WORLD HEALTH ORGANIZATION

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WORLD HEALTH ORGANIZATION

REGIONAL COMMITTEE FOR THE WESTERN PACIFIC FORTY -SIXTH SESSION

Manila, 11-15 September 1995

REPORT OF THE REGIONAL COMMITTEE SUMMARY RECORDS OF THE PLENARY MEETINGS

Manila November 1995

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WORLD HEALTH ORGANIZATION

REGIONAL COMMITI'EE FOR THE WESTERN PACIFIC FORTY ·SIXTH SESSION

Manila, 11·15 September 1995

REPORT OF THE REGIONAL COMMITTEE SUMMARY RECORDS OF THE PLENARY MEETINGS

Manila November 1995

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PREFACE

The forty-sixth session of the Regional Committee for the Western Pacific was held at the regional headquarters in Manila, Philippines, from 11 to 15 September 1995. Dr Joseph Williams (Cook Islands) and Dr Chhea Thang (Cambodia) were elected Chairman and Vice-Chairman, respectively. Ms Julia Nesbitt (Australia) and Dr Khamphay Rasmy (Lao People's Democratic Republic) were the Rapporteurs.

The Regional Committee met on 11, 12, 13, 14 and 15 September. The Report of the Regional Committee is in Part I of this document, on pages 1-69; the summary records of the plenary meetings are in Part II, on pages 71-241.

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CONTENTS

PART I - REPORT OF THE REGIONAL COMMITrEE

INTRODUCTION AND SUMMARY ... 3

I. REPORT OF THE REGIONAL DIRECTOR COVERING THE PERIOD 1 JULY 1993 TO 30 JUNE 1995 ... 5

II. NEW HORIZONS IN HEALTH ... ... 7

m.

PROGRAMME BUDGET ... 8

1. Budget perfonnance, 1994-1995 (interim report) ... .. 8

2. Changes in the 1996-1997 programme budget and in future programme budgeting ... . 8

3. Regional allocations ... .. 9

IV. SUB-COMMITTEE OF THE REGIONAL COMMITTEE ON PROGRAMMES AND TECHNICAL COOPERA nON ... ... ... ... 11

1. Country visits: Report of the Sub-Committee, Part I 11 2. WHO Response to Global Change: Report of the Sub-Committee, Part II ... .. 11

V. OTHERAGENDAlTEMS ... 12

1. Health and environmental effects of nuclear weapons ... 12

2. Annual report on AIDS, including sexually transmitted diseaSes ... 13

3. Joint United Nations Programme on AIDS ... 14

4. Eradication of poliomyelitis in the Region: Progress report ... 15

5. Development of health research ... ... ... ... ... 16

6. Nutrition: Progress report on infant and young child nutrition and on the implementation of the International Code of Marketing of Breast-milk Substitutes ... 16

7. Leprosy ... 17

8. Reproductive health ... .. ¹⁷ " - > . ' 9. International Decade of the World's Indigenous People ... 18

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CONTENTS

10. Correlation of the work of the World Health Assembly, the Executive Board

and the Regional Committee .... ... ... ... ... ... ... ... ... ... 19 11. Selection of topic for the Technical Discussions to be held in conjunction

with the forty-seventh session of the Regional Committee ... 20 12. Time and place of the forty-seventh and forty-eighth sessions

VI.

of the Regional Committee .... ... ... ... .... ... ... ... .... ... ... ... ... 20

RESOLUTIONS ADOPTED BY THE REGIONAL COMMITTEE 21

WPRlRC46.RI Health and environmental effects of

nuclear weapons ... ... ... 21 WPRlRC46.R2

WPRlRC46.R3 WPRlRC46.R4 WPRlRC46.R5 WPRlRC46.R6 WPRlRC46.R7 WPRlRC46.R8

WPRlRC46.R9

WPRlRC46.RI0 WPRlRC46.RII WPRlRC46.R12 WPRlRC46.RI3 WPRlRC46.RI4 WPRlRC46.R15 WPRlRC46.R16

New horizons in health ... . Changes in the 1996-1997 programme budget ... . Regional allocations ... . AIDS and sexually transmitted diseases ... . Joint United Nations Programme on AIDS ... . Eradication of poliomyelitis in the Region ... . Country visits: Report of the Sub-Committee of

the Regional Committee on Programmes and

Technical Cooperation, Part I ... . Membership of the Sub-Committee of the

Regional Committee on Programmes and

Technical Cooperation ... . WHO Response to Global Change ... ..

Method of work of the Regional Committee ... . Development of health research

Infant and young child nutrition

Leprosy ... ..

Reproductive health ... . International Decade of the World's Indigenous

People ... .

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21 22 23 24 26 27

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29 30 31 32 33 34 35 36

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2.

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WPRlRC46.RI7

WPRlRC46.RI8

WPRlRC46.R19

WPRlRC46.R20

WPRlRC46.R21

CONTENTS

Special Programme of Research, Development and Research Training in Human Reproduction:

Membership of the Policy and Coordination

Committee ... . Special Programme for Research and Training in

Tropical Diseases: Membership of the Joint

Coordinating Board ... . Members of WHO in the Western Pacific Region

entitled to designate a member of the

Executi ve Board ... ..

Forty-seventh and forty-eighth sessions of the

Regional Committee ... . Resolution of Appreciation ... ..

ANNEXES

AGENDA ... . LIST OF REPRESENTATIVES ... ..

LIST OF UNITED NATIONS SPECIALIZED AGENCIES AND

INTERGOVERNMENTAL AND NONGOVERNMENTAL ORGANIZATIONS WHOSE REPRESENTATIVES MADE STATEMENTS TO THE REGIONAL COMMITTEE AND SUBMITTED STATEMENTS FOR CIRCULA nON

TOMEMBERS ... .

37

38

38 39 39

41 45

69

PART II - SUMMARY RECORDS OF THE PLENARY MEETINGS ... 71

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PART I

REPORT OF THE REGIONAL COMMITTEE

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(WPRlRC46/22)

INTRODUCTION AND SUMMARY

The forty-sixth session of the Regional Committee for the Western Pacific was held at the regional headquarters in Manila, Philippines, from II to 15 September 1995.

The session was attended by representatives from Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Hong Kong, Japan, Kiribati, Lao People's Democratic Republic, Macao, Malaysia, the Federated States of Micronesia, Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Republic of Korea, Samoa, Singapore, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu and Viet Nam, and by representatives of France, United Kingdom of Great Britain and Northern Ireland and United States of America as Member States responsible for areas in the Region.

Mongolia and Palau attended as Members for the first time.

