing, urban and rural action programmes during the present decade, development, including community development and effective land reform, with particular emphasis on their contribution Noting: to overall development objectives and with the co- operation (a)TheviewssubmittedbyGovernmentsconcerning where appropriate of trade unions and other non- governmental proposals for action in the Development Decade 2 and concerning organizations in consultative status; the role of the regional economic commissions in the Decade,3 (g)Exploration and exploitation of natural resources with a (b)The proposals for action made by the related agencies,4 view to establishing a raw -material and energy basis for economic and development ; (c)The views expressed during the Council's discussion of this subject, 4.Recognizesthespecialsignificanceofinternational economic relations and looks forward to the report of the 1. Expresses appreciationto the Secretary -General for his working group set up under Council resolution 875 (XXXIII) work in producing the report and to the agencies and other of 13 April 1962, on the question of a declaration on interna- institutions which helped in its preparation; tional economic co- operation; 2.Endorsesthe emphasis placed in the report on the develop- ment process as a many faceted one, based principally on 5. Emphasizesthatpre- investmentactivitiesshouldbe industrial development and a highly productive agriculture designed to facilitate national efforts towards development; and requiring for success determined self -help and careful planning on the part of developing countries; 6. Urgesthe prompt attainment of the present goal of $150 million for the Expanded Programme of Technical Assist- 3. Calls uponthe Governments of Member States, as well ance and the Special Fund in the interest of accelerating the as United Nations bodies and specialized agencies, to give development of human resources, natural resources and national particular consideration, in the first years of the implementation and regional institutions, and requests the General Assembly of the Development Decade, in addition to their endeavours to consider, at an appropriate time, the establishment of new in other fields, to the following : targets, bearing in mind the observations of the Secretary - (a)Industrial development as a most important factor in General in his report; economic diversification and general economic development; 7. Urges further (b)Improved access to the world markets in order to pro- that participating Governments give full mote export trade of the developing countries, taking into support to the Freedom from Hunger Campaign of the Food account their foreign exchange needs for development and the and Agriculture Organization of the United Nations and invites effects of deterioration in their terms of trade, including steps the Governments of States Members of the United Nations and for early reduction or elimination of barriers to exports; members of the specialized agencies to take early steps to prepare for the Pledging Conference for the experimental 1 United Nations (1962)The United NationsDevelopment_ World Food Programme and, in determining their pledges, Decade: proposals for action,New York (United Nations to bear in mind the necessity of attaining the goal of $100 million document E/3613). in commodities, services and money; 2 United Nations document E/3613 Add. 2 and 3. 3 Official Records of the Economic and Social Council, Thirty - 8. Emphasizesthe need for increased domestic savings and fourth Session, Annexes,agenda item 4, document E/3664. investment in the developing countries, through appropriate 4 United Nations document E/3613 Add. 1. policies in the public and private sectors of the economy; ANNEX 13 173
9.Stresses the increasingly important role envisaged in the 12.Looks forward to the results of the United Nations Secretary -General's report for the United Nations, and expresses Conference on the Application of Science and Technology for the hope that resources commensurate with the task will be the Benefit of the Less Developed Areas and requests the Secretary -General to make appropriate recommendations for made available; action resulting from the findings of the Conference; 10. Requests the Secretary- General to submit to the thirty - 13.Requests the Secretary -General to prepare, in co- opera- sixth session of the Council a report on the measures taken to tion with the regional economic commissions and other bodies secure the full participation of the regional economic com- and agencies of the United Nations family, and with such missions in the work called for in the United Nations Develop- experts from outside as he may deem necessary, a programme ment Decade; consisting of detailed phased proposals for action with respect to the basic factors of economic growth in the light of the 11. Requests the Secretary -Generalinco- operation with objectives outlined above and a progress report setting forth the specialized agencies and the regional economic commissions, achievements in the period ending 31 March, 1963; the where appropriate, to provide on request assistance in 14.Further requests the Secretary- General to acquaint all field of planning to developing countries; looks forward to the United Nations bodies and the specialized agencies with the establishment and effective functioning of regional development present resolution and to transmit the aforementioned studies institutes and the economic projections and programming and reports to the thirty -sixth session of the Council for con- centre, as provided in resolution 1708 II (XVI); and requests sideration, wtienitwill review the detailed programmes of the Secretary -General to report to the Council at its thirty -sixth action in order to adjust them to the changing situation. session on progress made toward the goals envisaged therein; 1236th plenary meeting, 3 August 1962.
Appendix 3
WHO CONTRIBUTION TO THE UNITED NATIONS PAPER ON " A PROGRAMME CONSISTING OF DETAILED PHASED PROPOSALS FOR ACTION WITH RESPECT TO THE BASIC FACTORS OF ECONOMIC GROWTH "
for Presentation to the Economic and Social Council at its Thirty -sixth Session, in July 1963
Introduction Economic values are only in part applicable to the saving of human life, but it is not only for economic reasons that the The aims and the nature of the United Nations Development alleviation of suffering is important. It is indeed now universally Decade initiated by the General Assembly inits resolution recognized that the human factor isessential to economic 1710 (XVI) led the World Health Assembly at its last session development and that human beings are not only the most to adopt a resolution (WHA15.57) in which it stressed " the important and essential means for achieving that development, profound effect health standards of families, communities and but that they are also to be its beneficiaries.Better individual nations have on their social advancement and economic progress, health, eradication of epidemic and endemic diseases, a sound particularly in the developing areas of the world ", and recom- environment, better health consciousness and education, all mended that " in so far as the health aspects of accelerated contribute to heightening the vitality of the people. This, in economic and social development are concerned, governments turn, means better productivity, fewer casualties to care for participate in these programmes, with the assistance of the and new energies to learn the new skills and adjust to the new World Health Organization, if they so wish, by undertaking a patterns of living implicit in economic and social progress. ten -year public health programme with the objective of raising Thus, improvement of the people's health contributes to the the standards of the health of the peoples ". Thus, the Assembly progress in practically every sector of the development pro- not only approved WHO's participation in the Decade but gramme, just as advances in these other sectors can bring also recognized that this gives the Organization an opportunity important benefits to health. and a responsibility to expand health programmes and to During itsdiscussion on the Decade, the World Health review their focus as part of the common effort to speed up the Assembly recognized the need for maintaining a balance in the pace of development during the forthcoming years. activities of the Organization, but it indicated certain areas of In the development effort of newly- independent countries action which might be developed by governments in connexion health is important, not only per se, but as an essential factor with the Development Decade. for economic development.For many such countries, inde- Examples are given below of aspects of the programme which pendence may mean a suspension of even basic minimum health could be undertaken during the Decade by WHO, in conjunction services. Poor health and illness are among the most important with other sources of international assistance such as the Ex- contributing factors to the instability of the individual and of panded Programme of Technical Assistance, UNICEF and the family; they affect the entire community and lead to its the Special Fund, on the basis of the activities already planned economic inefficiency. The health problems of newly- indepen- for 1963 -1964. The long -term figures are only indicative of the dent and emerging countries must, therefore, be faced; a order of magnitude of an international effort if some of the concentration of efforts is required to overcome the basic health goals of the Decade, as indicated, are to be achieved.The deficiencies which still exist in many areas. figures do not include the cost to governments, but an attempt 174 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I has been made to keep the proposals within the probable limits during the Decade, the total cost involved would be approxi- of national absorptive capacity and within the boundaries mately $2.7 million. of feasibility. Education and Training Planning Education and training has long been recognized as one of the basic means for promoting the development of national In its resolution on the Decade the World Health Assembly health services. The guiding principles and methods of WHO made specific recommendations to governments for the establish- in this field have repeatedly been outlined in documents submitted ment of a ten -year health programme to be based on detailed to the United Nations governing bodies. In developing countries planning.The establishment of a national health plan for the greatest need is for professional and auxiliary health staff each country was recognized as being of primary importance. to man the existing services, and further efforts are being made WHO is developing a programme of assistance in national to focus assistance on building up national or inter -country health planning to countries.Such assistance would aim at institutions for the training of such staff. giving national health administrations technical support on a WHO's budget shows that some $2 900 000 would be devoted long -term basis for the various steps which are needed in in 1963 and 1964 to training activities under the regular budget establishing an overall health plan for a country as an essential alone.In all, slightly more than $6 million is expected to be part of general national social and economic planning.Such provided for fellowships from all sources of financing (including a programme would involve preliminary fact -finding in order the Pan American Health Organization) for the same period. to establish guidelines on which the further dévelopment of The immense need for health workers of professional and services and activities would be based. Detailed and co- ordinated auxiliary categories makes it essential for developing countries plans would then follow to determine priorities for health action, to establish new schools for health workers, and to extend reorganize existing services, plan future trends and establish existing ones.Some figures are given below of the possible machinery within the health services for application of the development of international assistance inthisfieldduring plan, training of personnel, both for general purposes and for the Decade. The total needs for training programmes are far the implementation of the plan, and for co- ordination with greater than the figures suggested and in medical education other government services. Such a plan would involve investiga- alone itis estimated that thirty to forty new medical schools tion of health needs in terms of personnel, building and supplies, are needed for African and Asian countries, but the proposals and recurrent costs for salaries, maintenance, etc., with a view made here are considered as more realistic. The figures given to determining the most efficient ways of implementing the plan. are in addition to the activities already undertaken by the Moreover, it would help international and other outside agencies Organization in the various fields of education and training as to concentrate their assistance on nationally -established and indicated above. agreed priorities. (i)Establishment of new medical schoolsisan urgent Planning is not considered as a static process, a one -phase necessity in Africa and in some Asian countries.Some of operation. As recommended by the World Health Assembly, these schools should be organized as inter -country institutions certain indices of health would be established as base -lines for the training of students with common cultural and socio- whence to gauge the degrees of realization of the goals pre- economic backgrounds, and those using a common language determined as targets for the Decade.Progress would be as a medium of instruction.If four medical schools in Africa evaluated by continuing operational research, which would and four in Asia are to be started in the next two years, a also give guidance for the periodic revision and adaptation of total amount of $120 million will be needed for this purpose the plan to changes occurring in time and in scope for action. during the Decade, of which about 20 per cent. would be The methods for implementing such national health plans needed in 1963 -1964. will clearly have to be adapted to the needs and conditions of (ii)The establishmentof post -basicandpost -graduate each country. It is envisaged that the formulation of a national training institutions to prepare teaching personnel for basic health plan will require about one year, to be devoted to detailed nursing and midwifery schools. Two schools in Africa and survey to determine the needs, the type of health services that best suit local conditions and their pattern of development, as two in Asia could be set up within the Decade for an estimated well as to the preparation of the plan itself. cost of $20 million, of which about one third would be needed For the period 1963 -1964, if funds become available for this in 1963 -1964. purpose, it is WHO's hope to be in a position to make available (iii) Training of auxiliary health workers who are an essential to ten countries interested in receiving assistance in this field, component of the health services of developing countries. mainly in Africa, planning services of the type suggested. WHO Taking into consideration the urgent needs for about 250 000 would provide a senior public health adviser and necessary health workers in this category to work in communicable staff specialized in planning for each of the requesting countries. diseasecontrol and eradication programmes during the Such planning activities would be combined with a certain Decade, and on the other hand the relatively short period of amount of local training for national personnel and financial formal training needed and the possibility of using already provision would be made for supplementing salaries and giving existing training institutions, an amount of about $10 million stipends for organizing courses in the countries. A certain is needed, of which about 60 per cent. could be used in 1963- amount of equipment and supplies would also be provided. 1964. Such assistance would be in addition to the advisory services already provided at the ministerial level in a number of develop- Communicable Disease Control and Eradication ing countries.Itis estimated that national health planning The prevalence of epidemic diseases is stillhigh in a number fora medium -sized country would require international assistance of countries, notwithstanding the possibilities that now exist costing around $50 000 and an additional $40 000 for training, for eradicating certain of them or for controlling them so that bringing the total cost of assistance to national health planning they no longer form an important public health problem. It has to about $90 000 per year. The initial cost for WHO for 1963- been amply demonstrated that community -wide efforts can 1964 would therefore be about $900 000, and itis expected leadtothepracticaleradicationofmalaria,smallpox, that, if the scheme is to be extended to some thirty countries poliomyelitis and to the control of a number of viral, bacterial ANNEX 13 175
and parasitic diseases such as trachoma, tuberculosis, leprosy, disease and be in a final maintenance period, provided that the the venereal infectidns, a number of diseases common to man present level of assistance from the agencies of the United and animal, bilharziasis, cholera and plague.The problem Nations, from bilateral agencies and from other sources is has now become more one of administrative and financial maintained. These countries cover the whole of the continents possibilities than of scientific knowledge or medical technology. of Europe and the Americas and the greater part of the continent The experience of the Organization has demonstrated that the of Asia -except the Arabian Peninsula and the region east of circle of disease, low productivity and poverty can indeed be 900 longitude E. successfully broken by a concentrated attack on its biological But in virtually the whole continent of Africa and in several components, through organized and sustained mass campaigns, countries in the Arabian Peninsula, East Asia and Oceania, and that the elimination of such scourges in areas where pre- pre- eradication programmes will have to be adopted as a valence isstill high has direct, positive repercussions in the preparatory measure.Itis anticipated that sixty such pro- fields of economic development, and particularly of agricultural grammes will be required (forty -two in Africa and eighteen in and industrial productivity. Asia and Oceania) phased over the next three years -ten com- As targets for the Decade, the World Health Assembly has mencing in 1962, twenty -six in 1963 and twenty -four in 1964. proposed that certain of the most prevalent communicable These pre -eradication programmes and their development in diseases be attacked in a more concentrated fashion with a due time into full eradication programmes may be costed as view to achieving their eradication or control. Some examples, requiring on an average $100 000 each per year as support considered as being fully within the realm of feasibility, are from WHO. Thus in all, up to 1970 it is estimated that approxi. given below. mately $50 million will be required for advisory services and such supplies and contributions to local costs as are normally Malaria provided by the Organization, of which about one -third for the Of the communicable diseases, malaria has the gravest effect period 1963 -1964. on the majority of countries in the tropical and sub -tropical For the total eradication programmes in the above -mentioned areas of the world. Approximately half the population of the areas, most governments have been required to seek the assist- world lived in malarious areas in the first half of this century ance of other United Nations agencies, bilateral and other and the annual global number of deaths from malaria was sources for the provision of types of assistance that the World considered to be over three million. The number who suffered Health Organization is not able to provide.The figure for from malaria each year was thought to be in the region of such a programme based on a population of 250 million over 250 million.The global economic loss from this disease, not the eight years to 1970 at $0.50 per head per year would approach only from human sickness and death but from aspects of land $1000 million. utilization, food production and industrial development, has never been assessed accurately, but already in 1935 in India it Yaws was estimated at $400 million a year,' an estimate which was This endemic infection by Treponema pertenue is prevalent later revised to over $500 million a year. in rural areas throughout the tropical belt.Itis transmitted From its inception the World Health Organization has given by direct contact with infectious skin lesions among children the highest priority to the control of malaria, and since 1955 and sometimes adults. Yaws is a relapsing disease, destructive the eradication of the disease from the world has been one of in its later stages :10 per cent. of untreated infected children the primary aims of the Organization. By the end of 1962, on and adolescents end up as adult invalids with hands and feet the basis of information received from countries reporting to affected to such an extent that their working capacityis WHO, the disease had been eradicated in areas with a population seriously or totally impaired. of 322 million and malaria eradication programmes covered Effective drugs and public health control methods are available a further 748 million people, but 377 million still lived in areas against yaws. WHO- assisted mass campaigns in high -prevalence where eradication was not yet being undertaken. endemic areas in countries in the Western Pacific, South -East This approach has been outstandingly successful in the Asia, and African Regions and the Region of the Americas continent of Europe and in many countries in the Americas have shown that the transmission of the disease can be interrup- and in Asia where the organization of the general health services ted, that the reservoir of infection can be effectively reduced, of the countries has been sufficient to provide, or has been and that bringing disease under control will prevent incapacita- capable of being rapidly built up to provide, an adequate tion and invalidism.In a WHO /UNICEF- assisted programme medical coverage of the population. against yawsinHaiti,approximately100 000 incapacited However, in countries where such general health services persons were returned to work, with a consequent increase in are as yet imperfect, eradication programmes have met with the national production potential estimated at $5 million a year.2 operational difficulties; the Organization has therefore adopted The second International Conference on Yaws Control in 1955 a programme designated as a " pre- eradication programme " estimated that, among the 400 million people living in the rural for these areas.In such a programme the initial emphasis is areas of the tropical belt, approximately one half are, during placed on building up the infrastructure of health services to their lifetime, exposed to the risk of infection with endemic a level where the country can provide simple but adequate treponematoses, particularly yaws.Between 1950 and 1960, health coverage and, at the same time, developing the malaria approximately 125 million people had been examined and, service of the country through intensive training of national when necessary, treated in WHO- assisted programmes in all staff. Both aspects of the programme are aimed at preparations regions.Itis now estimated that some 75 million people for a full malaria eradication programme in due time. remain in endemic areas not yet covered by surveys. By 1970, and in the majority of cases far earlier, the countries The WHO budget for 1963 -1964 shows that the cost of now undertaking malaria eradication programmes (subject to technical aid in this field, planned to be financed from funds factors at present unpredictable) should have eradicated the administered by WHO, amounts to about $400 000 per year,