The agenda appears as Annex 1 and the list of representatives as Annex 2.

Representatives of the United Nations Development Programme, the Food and Agriculture Organization of the United Nations, the United Nations Office of the High Commissioner for Refugees, the Asian Development Bank, the South Pacific Commission, and 40 nongovernmental organizations in official relations with WHO attended the session. Oral statements were made by the representatives of the Food and Agriculture Organization of the United Nations, the South Pacific Commission, and 11 nongovernmental organizations. Written statements were received for circulation to Member States from ten nongovernmental organizations (see Annex 3).

The Committee elected the following officers:

Chairman: Dr Joseph Williams (Cook Islands) Vice-Chairman: Dr Chhea Thang (Cambodia) Rapporteurs

in English: Ms Julia Nesbitt (Australia)

in French: Dr Khamphay Rasmy (Lao People's Democratic Republic)

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4 REGIONAL COMMITTEE: FORTY-SIXTH SESSION

The Committee appointed Dr Jimmie Rodgers (Solomon Islands) as Moderator of the Technical Discussions on "Occupational health risks in the workplace".

The report of the Regional Director on the work of WHO during the period I July 1993 to 30 June 1995 was presented to the Committee and discussed at its first and second meetings (see section I). As a supplementary agenda item, the health and environmental effects of nuclear weapons was also discussed at the second meeting (see section V).

Progress both at country level and in the Regional Office in operationalizing and implementing the approaches of New horizons in health was discussed at the third meeting (see section II).

The Committee reviewed the interim report on budget performance for 1994-1995 and changes in the 1996- I 997 programme budgeting and in future programme budgeting at its fourth meeting, and regional allocations at its fifth meeting (see section III).

At the fifth and sixth meetings, the annual report on AIDS, including sexually transmitted diseases, was discussed, together with the implications of the Joint United Nations Programme on AIDS for the programme in the Region. The progress towards eradication of poliomyelitis in the Region, and the next steps to be taken were also reviewed at the sixth meeting (see section V).

The Sub-Committee of the Regional Committee on Programmes and Technical Cooperation reported on its visits to Australia, China and Singapore to review WHO's collaboration in the field of healthy lifestyles with a focus on tobacco-or-health activities, at the sixth meeting. The sixth meeting also appointed the representatives of Cambodia, Fiji, Mongolia and Viet Nam as the new members of the Sub-Committee for a three-year term. At the seventh meeting, the Sub-Committee presented its report on the WHO Response to Global Change, including the renewal of the health-for-all strategy (see section IV).

The recommendations of the Western Pacific Advisory Committee on Health Research and the directors of Health Research Councils or Analogous Bodies at their joint meeting in August 1994 were endorsed at the seventh meeting. The Committee reviewed directions of health research in the future. The progress report, compiled from the data of countries and areas in the Region, on infant and young child nutrition and on the implementation of the International Code of Marketing of Breast-milk Substitutes, was also reviewed in that meeting. The Region's achievements ^III eliminating leprosy as a public health problem were also reported on and discussed.

The agenda items on reproductive health and the International Decade of the World's Indigenous People were discussed at the eighth meeting. Japan was selected to represent the Region

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REPORT OF THE REGIONAL COMMITTEE 5

on the Policy and Coordination Committee of the Special Programme of Research, Development and Research Training in Human Reproduction. China was selected to send a representative to the Joint Coordinating Board of the Special Programme for Research and Training in Tropical Diseases. The Committee decided that for the forty-seventh and forty-eighth session:;, the Technical Discussions would be replaced, on an experimental basis, by technical briefings, arranged in coordination with the host countries.

At the ninth meeting, it was decided that the forty-seventh session of the Regional Committee would be held in Seoul, Republic of Korea, and the forty-eighth session in Sydney, Australia, subject to the conclusion of agreements.

In the course of nine plenary meetings, the Committee adopted 21 resolutions, which are set out in section VI.

1. REPORT OF THE REGIONAL DIRECTOR COVERING THE PERIOD 1 JULy 1993 TO 30 JUNE 1995 (Document WPR/RC46/2)

Representatives congratulated the office bearers on their appointments, welcomed Mongolia and Palau to the Regional Committee, and congratulated the Regional Director on his report's clarity and comprehensiveness in setting out the developments in policy and planning and the progress in implementing disease prevention and control programmes.

In his introductory remarks, the Regional Director highlighted in particular the success in dealing with new, emerging and re-emerging communicable diseases in the Region, such as the recent instances of swift and effective collaborative action with countries against epidemics of dengue fever and diphtheria. The significant role played by extrabudgetary partners was an important theme in these efforts, and in the progress towards eradicating poliomyelitis and elimination of leprosy. This was emphasized by the one minute's silence observed by the Committee at the close of the item, in tribute to the generosity of the late Mr Sasakawa of the Sasakawa Foundation, which had provided very substantial funding to various programmes in the Region, notably leprosy. In connection with the eradication of poliomyelitis, representatives noted the need to consolidate efforts to strengthen epidemiological and laboratory surveillance and to continue national immunization days. The representative of Japan reiterated his country's commitment to

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6 REGIONAL COMMIITEE: FORTY-SIXTH SESSION

supporting this and other health issues in the Region and to strengthening its financial and technical contribution in this regard.

The Committee noted several aspects of WHO's work in the Region which would be important for future progress; namely increasing government commitment to health and human development issues at the highest levels of government; policy and action orientations that increasingly reflected a general move in the same priority directions; and strong external financial and logistic support to priority programmes, particularly in the field of disease prevention and control.

Of the various meetings that had taken place during the year, the Ministerial Conference on Health for the Pacific Islands, held in Fiji in March 1995, was felt to be of particular importance.

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This had as its outcome the Yanuca Island Declaration which placed the health and well-being of Pacific islanders firmly at the centre of national development plans. It had taken into account the new directions for health embodied in the document New horizons in health. The Organization's role in facilitating and supporting this conference was acknowledged, and the importance of New horizons in health in stimulating such activities.

Under the discussion of specific chapters of the report, the representative of New Zealand noted that per capita tobacco consumption was still increasing in the Region. She suggested that the Western Pacific Regional Office should be proactive in contributing to the development of an international strategy for tobacco control, in line with resolution WHA48.11.

The increasing participation of women in the work of the Organization and of the Regional Committee was noted as encouraging but it was felt that there was still a long way to go in this regard. The Regional Director was requested to include in future reports information on the recruitment of women to professional and higher grade posts.

The difficulty of monitoring achievements in health development was emphasized by the representative of the United States of America. In this context, the Regional Director was urged, in future reports, to present a more detailed analysis of data on countries' progress towards health, using existing and new health indicators more fully and systematically. The Regional Director indicated that this could be accommodated in future bienniums when countries would be requested to develop plans of action that made clear reference to "products". He agreed fully with the suggestion of the representative of Tonga to adjust the presentation of the report of the Regional Director to an annual health situation report, focusing on priority areas of activity, and their results, in line with the recommendation of the Executive Board Working Group on the WHO Response to Global Change.

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REPORT OF THE REGIONAL COMMlTIEE

II. NEW HORIZONS IN HEALTH

(Documents WPRlRC46/3 and WPRlRC461INF.DOC.lI)

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Twenty-one representatives spoke on this item, reporting on how the concepts and approaches of New horizons in health were being implemented in their countries, and substantiating the Regional Director's proposition that such progress provided a finn basis for the renewal of the health-for-all strategy in the Region. Although provisos were made for the work that still remained to be done on the continued development of indicators and objectives, in general the Committee was highly supportive of the initiative. Representatives expressed commitment to continuing to work on health and human development according to the directions outlined in the document and the consultations that had taken place at country level.

Representatives emphasized that the increased number of indicators, from which countries could choose those most appropriate, was useful. It was noted that use of any such indicator should not involve additional data collection. The Organization's technical collaboration in supporting countries to choose the most appropriate indicators for their situation would be essential. The representative of New Zealand noted that further work was necessary in fonnulating measurable targets for the Region. The Committee requested that Member States should be consulted in the development of achievable but challenging outcome targets for each of the 13 objectives. Progress towards achieving such targets could then be detailed in the Regional Director's annual report. It was suggested that once the policy development process, final set of indicators, and budgetary implications of change had been defined, these should be carefully reviewed by the Regional Committee.

The emphasis on individual responsibility and the need for multidisciplinary and multi sectoral collaboration and community involvement were considered to be of particular importance. The representative of Solomon Islands noted that the holistic approach advocated in New horizons in health was being implemented in the shape of the short-tenn intensified malaria control programme in the country. The Yanuca Island Declaration and the theme of Healthy Islands, which resulted from the Ministerial Conference on Health for the Pacific Islands, owed much to the concepts articulated in the document. The Regional Director noted these initiatives as being in the new direction of public health for the future. He suggested that the discussions taking place on New horizons in health and related issues, were also very relevant to the planned revisions to the health-for-all strategy, and provided an opportunity to explore a realistic and relevant framework for health work in the 21st century and beyond.

The Committee adopted resolution WPRlRC46.R2.

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8 REGIONAL COMMIITEE: FORTY-SIXTH SESSION

III. PROGRAMME BUDGET

I. Budgct performance. 1994-1995 (interim report) (Document WPRlRC46/4)

The Regional Director reported that expenditures and obligations incurred as at 31 May 1995 amounted to US$50 124462, representing an implementation rate in monetary terms of 70.43%. The budget was expected to be fully implemented by the end of the 1994-1995 biennium.

The reasons for the various modifications to the budget were explained, emphasizing that the intent in implementing the changes was to cnsure that countries were as little affected as possible.

For example, the Regional Director explained that, although only approximately half of the 4.2%

withheld by headquarters for the 1994-1995 programme budget had been returned to the Region, he had decided to reinstate the full amount to countries. The Committee noted that, in order to remain within the approved budgetary allocation figure, there had been a reduction in programme activities.

Although the increased transparency of the rcport was praised, some concern was expressed by representatives over the comparatively low rates of implementation of certain technical programmes.

The need for resources to be prioritized, particularly in view of budget decreases, was essential, so that the more pressing health problems in the Regional could be met. The important role played by extrabudgetary funds was recognized. The Regional Director confirmed that a column reflecting the amount of funds received in the Region would be shown in the report on final implementation.

The Regional Director assured the Committee that any adjustments to the programme budget had been made in close consultation with countries, taking account of the global priorities of the Director-General, the six regional priorities, and country priorities. The Committee noted that the shift of 5% in the 1996-1997 global budget to the five priority areas selected by the Executive Board would be applied during the 1996-1997 biennium.

2. Changes in the 1996-1997 programme budget and in future programme budgeting (Documents WPRlRC46/5 and WPRlRC46/INF.DOC.l2)

The Committee noted that the global budget increase for 1996-1997 would be 2.5%; the regional budget increase was 2.71 %, made up of a 1.94% cost increase and a 0.77% currency adjustment. Funds allocated to the Region for the biennium were therefore US$9.4 million or 13%

short of the amount needed to implement the planned programmes fully. It was noted that most of the budget increase granted by the World Health Assembly in May 1995 had gone to headquarters in Geneva and very little to regional and country programmes. The representative of the United States of America said that this was not how the Member States expected the funds to be expended.

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The Committee noted that the contributions of donor countries were likely to decrease in future; the representative of the United States of America advised that his country's appropriations to United Nations bodies would show at least a 15% shortfall for the fiscal year beginning on 1 October 1995, and it was therefore unlikely that his country would pay its assessed contributions in full for the foreseeable future.

Various representatives praised different aspects of the report. The representatives of Mongolia, New Zealand and the United States of America welcomed the focus on priorities and products, and urged that this should continue. The representatives of China and Viet Nam expressed appreciation for the Regional Office's consultative approach to planning and replanning the budget with the countries. The representatives of the Philippines and Viet Nam welcomed the transparent approach to budgeting and planning in the Region.

Concern was expressed over the loss of detail in the revised Classified List of Programmes, which consolidated programmes into 19 major programmes. In response to the requests from the representatives of Australia and the United States of America, the Regional Director confirmed that the regional proposal for the 1998-1999 programme budget would retain the level of detail provided by the 1996-1997 presentation, although the new programme classification would be applied for the actual presentation of the 1998-1999 programme budget to the World Health Assembly.

In reply to the requests from the representatives of Australia and the United States of America for information on how priorities had been established, the Committee was advised that a number of principles had been applied: to give global and regional priorities precedence over programmes of lesser importance; not to reduce country budgets, but to absorb the shortfall at intercountry and regional levels; and to keep country planning figures to at least the 1994-1995 level in dollar terms, giving special consideration to certain Member States which had joined recently and had low country planning figures.

3. Re~ional allocations (Document WPRlRC46/6)

This agenda item generated considerable discussion. The Regional Director drew the Committee's attention to the fact that the Region's allocation had not substantially increased with the return of China and Cambodia to the Region. Over the last 25 years, the Region had experienced the greatest percentage increase in number of Member States, with an increase of 125% from 12 in 1970 to 27 in 1995. This was second only to the European Region, whose membership had moved from 31 to 50 in the same period. He also pointed Ollt the disparity between regions of the country

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planning figures allocated, citing a region where the total of the country planning figures of three countries together was equivalent to more than 50% of the entire regular budget for the Western Pacific Region.