Sinton, J. A. (1935) What malaria costs India, nationally, 2 United States Department of State (1950) Point 4: co- socially and economically. In : Records of the malaria survey of operative program for aid in the development of economically India, New Delhi, vol. 5. under -developed areas, Washington, D.C. 176 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I and that the estimated expenditure from other extra -budgetary to be abandoned when the " river blindness " caused by this funds(including UNICEF) isapproximatelythe same -a parasite affected about 30 per cent. of the population, thus total of $800 000 per annum. A renewed impetus is required depriving countries of crops from some of the most fertile over the remaining years of the Decade to complete the objective lands in Africa, and also affecting fishing and the full use of of eliminating yaws in tropical countries as a serious public health the water resources. problem, a goal which could be achieved at an estimated total. Methods for controlling this disease are well known but cost of $2 million per year for six years, beginning in 1965. topographical and epidemiological data are still lacking for many endemic areas. WHO plans to spend some $150 000 in 1963 -1964 on epidemiological studies and on research. Bilharziasis At the completion of this preliminary phase to investigate the distribution of the disease, the practical application of control The transmission of bilharziasis is related to man's association measures under different conditions and the efficacy of new with water and to the snail which is the intermediate host. drugs in infected populations, it should be possible to expand Infection with the Schistosoma often leads to serious forms of health action considerably towards a pre- eradication stage of anaemia with consequent impairment of the physical and the disease.It is estimated that such a goal could be achieved mental productive capacity of people so affected. for some eight countries in the Volta River area in Africa In sixteen countries recently surveyed by WHO in Africa and within the Decade at a cost of about $1.5 million, and similar the Middle East it was found that essentially all infections action developed in the infected areas in Central and South are acquired in natural habitats of the snail and in water con- America with an additional $1.5 million. servation ponds, while in four of them infection took place primarily in irrigation systems. These countries have undertaken or have plans for water and soil resource development which call for supplying an additional 19.71 million acres of land Trypanosomiasis with perennial irrigation and the construction of thousands of ponds within the next ten years.Similar developments are This infection, better known as sleeping sickness, is highly also expected to take place in the endemic areas of South endemic in certain parts of Africa. The vector, the so- called America, South -East Asia and the Western Pacific. Realization tsetse fly, favours savannah -type areas, affecting particularly of these plans will cause the spread and enhance the intensity of regions of agricultural economy, with little mineral wealth, bilharziasis infection in agriculture development areas unless no access to the sea and no bright prospects for industrialization. proper control measures are instituted, and it is already apparent Trypanosomiasis creates a permanent danger for settlement that, notwithstanding some palliative measures undertaken of the areas where the tsetse fly is present because it infects not locally, the number of persons infected and the extent of the only man but also his cattle, thus making the development of infected areas are seriously increasing. mixed -typefarmingandoftenofagriculturealtogether Methods for controlling this disease are known. They include impossible.Other forms of trypanosomiasis withserious water management and agricultural practices, the use of mollusci- damaging influence on individual health and on the productivity cides, and the treatment of infected persons.In countries in potential of nations also exist in the Americas. Asia it has been possible, by improved water management and Various control measures have been undertaken in different agricultural methods, greatly to increase crop production and African areas, some with good and lasting success. More needs reduce the amount of molluscicide required. to be known, however, of the parasite, the vector, the distribu- Control activities can be developed according to an action tion of the infection and measures of control. WHO has schedule which includes a survey of about one year's duration, budgeted for 1963 -1964 some $50 000 each year for research a pilot control phase requiring about three years and thereafter and investigations;after such preliminary action has been a country or region -wide application of a prolonged duration. completed, it should be possible to proceed to a broad control Such action requires close co- operation between the health action in the infected areas.It is estimated that good progress authorities and those responsible for agricultural development could be achieved in this direction during the Decade at a cost schemes and water management from an early planning stage which is tentatively considered of an order of about $2 million and throughout its execution. for the period. In areas where general farming and cattle raising are dominant, with proper soil, water and crop management, snail control can be carried out for about $20 to $50 per 1000 acres. In areas Smallpox where molluscicides alone are used, annual costs range up to $3 per irrigated acre. The world incidence of smallpox is known :in 1961 there WHO activities in this field for 1963 -1964 are of the order of were 24 140 cases in Africa, 1923 in the Americas, 52 342 in about $400 000 each year for advisory services to governments, Asia, 25 in Europe, none in Oceania. Countries where smallpox surveys and research. In Africa alone an additional $5 million isprevalent are planning or applying eradication schemes would be needed during the Decade and $5 million more for through vaccination. A good, reliable vaccine exists and the other endemic areas in the world if the progressing trend of this problem is essentially one of manpower, equipment and supplies. serious parasitic infection is to be arrested and measures for In the developing countries the main difficulties in developing effective control instituted. a massiveattack on the disease are the lack of vaccine, of means for refrigerated distribution, and of sufficient transport. In 1959 cost estimates based on the world incidence of smallpox Onchocerciasis during the three preceding years showed that the average cost throughout the world for mass vaccination would be in the Onchocerciasis is transmitted to man by certain flies which order of $0.10 per person vaccinated. For about 1000 million develop in many riverine areas of Africa and parts of the inhabitants living in areas where smallpox isstill endemic, Americas.In West Africa large areas bordering streams had approximately $100 million from all sources, including the ANNEX 13 177 governments concerned, would be required to achieve total Strengthening of Basic Health Services coverage, divided as follows: Africa, $13 million; Americas, It cannot be too strongly emphasized that an essential pre- $11 million; Eastern Mediterranean, $17 million; South -East requisite for the implementation of any of the programmes Asia, $55 million; and Western Pacific, $4 million. already described is the existence at the country or regional WHO has budgeted for some $350 000 in 1963 and 1964 to level of an adequate infrastructure both of health installations assist countries with advisory services, and by supplying vaccine and health personnel.With such a provision of staff and and laboratory equipment.Plans for world -wide eradication facilities it should be possible in the majority of areas -subject already exist and an all -out attack could be undertaken in the to difficulties of terrain, transportation and distance -to give next four years of the Decade if an estimated $10 million could a minimum coverage of preventive and curative health services, be made available to assist countries with such items as vehicles and vaccine. and wherever feasible to integrate them so that the whole population, even in the rural areas, can benefit. Community Water Supply A notable contribution to the potential achievements of the Community water supplies have a vital role in the economic Development Decade can be made by the extension of the development, and especially the industrial development of service for maternal and child health. Itis remarkable how, with better activities in health education and child care, advantage urban areas in developing countries. The emergence of a nation can be taken of the recent developments in the control of the from a less developed to a more advanced status is a step -by -step communicable diseases of the early years of life.The saving process. There are certain stages of economic growth, some of of life in these age -groups adds to the potential of educable them well defined in economic terms, that must be attained children, who with appropriate training can become the techni- consecutively; at some of these stages the lack of safe and cians of the future, in whom the real wealth of a country lies. adequate supplies of piped water may retard or even be an It is important too that maternal and child health services actual bar to progress. Water supply is basic not only to health should be integrated with the basic health services, thus attaining but to a wide variety of economic activities, and investment the maximum of efficiency and availability. in producing sufficient supplies of water in urban areas may- Malnutrition also represents an immediate challenge to action be a major factor in determining the rate at which industrial during the Decade and the medical aspects of the problem and commercial growth will proceed. cannot be ignored.In close co- operation with the Food and Today, about 320 million people live in urban communities Agriculture Organization, other organizations, and particularly in developing countries receiving assistance from WHO. It is with the activities of the United Nations /FAO World Food estimated that this number will increase to about 415 million Programme, the World Health Organization will intensify its at the close of the Development Decade. Of this urban popula- activities in this domain.Plans have already been made for tion a recent study indicates that at least 70 per cent. have no 1963 -1964 toassist countries toascertain, through sample access to piped water within reasonable distance of their homes. surveys, the current nutrition problems and deficiencies of The need therefore exists to provide this essential service to a their populations, setting down standards for the development substantial proportion of the urban population- estimated at of nutrition conditions in subsequent years. The strengthening of national health services has been and more then 200 million people -who have at present no piped will continue to be the goal of WHO's activities in the developing water service, or an inadequate one. By the end of the Decade, countries for a number of years to come in accordance with the population increment will have raised this number to 300 the guidance provided by its governing bodies in various resolu- million. tions and in the General Programme of Work covering a Specific WHO's programme of technicalassistancetoMember Period. governments in promoting the creation or improvement of Most of the activities planned to be financed from funds community water suppliesis designed to provide assistance administered by WHO in 1963 (at an estimated total cost of at the rate of $1 million a year, if funds become available. almost $50 million), and of those proposed for 1964 (at an This would require capital expenditure by the countries at the estimated total cost of over $52 million) are aimed at the attain- rate of approximately $4 million a year. ment of this goal. It is anticipated, furthermore, that the United Nations Special Any accelerated health programme which might become Fund will continue to support community water supply activities possible during the remaining years of the Decade would have by projects of a pre- investment nature under which preliminary considerable influence on the future programme activities of engineering plans, feasibility reports and master plans for the Organization and on its financial requirements.It will be water supplies for urban centres or urban complexes may be possible to evaluate such repercussions after a more precise prepared. programme for economic and social development as a whole An attainable goal within the Development Decade would has been established, when the reactions of the governments be approximately to double the proportion of urban population concerned have become known, and when the availability of who have easy access to safe and adequate amounts of piped additional financial means has been investigated and, if possible, established. water.It is estimated that a programme of construction would cost approximately $400 million per year in order to attain this goal in 1970. This annual capital investment in community Summary water supplies would amount, on the average, to about 0.25 per cent. of the gross national product of the investing nations. Certain health goals which could be fulfilled during the Of these annual expenditures asubstantialpart -perhaps Decade have been indicated. While it is impossible to propose one fourth of the total, or $100 million per year- should become at this time a complete phased programme for health develop- available from foreign aid sources. ment in the under -privileged areas of the world, broad areas 178 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
for action have been described where energetic intervention concerned, but WHO's structure,itscloserelationshipto should lead to progressive avenues and rapid improvement in national health agencies, and its existing programmes in the the living conditions of the people, and to a higher degree of field put it in a condition to meet any additional requirements productivity and of individual achievement. which may emerge in connexion with the general programme The focus of immediate and local action will be in the countries of international assistance for the Development Decade.
Appendix 4
ECONOMIC AND SOCIAL COUNCIL RESOLUTION 920 (XXXIV)
Special Committee on Co- ordination with Particular Emphasis (a)(i)To keep under review the activities of the United on the United Nations Development Decade Nations and its related agencies in the economic, social, The Economic and Social Council, human rights and relatedfieldsinthe United Nations Development Decade; RecallingGeneralAssemblyresolution1710(XVI)of (ii)To consider, wherever appropriate, in consultation with 19 December 1961, the agencies concerned, priority areas or projects relating to Having considered the report of the Secretary -General The the objectives of the United Nations Development Decade United Nations Development Decade - Proposals for Action,' in accordance with its resolution 916 (XXXIV) of 3 August Recognizing that the United Nations Development Decade 1962; requires, for the fulfilment of its goals, concerted action within (iii)To submit recommendations on these matters to the the United Nations family of organizations in the economic, Council; social and human rights and relatedfields,inthe United (b)To assume the functions of the ad hoc Working Group Nations Development Decade, on Co- ordination as follows : Believing that co- ordination of the activities of the United (i)To study the reports of the Administrative Committee Nations and its related agencies would be facilitated if efforts on Co- ordination, appropriate reports of the United Nations were further concentrated upon selectedareas of strategic organs, the annual reports of the specialized agencies and the importance where the opportunities and needs for United International Atomic Energy Agency and other relevant Nations efforts are most apparent, documents; Believing further that the work of its ad hoc Working Group (ii)To submit its conclusions to the Council, for considera- on Co- ordination established by its resolution 798 (XXX) of tion, in the form of a concise statement of the issues and 3 August 1960 has greatly facilitatedthe discussion of co- problems in the field of co- ordination arising from these ordination matters by the Council, documents which call for special attention by the Council; 1. Decides to establish a special committee consisting of 3. Requests the Committee, infulfillingitstask under representatives of eleven States members of the Council or the paragraph 2 (a) above, to take into account any special observa- Technical Assistance Committee -to be elected annually at tions which the Administrative Committee on Co- ordination its resumed summer session on the basis of equitable geogra- may deem it appropriate to submit; phical distribution -who should be conversant with the pro- 4.Further requests the Committee to take into account the grammes and activities of the United Nations in the economic, activities of the ad hoc Committee of Ten on co- ordination of social, human rights and related fields, and of the related agencies, technical assistance activities; as well as with the practice and procedures of co- ordination among these organizations; 5. Decides to convene the Special Committee in the first instance in February 1963. 2.Decides further that this special committee shall have the following functions : 1236th plenary meeting, 3 August 1962.
Appendix 5
EXCERPT FROM THE TWENTY- SEVENTH REPORT OF THE ADMINISTRATIVE COMMITTEE ON CO- ORDINATION [From United Nations doc. E/3695 - 10 Oct. 1962] 2
Ill. UNITED NATIONS DEVELOPMENT DECADE Decade, and has noted that this resolution requests the Com- mittee to take into account any special observations concerning this resolution which the ACC may deem it appropriate to submit. 10.The ACC has also considered resolution 920 (XXXIV) relating to the creation of a Special Committee on Co- ordination 11.The Development Decade represents a new phase in the with particular emphasis on the United Nations Development continuing process of ensuring proper co- ordination of the wide range of activities through which the members of the 1 United Nations (1962) The United Nations Development Decade: proposals for action, New York (United Nations United Nations family are attempting, by a combination of document E/3613,andUnitedNations document E/3613 Add. 1, 2 and 3). 2 Mimeographed version. ANNEX 13 179 concerted and mutually complementary action, to achieve the manner in which co- operation within theUnited Nations general objectives set forth in the Charter; it embraces the family has previously been arranged on the basis of the relevant totality of all their activities and these can be adequately and provisions of the Charter and the relationship agreements. effectively co- ordinated only by the full use of all the resources The Charter provides for " participation " by the " repre- of the Charter and the relationship agreements. The general sentatives " of the specialized agencies in the " deliberations " view of members of the ACC has been, and continues to be, of the Council and its commissions, and the agreements provide that no new machinery for inter- agency co- ordination is required for such " participation " by " representatives " in " delibera- to implement the Development Decade. While holding these tions " as a matter of right; the inclusion of such a provision, views, the members of the ACC have nevertheless considered which is reciprocal in its operation, was one of the basic condi- the matter on the basis of the decision taken by the Council tions on which the agreements were concluded. The members at its thirty- fourth session. of the ACC assume that the co- operation of the agencies con- cerned with the Special Committee will take the form of the 12.The executive heads of the agencies, while willing to recom- participation in the deliberations of the Committee by their repre- mend to their respective governing bodies full and active co- sentatives provided for in the Charter and the agreements. operation with the Council through the Special Committee which the Council has established, feel it necessary to recall the 14.The ACC is keenly aware of the primary importance of basis of such co- operation, as stated fully by the Council itself wholehearted practical co- operation without undue emphasis as recently as 1958 when defining the basis on which the five - on matters of organization and procedure, in making a success year appraisals were undertaken, and as recapitulated in para- of the Development Decade.It ventures to hope that the graph 15 of the Appraisals Report.1It is the understanding emphasis of future discussions will be essentially upon the of the ACC that the principles so stated by the Council with problem of securing a scale and continuity of effort, a wise and reference to the appraisals continue to be applicable, and govern prudent use of the resources available, and an emphasis on the whole implementation of plans for the Development Decade. matching resources to needs, which will give real substance to Itis on this understanding that the executive heads of the the hopes so widely entertained.If the Development Decade agencies will recommend co- operation with the Special Com- is to result in an effective intensification of international action, mittee to their governing bodies. the provision, in both the common programmes and the budgets of the individual agencies, of resources adjusted to the targets 13. The executive heads of the agencies wish to draw special which emerge as the Decade develops will be indispensable. attention to the importance of such co- operation being arranged in a manner which carries out fully the spirit of the Charter 15. The peoples of the world will get out of the Development and of the relationship agreements. They have been greatly Decade what they and their Governments put into it and the concerned by certain recent cases in which committees appointed essential role in the matter of the members of the United Nations by the Council have, in effect, granted hearings to representatives family is to serve as an instrument of co- operation through of the specialized agencies and then proceeded to discuss, in which the determination of the peoples of the world to secure the absence of such representatives and with little or no further " better standards of life in larger freedom " can be sustained consultation with them, the conclusions to be drawn from such and made effective.In fulfilling this role all members of the hearings.Such an approach is a major departure from the United Nations family will endeavour to play their full part.
Appendix 6
EXCERPT FROM THE TWENTY- EIGHTH REPORT OF THE ADMINISTRATIVE COMMITTEE ON CO- ORDINATION
[From United Nations doc. E/3765 - 6 May 1963] 2
II.UNITED NATIONS DEVELOPMENT DECADE Development Decade. At this point, the ACC wishes to record that the " programme of phased proposals for action with respect to the basic factors of economic growth ", which is 3. In later sections, reference will be made to some of the being submitted to the Council under the title "United Nations major current international activities that are being undertaken Development Decade :Activities of the United Nations and -or expanded -within the framework of the United Nations free co- operation in the efforts designed to improve the lot 1 United Nations (1960) Five -year perspective, 1960 -1964, of men. Geneva (United Nations document E/3347/Rev.1). The relevant (c)The appraisals are not to be understood as implying part of paragraph 15 reads : that the programmes and budgets of the " United Nations or (a)The appraisals are regarded as a step in the dynamic the specialized agencies should, or could, be determined process of developing progressively the effectiveness of the outside the constitutional framework of each organization. United Nations and the specialized agencies as instruments They imply no attempt to interfere with the autonomy of for assisting the countries of the world to develop economically the organizations within the United Nations family. and socially at a greatly accelerated rate. (d)The appraisals do not require firm policy formulation (b)The appraisals are a further step in the development of looking ahead for the five -year period, or any rigid commit- co- ordination through which the respective programmes of ment in regard tospecific programmes.The appraisals the United Nations organizations have gained, over the should in no way interfere with the flexibility which the years, in purpose, depth and strength.Such co- ordination organizations must have in determining their programmes has been achieved not by way of centralization, not by direct- from year to year. ives or orders, but by consultation and persuasion and by 2 Mimeographed version. 180 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I related agencies in the immediate future " has been drawn up as understood as diminishing the importance of the programmes a co- operative effort by the staffs of all the organizations con- for current assistance in those fields. cerned. It also wishes to express its appreciation for the manner 5.The ACC has noted the suggestion of the Special Com- in which the Council's Special Committee on Co- ordination mittee that a general framework of functional classifications reviewed a draft of the above report at its recent meetings, has be devised to include the activities of all members of the United sought the fullest participation of all agencies in its work and Nations system under the Development Decade. Arrangements particularly for providing the ACC the opportunity of com- have been made for the preparation of a draft framework of menting on its own preliminary findings ... in the matter of this kind, and the ACC hopes to be able to report on the matter priority areas relating to the objectives of the Development later. Decade. 6. It also noted that the Special Committee had mentioned in 4.As regards the priority areas referred to by the Special its preliminary findings a number of matters regarding which Committee, the ACC feels that, while the preparations for the the ACC has already taken action; further progress on some United Nations Conference on Trade and Development call of them is recorded in its present report :for example, sec- tion III (d) refers to co- ordination in the field and the role of for special attention this year by the agencies directly concerned, resident representatives; co- operation in regard to the regional this should not imply any lessening of efforts directed towards development planning institutes is mentioned in section IX, the development of human and natural resources, including and some specific contributions that can be made to national agricultural production, as well as industrial development. development planning are suggested in sections V on education Nor should the emphasis placed on development planning be and training and VI on rural development.
Annex 14
MEETINGS OF THE REGIONAL COMMITTEE FOR AFRICA
[A16 /AFL /6 -4 April 1963] REPORT BY THE DIRECTOR- GENERAL
This item was placed on the agenda of the Health Government of South Africa or to sit side by side Assembly by the Executive Board, in the light of with them in regional meetings; resolution AFR /RC12/R17 adopted by the Regional Considering that such a situation is liable in the Committee for Africa at its twelfth session, the text near future to paralyse the functioning of the of which reads as follows : Regional African Organization and toprevent the Regional Committee from fulfilling its constitu- Reasons why the Regional Committee has met at tional functions; the WHO Headquarters in Geneva, and Measures Recognizing thattheConstitutiondoes to be taken to avoid the Recurrence of similar not Circumstances provide for the cessation of the membership of a State; The Regional Committee for Africa, Being conscious however of the needs of the Considering that the Government of the Republic South African population and of the necessity for of South Africa, in spite of its long association the World Health Organization to be able to assist with the World Health Organization, accepts and this population, practises the policy ofapartheid,which policy 1. REQUESTS the Director -General to draw the subjectsindigenousAfricancitizenstoracial attention of the next World Health Assembly to discrimination to the detriment of their physical, this situation; and mental and social well- being, in contravention of 2.REQUESTS the World Health Assembly to study the principles, aims, and purposes of the Constitu- the appropriate measures to put an end to this tion of the World Health Organization; situation, but without prejudicing the health rights Considering the increasing trend on the part of of the South African population. the Member States of the Region to refuse to admit This resolution is therefore transmitted to the Health on their own territory the representatives of the Assembly for consideration. For the information of the Health Assembly, there is appended to this report the text of Part IV (a) of
1See resolution WHA16.43. thereportof theRegional Committee. ANNEX 14 181
Appendix
EXTRACT FROM THE REPORT OF THE REGIONAL COMMITTEE FOR AFRICA ON ITS TWELFTH SESSION, 24 SEPTEMBER - 2 OCTOBER 19621
IV (a)Reasons why the Regional Committee met at the WHO The vote on the resolution (AFR /RCI2 /R17) was taken in Headquarters in Geneva and Measures to be taken to avoid the a call -over giving the following results : Recurrence of Similar Circumstances For the resolution: Cameroon, Congo (Brazzaville), Congo The representative of Senegal summarized the reasons why (Leopoldville), Dahomey, Guinea, Ivory the twelfth session of the Regional Committee could not be Coast, Madagascar, Mali, Mauritania, held in Dakar as had been decided. The addition of this new Niger,Nigeria,Senegal, Tanganyika, item to the agenda had been agreed upon because it was by no Togo, United Kingdom, Upper Volta means impossible that a similar case might occur again. If so, Against the resolution: South Africa the logical answer would be to hold sessions in Brazzaville, the Regional Head Office, since the provisions of the agreement Abstentions: France, Liberia, Sierra Leone, Spain made between WHO and the Congo (Brazzaville) in its capacity Absent : Central African Republic, Chad, Gabon, as host government, conferred the necessary privileges and Ghana immunities on the Organization. Not taking part in After a considerable debate the Regional Committee decided voting: Portugal to designate a sub -committee to draft a resolution. This resolu- tion was the subject of further discussion forty -eight hours Number of Members present and voting 17 later. Simple majority 9 For the resolution 16 Against the resolution 1 1 Document AFR /RC12 /14 Rev.l. Abstentions 4 182 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Annex 15
ORGANIZATIONAL STUDY ON MEASURES FOR PROVIDING EFFECTIVE ASSISTANCE IN MEDICAL EDUCATION AND TRAINING TO MEET PRIORITY NEEDS OF THE NEWLY INDEPENDENT AND EMERGING COUNTRIES 1
[A16 /P &B /10 - 19 April 1963]
The Fifteenth World Health Assembly,2 on the recommendation of the Executive Board,3 decided that the subject for the next organizational study of the Executive Board should be " Measures for providing effective assistance in medical education and training to meet priority needs of the newly independent and emerging countries ". The Executive Board studied the subject at its thirtieth and thirty -first sessions, and the draft report was circulated for final remarks to members of the Board in accordance with the Board's decision.' The report of the Executive Board on its study is given below.
REPORT BY THE EXECUTIVE BOARD TO THE SIXTEENTH WORLD HEALTH ASSEMBLY
CONTENTS
Page Page
Foreword 182 Appendix 1: Education and Training of Health Personnel in Africa (Extracts from a working paper 1. Introduction 183 contributed by WHO to the UNESCO /ECA 2.Extent and Nature of Needs 183 ConferenceofAfricanStatesonthe 3. How to meet the Needs Development of Education in Africa, Addis 3.1Guiding Considerations 185 Ababa, May 1961) 3.2Nature of Assistance Needed 186 Table I - Medical and Paramedical Per- 3.3Some SpecialConsiderationsinestablishing sonnel in Africa in 1960 191 Teaching Institutions 187 Table III - Estimated Health Personnel for
Africa for the Decade 1960 -1970 . 4.Problems of Policy and Implementation 192 Technical Table IV - Estimate of Number of Gra- 4.1 190 duates in the Various Categories required 4.2Organizational 190 to fill the Posts in 1970 192 4.3Financial 190 Appendix 2: Some Information on Medical Schools in Concluding Note 191 the African Continent 193
FOREWORD suggestions made by members of the Board at the On the recommendation of the Executive Board at meeting and after it.5 its twenty -ninth session,3 the Fifteenth World Health In addition, a note, based mainly on the findings of Assembly decided that thesubjectfor the next the surveys carried out in seventeen countries of Africa, organizational study of the Executive Board should was prepared for the twelfth session of the Regional be " Measures for providing effective assistance in Committee for Africa, which met in Geneva from medical education and training to meet priority needs 24 September to 2 October 1962. An informal meeting of the newly independent and emerging countries ".2 was devoted to obtaining the views of the members of At its thirtieth session the Executive Board con- the Regional Committee on the planning for health sidered a preliminary outline for the organizational personnel training in Africa. study, and requested the Director -General to prepare The report requested by the Executive Board was for the thirty -first session of the Board a report on the discussed at its thirty -first session, and amendments subject,takingintoaccount the comments and and clarifying elaborations have been incorporated in the present text for presentation to the Sixteenth 1 See resolution WHA16.29. World Health Assembly by the representatives of the 2 Resolution WHA15.59. Executive Board, after circulation to the members 3 Resolution EB29.R53. of the Board for their final remarks.' 4 Resolution EB31.R36. In preparing this report the expression " medical 5 Resolution EB30.R18. education and training " has not been taken literally ANNEX 15 183 but has been used to cover medical education not and implementation -technical,organizationalor only at university standard but also at the auxiliary financial. level, together with the education and training of It is clearly understood that, in the meantime, the paramedical personnel, both professional and auxil- existing programme of assistance to newly independent iary.The problem of training health and medical countries will continue and will probably be expanded personnel has to be faced as a whole, since the various in certain directions, on the basis of surveys of needs, types and levels of such personnel are functionally especiallytowardstheestablishmentof training interdependent. facilities within the countries.In this regard, itis useful to refer to the chapter on education and training 1.Introduction of the report on continued assistance to newly inde- The attainment of independence by many countries pendent States 1submitted to the Fifteenth World and their plans for rapid social and economic develop- Health Assembly. ment encompass, naturally, the expansion of such 2.Extent and Nature of Needs health services as exist and the establishment of others. World communications have made the peoples of The newly independent and emerging countries, although they have many problems in common, are those countries aware of standards of services existing in other countries and their demands are therefore at very different stages of development. Some already have a substantial nucleus of trained personnel among increasing. their nationals and a number of training institutions, The expansion of services, however, depends on the including medical schools, though these are almost availability of the necessary trained personnel.In many instances trained personnel do not exist, or always inadequate to meet the country's needs.At their numbers are inadequate. Furthermore, the the other extreme there are countries where a beginning departure of expatriatestaff has, in many cases, has yet to be made in almost every field of medical and allied education and training. aggravated the situation. At the same time, the gaps in trained personnel cannot be filled peremptorily This study does not attempt to appraise the needs of each country.It is aimed at stating the common from outside sources. There is therefore urgency for these countries to elements among the needs of many emerging countries for the education and training of their medical and make provision for the training of their own personnel, either at home or abroad or both.They need to health personnel, and thus at providing a basis for discussions of policies and their implementation to become self-sufficient in personnel as soon as possible. meet these needs on a broad scale.By " needs " Totalself -sufficiencyisperhaps adistantgoal - especially as it depends upon a sufficient level of ismeant the gap between the trained personnel available and those reasonably required now and at general education, which attainment is in itself a long certain target dates in the future (e.g.,five years, process.But there are many steps that can be taken towards that goal, either by individual countries or ten years), as well as the facilities necessary for their training. by groups of countries with similar circumstances. In order to permit such an over -all review, there has Although the process of attaining self -sufficiency may be a gradual one, especially in the sense of been selected as an example the part of the world where the largest number of newly independent and countries developing the necessary institutions within emerging countriesis their own territory, it could certainly be accelerated. grouped -the continentof The emerging countries would have the advantage of Africa. Fact -findingsurveys, mostly by a team a pool of experience from " older " countries and consisting of a doctor and a nurse specialized in educa- tion, covered seventeen of these countries in 1961 and of a large fund of international goodwill and assistance. This external assistance must be visualized as of 1962 and have contributed to providing a general long duration, probably tapering in quantity as the view of the problem and of possible solutions. Publisheddata 9 personnel,hospital years go by. To be effective, the assistance may need on health to be considerably greater than that which is furnished 1 Off. Rec. Wld Hlth Org. 118, Annex 4, Part 4. today as normal practice by WHO and other assisting s World Health Organization(1962),Statistics of health personnel and hospital establishments.In :Annual epidemio- agencies.It may in fact require joint action, or logical and vital statistics, 1959, Geneva, p. 650; distribution of tasks among more than one agency, World Health Organization (1957) World directory of medical and perhaps forms of assistance not now current. schools, 2nd ed., Geneva; World Health Organization (1961) World directory of dental It is the purpose of this study to explore the needs schools, Geneva; and the ways of meeting them, and in this process, to World Health Organization (1963) World directory of veterinary schools, Geneva; draw attention to possible orders of priority in meeting Second Report on the World Health Situation, 1957 -60 (Off. these needs; and also to explore problems of policy Rec. Wld Hlth Org. 1963, 122). 184 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I establishmentsandcertaintraininginstitutions, completed full secondary -school education. However, although lacking in precision, or not reflecting the at a level lower than that required for professional latest changes, illustrate sufficiently the shortage of training there is a relatively large source of school- medical and health personnel in some of the newly leavers with primary or mid -secondary education. independent countries. Three publications by UNESCO provide data on the A summary of health personnel available, and their existing situation as to general education.Another ratio to the population, was prepared in simplified publication gives insight into the problem of higher form for the purposes of the UNESCO /ECA Con- education in general, with specific reference to Africa.2 ference of African States on the Development of Close contact should be maintained with UNESCO, Education in Africa, which was held in Addis Ababa since its assistance to countries may greatly contribute in May 1961.Tables I, III and IV, presented to the to the development of general education facilities - Conference, are given as Appendix 1 to this report. thus increasing the reservoir of suitable candidates Table IV especially emphasizes, if it were not already for medical and allied education and for auxiliary known, the nature and extent of the needs in trained training, as well as promoting all forms of higher personnel.These figures take on added significance education. when itis remembered that facilities for training A programme of health personnel training should these personnel are inadequate, and in some countries cater for immediate needs and for the future. In non -existent.Appendix 2, on medical schools in the addition to professional personnel in medical and continent of Africa, summarizes data made available paramedicalcategories, there are required trained by the authorities concerned for the third edition of auxiliary 4 personnel in large numbers and in appro- the World Directory of Medical Schools. priate numerical relation to the professionals who The magnitude of-the problem may be illustrated will teach, lead and later supervise them.Auxiliary by some figures relating to medical graduates.For personnel, for whom the educational requirement is this illustration the field of medicine proper has been lower (primary or elementary school for all but medical selected, sinceitis more uniformly and generally assistants, in whose case a higher level is desirable) understood than that of auxiliary medical personnel, are normally produced after one or two years' training, as regards both the training required and the functions mainly in specific skills and techniques, and thus are performed. It is of crucial importance, because of the available for service earlier than the fully qualified leadership role of medical personnel, and it can be professional groups in the same field. considered as an indication of the problem as a whole. It will therefore be necessary to rely on medical and In the area covered by the WHO African Region paramedical auxiliary personnel to provide the bulk (excepting the Republic of South Africa), the estimated of the medical and health services for many years to population is 150 million, the total number of fully come.These auxiliaries (medical assistants -for the qualified physicians little more than 7000.The pre- diagnosis and treatment of common diseases -assistant sent ratio of physicians to population is therefore less nurses,assistantmidwives,assistantsanitarians, than 1: 20 000, or one physician to over 21 thousand laboratory assistants, etc.) have a place of their own people. In order to bring the ratio even to 1 :10 000, in the health team, are especially trained for it, and it would be necessary over the next twenty years to produce each year a minimum of -1200 medical 1 The educational situationinAfrica today (UNESCO/ graduates (350 per annum to meet wastage, plus EDAF /S /4, April 1961, mimeographed document); 350 to bring gradually the ratio to 1 :10 000 of existing UNESCO (1961) Basic facts and figures, Paris; UNESCO (1961) World survey of education, III, Secondary population, plus 500 to cover the estimated natural education, Paris. increase in population).The maximum potential 2 UNESCO (1963) The development of higher education in output of the existing medical schools in the area by Africa (Conclusions and Recommendations of the Conference on the Development of Higher Education in Africa, Tananarive, 1970 may be estimated at 450 medical graduates a 3 -12 September 1962), Paris. year.An output of 750 more graduates a year is 3 For the purpose of this paper, the term " paramedical thereforerequired. Assuming an averageannual personnel " includesallthe professions allied to medicine which together make up the team of health personnel, i.e., output per school of between fifty -five and sixty nursing and midwifery, sanitation, dentistry, veterinary health, graduates, thirteen new medical schools are needed pharmacy, physiotherapy, statistics, microbiology, etc. in the area -and it should be borne in mind that on the 4 According to the definition accepted by all United Nations basis of this calculation these thirteen schools should agencies, an auxiliary worker is " a paid worker in a particular field, with less than full professional qualifications in that field be starting to function now, but this is not realistic. who assists and is supervised by a professional worker ". Thus, The problem is complicated by the fact that many these may be auxiliary personnel in medicine, nursing, sanitation, etc. Furthermore, there can be different levels within the broad countries have available for professional medical or category of auxiliaries,e.g.,in nursing there are auxiliary paramedical studies very few candidates who have nurses, nursing aides, etc. ANNEX15 185 should not be the product of a lower standard of constant demand and a large enough number of training in the various professions to which they persons available to be trained. Training under belong. The importanceof auxiliarypersonnel conditionsprevailinginthecountryitself,with becomes even more evident when it is recalled that attention to its particular health problems, is necessary much of the population of the developing countries for the basic formation of all auxiliary personnel and is rural, lives in small scattered communities with few has advantages even for professional basic education. means of communication, and has a low income level. In the broadest terms, the situation as to health 3.1.3Training at Home and Abroad: Professional personnel training in newly independent and emerging and Auxiliary countries, such as those in Africa, may be summarized External assistance, including international assist- as follows : ance, is utilized for two parallel courses of action : (1)In all the countries there is an overwhelming (a) to develop teaching institutions within the country need for the development of local training resources, for the four main types of personnel (see 3.1.4), both which depend, however, on progress in general at the professional and at the auxiliary level; and education and the expansion of health services. (b) to provide basic professional training abroad (in Both these factors, in turn, depend on the economic medicine,nursing,etc.),whilefacilitiesfor such conditions and potentialities of the several countries. training are not yet available within the country, and post -basic or post -graduate training of key personnel, (2)International assistance will be necessary in especially for leadership and teaching.Students sent practically all instances.The full magnitude of abroad are usually accommodated within existing assistance will have to be studied in detail within courses. Special arrangements may, however, be the Region before a consolidated programme can necessary for special or for large groups. One instance be formulated. is the case of assistants médicaux from the Congo (3)In many instances agreement between two (Leopoldville) and other médecins africains com- or more countries, or joint action, may also be plementingtheirmedicaleducationinEurope. required to give the best results. Another instance is the organization of classes for English -speaking students at the Hadassah Medical 3.How to meet the Needs School of the Hebrew University, Jerusalem, Israel. The qualitative and quantitative needs in trained 3.1 Guiding Considerations personnel may be best met by two parallel pro- The following paragraphs set out guiding considera- cedures- namely, the production of a small number tions for preparing an overall programme of medical of fully qualified personnel in medicine and para- and allied education and training for countries in a medical fields (such proportion of the secondary - stage of rapid development. school output as itis feasible to orient to health professions), and the training of auxiliary personnel in' much larger numbers. The former would provide the 3.1.1Fact-finding and Planning sustaining and supervisory cadres, the leaders, the When essential information has been procured teachers; the latter would provide the manpower concerning the existing assets, both of service personnel necessary for increasing the coverage of direct services and establishments and of the training potentialities to the community. to provide for replacement and expansion, plans based Attention needs to be paid to wastage of candidates on targets of personnel to be trained during stated admitted to teaching institutions, especially medical periods of years should be prepared.Though such schools, at home or abroad.High failure rates call plans, if they are to be realistic, should be extremely for investigation of and possible improvement in the flexible, they should in their earlier stages attempt to extent and level of prior general education,the meet the immediate needs, and incorporate measures methods of selection of candidates for medical schools for the relief of those needs into the longer -term and other teaching institutions for health personnel, programme. The importance of avoiding expedients and the methods of teaching and the provisions for which might be sources of trouble in the future, such student counselling in these institutions. At the same as the creation of two grades of professional medical time -since the number of candidatesisusually personnel, should be noted. limited -it is justifiable to try to retain for the health services students who have failed at some stage of 3.1.2Training inthe Country Itself their medical education by orienting them towards Efforts to make available training facilities in the training for other types and levels of health work, for country itself are clearly indicated when there is a which they may be suitable and adequate. 186 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
3.1.4Priority TypesofPersonnel 3.1.8Advancement of Auxiliaries Training should aim at the production primarily For auxiliaries there should be opportunities for of four types of personnel, for whom there is a con- advancement within their field by providing for train- sistently large demand : medical practitioners, nurses, ing, including refresher courses, to enable them to midwives and sanitarians, with their corresponding change from single -purpose and specialized work to auxiliary grades.Provision should also be made, general multi -purpose work, and to assume responsibi- however, for training dentists, sanitary engineers, lities in the chain of supervision of auxiliaries with health statisticians, public health veterinarians, ento- more limited training, experience or range of activities. mologists, laboratory technicians and others, again with the corresponding auxiliary categories, to the 3.1.9DistributionofResponsibilities among Countries extent that these personnel are necessary in the health services of the country. Where a country cannot embark upon its own full - A judicious distribution of functions between medi- range programme of personnel training at all levels, cal and paramedical personnel on the one hand, and possibilitiesof trainingofferedby neighbouring their respective auxiliaries on the other, should make countries should be considered. A group of countries for economies in two ways :first, an economy of might collaborate in providing a whole range of trained staff, and secondly, an economy in the time training facilities, each country assuming responsibility absorbed on training, by reducing to a minimum the for one or more types of training and making them number of persons requiring the lengthiest and most available to the other countries. complex forms of higher trainingThis calls for a serious planning effort by national health authorities 3.2NatureofAssistance Needed inco- operation with educationalauthorities and The following paragraphs are intended to give an national planning bodies. indication of the types of assistance that may be needed; the list is not exhaustive and is not limited to assistance that may be obtainable from WHO. 3.1.5Patterns of Training
Training should, the patterns 3.2.1Indirect Assistance with which the countries are familiar and which have proved useful elsewhere.It is not advisable to in- 3.2.1.1 Recommendations of expert committees on troduce totally new concepts likely to meet resistance various aspects of medical, paramedical and auxiliary and to provoke contradictory advice.Furthermore, education and training (including the report of the the presence of comparable types of personnel in Study Group on Internationally Acceptable Minimum several countries has many advantages, not the least Standards of Medical Education,' and the report being that it increases the scope of assistance for both on the Use and Training of Auxiliary Personnel in basic and advanced training, and makes easier inter - Medicine, Nursing, Midwifery and Sanitation2 by country co- operation in obtaining both operational the Expert Committee on Professional and Technical and teaching personnel. Education of Medical and Auxiliary Personnel). 3.2.1.2Information on medical and paramedical education in the world, both published and otherwise 3.1.6Broad Basic Training compiled and available from WHO (World Directory Basic training of a too specialized character should of Medical Schools,WorldDirectoryofDental be avoided as far as possible.A broad content of Schools, World DirectoryofVeterinary Schools, etc.). initialtrainingprovidesareservoir from which persons can be drawn for more specialized work 3.2.1.3Recommendations of the presentorgani- according to their aptitudes and the changing needs zational study, of the previous organizational study training,3of the of the services. on the subject of education and technical discussions at the Fourth World Health Assembly,4and of resolutions of the Health Assembly 3.1.7Opportunities for Existing Personnel and Executive Board on education and training. Persons employed inhealth services who have receivedonlypartialtraining,strictlyspecialized 1Wld Hlth Org. techn. Rep. Ser., 1962, 239. training, or training of a type likely to be abandoned, SWld Hlth Org. techn. Rep. Ser., 1961, 212. may be fitted into more complete and up -to -date 3Off: Rec. Wld Hlth Org. 46, 131. courses. 4Chron. Wld Hlth Org., 1951, 5, 287. ANNEX 15 187
3.2.2Direct Assistance 3.2.2.8Salary or salary complements to nationals available to hold key posts in teaching institutions, As the term " assistance " implies, and in accordance until such time as the country can make adequate with the normal practice of WHO, outside assistance, budgetary provisions. Need for caution was expressed, large or small, must supplement -not supplant -the however, with regard to supplementation of local efforts of the country itself in establishing needed and salaries. feasible training facilities. The country's own material and human contribution is basic to any undertaking. 3.2.2.9Buildings for teaching institutions.