A range of other factors or criteria were discussed by the Committee, with representatives noting that a more equitable distribution of regional allocations should be based on clear and logical criteria, and that a review of the criteria used would therefore be appropriate before conclusions were drawn as to the real level of disparity between the regions. These criteria included recognition of the fact that the Western Pacific Region is responsible for the largest population of any region but has the lowest allocation per capita; the needs of the poorest and least developed countries and those with the poorest health indicators; the programme priorities at country level within the Region; and the context provided by the health-for-all strategies, global priorities as recommended by the Executive Board, and budgetary reform within the Organization as a whole. It was noted, however, that the issue was not that of a simple increase in the amount allocated but of an increase in the proportion allocated, which would mean a decrease for another region.

The representative of New Zealand supported the development of a global population-based funding formula which would include technical adjustments for programme and country priorities, and phased progression to greater equity. This was endorsed by the representative of France, recalling that the purpose of resource allocation was to close the gaps in health status between peoples, whether at global, regional or country level. Representatives of some Pacific island countries expressed concern that allocations on a simple per capita basis where populations were small, but health needs great, would not necessarily be equitable.

Responding to the concerns expressed, the Director-General assured the Committee that all the factors raised would be taken into consideration by the Global Policy Council and the Executive Board. He reminded the Committee that WHO was mandated to extend technical cooperation to all countries, and called on the major contributors to support the definition of which countries were most in need of WHO technical cooperation. He noted that if basic health indicators were used for that exercise then the Region would receive a reduced allocation because of its success in management of disease programmes. He stressed the importance of including, in the proposal to the Executive Board, identification of the Region's priorities at both regional and country level, and of presenting a united and vocal front on the issue.

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REPORT OF THE REGIONAL COMMITTEE

IV. SUB-COMMITTEE OF THE REGIONAL COMMITTEE ON PROGRAMMES AND TECHNICAL COOPERATION

1. Country visits' Report of the Sub-Committee Part I (Document WPRlRC4611 0)

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The report covered the visits of the Sub-Committee to Australia, China and Singapore to review cooperation in the field of healthy lifestyles, with focus on tobacco-or-health activities. The Committee endorsed the report and its recommendations, including the suggestion that the subject of the next year's visit should be WHO's collaboration in the field of health systems reform. The countries to be visited were New Zealand and Viet Nam.

The suggestion was raised to review the value of such visits, given current fmancial constraints. The representatives of China, the Federated States of Micronesia and Solomon Islands all confirmed that their countries had benefited from participation in the country visits. The representative of Solomon Islands suggested that it was more cost-effective for small island countries to study and learn from the findings of the country visits than to arrange a number of individual study tours. The Regional Office was requested to evaluate the country visit exercise formally, and report to the Committee at its next session. A report on the value and effectiveness of the work of the Sub- Committee of the Regional Committee on Programmes and Technical Cooperation will be presented in 1996.

2. WHO Response to Global Chanie: Report of the Sub-Committee. Part II (Document WPRlRC46/11)

The Committee endorsed the report and recommendations of the Sub-Committee, which focused on six areas: nomination and terms of office of the Regional Director; the development of the WHO Management Information System; the greater emphasis on product delivery at country level (with regard to programme support costs); the question of the inclusion of Executive Board members in national delegations to the Regional Committee; the consultation process, particularly the timetable, for renewal of the health-for-all policy; and the relationship of special regional initiatives to the health-for-all renewal effort.

The Committee noted that Executive Board members for the Region should be technically qualified and in a position to make decisions at the political level. The responsibilities of WHO representatives was being reviewed but the recommendation of the Sub-Committee was that medical

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12 REGIONAL COMMITIEE: FORTY-SIXTH SESSION

qualification need not be a criterion provided that other relevant qualifications and experience were met. The Regional Committee was already actively reviewing its method of work but it was agreed that this should be an institutionalized process.

There was concern that the regional management information system, which was the most advanced in the Organization, should be compatible with the global system being developed and that there should be no duplication of effort and resources. The system should meet the needs of efficient and effective management of the Organization globally, as well as meeting the needs of the Region.

The Regional Director introduced the consultation document Renewing the health-for-all strategy, emphasizing that, in the Region, the issue was not one of starting the process, but one of consolidating what had been already done and clearly documenting it. He suggested an analysis at regional and country level of what had been achieved so far, and consideration of how to enhance the ongoing policy development process, in particular involving other sectors in the consultation process.

The Committee agreed that New horizons in health, the Yanuca Island Declaration and the Healthy Islands concept were an appropriate response to global change and health-for-all policy renewal.

It was suggested that any enhancement of consultation processes should include consideration of gender. Increased representation of women in delegations and Regional Committee offices would go some way towards this. The Regional Committee agreed to include an agenda item for the forty-seventh session on "The full involvement of women in all aspects of WHO in the Western Pacific Region".

The Committee adopted resolutions WPRlRC46.RI0 and WPRlRC46.RII

V. OTHER AGENDA ITEMS

1. Health and enyironmental effects of nuclear weapons (Supplementary agenda item)

This supplementary item was proposed by the representative of Cook Islands, as that country was closest to the French nuclear testing site at Muroroa in the Pacific. Representatives expressed deep concern about the possible damage to the fragile marine environment, particularly fissures in the atolls, and the effect of the presence of artificial radioactivity. A draft resolution was proposed, which was spoken to and supported by 12 representatives. Acknowledging the fears expressed by some representatives, the representative of France cited technical reports by experts in the field, which provided evidence of the harmlessness of such tests. The representative of China stated that

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REPORT OF THE REGIONAL COMMITTEE ¹³

his country had exercised the "utmost restraint" in nuclear testing, and aimed for the complete prohibition and destruction of nuclear weapons. After debate on the wording of the resolution, which the representative of France was not able to agree to, a vote was taken. The draft resolution was then adopted by 24 votes to 1 with 2 abstentions (see resolution WPRlRC46.RI).

2. Annual report on AIDS, includin& sexually transmitted diseases (Document WPRlRC4617)

The Regional Director reported that, as at I September 1995, the total number of reported HIV infections was 43650 and the total of reported AIDS cases 8401 in the Region. Seven countries had reported having no HIV infections or AIDS cases. The Committee noted that intervention strategies to reduce HIV transmission had focused on control of sexually transmitted diseases, influencing changes in behaviour and avoiding risk, through health promotion, education and training. Attention was drawn to the importance of political support and improving the quality of surveillance systems.