3.2.2.1Consultations with headquarters and regional 3.3SomeSpecialConsiderations inestablishing staff for the following purposes : to enable the national Teaching Institutions on authoritiesconcernedtoobtainclarifications Training designed to meet Local Needs possible assistance; to enable them to benefit from 3.3.1 cumulating knowledge and experience in the solution It is of great importance that training should be of similar problems in other countries; to enable them designed to meet local needs and conditions.This to obtain help in drawing up plans for developing should present no great difficulty at the auxiliary level personnel training and to avail themselves of WHO's and should also be relatively easy in the training of services in any multi -national effort. professional nurses, midwives and sanitarians.At the level of professional medical training, however, the 3.2.2.2Consultants to help in fact -finding surveys adjustments to meet local needs have to be made and planning, as one means of assisting governments, within the framework of the accepted patterns and if requested, to identify their needs and to develop standards of education.Much of the teaching staff comprehensive practical national plans to meet these will, in the beginning, come from abroad and the needs. Once such plans are developed, any assistance graduates of the school must be able to receive provided by the international organizations would be recognition abroad in order to be admitted to post- designed to fulfil the requirements of some part of graduate studies. them. 3.3.2Standards of Training 3.2.2.3Visiting professors, internationally recruited, to fill gaps in national teaching personnel, organize The scope and operations of training schools, the relevant departments, and increase the training including schools of medicine, should be realistic and not over- ambitious, at any rate in the early stages, qualifications of their counterparts or prepare younger until the capacity of students improves with higher assistants for more responsibilities. standards of general education and until the faculty 3.2.2.4Fellowshipstonationals :(a)forbasic issufficientlywelldeveloped,qualitativelyand medical education, where this is unobtainable locally; quantitatively. On the other hand, there should be no (b) for the training of teachers, organizers and leading deliberate lowering of standards for purposes of personnel; and (c)for attendance at educational expediency, such as haste to produce greater numbers meetings organized by WHO for the discussion of of doctors and other qualified personnel.The pre- specifictopicsof medical andalliededucation, paration of future teachers and specialists enters into exchange of experience, and improvement of work all programmes of medical and paramedical education, through the cross -fertilization of ideas. and the basic diplomas obtainable in each country should be acceptable to higher institutions abroad 3.2.2.5Maintenance and travel costs for students where, as graduates, the students will need to study to attend internationally assisted teaching institutions at advanced levels. in their own countries, until such time as the countries As regards medical education, itis necessary to can make adequate budgetary provision for all their distinguish between the training of a lower " second " students.' category of physicians, which is in general undesirable, 3.2.2.6Equipment and supplies :(a) for teaching and the training of a clearly distinct category of institutions; and (b) for service institutions (such as auxiliaries in general medicine who, by their lower hospitals, health centres) used for training. general education and by their technical training, cannot be confused with fully qualified physicians and 3.2.2.7Service staff, internationally recruited, to fill who work under supervision and only within an gaps in the key -personnel establishment of institutions organized system of health services.This type of used for training (hospitals, health centres, etc.). auxiliary in general medicine will probably be needed in many countries, but the pattern of their training 1 In accordance with resolution WHA6.35. and utilization should be established in close relation- 188 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
ship to the plans for development of the country's be assigned successively to newly established institu- health services. tions until they develop their own staff.The recruit- The example may be given of a certain country ment of teachers from abroad may, however, be where abbreviated emergency training for doctors sufficiently successful, with the normal contracts, to was introduced twice under war conditions, but was make the consideration of measures of this kind soon abandoned, and where the training of doctors unnecessary. and auxiliaries in general medicine is being continued. In another country, where two categories of medical 3.3.5Establishing a New Medical School schools originally existed, the situation has been The establishment of a medical school of university remedied by either up- grading or abandoning the standard is the most difficult of the undertakings for lower category of training. training health personnel, and cannot be determined 3.3.3Preparation of Teaching Staff solely on the basis of the needs for education in medicine.It entails a thorough review of the human As to the preparation of teachers of medical and and material resources available for assuring that the allied subjects, even in very recently opened training medical school will function at a creditable level. establishments selected students might be assigned to The following are among the matters for con- junior posts as demonstrators and instructors, thus sideration : preparing them for future training for more responsible posts and adding to the teaching potential of the (a)Location and teaching language of existing institution.There might be added to the conditions medical schools within the country or' in neigh- for fellowships for post -graduate training abroad bouring ones; possibilities for increasing the yearly the requirement that the fellow be given practice in number of admissions. tutoring or class teaching in his subject. (b)Output of secondary schools in the country and possible number of candidates for medical studies; 3.3.4Importing Teaching Staff number of nationals with medical qualifications, When medical schools are established, staff are from among whom a nucleus of teaching staff may usually recruited from other schools, if such exist in be gradually formed. the country.Where this movement has been well prepared some years in advance, and where the future Until both appear adequate, the only solution will teachers have been selected according toa plan continue to be, for some time to come, to send students covering their preparation for their new posts, the abroad to study. loss to the " giving " schools is not serious.Where, 3.3.5.1When there is no immediate prospect of however, such procedures are impossible owing to establishing a medical school, the possibility may be the absence of " giving " schools, almost total reliance explored of utilizing any available hospital for the has to be placed on teachers from foreign countries. clinical training of those who have carried out their The practice of affiliation between a " new " medical medical studies abroad.If the hospital facilities school and an " old " one in a developed country has -installation, equipment, medical, nursing and other considerable advantages from the staffing angle, as staff -are adequate it may be possible to arrange for regards both the provision of personnel and the the new graduates to take their internship year training of national graduates for future teaching there, and perhaps even some of the clinical work in posts.Fellowships programmes enter very largely the course of their studies. Arrangements would need into the training of teachers. to be made with the medical schools abroad.Such For schools of medicine there is today a world- arrangements, however difficult they may be, might wide lack of suitable teachers who are prepared to prepare the way for an increasing assumption of take posts outside their own countries for limited responsibilitiesand -if otherconditionsbecame periods.This shortage of teachers is especially acute favourable -might gradually lead to the establishment in the non -clinical subjects and in preventive and social of a full medical school, by adding facilities for basic medicine. Even contracts for five years are not often medical sciences. attractive to keen young teachers, who see their A teaching institution is not only a device for pro- chances of promotion in their own countries seriously ducing trained personnel. Important as this training diminished if they are away for one or more years. function certainly is, a new school of medicine is Career contracts of ten to fifteen years are more likely expected to exert still other beneficial influences on the to produce applicants. development of a community and of a country. This Under the circumstances one may also consider a is particularly manifest in the case of the first school suggestion for the establishment of what may be of this type in a country, where it provides a strong described as an " international nucleus faculty ", to stimulus for setting up higher standards of medical ANNEX 15 189 care in the community, compatible with modern abroad and experience with their foreign advisers science and techniques. The school also provides an at home. Where there is no other source of potential opportunity for advanced training in scientific and teaching personnel in a country or area, a lengthy practical areas of medicine.It further attracts the period (ten to twenty years) must be expected to potential scientists, teachers and leaders, and helps elapse before the medical school can be independent them to develop their potentialities.The medical of foreign aid as regards the normal curriculum. school is also likely to accept some responsibilities (d)Attention needs to be paid, by local and visiting in leading the health and social progress of the com- professors alike, to drawing up a curriculum which munity and the country, e.g., by providing the legis- will primarily meet the minimum requirements for lators and administrators with competent scientific adequate medical education (see 3.2.2.1 and 3.3.1) interpretation of the health phenomena and health with due regard to local needs and conditions.It needs of the society. Such a school keeps the country should form a balanced whole, in which particular aware of scientific progress in medicine and thus or specialized disciplines would not take pride of assists the medical profession and the service institu- place, and in which the teaching of clinical sciences tionina continuing improvement of theirper- would not be crowded out by basicsciences, formances. teaching displaced by research or service, and social 3.3.5.2In countries where the establishment of an and preventive medicine rejectedin favour of undergraduate medical school is not precluded, the curative medicine or vice versa. following considerations are relevant : (e)Note might be taken of the order of magnitude (a)In ordinary circumstances an annual intake of of thecapitalcostsand maintenance charges not less than fifty students should be foreseen for (including staff) of a modern medical school. These an undergraduate medical school. This implies that naturally vary greatly both within and between the school serves a country or an area with a popu- countries, but in general terms and within very lation of about two and a half to three million if the wide approximations one might expect the buildings number of secondary -school graduates is reasonably and equipment of a medical school, catering for an large; not more than one -tenth of them can be annual intake of fifty to a hundred students, to expected to take up medicine as a profession.At be around $10 000 000, and the annual cost per the beginning, the annual intake may have to be student to be between $1500 and $3000.These less than fifty and this would be better for the figures do not include the cost of an ad hoc teaching beginning of their teaching.If itisforeseen, or university college hospital nor the salaries of however, that the intake will remain small, careful clinical and laboratory hospital service staffs, much appraisal of the need for a medical school is of whose time may be given to teaching. indicated, in view of the high costs involved and 3.3.6Training and Employment Possibilities the scarcity of teachingstaff. In appropriate The production of both medical and paramedical circumstances neighbouring countries sufficiently personnel depends on : (a) the government's personnel similar in culture and using the same language might establishment and its capacity to absorb all trainees as join to establish a school serving all of them. they qualify; and (b) the attractiveness of these careers (b)One of the first steps to be taken would be to (chiefly in professional nursing, midwifery, and sanita- set up an organizing committee ora nucleus tion) compared with careers in commerce, in school - faculty council with an executive officer, who would teaching, and in other government departments, all be responsible for all the preparatory work (plan- of which take their proportion of secondary school ning, etc.) and with whom negotiations -in the leavers. first place -would be carried out as to the outside The great length of full medical studies (a minimum assistance needed. of six years) may need to be compensated by special (c) A period of four or five years should be allowed advantages during and after the studies in order to for the development of the medical school to the attract good and ambitious candidates now pre- stage of admitting students; during that time staff ferring more immediate opportunities outside the are prepared, buildings constructed and equipped health field. and the programme of studies outlined.Where On the other hand, there is seldom a lack of local experience is not available external counsel applicants for training for auxiliary grades requiring should be used in planning. Later, teams of foreign no more than elementary education. teachers may initiate and conduct courses until It cannot be too strongly emphasized that the such time as their posts can be taken over by training of various types (medical, nursing, etc.) and counterpart nationals who have had special training levels (the professional and the auxiliary) of health 190 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I personnel should be related to the plans and oppor- bilateralorprivate -who areavailableto give tunities for their employment. Special provisions may assistance.The first aim of such a committee might be necessary to attract and retain professional per- be to discuss the broad lines of the problem and to sonnel, especially doctors, in key localities throughout learn to what extent co- ordination of planning and the country and avoid their concentration in the implementation would in principle be possible.The capital city.Satisfactory conditions of professional committee itself might be subdivided into two or three work should be secured by proper organization of sub -committees on a language -of- teaching basis. medical facilities.Also, living conditions, and cir- cumstances such as facilities for education for the 4.2.1.2To promote the establishment of medical children, should be taken into consideration by the and allied education committees for groups of neigh.. governments desirous of obtaining the services of bouring countries using the same language for teaching professional personnel in smaller towns or remote purposes. These committees, again, would consist of places. government representatives and representativesof agencies. 4.Problems of Policy and Implementation The functions of a medical and allied education committee would have to be carefully considered and 4.1 Technical agreement as to their range would have to be reached. Consideration of the various items under section 3, 4.2.2The following are subsidiary questions dis- " How to meet the needs ", afforded an opportunity cussed : of considering some of the technical issues involved in providing assistance to newly independent and 4.2.2.1 Pairing of teaching institutions.The value emerging countries in education and training.The of schemes whereby new teaching institutions are conclusions reached, together with established prac- " paired " with old- established ones is not in doubt; tices based on resolutionsof the World Health among other things, they may help in overcoming Assembly and Executive Board, expert committee difficulties with the recruitment of teaching staff, espe- recommendations, etc., provide the necessary technical cially for university level education.In its consulta- guidance.It is unnecessary to go over the same tions with national authorities WHO may, therefore, ground again. take the initiative in promoting " pairing " between particular institutions. 4.2Organizational 4.2.2.2Associating bilateral agencies. There would 4.2.1 Inter -countryCommittee(s)on Medical and be advantages in WHO's inviting the co- operation of Allied Education countries providing bilateral aid, with a view to asso- ciating them in any one long -term development plan. One of the basic considerations is how to approach the situation in a particular group of countries with a view, on the one hand, to possible distribution of 4.3Financial functions among them and, on the other hand, to the 4.3.1Providing Effective Assistance assumption of responsibilities for assistance which Providing effective assistance to meet the needs of may be given, in particular activities or in particular the newly independent and emerging countries would countries, not only by WHO but also by other assisting require additional funds.Some indication of costs organizations. is given in the report submitted to the Fifteenth World There would seem to be advantages in developing Health Assembly on continued assistance to newly a plan applicable toa whole area,if this were independent States.' feasible; not the least of these advantages would be the centralization of resources and the co- ordination of 4.3.2Obtaining the Funds their use, in contrast to uncoordinated expansion The resolution of theFifteenth World Health of services by individual countries, which would tend Assembly on continued assistance to newly inde- to perpetuate and extend existing inequalities. pendent States refers to one source of funds for this For pursuing this aim, several possible methods of Special Account for Accelerated procedure were considered, including the following : programme, the Assistance to Newly Independent or Emerging States.2 4.2.1.1To take the opportunity of a regional com- It is, however, unlikely that this account and the mittee meeting (in the case of Africa, for example) regular budget of WHO would suffice, and it would and utilize its membership as a medical and allied education committee for the Region, with the addition 1 Off. Rec. Wtd Hith Org. 118, Annex 4, Parts 3 and 4. of representatives of other agencies -international, 2 Resolution WHA15.22, para. 8. ANNEX 15 191 seem appropriate to consider other possible sources of ance for the training of health personnel to meet the financing 1such as the Expanded Programme of priority needs of the newly independent countries : Technical Assistance, the United NationsSpecial first, a study of the extent and nature of the needs; Fund, the International Bank for Reconstruction and second, how these needs can be met; third, what Development, the African Development Bank, the problems of policy and implementation arise,in- International Development Association, bilateral aid, cluding problems of financing, not only forthe and foundations and other private sources.In this establishment of the training facilities themselves, but connexion, it must be borne in mind that funds from also for their annual running costs thereafter.Also certain sources are available for certain types of to be taken into account is the cost of the salaries of expenses only and not for others (e.g., personnel - the personnel available for employment after their international and local; equipment and supplies; training has been successfully completed. buildings; fellowships). The whole process implies establishing an order of priority and a reasonable plan of development, for 4.3.2.1Two suggestions with regard to financing have immediate and long -term action, taking into account been consideredastotheirrelative merits and socio- economic, educational and other circumstances, feasibility : including the nature and pattern of prevalent health 4.3.2.1.1Establishing a single fund.While a single problems and the outstanding needs of the population fund, subscribed to by assisting agencies and admin- and its component groups. istered by one authority, has its attractions, it is not The report does not purport to embrace every feasible because of the regulations governing such aspect of the extensive and complex problems it funds. This does not exclude, however, consideration attempts to consider.We have reason to believe, of establishing a fund to be devoted exclusively to however, that it will serve as a guide to the consider- medical education and training, including the establish- ation of many facets of the problems of medical and ment of medical schools, where unrestricted voluntary allied education and training, whose solution is neces- contributions might accrue. sary for the maintenance and development of health 4.3.2.1.2Multiple financing of a programme.More services in all countries of the world, no matter what realistic appears to be the seeking of contributors who stage of development they may have reached. would finance, and in some instances assist in carrying out,specific aspects of an agreed comprehensive programme. Appendix 1
4.3.3With regard to the financing of internationally EDUCATION AND TRAINING OF HEALTH recruited service staff for institutions used for training PERSONNEL IN AFRICA (see3.2.2.7), attentioniscalled to the provisions (Extracts from a working paper contributed by WHO to the regarding operational staff in the resolution of the UNESCO /ECA Conference of African States on the Fifteenth World Health Assembly oncontinued Development of Education in Africa,' Addis Ababa, May 1961) assistance to newly independent States.2Stress has already been laid (see 3.2.2.8) on the need for caution TABLE I. MEDICAL AND PARAMEDICAL PERSONNEL with regard to the payment of salaries and salary IN AFRICA IN 1960 (EXCLUDING UNITED ARAB complements of local personnel involved in teaching, REPUBLIC (PROVINCE OF EGYPT) AND even in those cases where the regulations governing UNION OF SOUTH AFRICA 2) assistance from international funds permit it. Another problem, which needs to be worked out in each parti- Total Ratio to Category number of popul- cular case, is that of providing for and distributing personnel ation * among countries costs for local personnel employed in inter -country projects. Physicians 9 869 1: 20 204
Dentists 1 167 1: 170 860 CONCLUDING NOTE Pharmacists 2 647 1 : 75 300 This report, in its structure, has followed the three Nursing personnel ** . . 47 399 1: 4 200 Medical auxiliaries . . . . 1 377 1: 144 800 steps which need to be taken when a study has to be made -either for a number of countries or for one of them -of the measures for providing effectiveassist- 1 Document UNESCO /EDAF /S /6,of 10April1961(with figures corrected). 2 Now Republic of South Africa. 1 See resolution WHA15.22, para. 7. * Population estimate, 1960: 199 400 000. 2 Resolution WHA15.22, especially paras 4 and 6 (a). ** Includes nurses, assistant nurses, midwives and assistant midwives. 192 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
TABLE III.ESTIMATED HEALTH PERSONNEL FOR AFRICA FOR THE DECADE 1960 -1970 (EXCLUDING UNITED ARAB REPUBLIC PROVINCE OF EGYPT) AND UNION OF SOUTH AFRICA 1) AT THE MINIMUM REQUIRED RATIO TO POPULATION
Category 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970
Estimated population
(in millions) . . . . 199.4 203.2 207.2 210.9 215.0 219.0 223.2 227.4 231.8 236.2 240.7
Physicians 19 940 20 320 20 720 21 090 21 500 21 900 22 320 22 740 23 180 23 620 24 070 Dentists 6 646 6 773 6 906 7 030 7 166 7 300 7 440 7 580 7 726 7 873 8 023 Pharmacists 3 988 4 064 4 144 4 218 4 300 4 380 4 464 4 548 4 636 4 724 4 814
Sanitary engineers . . 199 203 207 211 215 219 223 227 232 236 241
Medical auxiliaries . 33 233 33 866 34 533 35 150 35 833 36 500 37 200 37 900 38 633 39 366 40 116 Sanitarians 13 293 13 546 13 813 14 060 14 333 14 600 14 880 15 160 15 453 15 746 16 046 Nurses and nurse - midwives. 39 880 40 640 41 440 42 180 43 000 43 800 44 640 45 480 46 360 47 240 48 140 Laboratory technicians 39 880 40 640 41 440 42 180 43 000 43 800 44 640 45 480 46 360 47 240 48 140 Nurse- and midwife - aides 39 880 40 640 41 440 42 180 43 000 43 800 44 640 45 480 46 360 47 240 48 140
Sanitarian assistants . 39 880 40 640 41 440 42 180 43 000 43 800 44 640 45 480 46 360 47 240 48 140
Assistant pharmacists . 3 988 4 064 4 144 4 218 4 300 4 380 4 464 4 548 4 636 4 724 4 814
1 Now Republic of South Africa.
TABLE IV.ESTIMATE OF NUMBER OF GRADUATES IN THE VARIOUS CATEGORIES REQUIRED TO FILL THE POSTS IN 1970
Approximate Numbers Ratio to Minimum ratio Numbers required number of Category in 1960 population required by 1970 new graduates required 1960 -1970
Physicians 9869 1: 20000 1: 10000 24070 13000
Dentists 1167 1 : 170000 1: 30000 8023 6850 Pharmacists 2647 1: 75000 1: 50000 4814 3850 Sanitary engineers - - 1: 1000000 241 240 Total- Professional Personnel 13683 - - 37148 23940
Nurses and midwives 4330 1 : 46000 1 : 5000 48140 44000 Nurse -aides 43069 1 : 4600 1: 5000 48140 5000 a Total- Nursing Personnel 47399 - - 96280 49000 b
Sanitarians - - 1 : 15000 16046 16000 Medical auxiliaries 1377 1: 145000 1: 6000 40116 38500 C Laboratory technicians d - - 1 : 5000 48140 30000 Total- Sub -professional Personnel - - - 104302 84500
Sanitarian assistants - - 1 : 5000 48140 48140 Assistant pharmacists - - 1 : 50000 4814 4800 TOTAL - - - 52954 52940
a In some country reports, no distinction is made between nurses and nurse -aides.It is probable, therefore, that the number of graduate nurses is somewhat higher at the expense of the number of nurse -aides. b In some French -speaking countries the term "infirmier " is used to denote both " nurse " and " medical auxiliary ".It is probable, therefore, that the number of nurses and nurse -aides is somewhat smaller. e The number of medical auxiliaries at present is actually higher (see note b). d The present number of laboratory technicians is not known, but it is not likely to exceed 10 000 -15 000, including many untrained technicians. ANNEX 15 193
Appendix 2
SOME INFORMATION ON MEDICAL SCHOOLS IN THE AFRICAN CONTINENT 1
Total Approximate Year founded Teaching Admissions staff in 1960E enrolment in 1960 Graduates annual in 1960 tuition fees
Algeria Faculté mixte de Médecine et de Pharmacie de 1857 l'Université d'Alger, ALGIERS
Congo Faculté de Médecine de l'Université officielle 1956 d'Elisabethville, ELISABETHVILLE
Faculté de Médecine de l'Université Lovanium, 1954 6 80 5 * Fr. 2 000 LEOPOLDVILLE
Madagascar Ecole de Médecine et de Pharmacie, 1896 16 137 m 20 17 None TANANARIVE (6) 8 f
Ecole nationale de Médecine et de Pharmacie, 1961 5 Fr. CFA 3 825 Université de Madagascar, TANANARIVE
Nigeria Faculty of Medicine, University College, 1948 50 213 60 19 £BWA 161 -261 IBADAN
Medical School, University of Lagos, 1962 28 * LAGOS
Senegal Faculté mixte de Médecine et de Pharmacie, 1950 44 160 60 Fr. CFA 2 400 Université de Dakar, DAKAR
South Africa Faculty of Medicine, 1956 20 257 106 Rand 112 -170 University of Stellenbosch, (54) BELLVILLE,Cape Province
Faculty of Medicine, 1911 107 659m 188 81 Rand 232 -240 University of Cape Town, (167) 114 f CAPE TOWN
Faculty of Medicine, 1951 38 190 m 41 16 Rand 121 -151 University of Natal, (69) 23 f DURBAN
Medical School, 1919 87 502 m ** 138 ** 75 m Rand 242 University of Witwatersrand, 96 f ** 9 f JOHANNESBURG
1 Unless otherwise indicated the information relates to 1960. 2 Figures in brackets denote part -time teaching staff. * 1962 data. ** 1961 data. m Male. f Female. 194 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Teaching Total Approximate Year founded enrolment Admissions Graduates annual staff in 19601 in 1960 in 1960 tuition fees
Faculty of Medicine, 1943 34 857 177 118 Rand 180 University of Pretoria, (60) 885* 197* PRETORIA
Sudan Faculty of Medicine, 1924 18 152 m 36 22 £ S 84 t University of Khartoum, (8) 7 f KHARTOUM
Uganda Makerere College Medical School, 1924 26 137 m 30 15 LEA 51 University College of East Africa, (30) 4 f KAMPALA
United Arab Republic Faculty of Medicine, 1942 136 2 010 352 240 LE 10 Alexandria University, ALEXANDRIA
Faculty of Medicine, 1960 24 296 198 - LE 10 Asyût University, ASYÛT
Abbasia Faculty of Medicine, 1947 154 2 491 287 240 LE 10 University of Ein Shams, CAIRO
Kasr -el -Aini Faculty of Medicine, 1866 285 3 220 422 335 LE 10 Cairo University, CAIRO
El Mansûra Faculty of Medicine, 1962/1963 LE 10 EL MANSÛRA
Tanta Faculty of Medicine, 1962/1963 £E 10 TANTA
1 Figures in brackets denote part -time teaching staff. * 1962 data. t Frequently reduced by the award of government fellowships, and may be as little as £S 5. m Male. f Female. ANNEX 16 195
Annex 16
SMALLPDX ERADICATION PROGRAMME1
[A16 /P &B/9 -18 April 1963]
REPORT BY THE DIRECTOR- GENERAL
CONTENTS
Page Page PART 1 Part II I.Introduction 195 A. Progress towards Smallpox Eradication 202 2.World Incidence of Smallpox 196 3. Study of Reported Incidence in relation to Endemicity197 B.Progress inthe Smallpox Eradication Programme
4.Epidemiological and other Studies in Progress . . 199 in the WHO Regions with some Estimâtes of Financial
5. Vaccine : Contributions to WHO 200 Needs 202
PART I
1.Introduction 1957 -1958 (154 446 and 245 978 cases respectively) are a warning of what may be expected in 1963 and This report has been prepared in two parts.In the 1964 if eradication campaigns or vaccination control first part an attempt is made to study the world measures are not intensified by immediate effort at incidence of smallpox in relation to the endemic areas, both national and international levels. as suggested by some members of the Executive Board Effective eradication schemes are based on two during the discussion on the smallpox eradication fundamental elements, the ability of a public health programme at the Board's thirty -first session.The service to organize -technically and administratively second part gives a summary of the present progress -a mass vaccination programme to cover at least in the programme, as reported by Member States. 80 per cent. of a country's population, and the avail- The number of reported cases of smallpox in 1962 ability of a vaccine which is fully potent at the time was 73 913, which is less than the number reported for of inoculation. A few countries with relatively well- 1961 (78 325) and 1959 (77 555), but more than for organized health services have been unable to eliminate 1960 (59 221) (see Table I).The eradication pro- endemic foci of smallpox after years of apparently gramme, therefore, has not yet substantially reduced intensive vaccination and revaccination, but when the incidence of the disease and in the countries of all the factors involved in national control measures Africa and Asia where it is endemic the rates have are considered -vaccination coverage of the various declined only slightly. age -groups; potency of the vaccine used (particularly The persistence of endemic foci in Africa, Asia and, of that used in remote rural areas); vaccination although on a smaller scale, in South America, con- technique; observation and recording of vaccination tinues to be an important health problem to countries results -it has been found that one or more of these in which smallpox is present, and a menace to their measures has been incorrectly applied, and that that neighbours and to all those countries throughout the can account for the failure.In endemic areas not world that are now free from the disease. enough emphasis has ever been placed on the im- In endemic areas, and particularly those that are portance of evaluating vaccination campaigns and on densely populated, epidemics are known to occur at the efficient recording of vaccination and revaccination regular intervals -usually in cycles of between five and results. seven years -owing to large accumulation of suscep- A number of problems relating to the epidemiology tibles.The epidemics of 1951 (489 922 cases) and of and virology of smallpox still require elucidation. The Organization (as will be seen later in this report)
1See resolution WHA16.37. is closely associated with smallpox research efforts 196 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I being undertaken in many places, since the findings and the free exchange of information between them have a direct effect on methods of eradication.It is so that their efforts can be synchronized. As a result, proposed to convene an expert committee on smallpox a large area of West Africa, comprising Ghana, Guinea, in 1964 to advise on the problems related to the Ivory Coast, Liberia, Mali and Upper Volta, is im- epidemiology and prevention of smallpox, and also plementing a co- ordinated plan of eradication. to review the studies which have been carried out. Since the adoption by the Eleventh World Health 2.World Incidence of Smallpox Assembly of resolution WHA11.54 on smallpox eradication, the Organization has continued to assist Table I shows the world incidence of smallpox in with national eradication campaigns by giving advice the years 1958 to 1962.' on planning and organization and by recommending TABLE I.CASES OF SMALLPDX, 1958 -1962 8 the use of a thermo - stable freeze -dried vaccine and in some cases supplying it. Continent 1958 1959 1960 1961 1962 The Fifteenth World Health Assembly,inits resolution WHA15.53, recognized that countries in endemic areas are meeting difficulties in organizing Africa . . . 14403 14155 15854 24159 24119 America . . 4334 4899 4091 1 923 3029 country -wide campaigns.The resolution called for Asia. . . . 227229 58487 39228 52218 46629 further national efforts and additional international Europe . . I2 14 47 25 136 assistancetotheglobaleradication programme. Oceania . . -- I The Director -General in his circular letter C.L.32 1962, dated 31 July 1962, invited the attention of Member TOTAL 245978 77555 59221 78325 73913 States to the resolution and called for voluntary contributions in cash or in kind towards the provision In 1962 the incidence in Africa was 0.7 per cent. offreeze -driedvaccine,transportvehicles,and and in Asia 11 per cent. lower than in 1961; in America, laboratory and cold- storage equipment for distribution by the Organization to countries which have set up Brazil had a large number of cases (2759) in 1962. The countries and territories from which cases were sounderadicationprogrammes and which have requested assistance. reported in 1960, 1961 and 1962 are listed in Table II. This appeal has so far brought only three offers of additional vaccine supply : Switzerland donated freeze - TABLE 11.COUNTRIES AND TERRITORIES dried vaccine to the value of Sw. fr. 100 000 (approxim- REPORTING CASES OF SMALLPDX ately 2 000 000 doses) and two other Member States IN 1960, 1961 AND 1962 have offered to donate freeze -dried vaccine -Chile, 500 000 doses; and Italy, 100 000 doses. Cases In another resolution (WHA15.54) the Fifteenth Country or territory World Health Assembly expressed the hope that 1960 1961 1962 UNICEF would find it possible to give full support to the programme :this appeal has been favourably Africa received. Algeria 7 8 Fourteen countries in the endemic areas were at the Angola 23 time of reporting conducting eradication programmes Basutoland 85 52 orcompletingtheirprogrammes byeliminating Bechuanaland 21 16 4 residual foci.Others, though wishing to do so, are Cameroon 1 345 792 Central African Republic . 1 57 still encountering difficulties due to insufficient health Chad 4 273 749 personnel and to the inadequacy of transport and Congo (Brazzaville) 22 1 313 refrigeration equipment, which has to be purchased Congo (Leopoldville) 605 2 251 3 785 from abroad with hard currency. Dahomey 768 119 90 Ethiopia 293 761 360 Lack of money is not the only reason for the slow Federation of Rhodesia and progress.In some countries the administration finds Nyasaland 994 that the smallpox problem cannot be tackled effectively Nyasaland 795 1 465 with the existing inadequate health services. Northern Rhodesia . 350 233 Southern Rhodesia 12 3 TheOrganization,recognizingthedangersof infection spreading across frontiers, has encouraged i ln Table I as well as in Tables II, III, IV and VI, countries and the co- ordination of eradication programmes in neigh- territories are grouped by continents and not by WHO Regions. bouring countries in areas where smallpox is endemic 2 Based on data available at time of reporting. ANNEX 16 197
Cases Cases Country or territory Country or territory
1960 1961 1962 1960 1961 1962
Africa (continued) Asia (continued) Gabon -- 1 Pakistan : Gambia 7 12 4 East 1086 420 461 139 70 135 Ghana West 780 1 396 1 806 Guinea 176 96 2 948 Karachi 139 925 1153 Ivory Coast 1 634 4 656 1 900 Saudi Arabia 32 1 Kenya 151 289 96 - Thailand 32 33 2 Liberia 1119 323 - Trucial Oman 17 Mali 1 212 1 706 1 427 -- Mauritania 44 12 40 TOTAL 39228 52 218 Mozambique 81 51 67 46 629 Niger 2 408 1 740 1 038 Nigeria 4 140 3 538 3 863 Europe Portuguese Guinea 1 7 2 Belgium - 1 - Ruanda Urundi 22 Germany, Federal Republic - 5 36 Burundi 7 26 Poland -- 32 Rwanda 10 30 Spain - 17 - Senegal 6 201 231 Switzerland -- Sierra Leone 12 6 78 UnionofSovietSocialist South Africa 65 7 112 Republics : Spanish Equatorial Africa . . 1 -- Moscow 46 -- Sudan 135 104 70 Tadzhik SSR - 1 - Tanganyika 1 584 908 973 United Kingdom of Great Togo 347 281 572 BritainandNorthern Uganda 707 398 628 Ireland : ' 126 2 360 1 335 Upper Volta England and Wales . . 1 1 67
TOTAL 15 854 24 159 24 119 TOTAL 47 25 136
Oceania America Niue 1 -- Argentina 65 4 2 Bolivia 1 -- Brazil : Rio de Janeiro 650 1 411 1 254 3.Study of Reported Incidence in relation to Endemi- Other -- 1 505 city Canada -- 1 The information in Table III shows that eighteen Colombia 171 16 41 Ecuador 3 185 491 205 countries or territories reported more than 500 cases Uruguay 19 1 10 in 1962 (see page 198). Venezuela -- 11 The rates per 100 000 total population indicate that smallpox is as highly endemic in Africa as in Asia with TOTAL 4 091 1 923 3 029 its much more densely populated endemic areas. In 1962, fourteen countries in Africa reported over Asia 500 cases each. Eight of these showed an incidence rate of 30 or more per 100 000 population.In Asia, Aden : however, the highest incidence rate per 100 000 popu- Colony 8 1 - Protectorate 5 -- lation was in India, which showed 10. Afghanistan 111 174 303 While the incidence rate is approximately 7 per Burma 392 88 21 100 000 population for all the endemic countries in Cambodia - 1 - Asia, it is 15 per 100 000 for those in Africa. Ceylon - 34 12 India 31 052 45 195 42 231 Table IV, which shows the number of weeks in Indonesia 5 196 3 777 586 which smallpox was reported, indicates that it was Iran 378 168 28 present during forty or more weeks in the year in Korea, Republic of 2 1 - 15 countries in 1960, and in 18 countries in 1961 and Malaya, Federation of . . . 15 -- 1962. In Africa such reports were received from Muscat and Oman -- 8 Nepal - 5 - 11 countries in 1960, and from 14 in 1961 and 1962. 198 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
There seems, therefore, to be a clear indication of the Weeks persistence of infection in the endemic areas, from Country or territory which the weekly reports of smallpox incidence 1960 1961 1962 have been constant in 1961 and 1962. It is of interest that while in some countries smallpox Africa (continued) cases are reported during a few weeks of the year only, Cameroon - 48 45 in most countries cases occur almost all the year Central African Republic . . . . 1 - 7 round. Chad 4 26 44 Though the degree of endemicity of smallpox in a Congo (Brazzaville) - 7 39 Congo (Leopoldville) 47 48 26 given country cannot be measured by the frequency Dahomey 39 26 33 of the weekly reports of smallpox incidence, the Ethiopia 51 45 47 information in Table IV clearly indicates -allowing Federation of Rhodesia and Nyasa- for unreliable and irregular reporting systems in some land : Nyasaland 52 52 52 countries -the areas of highest endemicity and the Northern Rhodesia 24 34 38 constant exposure that neighbouring countries suffer Southern Rhodesia 8 2 10 from their contiguity to infected areas. Gambia 2 8 4 Ghana 27 28 27 Guinea 10 18 36 TABLE III.COUNTRIES AND TERRITORIES Ivory Coast 51 52 51 REPORTING OVER 500 CASES OF SMALLPDX IN 1962 Kenya 41 47 48 Liberia - 52 48 Approximate Mali 41 50 45 Country or territory rate per 100 000 Mauritania 26 7 9 population Mozambique 8 18 25 Niger 51 50 47 Nigeria : Africa Eastern Region 20 9 32 Northern Region 52 51 Cameroon 20 52 Western Region 40 30 Chad 35 42 Portuguese Guinea 2 4 8 144 Ruanda Urundi: Congo (Leopoldville) 29 Burundi 8 4 7 Federation of Rhodesia and Nyasaland . . 12 Rwanda 6 4 Guinea 100 12 Senegal 4 28 Ivory Coast 58 13 Sierra Leone 7 4 Mali 38 22 Somalia (Northern Region) . . . 1 Niger 34 -- South Africa 12 4 11 Nigeria 11 Spanish Guinea 1 Tanganyika 10 -- Sudan 23 17 Togo 38 14 Tanganyika 52 52 Uganda 10 51 Togo 42 44 Upper Volta 30 51 Uganda 51 50 49 Upper Volta America 24 47 50 Brazil 4 Asia Asia Aden Protectorate 3 India 10 -- Afghanistan 44 51 52 Indonesia 1 Burma Pakistan 4 30 18 7 Cambodia - 1 - Ceylon - 12 4 India 52 52 52 TABLE IV.NUMBER OF WEEKS IN WHICH CASES Indonesia 52 52 52 OF SMALLPDX WERE REPORTED, 1960, 1961 AND 1962 Iran 26 9 8 Korea, Republic of 2 1 - Weeks Malaya, Federation of 4 -- Country or territory Nepal - 2 - 1960 1961 1962 Pakistan : East Pakistan 52 41 49 Africa West Pakistan 52 48 52