A number of representatives reported on the HIV I AIDS situation and expressed both appreciation of WHO's support, and concern at the evidence of rising rates of HIV infection in some countries. Activities in education and infonnation on the HIV/AIDS risk and in surveillance were noted as being essential. The Committee also recognized that syndromic case management of sexually transmitted diseases had proved a useful tool and should be further promoted.

The representative of the United States of America noted the need for a greater sense of urgency in collaboration between WHO and Member States so that adequate preparation might be made for the full brunt of the epidemic yet to come. This included detennining the best use of resources and developing effective interventions, both at country and intercountry levels.

The representative of Japan stated that US$3000 million had been eannarked by the Government of Japan for support to developing countries between 1994 and 2000 under its Official Development Assistance Scheme. Japan committed to continued close collaboration with WHO in the provision of experts and equipment, supporting WHO in strengthening regional surveillance capabilities.

The representative of Solomon Islands expressed the concern of small island countries regarding the importation of HIV infection through foreign workers and the need for controls. The Regional Director noted that WHO policy was to observe confidentiality and that there should be no restrictions on the short-tenn travel of infected people. Australia's experience in this regard was offered.

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3. Joint United Nations Pro~amme on AIDS (Document WPRfRC46/8)

The Committee heard a brief history of the background to the establishment of the new Joint 'i. United Nations Programme on AIDS (UNAIDS), which would officially commence operations on I January 1996, and an overview of the mechanisms for the operations and administration of the Programme. The manner in which the Regional Office would work closely with the new Programme was briefly outlined. This included the funding of one professional and one general service post for sexually transmitted diseases and AIDS in the Regional Office. The Regional Director stressed the Regional Office's commitment to the continued prevention and control of sexually transmitted diseases, including HIV, and assured the Committee that the Office would work unconditionally with UNAIDS to address these important public health problems. He noted that it would be important to work together at country level, and to ensure continued fund raising.

Support for the establishment of UNA IDS was expressed by II representatives. Emphasis was placed on the technical role that WHO should play in country-level activities and the requirement for WHO and UNAIDS to work together fruitfully. The Committee noted that the governments and ministries concerned must also consolidate their efforts and develop national plans to deal with the disease. Logistical and other support services would be provided by the Regional Office to UNAIDS staff at country level.

Representatives urged that the new programme should encompass sexually transmitted diseases as well as HIV/AIDS, given the close link between the two areas. The Regional Director conftrmed that the Committee's discussion on this would be transmitted to the UNAIDS Executive Director. It was likely that he would work through WHO's mechanisms on sexually transmitted disease control in the Region.

Although some reservations were expressed by representatives over the lack of clarity in coordination and administration of the new Programme in conjunction with WHO and countries, others believed that UNAIDS was an exciting development. The representative of the United States of America noted that, after the Programme started in January 1996, the main impact would be in strengthening the role of governments in activities in the prevention and control of HIV/AIDS and coordinating the work of the various United Nations agencies to ensure collaboration in a unified plan. He was confident that the Programme Coordinating Board, the governing body of UNAIDS, with the Executive Director, would consider appropriate operating methods that would meet the concerns expressed as to the country-by-country running of the Programme. The role of the Programme Coordinating Board would be important in making the transition work smoothly and effectively. Australia, China and Japan were members of the Board, and were encouraged to play an active role.

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The Committee adopted resolution WPR/RC46.R6.

4. Eradication ofpolioroyelitis in the Region- Progress report (Document WPR/RC46/9) Fourteen representatives spoke on this agenda item.

The Committee noted the progress made towards the eradication of poliomyelitis, with a provisional total of 699 cases reported for 1994. The Regional Director reported that the Region was near to being free of the wild poliovirus, with the Mekong Delta area of Cambodia and Viet Nam the last remaining focus. He attributed the success of the poliomyelitis eradication initiative in large part to the support of extrabudgetary partners, and to the strong commitment and organizational capabilities of countries themselves, especially during national immunization days.

Although several representatives paid tribute to the efforts of the Regional Office in the eradication of poliomyelitis, the need for continued momentum was also stressed in interventions.

The Committee heard that, in addition to the vaccines required under the Expanded Programme on Immunization, a further l3.7 million doses would be needed in 1995. The Regional Director detailed the annual costs for such supply up to 1999, and acknowledged the essential role extrabudgetary partners had played, and would continue to play in this.

In reply to a question from the representative of the United States of America on the date of final eradication, the Committee heard that transmission of wild poliovirus was expected to cease in China, the Lao People's Democratic Republic, the Philippines, and northen: Viet Nam by the end of 1995. Such transmission would probably be greatly reduced in Cambodia and southern Viet Nam by the same date. The Regional Director estimated that by the end of 1997 there would be no more cases associated with wild poliovirus in the countries. Supplementary immunization would be continued until the circulation of poliovirus had completely ceased. Surveillance would be an important detenninant of this. The following timescale for further national immunization days was offered: Cambodia up to 1998; China, possibly, to 1996; Lao People's Democratic Republic to 1997; the Philippines to 1999; and Viet Nam to 1996.

In reply to a question from the representative of Australia on the operations of the proposed regional certification commission, the Committee heard that the regional certification commission would need to apply four criteria: high-quality surveillance of acute flaccid paralysis; high-quality surveillance of wild poliovirus; active case searches in both high-risk areas and polio-free countries;

and no indigenous cases associated with wild poliovirus for at least three years. The representatives welcomed the proposed establishment of such a commission in 1996.

The Committee adopted resolution WPR/RC46.R7.

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I 1

16 REGIONAL COMMITIEE: FORTY -SIXTH SESSION

5. Deyelopment of health research (Document WPRlRC46/12)

The Committee endorsed the recommendations of the Western Pacific Advisory Committee on Health Research and the Health Research Councils or Analogous Bodies, including the call for a regional health research strategy as a prerequisite to policy development and prioritization of programmes and to strengthen coordination and management of research capabilities, at national and regional levels.

The representative of the United Kingdom expressed the view that emphasis should be placed on needs-based research and the practical problems of the health systems of Member States.

The representative of the Republic of Korea noted also the need to establish and improve research and development systems in health-related industries.

The Committee heard that a Strategic Plan for Health Research had been developed, which identified priority fields of research for 1996 to 2000. The draft Strategic Plan would be evaluated for discussion at the meeting of the Western Pacific Advisory Committee on Health Research in 1996, and also to governments. As funds for research were limited, further support would be needed from other external funding partners. The Committee expressed the hope that once the Organization had supported initial research in areas that would have immediate application at operational level, such support by partners would be given.