Algeria 6 7 1 Saudi Arabia 14 5 1
Basutoland 19 15 Thailand 1 3 3 Bechuanaland 7 9 2 ANNEX 16 199
4.Epidemiological and other Studies in Progress make smallpox vaccinestable and heat -resistant. Several campaigns carried out with dried vaccines Epidemiological Investigations have failed because the vaccine deteriorated under An understanding of the epidemiology of smallpox field conditions.Because of this, WHO organized is the basis for the sound planning of eradication studies of methods to ensure the regular production of campaigns. It might be thought that all the necessary a suitable heat -resistant dried vaccine.Laboratory information would be available in the literature which tests of vaccines produced by different methods in extends over a century, but unfortunately on many of different laboratories were carried out in a comparative the points of particular importance to eradication study in which laboratories from several countries campaigns information iseither entirely absent or participated. These tests showed that vaccine produc- incomplete.It is necessary to know more of the tion based on desiccation from the frozenstate behaviour of the disease in densely populated areas (lyophilization) gave 100 per cent. successful primary as compared with that in the sparsely populated areas; vaccination rates after periods of storage of up to in different age -groups; in persons in whom immunity 64 weeks at 37° C and 45° C, while other vaccines were has partly waned because of long intervals between less satisfactory.Information about this method of revaccination or because of the use of vaccines which, production and about subsequent technical improve- though adequate for primary vaccination, are not ments have been distributed to competent production sufficiently potent for revaccination. It is also necessary laboratories and assistance has been given to some of to know if partially immune persons constitute a them to produce the vaccine. reservoir of infection in the over -crowded parts of the The importance of producing stable and highly larger cities.If they do, would elimination of the potent vaccines cannot be over -emphasized.It has reservoir by adequate vaccination result in a sub- been established that a certain concentration of virus stantial decrease in the general incidence of the disease? is necessary in order to obtain a high percentage of Since definite answers to such questions are not " takes ".Based on studies carried out under the available, inquiries are being made to find suitable sponsorship of WHO on persons previously vac- areas for pilot studies and investigators to carry them cinated,' the Study Group on Requirements for out.If such studies fulfil their promise they will be Smallpox Vaccine 2 established potency tests to ensure extended. effectivenéss in the field.More recent studies 3 have Studies are also being made on methods of measuring shown that only vaccines of the highest potency will the level of protection of populations against smallpox. give satisfactory revaccination " take " rates. With a Vaccination and revaccination with a standard vaccine standard vaccine the percentage of " takes " increases of high potency are being carried out on random with the lapse of time from the previous vaccination. samples of population to determine the percentage of For example, after two years we may expect a revac- susceptibles, by age and by the interval since the cination " take " rate of 33 per cent. After five years last vaccination.This will give information on the the " take " rate will increase to about 70 per cent. optimum intervals for the revaccination of persons of These findings are of obvious importance in relation different ages. to eradication campaigns.A vaccine producing a Laboratory studies are being developed on the high percentage of " takes " in primary vaccinations levels of antibodies, in the blood of vaccinated persons, but failing partially or completely in revaccinations that afford protection against challenge with highly not only dooms a campaign to failure, but also gives potent vaccines.Itis assumed that resistance to a dangerous false sense of security.Unfortunately challenge by vaccination runs parallel to resistance practical examples of occurrences of this kind come to to natural infection, and knowledge of the serum the attention of the Organization not infrequently. protection level would permit serological surveys to be carried out to determine the susceptibility of Methods of Administration of the Vaccine populations to smallpox. The successful utilization of jet injectors for the rapid vaccination of large numbers of persons has A Better Vaccine been reported.4 Comparative trials on the percentage
One of the great difficulties in vaccination campaigns, 1 Cockburn, W. C. et aI. (1957) Bull. Wld Hlth Org. 16, 63. especially those in tropical areas, has always been 2 W/d Hlth Org. techn. Rep. Ser. 1959, 180, 19. the rapid deterioration of glycerinated lymph vaccine. 3 Hobday, T. L. et al. (1961) Bull. Wld Hlth Org. 25, 69; Attempts to surmount thedifficulty have largely Mastyukova, Y. N. et al. (1961) Prob. Virol. 6, 207; Espmark, resolved themselves into the production of dried Espmark & Rabo cited by Dostal, V. (1962) Prog. med. Virol. 4, 259. vaccines,butlaboratoryexperimentsandfield 4 Elisberg, B. L. et al. (1956) J. Immunol. 77, 340; Barclay, experience have shown that desiccation alone does not E. N. et al. (1962) Bull. Acad. Med. Cleveland. 200 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I of " takes " obtained by using jet injectors and by pox patients at various stages of the disease.' Contrary inoculation by the multiple -pressure method are in to what was suspected, viruses were very difficult to progress in Liberia.In preliminary trials it has been recover, even when large volumes of air were collected observed that some persons inoculated withjet in the proximity of acutely ill patients.In order to injectors respond with induration without vesiculation, explore this matter further, new studies are being and the immunological significance of this response is carried out, using more sensitive air -sampling methods. also being studied. Prevention of Complications Passive Protection Smallpox vaccination is still unfortunately marred The vaccination of contacts is not always successful by the rare but serious complications of post -vaccinal as a protective measure against smallpox. The chance encephalitis.Cases of post -vaccinal encephalitis are of failure increases as the interval between exposure regularly reported from some countries, but never from and vaccination lengthens.Studies have been carried others. The reasons for this are not clear. No modifica- out, with the support of WHO, on the use of vaccinal tion introduced in the manufacture or administration hyperimmune gamma -globulin in the prophylaxis of of the vaccine has yet been shown to be effective in smallpox in contacts.'These studies showed the preventing the occurrence of post -vaccinal encephalitis. efficacy of gamma -globulin as a preventive agent. Recently the successful prophylactic effect of anti - Because of the limited supply of this substance, its vaccinal gamma -globulin administered at the same time prophylactic use has to be restricted to those at highest as the vaccination was reported.' Efforts, so far without risk.If an animal gamma -globulin could be used for great success, are also being made to develop inacti- this purpose, larger quantities could be made available. vated vaccines. If an effective inactivated vaccine were Ithas been reported that gamma -globulin from available its use might permit later vaccination with hyperimmune animals gives highly effective results a live vaccine, and thus provide a satisfactory im- in the prevention of experimental vaccinal infection.' munity without the risk of post -vaccinal complications. WHO is supporting studies on the production and In addition, it might be possible to combine such a testing of animal hyperimmune gamma- globulin with vaccine with other antigens, diminishing in this way a view to its possible use in prevention and treatment. the number of inoculations, already quite large, that each child has to receive during the first period of his life. Studies on the Infectiousness of Smallpox in the Early Stages of the Disease and on the Dissemination of the Virus by Air 5.Vaccine :Contributions to WHO Epidemiological observations suggest that smallpox AsreportedtotheFifteenthWorldHealth is not highly infectious in the pre- eruptive period of Assembly,' the Organization continuestosupply illness. The clarification of this point is of great Member States, on request, with freeze -dried vaccine practicalimportancefordeterminingtheperiod for use in their eradication programmes. The vaccine during which a patient might be infectious and for is drawn from the amounts donated by a number Studies on this purposes of isolation of contacts. of Member States. problem were carried out in Madras with the support One obstacle has been largely surmounted in the of WHO.3 No virus could be recovered from mouth - smallpox eradication programme, namely the develop- washings and garglings from patients in the first two ment of a potent and thermostable vaccine to meet the days of the disease. It was, however, frequently found requirements of national mass vaccination campaigns. in specimens collected from the sixth and the ninth The main problem now is to ensure that vaccines day of illness. This is further proof that most smallpox used in mass campaigns are of adequate potency at patients are not infective in the first days of fever, the time when they are administered in the field, parti- before the rash appears. cularly in remote rural areas, where storage and The question of the aerial spread of smallpox has transport facilities are deficient. aroused great controversy for many years.It was Before accepting any donated vaccine, the Organi- therefore thought of interest to obtain information on zation-as previously reported to the Fifteenth World the amount of virus disseminated in the air of a small- Health Assembly' - carries out tests on a sample of the pox ward and in the immediate surroundings of small- ' Meiklejohn, G. et al. (1961) Bull. Wld Hlth Org. 25, 63. ' Kempe, C. H. et al. (1961) Bull. Wld Hlth Org. 25, 41. 5 Nanning, W. (1962) Bull. Wld Hlth Org. 27, 317. 2 Marennikova, S. S. (1962) Bull. Wld Hlth Org. 27, 325. 6 Mimeographed document A15 /P &B /18 and A15 /P &B /18 3 Downie, A. W. et al. (1961) Bull. Wld Hlth Org. 25, 49. (Corrs 1 & 2) May 1962. ANNEX 16 201 vaccine from the lot offered for donation to the TABLE V. DONATIONS OF VACCINE Organization.This procedure is in accordance with TO THE SMALLPDX ERADICATION PROGRAMME thedecisionof theExecutive Board (resolution Receiving Called Estimated EB22.R12) that all vaccines donated to the Organi- Donor and project Deliveredforward-require- Doses quantity donatedor country not yet ments remaining zation for use in the eradication programme should be delivered for 1963 of an acceptable quality.The tests conform with those laid down in the WHO Study Group on Require- Union of Soviet Afghanistan 1 000 000 Socialist (SEARO30) ments for Smallpox Vaccine 1 and are made in one Republics Yemen 8 30000 of two reference laboratories of world repute.The 15 000 000 doses Yemen 16 750 000 500000 750 000 results are communicated to the donating Member (packed in 20 -dosePakistan 41 5 000 000 vials) Sudan 28 4 500000I 5000001 500000 State, and vaccines which pass the test are accepted. Ivory Coast 14 100000 320000 Hitherto, these tests have been made only on the Mali 7 5000001 000 000 Burundi 1 400000 first one or two batches of vaccine donated. Experience Nepal 100000 has shown, however, that potency variations can occur (SEA RO 30) Saudi between batches as produced. In addition, vaccines of Arabia 1 500 000 high potency, when dispatched from the production Togo 1 .150000 200000 Ghana 1 500 000 laboratory, may, for one or more of a number of Upper Volta 2 000 000 reasons, lose part of their potency. To some extent Dahomey 1 000 000 this is guarded against by the recommendation of the Guinea 300000 Seychelles 35 000 Organization that before a fresh batch of vaccine is Burma 900000 900000 distributed to the field it should be tested by an expe- 12 380 000 4 050 00010 005 000(1 435 000) rienced vaccinator for the primary vaccination of 50 to 100 children.If in these circumstances the Jordan Lebanon 2 350 000 " take " rate is under 90 to 95 per cent. it would be 3 000 000 doses (EMRO 16) unwise to distribute the batch before its potency is (liquid vaccine) Yemen 5 000 Sudan 100000 checked in the laboratory. This test, however, does not Cyprus 200000 show when the potency of the vaccine is not sufficient 2 655 000 for it to be used for revaccination. The importance of 345 000 this problem of potency of lymph for revaccination has India 1 000 000 become more apparent recently.The Organization Netherlands (SEARO 30) 2 000 000 doses proposes that in future a sample of each batch donated Nepal 9 100 000 (packed in 100- Ivory should be examined asitleaves the production dose vials) Coast 14 530000 laboratory and,if doubts arise,itshould be re- Somalia 14 370 000 examined after distribution in the field, sinceitis 2 000 000 Nil essential for the success of eradication that vaccines be used only when their potency is at its highest. Red Cross in Table V shows the position, at the time of reporting, German Ivory Democratic Coast 14 400800 599200 Nil of the donations of vaccine to WHO. It will be noted Republic that, in fact, there will be a shortfall of approxim- 1 000 000 doses ately 1 million doses in the 1963 requirements unless (100 -dose vials) further substantial donations are received by the Organization in the near future. Mexico Total gift transferred to the Regional 3 000 000 doses Office for the Americas fordisposal. 1 Requirements for biological substances, 5: Requirements for (liquid vaccine) smallpox vaccine (Wld Hlth Org. techn. Rep. Ser.1959, 180). 202 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
PART II A. PROGRESS TOWARDS SMALLPDX ERADICATION
Table VI shows the status at the time of reporting smallpox after having completed eradication pro- of countries participating in the global smallpox grammes. Four countries -Liberia in Africa, Colombia eradication programme.In all of them, smallpox in America, and Cambodia and Iran in Asia -have was endemic in1958 (when the Eleventh World completed eradication campaigns butstillreport Health Assembly decided to initiate a world -wide some residual foci.Ten countries (three in Africa, two in America and five in Asia) are at present deve- programme of smallpox eradication). loping eradication programmes. Twenty -two countries It will be noted that since 1958 five countries - (eighteen in Africa, one in America and three in Asia) Bolivia and Paraguay in America, and Ceylon (except have eradication programmes planned and ready. for small outbreaks as a consequence of imported Eight countries (seven in Africa and one in Asia) cases), Iraq and Lebanon in Asia - are now free from have as yet not set up plans for eradication.
TABLE VI. STATUS OF SMALLPDX ERADICATION PROGRAMMES IN ENDEMIC COUNTRIES (April 1963)
1. COUNTRIES WHICH HAVE NOT YET REPORTED PLANS FOR 3. COUNTRIES WHERE SMALLPDX ERADICATION PROGRAMMES SMALLPDX ERADICATION ARE IN PROGRESS
Africa America Asia Africa Asia Ivory Coast Argentina India Angola Mozambique Indonesia Mali Ecuador Nepal Bechuanaland Portuguese Guinea Sudan Pakistan (East) Ethiopia Togo Saudi Arabia Kenya Yemen
2. COUNTRIES WHICH HAVE A SMALLPDX ERADICATION PRO- 4. COUNTRIES WHICH HAVE COMPLETED SMALLPDX ERADICATION GRAMME READY CAMPAIGNS BUT WHERE RESIDUAL ISOLATED FOCI ARE STILL REPORTED
Africa America Africa America Asia Cameroon Guinea Brazil Liberia Colombia Cambodia Central African Mauritania Iran Republic Niger Chad Nigeria Congo (Brazzaville) Senegal Congo Sierra Leone 5. COUNTRIES WHICH HAVE SUCCESSFULLY COMPLETED SMALLPDX (Leopoldville) Tanganyika ERADICATION AND HAVE NOT REPORTED CASES THREE YEARS Dahomey Uganda AFTER THE CAMPAIGN Federation of Upper Volta Asia Rhodesia and America Asia Nyasaland Afghanistan Gambia Burma Bolivia Ceylon Lebanon Ghana Pakistan (West) Paraguay Iraq
B. PROGRESS IN THE SMALLPDX ERADICATION PROGRAMME IN THE WHO REGIONS, WITH SOME ESTIMATES OF FINANCIAL NEEDS
African Region Angola Population 4 832 677 (1960 census); no case was In the African Region where smallpox is endemic in many areas some appreciable progress in national reported in 1960 or 1961, 23 cases in 1962. A systematic vaccination programme is carried out annually. eradication activities is noted in some countries and territories, and vaccination control measures have been Basutoland intensified in a number of others. Population 697 000 (1961 estimate); 85 cases were ANNEX 16 203
reported in 1961, 52 cases in 1962. Over 80 per cent. provision of 150 000 doses of vaccine it would need of the population is stated to have been successfully for its campaign. vaccinated during the year and efforts are being made to improve the standard of vaccination. Congo (Leopoldville) Population 14 450 000 (1961 estimate); 605 cases Burundi and Rwanda were reported in 1960, 2251 in 1961, and 3785 in 1962. Population 4 929 000 (Burundi 2 234 000, Rwanda An epidemic occurred in the early months of 1962 in 2 695 000 -1960 estimate); 22 cases were reported in Leopoldville and was brought under control through 1960, 7 in Burundi and 10 in Rwanda in 1961, and a mass vaccination campaign. Sporadic cases of small- 26 in Burundi and 30 in Rwanda in 1962. In 1961 and pox and local outbreaks of varying severity are fre- the beginning of 1962 a mass vaccination campaign quently reported from provincial areas.A WHO was carried out in Rwanda. medical officer from headquarters was sent to Leopold- ville in February 1962 to advise on the mass vaccination Cameroon campaign which was implemented in the city and, in Population 4 097 000 (1960 estimate); 1345 cases November 1962, he paid a second visit to advise on were reported in 1961 (epidemic in North Cameroon), future activities in the control of smallpox and its 792 cases in 1962. A vaccination campaign has been ultimate eradication from the entire territory. A plan planned to cover about 1.5 million inhabitants each for a pilot eradication scheme in one province was year over three consecutive years. The total expend- prepared and presented to the Government.The iture necessary for the implementation of a smallpox Organization will provide the vaccine needed for mass eradication campaign is estimated at US $163 000. eradication campaigns.Transport, equipment and If this were combined with other health activities supplies will also be needed for the pilot scheme and the in the field, the cost would be about US $57 000. mass vaccination campaign which follows.
Central African Republic Dahomey Population 1 227 000 (1961 estimate); one case was Population 2 050 000 (1961 estimate); 768 cases were reported in 1960, none in 1961 and 57 cases in 1962. reported in 1960, 119 in 1961, and 90 in 1962.No Smallpox vaccination isbeing carried out by the formal smallpox eradication programme has as yet " Service de Lutte contre les Grandes Endémies " been planned. At the twelfth session of the Regional and will cover the total population in three years. Committee in 1962, the delegate of Dahomey expressed The Government has requested assistance in obtaining the Government's desire to participate in the regional 1 200 000 doses of vaccine, supplies and equipment, eradication effort and accordingly an eradication the totalcost of which would be approximately campaign will soon be planned with WHO's assistance. US $10 000. Assistance needed would mainly consist of supplies Chad ofvaccines -twomilliondoses -and equipment and other supplies. Population 2 680 000 (1961 estimate); 4 cases were reported in 1960, 273 in 1961 and 749 in 1962.The Federation of Rhodesia and Nyasaland Government's cost estimate for an eradication pro- gramme is US $163 265.In addition, one medical Population 8 630 000 (1961 estimate); 1157 cases officer, 30 dressers and 60 auxiliaries, 15 vehicles, were reported in 1960, 1701 in 1961, and 994 in 1962. equipment and supplies, and three million doses of The Government considers that, at present, it can dried vaccine are needed. cope with its programme, including the purchase of vaccine lymph.The Government would welcome a Congo (Brazzaville) visit from a WHO consultant to observe work done Population 900 000 (1960 estimate); 22 cases were in the field of smallpox eradication in countries in reported in 1961, and 1313 in 1962. Smallpox vaccin- south -central Africa. ation campaigns are carried out regularly each year by the " Service des Grandes Endémies ". In Brazza- Gambia ville and Pointe- Noire, the Pasteur Institute and the Population 284 000 (1960 estimate); 7 cases were general health service help in the development of the reported in 1960, 12 in 1961, and four in 1962.It is annual vaccination programme. In 1962 the epidemic planned that a smallpox eradication programme in which broke out in Brazzaville was brought under Gambia would last for three years.The principal control as the Government had vaccine available. For needs in this connexion would be a suitable vehicle 1963, the Government requested assistance in the and a supply of vaccine. The annual cost, estimated by 204 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I the Government, would be US $4200, and the total The Governmenthasrequested WHO's and cost of a three -year programme US $12 600. UNICEF's assistance to develop a freeze -dried vaccine Ghana production centre at the Pasteur Institute at Kindia. Population 6 943 000 (1961 estimate); 139 cases Once this centre is established it could produce about were reported in 1960, 70 in 1961, and 135 in 1962. 20 million doses of freeze -dried vaccine to meet the In view of the fact that the incidence of smallpox needs of neighbouring countries, in addition to those in Ghana is low compared with that in some of for smallpox control measures in Guinea. the neighbouring countries,the Government has Ivory Coast decided tointensifyitsexisting smallpox control Population 3 300 000 (1961 estimate); 1634 cases measures rather than initiate a country -wide mass were reported in 1960, 4656 in 1961, and 1900 in 1962. vaccination campaign.This new programme will A national smallpox eradication campaign was started be supported by legislative and administrative meas- in July 1961 and is still in progress. Up to 31 December ures to enforce vaccination and to give the vaccinators 1962, a total of 3 109 943 vaccinations had been per- the necessary authority for the effective vaccination of formed.The campaign, which started along the the population, since co- operation from the public northern, eastern and western boundaries of the may not always be forthcoming. The population of country, is now moving towards the southern areas. the rural areas will be vaccinated by the medical It is scheduled to be completed by the end of 1963, field units, whose sphere of activity has been enlarged whenitisexpected tohave covered thetotal in recent years.They will also be responsible for population. vaccination at frontier posts on the main highways The Organization has provided freeze -dried vaccine near the borders.Hospitals, maternal and child for the campaign and a supply of approximately health clinics, health centres and dispensaries will all 600 000 doses has been called forward for 1963. take part in the intensified vaccination programme which, it is hoped, will cover infants, their mothers Kenya and the general public.The school population will Population 7 287 000 (1961 estimate);151cases be vaccinated by school- teachers (600) who have were reported in 1960, 289 in 1961, and 96 in 1962. alreadybeentrainedinvaccinationtechniques. No eradication campaign is planned for Kenya which These volunteers, it is hoped, will maintain an adequate places reliance on a continuing programme to main- group immunity among school -age children. tain an 80 per cent. current vaccination status. Other groups, such as the army, police, factory and otherspecializedgroupsofworkers,university Liberia students, and the large number of people usually Population1 290 000 (1960 estimate); 1119 cases encountered at lorry parks, markets, etc.,will be were reported in 1961, and 323 in 1962.A WHO - vaccinatedthroughthisstrengthenedvaccination assisted smallpox eradication project was due to start programme. at the end of 1962. An amendment to the project has The estimated costtothe Government during recently been agreed upon whereby the WHO senior the period of this intensified smallpox campaign will medical officer assigned to the campaign will conduct a be approximately US $548 800 per year.Ghana has study to assess the immunity status of the inhabitants requested assistance in the supply of six million doses in the light of the mass vaccination campaign which of freeze -dried vaccine for the four -year period of the covered a large proportion of the population in 1961 intensified programme, and transport and refrigerators and the first five months of 1962.This assessment would also be needed. campaign,whichstartedinDecember1962,is scheduled to last six months. Guinea WHO has provided one senior medical officer and Population 3 000 000 (1960 estimate);176 cases has agreed to provide the total amount of vaccine to were reported in 1960, 96 cases in 1961, and 2948 in carry out a mass vaccination programme, but not 1962. Wishing to participate in the regional smallpox the vaccine required for maintenance of vaccination. eradication effort, the Government ispreparing a WHO has also been requested to provide a fellowship vaccination programme to cover the whole population for the training of a medical officer. of the country. A WHO medical officer from head- quarters recently visited Guinea and advised on the Mali planning of an eradication campaign. The Govern- Population 4 100 000 (1961 estimate); 1212 cases ment would need assistance in obtaining the necessary were reported in 1960, 1706 in 1961, and 1427 in 1962. quantities of freeze -dried vaccine for the campaign In 1961 a short -term consultant visited Mali to advise and also transport vehicles for remote rural areas. on the smallpox situationthere. Following his ANNEX 16 205 report a WHO- assisted plan of operation for smallpox storage of the vaccine at Niamey and Zinder; and also eradication was agreed upon, whereby at least 80 per vaccination equipment and supplies. The teams' cent. of the total population will be vaccinated within a sole duty would be to vaccinate the population in three -year period. The Organization is providing the villages, market places and in scattered dwellings in freeze -dried vaccine for the campaign. Some 300 000 the rural areas. The Service des Grandes Endémies inhabitants were vaccinatedinearly1962 before will direct the programme and it is hoped that with the rainy season and the campaign was resumed in the new group of mobile teams the entire population December. The Government has requested a WHO of the country will have been covered in two years. medical officer to assist in the implementation of the Special smallpox vaccination cards will be delivered campaign. to those vaccinated.
Mauritania Nigeria Population 791 000 (1960 estimate); 44 cases were Population 36 473 000 (1962 estimate); 4140 cases reported in 1960, 12 in 1961, and 40 in 1962. Mauri- were reported in 1960, 3538 in 1961, and 3863 in tania's health services have recently established four- 1962. The estimated needs, expressed as costs, to teen health divisions. A doctor is in charge of the implement a smallpox eradication programme in the medical centre of each division and its dispensaries regions of Nigeria are as follows : in the rural areas. Forty -eight such dispensaries us$ serve the ruralareas and a qualifieddresseris (a) Northern Nigeria - over a three -year period : responsible for each dispensary.Since 1958, three Labour, transport, vaccine equipment and regional hospitals have been established in the im- permanent staff 1680000 portant centres of Atar, Aïon- el- Atrouss and Kaidi. (b)Eastern Nigeria : In order to attend the nomadic population, four Four boats, land transport and travelling, nomad squads and a special unit have been set up. temporary staff, vaccine, equipment, etc. The National Hospital of Nouakchott, with its school health education, contingencies 1674400 of nursing, will be the training centre for male and (c)Western Nigeria : female nurses in Mauritania. When completed, it will Wages, salaries, drivers, drugs and equipment, help pilot schemes for eradication activities in Mauri- fuel and maintenance of transport, boats tania. for creek areas 359800 In addition, 16 million doses of freeze -dried Mozambique vaccine. Population 6 592 994 (1960 census); 81 cases were (d)Federal Territory of Lagos : reported in 1960, 51 in 1961, and 67 in 1962.No Additional staff and equipment for three years 28000 eradicationschemeisplannedfor Mozambique. However, a yearly vaccination programme is main- Rwanda tained, whereby thousands of vaccinations are per- See Burundi and Rwanda. formed with a locally produced vaccine. Senegal Niger Population 2 980 000 (1961 estimate); 6 cases were Population 3 112 000 (1962 estimate); 2408 cases reported in 1960, 201 in 1961, and 231 in 1962. A were reported in 1960, 1740 in 1961, and 1038 in 1962. quadrennial vaccination plan is in progress. Beginning In Niger thereisa programme for quadrennial in 1963 the Service des Grandes Endémies is starting vaccinationagainstsmallpoxandyellowfever. vaccination of the whole population of the seven Vaccination is carried out by (a) mobile teams for regional areas. The Cape Vert region, however, will nomads -in west and east Niger; (b) mobile units in be dealt with by the health service. The Government the district; (c) school health services; and (d) maternal has requested assistance in the form of freeze -dried and child health services.In 1961, 124 000 persons vaccine (one million doses each year); and has also were vaccinated. Coverage, however, is not more than indicated that it will need additional personnel for 56 per cent. In order to reach a high proportion of the the vaccination campaign (US $12 898) and financial population and obtain at least an 80 per cent. vaccina- help for the operation and maintenance of existing tion and revaccination coverage over a period of two transport (US $8571). years, five new mobile smallpox vaccination teams would be necessary. The Government has requested Sierra Leone assistance as follows :transport (five vehicles), two Population 2 450 000 (1961 estimate); 12 cases were million doses of vaccine and two refrigerators for the reported in 1960, 6 in 1961, and 78 in 1962.It is 206 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I estimated that four teams will be required for launch- follows :1 medical officer; 3 sanitarians; 10 000 000 ing a mass vaccination campaign in Sierra Leone. doses of freeze -dried vaccine and insulated lymph These teams will work simultaneously in each of containers;34 four -wheel -drivevehicles;60 ultra the four provinces, the western area being regarded light- weight collapsible motor -cycles; 248 light- weight as a province, in order to cover the whole country camp beds; 596 blankets; 38 sets of camp equipment; within a period of from nine to twelve months, taking 34 pressure lamps; 100 hurricane lamps. into consideration that very little can be done during Togo the heavy rains.The composition of each team, Population equipment and estimated cost per province are : one 1 500 000 (1962 estimate); 347 cases health superintendent or senior health inspector, were reported in 1960, 281 in 1961, and 572 in 1962. A smallpox vaccination programme, to be integrated five vaccinators, and two drivers; two four -wheel -drive vehicles (long wheel- base), one portable refrigerator, with a WHO- assisted yaws campaign, is being finalized The Organization will provide the freeze -dried vaccine. two large vacuum flasks, five vaccination kits, one first - aid box with equipment to last nine months, travelling Uganda expenses, fuel and oil, overtime fees (drivers), sta- Population 6 845 000 (1961 estimate); 707 cases tionery, 14 motor -cycles (350 cc) -US $31 088. The were reported in 1960, 398 in 1961, and 628 in 1962. cost for the four provinces is therefore estimated at The average vaccination rate in Uganda over the US $124 352. past five years is one million vaccinations per year. South Africa To carry out a mass vaccination campaign would Population 16 236 000 (1961 estimate); 65 cases were present little difficulty from the point of view of staff. reported in 1960, 7 in 1961, and 112 in 1962. Measures The Government's requirements have been indicated for controlling and eventually eradicating smallpox as follows : have been in continuous operation for over forty (a) Vaccine: depending on whether or not dried years. These measures have recently been intensified. vaccine is to be used, financial provision is required Sporadic outbreaks, which are frequently proved to for the purchase of suitable insulated containers have been caused through infected persons from for the transport and storage of lymph in rural other territories entering the Republic, still occur. areas.Estimated cost US $1400.The estimated Such outbreaks are, however, quickly brought under cost of lymph is US $70 000. control and localized, thus preventing the spread of the (b)Transport: vehicles. Estimated cost US $2800. disease to other areas.Adequately equipped to deal Upper Volta with the situation in its territory, the Government 126 cases consequently does not requirefinancialor other Population 4 400 000 (1961estimate); assistance for the implementation of its smallpox were reported in 1960, 2360 in 1961, and 1335 in 1962. campaign. The Government is eager to carry out a smallpox eradication programme. During the visit of a medical Tanganyika officer from WHO headquarters in October 1962, a Population 9 560 000 (1962 estimate); 1584 cases scheme was discussed with the health authorities and were reported in 1960, 908 in 1961, and 973 in 1962. it was agreed that a formal eradication plan should The Government has prepared a smallpox eradication be sent to the Regional Office for Africa. The Govern- scheme, the basis of which is the vaccinating unit, ment will need assistance in the form of supplies of consisting of a vaccinator and a recorder whose duties vaccine necessary for the mass campaign, vehicles and are interchangeable.Each such unit is expected to portable refrigerators. The mobile units of the Service vaccinate an average of 150 persons per day for 300 des Grandes Endémies will be supported during the days a year. These units will be organized in teams of vaccination campaign by a large number of vaccin- three units, with one supervisor and one driver, ation centres to be established in dispensaries, health travelling in a four- wheel -drive vehicle, and having centres, etc. ultra light- weight motor -cycles to enable them to reach small pockets of population groups inaccessible to Region of the Americas four -wheel transport.Ten vaccinating teams will be The smallpox eradication programme in the southern supervised by a sanitarian, travelling in a four- wheel- hemisphere is progressing satisfactorily.Of the 1923 drive vehicle and accompanied by a clerk -interpreter. cases of smallpox reported in 1961, 1411 occurred in The whole scheme will be supervised by a medical Rio de Janeiro, Brazil, 491 in Ecuador, 16 in Colombia, officer, who will travel by four- wheel-drive vehicle, 4 in Argentina and one (imported) in Uruguay.In and have a clerk -interpreter.The Government has 1962 a total of 3029 cases was reported, of which 2759 indicated that it will require considerable assistance, as occurred in Brazil, 205 in Ecuador, 41 in Colombia, ANNEX 16 207