6. Nutrition' Pro"ress report on infant and youp" child nutrition and on the implementation of the International Code of Marketin" of Breast-milk Substitutes

(Document WPRlRC46/13)

The Regional Director drew attention to the increase in the number of baby-friendly hospitals in the Region. This was expected to have a positive impact on the currently declining rate of breast- feeding in many countries. He reported that 19 countries had, in some form, adopted the International Code of Marketing of Breast-milk Substitutes. The close collaboration of the Food and Agricultural Organization ofthe United Nations was acknowledged.

Fourteen representatives reported on infant nutrition and the status of breast-feeding. Despite efforts to promote breast-feeding through education, training, policy and legislation, there was still an overall decline in breast-feeding in the Region. The Committee agreed that efforts to promote infant nutrition should be increased. The Regional Office would make available standard defmitions for

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REPORT

or

THE REGIONAL COMMITTEE 17

terms employed with regard to infant and young child nutrition for discussion and dissemination at appropriate workshops, as well as the list of criteria for qualification as a baby-friendly hospital.

The Committee adopted resolution WPRlRC46.RI3.

7. Leprosy (Document WPRlRC46114)

The Regional Director reported that 18 out of 36 countries and areas have reached the elimination target of prevalence rates less than one case per 10 000 population. Regionally, the average prevalence rate is well below the elimination target rate, largely owing to the progress achieved towards full coverage with multidrug therapy. However, at country level, areas of high prevalence still exist. The Committee heard that six countries had received special attention in strengthening programme management and improving reporting and recording systems. The Committce noted the importance of maintaining commitment at all levels; mobilization of community action through health education and advocacy, and strengthening of national capacity to ensurc early detection and effective monitoring of progress.

The representatives of the six countries still reporting high rates of endemicity in certain regions repOited on the leprosy situation. It was noted that case-finding continued to be an issue in some countries. In others, there was high endemicity in remote areas which were difficult to access.

The valuable collaboration and support of the Pacific Leprosy Foundation and the Sasakawa Foundation were acknowledged, as well as that of WHO.

8. Reproductiye health (Documents WPRlRC46/15 and WPRlRC46/15 Add.l)

The Regional Director reported large disparities in the outcome of human reproduction within and among countrics. Maternal mortality ratios are more than 50 times higher in parts of some developing countries of the Region than in the most developed countries. Improvement in obstetric services and delivery practices was recommended to reduce infant and maternal rates, as the majority of mortality occurred during the early neonatal period. The expansion of family planning services was another means to improve reproductive health outcomes.

The representatives of six countries and areas gave brief overviews of the approach to reproductive health in their respective countries. The success of such measures as family planning, prenatal care, provision of information on maternal and child health to mothers, as well as on the use of contraceptives, was discussed in a variety of cultural settings, which determined emphasis and presentation.

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Interest was expressed in the regional workshop on reproductive health to take place 11-15 December in Kuala Lumpur, Malaysia, which would continue to promote this important topic, following the Fourth World Conference on Women, held in Beijing, China, in September 1995.

The representative of Papua New Guinea requested support for projects for village birth attendants and community-based distributors of contraceptives to reach women in the more remote rural areas. In reply to this, the Committee was informed that USSSOO 000 from UNFPA for a maternal and child health project in that country had recently been approved and would include a post for one staff member.

The Committee adopted resolution WPRlRC46.R1S.

9. Internatjonal Decade of the World's Indjgenous PeQPle (Document WPRlRC461l6)

The Committee's attention was drawn to the fact that the United Nations was actively promoting the International Decade of the World's Indigenous People, which had begun in December 1994, to increase the participation of those often-disadvantaged people in social and economic progress. WHO was focusing on the health needs of indigenous peoples in the context of the International Decade, emphasizing equity of access to services and attention to special needs.

Document WPRlRC46/16 contained an overview of the subject, but the terminology contained in it was not intended to be defmitive on the subject. The Committee was urged to discuss the document from a public health standpoint.

The Government of New Zealand had requested that this item be addressed in the session. The representative of New Zealand introduced the topic, and discussed the situation in his country. He pointed out the gap in health status between the Maori people and the rest of the population, and the Government's response, designing strategies to improve Maori health, emphasizing responsiveness to the needs of Maori as individuals and as communities, and accommodating Maori traditional healing practices. The Committee agreed that the presentation of the indicators in New horizons in health should differentiate between the health of the indigenous population and the rest of the population, where appropriate.

The representative of Australia stated that indigenous Australians consistently had a significantly poorer health status than non-indigenous Australians, but that his Government was working on this, having acknowledged the need for culturally appropriate delivery of health services to indigenous communities.

The representatives of three other countries briefly outlined their policies with respect to indigenous people, namely those for Malaysia, the Philippines and the United States of America.

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REPORT OF THE REGIONAL COMMITIEE 19

The Committee agreed that Member States should participate fully in the development of the health aspects of the fmal comprehensive programme of action for the International Decade of the World's Indigenous People, which will be considered by the United Nations General Assembly at its fiftieth session.

10. Correlation of the work of the World Health Assembly. the Executiye Bpard and the Reaipnal Cpmmittee (Documents WPRlRC46/19 and WPRlRC46/20)

The attention of the Committee was drawn to document WPRlRC46/19 containing nine resolutions of relevance to the Region, adopted by the Forty-eighth World Health Assembly.

In discussions on Resolution WHA48.1, Transfer of MOflgolia to the Western Pacific Region, the Committee heard that there was no set procedure for a country to transfer between regions. The Regional Director explained that the Government of Mongolia had made its request through WHO headquarters and the decision for transfer had been taken at that level. On the wider issue of whether and in what way the two relevant regional committees should become involved, he detailed three aspects, querying whether it would be appropriate to determine rules of prior consultation of the two concerned regional committees, whether certain criteria such as size of population should be used in a decision on such a matter, or whether there should be simply no change to the procedure.

The representative of Tonga favoured no change to the procedure. As there were no further comments, the Committee agreed.

In discussion of resolution EB 96.RI - Amendments to Articles 24 and 25 of the Constitution:

Increase in membership of the Executive Board, the representative of Japan, supported by the representatives of the Philippines, Samoa, Solomon Islands and Tonga, proposed an increase from four to five in the number of seats on the Executive Board for Member States of the Western Pacific Region. The Committee adopted resolution WPRlRC46.R19.

There were no comments on the remaining resolutions.