11 in Venezuela and 10 in Uruguay.The highest areas in the mountains and on the coast, still have incidence of smallpox is still in Brazil and Ecuador. to be vaccinated. The Government request for material The smallpox eradication campaign in Colombia is assistance for vehicles for the transport of personnel, a good example of proper planning, organization and laboratory equipment to increase the production of operation.The Organization collaborated with the dried smallpox vaccine, field equipment, as well as Government of Colombia in the conduct of this sanitary inspectors to co- operate with local personnel programme by furnishing a full -time consultant and in the organization, development and supervision of a consultant specialized in dried -vaccine production, field activities, amounting to approximately US $57 000 and by providing fellowships. has been met. ThePanAmericanSanitaryBureau /Regional Office for the Americas signed an agreement with South -East Asia Region Bolivia in February 1963 for a nation -wide campaign Encountering many demographic, financial and, to to vaccinate three million Bolivians against smallpox. some extent, technical difficulties, this densely popul- The figure represents 86 per cent. of the nation's total ated and highly endemic region is,at the present, population of 3.5 million.Following the vaccination particularly active in the global eradication effort. of almost 80 per cent. of the population in 1958, the The Indian national eradication programme, planning reported number of smallpox cases dropped from the and implementation are being watched with great yearly average of 604 between 1946 and 1957, to interest and hope. 7 in 1959.One case was reported in 1960; none in Afghanistan 1961 and 1962. The nation -wide campaign will be the country's Population 13 800 000 (1960 estimate); 111 cases first since 1958. Its aim is to maintain in the population were reported in 1960, 174 in 1961, and 303 in 1962. a high level of immunity against smallpox. In 1959 the Government adopted a country -wide pre- eradication control programme, making vaccin- Brazil ation compulsory. Up to March 1962, four million Population 75 271 000 (1962 estimate); 650 cases people had been vaccinated in Kabul and the provinces. were reported in 1960, 1411 in 1961, and 2759 in 1962. WHO has provided a medical officer to advise on the The Government has recognized the need to eradicate organization of the eradication programme. Assistance the disease and has decided to initiate a programme needed by the Government consists of transport, experimentally in some areas of Rio de Janeiro and of refrigerators, thermos flasks and 3 750 000 doses of the state of Sergipe, and subsequently to extend it to freeze -dried vaccine to be supplied in instalments the state of Alagoas. Once the most suitable working through 1962, 1963, 1964 and 1965. One million doses methodshavebeenestablished,thevaccination of vaccine have already been supplied. campaign will be extended to cover the entire country, Burma unti180 per cent. of the population has been covered. The Organization has provided the equipment for pro- Population 22 342 000 (1962 estimate); 392 cases ducing freeze -dried vaccine; in addition a fellowship were reported in 1960, 88 in 1961 and 21 in 1962. has been awarded to enable a medical officer to visit In recent years progress in reducing the incidence of various centres producing dried vaccine on a large smallpox has been achieved by a vaccination pro- scale. gramme carried out by the network of rural health centres.In December 1961 a plan for a smallpox Colombia eradication programme was prepared by the depart- Population 14 443 000 (1961 estimate); 171 cases ment of health and is being considered by the Govern- were reported in 1960, 16 in 1961, and 41 in 1962. ment. Under this plan it is recommended that pilot The smallpox vaccination programme was initiated areas representative of the prevailing conditions in the in October 1955 and completed in April 1962.In all country should be selected in order to study the most 11 273 085 persons were vaccinated, of whom about practical approach and the requirements for a sub- 4 484 000 were primary vaccinees. sequentnation -wide mass vaccinationcampaign. The pilot eradication programme is expected to be Ecuador started in May 1963. WHO assistance to the pilot Population 4 579 000 (1962 estimate); 3185 cases projects would consist of supplies of freeze -dried were reported in 1960, 491 in 1961 and 205 in 1962. vaccine. The aim of the smallpox eradication programme in Ecuador, which was initiated in 1958, is to vaccinate India 80 per cent. of the population within a period of five Population 441 631 000(1961estimate);31 052 years.Over 1.5 million persons, who live in remote cases were reported in 1960, 45 195 in 1961, and 208 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
42 231 in 1962. After the conclusion on 31 March 1961 authorities organized vaccination campaigns.Cases of the pilot projects which were carried out in all of smallpox were also reported from some areas in 16 states, and after much useful experience had been South Sumatra.In September and October 1962 an gained in the planning of an economical, practical outbreak occurred in Bandung and an intensified and effective eradication campaign, the Government vaccination programme was immediately set up to reported on 25 April 1962 that the national eradication control the epidemic.In November 1962 a smallpox programme had already been launched. By January epidemic occurred in Bekasi (about 50 kilometres 1963 the smallpox eradication programme was com- east of Djakarta) and a mass vaccination campaign has pleted in 23 districts and is now in progress in 125 been started by the epidemiological unit and the local others.53.65 million vaccinations were performed. health authorities. UNICEF has provided five jeeps. A committee was constituted to assess and evaluate the The UNICEF /WHO- assistedfreeze -driedvaccine smallpox eradication programme in the Union Terri- manufacture unit in Bandung was, at the time of tory of Delhi in its attack phase. The assessment work reporting, in the experimental phase of production. started on 13 March 1963, and the results, when completed, could serve as a prototype for assessment Nepal of the programmes elsewhere in India. Population 9 388 000 (1961 census); no cases were The Government of the USSR, under a bilateral reported in 1960, five in 1961, and no cases in 1962. assistanceagreement,hasundertakentosupply The WHO- assisted smallpox control pilotproject 250 million doses of freeze -dried vaccine free of charge which started in February 1962 is in progress. Planned to India in eight equal quarterly instalments, com- to cover a population group of approximately 450 000 mencing in January 1962, to meet the additional people in Kathmandu, the pilot project's short -term requirements of smallpox vaccine for the national objectives are : smallpox eradication programme.The Government (a)to train national health personnel in vaccina- of India requires for its vaccine- producing institutes tion techniques, care of vaccine, record -keeping, equipment such as deep- freeze cabinets for storing and generally in the organization and conduct of the vaccine. In addition, it has considered the possibil- the vaccination programme, including health educa- ity of starting to manufacture freeze -dried vaccine at tion aspects of the scheme; Belgaum (Mysore) and Namkum (Bihar) to supplement (b)to build up a nucleus of smallpox vaccination the existing WHO- and UNICEF -assisted producing activities in a limited area in the first instance. centresatGuindy(Madras)andPatwadangar (Uttar Pradesh). The Government also found it The long -term objectives of the pilot project are necessary to plan a health education campaign as an gradually to expand the smallpox control programme essential part of the eradication programme. as and when the situation permits, in order to build up The estimated cost of assistance needed from inter- the group immunity of the population to a level at national sources is US $2 549 412.The total cost which smallpox is no longer a public health problem. estimate for the national programme is approximately The Organization's assistance consists of one public 16 million dollars. health nurse, and equipment and supplies which include transport (one jeep station -wagon) and freeze - Indonesia dried vaccine for the campaign. An estimate of Population 96 750 000 (1961 estimate); 5196 cases international assistance which may be required for an were reported in 1960, 3777 in 1961, and 586 in 1962. eradication campaign in Nepal will only be possible No formal smallpox eradication programme for the some time in 1964, after the results of the pilot project country has as yet been planned. A WHO epidemio- over a period of two years have been assessed. logist in Indonesia is helping the health authorities to establish a network of provincial epidemiological Thailand services. Epidemiological sections have now been Population 27 181 000 (1961 estimate); 32 cases in established in Djakarta, Semarang and Surabaya, 1960, 33 in 1961, and two in 1962.For the last few and inthe near futuresimilarsectionswill be years, smallpox has not been a major problem in established in Medan (North Sumatra), Makassar Thailand. The smallpox eradication programme which (South Sulawesi) and in Palembang (South Sumatra). was launched by the Government in 1961 is in progress. With this strengthening of the country's epidemio- The objective of this programme is to vaccinate yearly logical organization a country -wide programme for one -third,or about eight million people, of the smallpox eradication would be developed. Outbreaks estimated total population of 25 millionA total of have been reported in 1962 from Serang and some 7 261 141 vaccinations was performed in 1961.Inter- regencies in Bandung (West Java) and the local health national assistance requested consists of six vehicles ANNEX 16 209 for supervisors of field work, and supplies of vaccine was started in November 1961. The vaccination of the in 1962 and 1963 respectively.The UNICEF /WHO- total population of East Pakistan will be achieved in assistedfreeze -driedvaccineproductionunitin three phases from November 1961 through December Bangkok started production in 1960 and the output 1967. The first phase will be terminating at the end is expected to increase in 1963 with additional equip- of 1963 and the two subsequent follow -up phases will ment. be conducted from 1964 through 1965, and from 1966 through 1967.This programme has been made the direct responsibility of an assistant director of Eastern Mediterranean Region health services under the control of the director of In the Eastern Mediterranean Region almost all health services.In the 17 districts the chief medical the remaining endemic countries and territories are officer of health or the district health officer is in now actively implementing eradication programmes. charge of the implementation of the scheme. At the Pilot controlprojects,eradication campaigns and sub -divisional level, the health officers are responsible intensified vaccination control measures have shown for the detailed planning, operation and supervision substantial progress in 1962. of the vaccination campaign. Vaccine. Since the middle of 1961 the Institute of Ethiopia Public Health in Dacca has ' produced freeze -dried Population 20 000 000 (1960 estimate); 293 cases smallpox vaccine of satisfactory quality. The present were reported in 1960, 761 in 1961, and 360 in 1962. output is about 1.2 million doses a week which can The Government is finding it difficult to undertake a easily be raised to 2 million doses and which largely mass campaign against special diseases because of covers the requirements for the planned province -wide the very inadequate basic public health services.At mass campaign. The Organization supplied the present,all efforts are being concentrated on the Government of East Pakistan with 5 million doses gradual development of these services, and the small- of vaccine from the USSR donation, and that vaccine pox campaign is to be integrated with the over -all was used in the pilot phases. Further requirements for services of the health centres and health stations. the campaign are indicated as transport and equipment Since 1961 a department has been established in the and supplies for freeze -dried vaccine production at central reference laboratory (at the Pasteur Institute) an estimated cost of US $619 727. with the assistance of the Organization, for the pro- duction of lyophilized vaccine, the quality of which West Pakistan.Population 42 880 378. has been found to meet the recommended standards. The Government has decided to integrate a smallpox This is a good step towards eventual undertaking of vaccination campaign with the BCG campaign over mass vaccination in remote areas, using the local health a period of five years.Assistance required for the facilities. A combined mass vaccination campaign smallpox eradication programme has been indicated against smallpox and yellow fever was carried out in as 50 jeeps, 200 refrigerators and 4000 thermos flasks. the south -western provinces of Ethiopia early in In addition, equipment will be required for the 1961. About 800 000 persons were vaccinated and increased production of dried smallpox vaccine. The vaccination campaignsarebeing continued and estimatedtotalcostoftheserequirementsis systematically expanded to cover large areas and more US $330 743. of the population. Saudi Arabia Pakistan Population 6 036 000 (1956 estimate); 32 cases were Population 93 720 613 (1961 census); 2005 cases reported in 1960, but none in 1961, and one only in were reported in 1960, 2741 in 1961, and 3420 in 1962. The Government, being aware of the endemicity 1962. of smallpox, its periodic outbreaks in certain parts of the peninsula and the potential danger to the East Pakistan. Population 50 840 235. country of international traffic, has planned an eradica- Following the visit of a WHO consultant in 1960, tion programme with the assistance of the Organi- East Pakistan has planned a scheme aiming at the zation. The objective of the agreement is the eradica- eradication of smallpox in that province.After a tion of smallpox through the vaccination of the entire pilot phase, which was carried out in the districts of population within three years. The Organization will Tipperah (population of approximately 4.4 millions) provide assistance in the form of ad hoc short -term andFaridpur(populationof approximately3.2 consultants as may be required in 1963, 1964. and millions) from January to November 1961, a mass 1965, 4.5 million doses of freeze -dried vaccine to be vaccination campaign covering the whole province supplied by instalments, and transport. 210 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Sudan eradication project in Yemen was agreed toin Population 12 650 000 (1962 estimate); 135 cases December 1961. The aim of the project is to eradicate were reported in 1960, 104 in 1961, and 70 in 1962. smallpox by vaccinating the entire population within A plan of operation for a WHO- assisted smallpox three years. The Organization has agreed to provide control and eradication project in Sudan was agreed to one short -term consultant for three months in 1962 in July 1962. The project aims at eradicating smallpox and three months in 1963, three million doses of by vaccinating the entire population in four years. To freeze -dried vaccine to be provided in instalments, this end the country would be divided into four transport and all medical supplies needed for the divisions, each to be covered in one full year of opera- campaign. A decree for compulsory and free vaccina- tions.In the first year a pilot scheme will cover, in tion of all the inhabitants of Yemen, including the the western zone of the country, the Kordofan and newly -born, was issued on 2 July 1962. On 10 Sep- Darfur provinces with a total population of 3 417 000 tember 1962 the whole population of the city of Sanaa, inhabitants.The Organization's assistance for the the capital, was vaccinated. pilot scheme is one short -term consultant /epidemio- logist for a month in 1961, and a month in 1962; three million doses of freeze -dried vaccine to be Western Pacific Region supplied in instalments of one million doses, transport, Countries in the Western Pacific Region are at the sterilizers, refrigerators and thermos flasks. present time free from endemic smallpox. Vaccination control measures and intensified vaccination pro- Yemen grammes are, however, being undertaken by most Population 5 000 000 (1960 estimate); no reports countries in order to maintain a level of immunity by are available on the incidence of cases.A plan of which serious outbreaks could be avoided when and operation for a WHO -assisted smallpox control and where the disease is introduced. INDEX TO RESOLUTIONS AND DECISIONS
The resolutions are printed, in the numerical order of the resolution symbol, on pages Ito 22. The procedural decisions, indicated by roman numerals in brackets, appear on pages 23 and 24.
Resolution No. Resolution No Accommodation, headquarters, progress report, W HA 16.22 FAO /WHO joint programme on food standards,WHA16.42 Regional Office for Africa, WHA 16.9 Financial report on accounts of WHO for 1962, WHA16.5 Africa, Regional Committee, meetings, WHA 16.43 Food standards, joint FAO /WHO programme, WHA16.42 Africa, Regional Office, accommodation, WHA16.9 African Regional Office Building Fund, WHA16.9 General Committee, establishment, (vi) Agenda, adoption, (vii) Algeria, assessment for 1962 and 1963, WHA16.7 Headquarters accommodation, progress report, WHA16.22 credit towards contributionto malaria pro- Health education, through television, WHA16.25 gramme, WHA16.8 Annual Report of the Director -General for 1962,WHA16.12 International Atomic Energy Agency (IAEA), Apartheid WHA16.43 seeUnited Nations Appropriation Resolution, 1962 and 1963, addi- International Civil Service Advisory Board, WHA16.32 tion to Schedule A, WHA16.8 International Quarantine, Committee on, eleventh 1963, amendment, WHA16.6 report, WHA16.35 1964, WHA16.28 International Sanitary Regulations, amendments,WHA16.34 Arrears of contributions, WHA16.20 Assessment, new Members, for 1962 and 1963, WHA1 6.7 Jamaica, assessment for 1963, WHA16.7 scale, for 1964, WHA16.10 credit towards contributionto malaria pro- Associate Members, admission, Kenya, WHA16.4 gramme, WHA16.8 Mauritius, WHA 16.3 Kenya, admission to associate membership, WHA16.4 Budget, level for1964, and effective working credit towards contributionto malaria pro- budget, WHA16.13 gramme, WHA16.8 supplementary estimates for 1963, WHA1 6.6 Burundi, assessment for 1962 and 1963, WHA1 6.7 Main committees, officers, (v) credit towards contribution to malaria pro- Malariaeradication,acceleratedprogramme, gramme, WHA1 6.8 financing, WHA16.17 development of programme, WHA16.23 Children, influence of television on, WHA16.25 Members eligible for credits, for 1962 and 1963,WHA16.8 Codex Alimentarius, WHA16.42 for 1964, WHA16.28 Committee on Credentials, composition, (i) postage stamps, WHA16.18 Committee on International Quarantine, eleventh UNICEF assistance, WHA16.24 report, WHA16.35 Malaria Eradication Special Account, WHA16.17 Committee on Nominations, composition, (ii) Mauritius, admission to associate membership,WHA16.3 Community water supply programme, WHA16.27 credit towards contribution to malaria pro- Conferencescheduling,co- ordination, WHA16.33 gramme, WHA16.8 Contributions, status of collection, WHA16.20 Medical education, in newly independent countries, See alsoAssessment organizational study, WHA16.29 Credentials, Committee on, composition, (i) Medical research programme, WHA16.26 verification, (iii) Mental health, influence of television on, WHA16.25
Director -General, Annual Report for 1962, WHA16.12 Newly independent States, continued assistance to,WHA16.31 appointment, WHA16.1 medical education in, organizational study, WHA16.29 contract, WHA16.2 Nominations, Committee on, composition, (ii) Drugs, clinical and pharmacological evaluation, WHA16.36 standards, for export, WHA16.38 Officers, of Health Assembly, of main committees, (v) Executive Board, election of Members entitled to Organizationalstudy,medicaleducationand designate a person to serve on, WHA16.11 training in newly independent countries, WHA1 6.29 organizational study, medical education in newly planning and execution of projects, WHA16.30 independent countries, WHA16.29 planning and execution of projects, WHA16.30 Pension Board, United Nations Joint Staff, annual thirtieth and thirty -first sessions, reports on, WHA16.44 report for 1961, WHA16.19 External Auditor, appointment, WHA16.14 Pension Committee, WHO Staff, appointment of report for 1962, WHA16.5 representatives, WHA16.21 - 211 - 212 SIXTEENTH WORLD HEALTH ASSEMBLY, PART I
Resolution No. Resolution No. Planning and execution of projects, organizational Trinidad and Tobago, assessment for 1963, WHA16.7 study, WHA16.30 credit towards contributionto malaria pro- Regional Committee for Africa, meetings, WHA16.43 gramme, WHA 16.8 Regional Office for Africa, accommodation, WHA 16.9 Rwanda, assessment for 1962 and 1963, WHA 16.7 Uganda, assessment for 1963, WHA16.7 credit towards contribution to malaria pro- credit towards contributionto malaria pro- gramme, WHA16 8 gramme, WHA16.8 United Nations, decisions affecting WHO, admin- Salaries and allowances, inter -organization ma- istrative, budgetary and financial matters, WHA16.32 chinery for matters of, WHA16.32 conference scheduling, WHA16.33 Seventeenth World Health Assembly, country of inter -organizational machinery for matters of meeting, WHA16.16 pay and allowances, WHA16.32 Smallpox eradication programme, WHA 16.37 programme matters, WHA16.39 Special Account for Accelerated Assistance to United Nations Children's Fund (UNICEF), co- Newly . Independent and Emerging States,WHA16.31 operation with, WHA16.24 Special Account for Community Water Supply,WHA16.27 United Nations Development Decade, WHA 16.40 Special Account for Medical Research, WHA16.26 United Nations Joint Staff Pension Board, annual Specialized agencies, decisions affecting WHO, report for 1961, WHA16.19 administrative, budgetary, and financial mattersWHA16.32 United Nations Relief and Works Agency for Pa- conference scheduling, WHA16.33 lestine Refugees in the Near East (UNRWA), inter -organizational machinery for matters of extension of agreement with, WHA16.41 pay and allowances, WHA16.32 programme matters, WHA16.39 Voluntary Fund for Health Promotion, Special Staff Pension Committee, appointment of represen- Account for Community Water Supply, WHA16.27 tatives, WHA16.21 Special Account for Medical Research, WHA16.26 Staff Rules, amendments, WHA16.15 Supplementary budget estimates for 1963, WHA16.6 WorkingCapitalFund,advancefrom,for Swiss Confederation, contribution to headquarters Regional Office for Africa, WHA16.9 building, WHAI6.22 status of advances, WHA16.20 World Health Assembly, Seventeenth, country of Television, influence on youth, WHA16.25 meeting, WHA16.16