The Committee also reviewed document WPRlRC46/20, showing the correlation between the Committee's current agenda and items to be discussed at the ninety-seventh session of the Executive Board and the Forty-ninth World Health Assembly. The representative of Australia, who was also a member of the Executive Board, notified the Committee of his intention to speak at the ninety- seventh session of the Executive Board on the impact on WHO staff of the WHO reforms, the global change strategy and the programme budget adopted in May 1995. In this regard, the statement by the

,

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20 REGIONAL COMMITfEE: FORTY-SIXTH SESSION

representative of the WHO staff associations, should be placed higher up the agenda under item 4.5, personnel policy, and the statement distributed in advance. The Regional Director undertook to convey these comments and said that he would raise them at the forthcoming meeting of the Global Policy Council.

11. Selection oftQpjc for the Technical Discussions to be held in conjunction

with

the forty- seventh sessjon of the Regional Committee (Document WPRfRC46/2I)

The Committee was asked to select a topic for the following year's Technical Discussions, either from document WPRfRC46/2I, or one of its own choosing. Additionally, the Committee's attention was drawn to the fact that the Executive Board had decided that from the Forty-ninth World Health Assembly in 1996, and on a trial basis, Technical Discussions would be replaced by a limited number of well-organized technical briefmgs and by informal forums for dialogue. That decision had been endorsed by the Forty-eighth World Health Assembly in its resolution WHA48.l7.

Several representatives supported the proposed "technical briefmgs", to be held in close coordination with the host countries for the Regional Committee at its forty-seventh and forty-eighth sessions. This was incorporated in resolution WPRfRC46.R 11.

12. Time and place of the forty-seventh and forty-eighth sessions of the Regional Committee The representative of the Republic of Korea confmned his Govemmenfs invitation to hold the forty-seventh session of the Regional Committee in the Republic of Korea. The dates for the session will be 9 to 13 September 1996. The Committee likewise accepted the offer of Australia to act as host to the forty-eighth session, the suggested dates for which were 22 to 26 September 1997 (see resolution WPRfRC46.R20).

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VI. RESOLUTIONS ADOPTED BY THE REGIONAL COMMITTEE

WPRlRC46.RI HEALTH AND ENVIRONMENTAL EFFECTS OF NUCLEAR WEAPONS

The Regional Committee,

Recognizing the potential threat to human health and ecosystems of any increased exposure to man-made radioactive material;

Recognizing also the large quantities of long-lasting hazardous materials generated by the testing of nuclear weapons;

1. DEPLORES the testing of nuclear weapons anywhere in the world and particularly in the Region; and

2. CALLS UPON those governments intending to test such weapons to desist from doing so immediately.

WPRJRC46.R2 NEW HORIZONS IN HEALTH The Regional Committee,

Second Meeting, 11 September 1995 WPRlRC46/SRJ2

Having considered the Regional Director's report on progress in developing the strategies and budgets for implementation of the approaches outlined in New horizons in health in the Region; ¹

Noting the extent to which the concepts and approaches have been adopted in the Region, and are forming part of policy making and activity implementation at country level;

Confirming that the approaches described in the document are compatible with the requirements of the revised health-for-all strategy;

I. ENDORSES the work being done in the Region at both Regional Office and country level to realize the aspirations of better quality of life for the people of the Region;

2. URGES Member States:

(1) to continue and deepen their commitment to multisectoral coordination to achieve appropriate public policies that support individual actions in health and human development;

(2) to continue to provide political commitment from the highest levels to this initiative;

lDocumenl WPRlRC46I3.

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(3) to allocate resources to programmes and activities that reflect the approaches of New horizons in health;

3. REQUESTS the Regional Director:

(1) to continue to work closely with countries and areas in the development and implementation of these approaches including setting achievable health outcome and other targets at the regional level to enable monitoring and reporting on the state of the Region's health;

(2) to continue to refine the indicators in document WPR/RC46/3 taking into account health-for-all monitoring and evaluation requirements, and individual country capabilities;

(3) to establish a minimum set of regional indicators;

(4) to present the indicators in a form which differentiates between the health of the indigenous population and the health of the rest of the population, where appropriate;

(5) to advocate the approaches of New horizons in health to the Executive Board and the World Health Assembly, with a view to ensuring that these approaches form part of the overall planning process for renewal of the health-for-all strategy and other such policy guidelines;

(6) to report to the Regional Committee at its forty-seventh session on the progress of implementation of health for all, New horizons in health and this resolution.

Fifth Meeting, 13 September 1995 WPR/RC46/SRl5

WPR/RC46.R3 CHANGES IN THE 1996-1997 PROGRAMME BUDGET The Regional Committee,

Having examined the report of the Regional Director on changes in the 1996-1997 programme budget and in future programme budgeting; ^I

Noting the implications of World Health Assembly resolution WHA48.2S Consolidating budgetary reform, and resolution WHA48.32 Appropriation resolution for the financial period 1996-1997;

Noting also the relevance of New horizons in health to programme development and implementation;

Endorsing the measures taken by the Regional Director to address the impact of the above resolutions on the programme budget for 1996-1997;

Noting the need for development of plans of action;

IDcoument WPR/RC4615.

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REQUESTS the Regional Director:

(1) to implement the 1996-1997 programme of collaboration, maximizing both the effectiveness of priority programmes and gains in efficiency;

(2) to provide support to countries and areas in the preparation of the plans of action;

(3) to ensure prioritization of the health needs of the Region as set out in New horizons in health;

(4) to reflect these health needs closely in the allocation and implementation of all available resources as well as in the monitoring of the impact of such allocations on gains in health status;

(5) to forward to the Executive Board at its ninety-seventh session, through the Director-General, the request of the Regional Committee that, in the spirit of WHA48.32, casual income up to the amount of US$1 0 million be devolved to the regions in both 1996 and 1997 for priority country programmes;

(6) to prepare future regional programme budgets for presentation to the Regional Committee at the level of specific detailed programmes, including relevant extrabudgetary information.

WPRlRC46.R4 REGIONAL ALLOCA nONS

The Regional Committee,

Seventh Meeting, 14 September 1995 WPRlRC46/SRl7

Having considered Part I of document WPRlRC46/6 containing an excerpt of the Director- General's report on regional allocations in relation to the distribution of regular budget funds to the different levels of the Organization; I

Taking note of resolution WHA48.26 whereby the Executive Board and the Director-General were requested to take steps to transfer allocations to priority health programmes at country level;

Recalling the discussions at the ninety-sixth session of the Executive Board with regard to the need for a review of regional allocations;

Recalling also the regional emphasis on addressing regional health needs, including new, emerging and re-emerging diseases;

Taking into account a number of significant factors in respect of budgetary requirements in the Western Pacific Region such as:

(a) the size of the population served compared to other regions;

1 Document WPR/RC46/6.

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24

(b) (c) (d) (e)

REGIONAL COMMIITEE: FORTI-SIXTH SESSION

the health needs of that population;

the level of per capita funding compared to other regions;

the increasing number of Member States in the Region; and the ability of the Region to fully absorb its present budget;

REQUESTS the Regional Director to convey to the Executive Board through the Director-General:

(I) the summary records of the discussion on this item;

(2) the Regional Committee's request for a review of the logic and criteria used to determine the regional allocations;

(3) the Regional Committee's belief that an objective review of the criteria for division of the WHO regular budget would show that a proportionate increase for the Western Pacific Region is justified;

(4) the Regional Committee's support for the practical application of resolution WHA48.26, and the transfer of allocations to priority programmes at country level in this Region, with this need being reviewed every biennium.

WPRlRC46.R5 AIDS AND SEXUALLY TRANSMITTED DISEASES The Regional Committee,

Having considered the annual report on AIDS, including sexually transmitted diseases; I

Realizing that the response to the HIV challenge must be supported by all sectors of society and governments;

Recognizing the fact that one of the most common modes of transmission of human immunodeficiency virus (HIV) is the same as for other sexually transmitted diseases and that sexually transmitted diseases facilitate the transmission of HIV;

Noting with concern the spread of HIV infection and the emerging upward trend of transmission in the Region;

Noting, however, with satisfaction, the improvement in surveillance for HIV/AIDS achieved by countries in the Region;

Acknowledging the advantages of using syndromic case management for sexually transmitted diseases;

I Document WPRlRC4617.

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REPORT OF THE REGIONAL COMMITTEE ²⁵

1. URGES Member States, in collaboration with the Joint United Nations Programme on AIDS:

(1) to provide strong political commitment to the development of public health policies which reduce the impact ofmV/AIDS and sexually transmitted diseases in the Region;

(2) to integrate activities in support of health promotion, education and training which influence behaviour changes to avoid risk;

(3) to further improve surveillance systems in countries and to continue to support and to improve access to testing;

(4) to implement a sexually transmitted disease care and prevention programme, which should include:

(a) promotion of safer sexual behaviour, including condom use;

(b) provision of comprehensive care at community-level clinics using syndromic case management of sexually transmitted diseases;

(c) promotion of appropriate health-care seeking behaviour;

(d) integration and close coordination of the AIDS and sexually transmitted disease programmes;

(1) to collaborate closely with the Joint United Nations Programme on AIDS;

(2) to encourage Member States to further improve their mY/AIDS surveillance systems;

(3) to further strengthen the regional surveillance system on mY/AIDS;

(4) to encourage political commitment to the formulation of sound public health policies which reduce the impact ofmV/AIDS and sexually transmitted diseases in the Region;

(5) to promote syndromic case management of sexually transmitted diseases.

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WPRfRC46.R6 JOINT UNITED NATIONS PROGRAMME ON AIDS The Regional Committee,

Having considered the report on significant developments of the new Joint United Nations Programme on AIDS (UNAIDS);i

Noting that the new United Nations Programme on AIDS will officially commence operations on 1 January 1996;

Recognizing the programme's objectives and management structure;

Noting also that, from the Western Pacific Region, Australia, China and Japan have been selected as members of the Programme Coordinating Board which is the governing body of the new programme;

Anticipating that the Region can, in coordination with the new programme, continue its work to strengthen national sexually transmitted disease programmes, HIY and AIDS surveillance, training of special population groups, including health care workers, and integrating WHO activities into the new programme's intercountry and country activities;

1. URGES Member States:

(1) to strengthen their national programmes on prevention and control ofHIY/AIDS;

(2) to give their full support to the new Joint United Nations Programme on AIDS towards the achievement of its goals;

(3) to participate actively in the Programme Coordinating Board;

(4) to recommend future directions for collaboration with the new programme;

(5) to coordinate closely with the new programme's focal point in each country to ensure effective integration with the mu[tisectoral national AIDS prevention and control efforts;

(I) to ensure the active involvement of the Regional Office in the Joint United Nations Programme on AIDS;

(2) to develop an appropriate technical and support role for the WHO country offices within the framework of the new programme;

(3) to report in 1996 on significant developments relating to the new programme.

i Document WPR/RC461S.

Seventh Meeting, 14 September 1995 WPRfRC46/SR7

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REPORT OF THE REGIONAL COMMITTEE ²⁷

WPRJRC46.R7 ERADlCA TION OF POLIOMYELITIS IN THE REGION The Regional Committee,

Recalling resolutions WPRlRC39.RI5, WPRlRC41.R5, WPRlRC42.R3, WPRlRC43.R3, WPRJRC44.R4, WPRlRC45.R5, which call for the eradication of poliomyelitis in the Western Pacific Region by the year 1995, and resolution WHA46.33, which reaffirms WHO's commitment to the eradication of poliomyelitis as one of the highest priorities for global health work;

Having considered the progress report of the Regional Director on the eradication of poliomyelitis in the Region;1

Pleased with the achievements made by Member States towards eradicating poliomyelitis;

Noting the decrease in the number ofreported poliomyelitis cases in 1994 to a provisional total of 699, the lowest ever reported to the Regional Office;

Noting also, that despite greatly improved surveillance, no wild poliovirus-associated cases of poliomyelitis were reported in China, the Lao People's Democratic Republic, Papua New Guinea, the Philippines, and the northern region of Viet Nam in 1995;

Noting further that surveillance is now approaching the high standards of reliability that will be required for the certification of poliomyelitis eradication;

Recognizing the critical role that virological surveillance plays in eventual certification based upon reliable laboratory examination;

Recognizing also the success of the national immunization days that were conducted in five countries during the low disease transmission seasons of 1994 and 1995;

Acknowledging that routine immunization programmes and other disease control initiatives such as neonatal tetanus elimination and measles control are strengthened by the poliomyelitis eradication initiative;

1. EMPHASIZES that the poliomyelitis eradication initiative in the Region must remain a high priority within the Region until global certification is achieved;

2. URGES all Member States which are still reporting poliomyelitis cases:

(I) to continue with supplementary immunization activities, the scope of which will depend upon the reliability of surveillance and the extent of wild poliovirus circulation, until countries are confident that transmission of poliovirus has ceased;

(2) to continue to develop virological surveillance and the laboratory network to attain the levels recommended for certification of eradication of poliomyelitis;

(3) to continue to maintain high routine immunization coverage;

IDocument WPRlRC4619.