E B 6 1 / 3
17 N o v e m b e r 1977 INDEXED WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTÉ
E X E C U T I V E B O A R D S i x t y - f i r s t S e s s i o n
P r o v i s i o n a l a m e n d a item 4 广 — 产 , 々
E X P E R T C O M M I T T E E M E E T I N G S R e p o r t b y the D i r e c t o r - G e n e r a l
In c o m p l i a n c e w i t h p a r a g r a p h 10.6 of the R e g u l a t i o n s for E x p e r t A d v i s o r y P a n e l s a n d C o m m i t t e e s , 1 the D i r e c t o r - G e n e r a l s u b m i t s this r e p o r t on n i n e m e e t i n g s of e x p e r t c o m m i t t e e s w h o s e r e p o r t s ^ h a v e been p r e p a r e d in E n g l i s h a n d F r e n c h s i n c e the s i x t i e t h s e s s i o n of the E x e c u t i v e B o a r d .
N i n e m e e t i n g s of e x p e r t c o m m i t t e e s a n d their r e p o r t s are r e v i e w e d h e r e u n d e r , in the f o l l o w i n g order：
1 W H 0 L E S 0 M E N E S S O F I R R A D I A T E D F O O D
R e p o r t of a J o i n t F A o / I A E A / W H O E x p e r t C o m m i t t e e H E A L T H N E E D S O F A D O L E S C E N T S
R e p o r t of a W H O E x p e r t C o m m i t t e e A D V A N C E S IN V I R A L H E P A T I T I S
R e p o r t of the W H O E x p e r t C o m m i t t e e on V i r a l H e p a t i t i s C H E M O T H E R A P Y O F S O L I D T U M O U R S
R e p o r t of a W H O E x p e r t C o m m i t t e e
C H I L D M E N T A L H E A L T H A N D P S Y C H O S O C I A L D E V E L O P M E N T R e p o r t of a W H O E x p e r t C o m m i t t e e
W H O E X P E R T C O M M I T T E E O N B I O L O G I C A L S T A N D A R D I Z A T I O N T w e n t y - e i g h t h R e p o r t
P E S T I C I D E R E S I D U E S IN F O O D
R e p o r t of the 1976 J o i n t M e e t i n g of the FAO P a n e l of E x p e r t s on P e s t i c i d e R e s i d u e s a n d the E n v i r o n m e n t a n d the W H O E x p e r t G r o u p on P e s t i c i d e R e s i d u e s
W H O B a s i c D o c u m e n t s , 27th e d . , 1 9 7 7 , p . 9 3 .
2 F o r e a s y r e f e r e n c e , c o p i e s of these r e p o r t s a r e a n n e x e d to this d o c u m e n t (for m e m b e r s of the E x e c u t i v e B o a r d o n l y ) . W i t h the e x c e p t i o n of one r e p o r t in E n g l i s h a n d two in F r e n c h , a l l r e p o r t s h a v e a l r e a d y been p u b l i s h e d in the T e c h n i c a l R e p o r t S e r i e s . In order n o t to d e l a y p r e s e n t a t i o n to the B o a r d , the r e p o r t s w h i c h a r e s t i l l in the p r o c e s s of b e i n g p r i n t e d or e d i t e d are s u p p l i e d in the f o r m of u n c o r r e c t e d p r o o f s or as o f f s e t d o c u m e n t s , and m a y c o n t a i n m i n o r e r r o r s . T h e s e w i l l be c o r r e c t e d b e f o r e the r e p o r t s a r e f i n a l l y p r i n t e d in the
T e c h n i c a l R e p o r t S e r i e s .
0 S S 7
7
EBÓI/З p a g e 2
8 . U S E O F I O N I Z I N G R A D I A T I O N A N D R A D I O N U C L I D E S O N H U M A N B E I N G S F O R M E D I C A L R E S E A R C H , T R A I N I N G , A N D N O N M E D I C A L P U R P O S E S
R e p o r t of a W H O E x p e r t C o m m i t t e e 9 . THE S E L E C T I O N O F E S S E N T I A L D R U G S R e p o r t of a W H O E x p e r t C o m m i t t e e
1 . raOLESOMENESS OF I R R A D I A T E D F O O D
R e p o r t of a J o i n t F A q / i A E A / w H O E x p e r t C o m m i t t e e G e n e v a , 31 A u g u s t - 7 S e p t e m b e r 1 9 7 6 1
1.1 B a c k g r o u n d i n f o r m a t i o n
In 19 69 the J o i n t F A O / I A E A / W H O E x p e r t C o m m i t t e e on the W h o l e s o m e n e s s of I r r a d i a t e d F o o d ^ w h e a t , p o t a t o a n d o n i o n s , w h i l s t a l s o on the w h o l e s o m e n e s s of these i r r a d i a t e d m e a n t i m e on these a n d o t h e r i r r a d i a t e d r e c o m m e n d e d t e m p o r a r y a c c e p t a n c e of the i r r a d i a t i o n of
r e c o m m e n d i n g t h a t f u r t h e r s t u d i e s s h o u l d be u n d e r t a k e n f o o d i t e m s . T o c o n s i d e r the n e w d a t a p r o v i d e d in the f o o d s , a n o t h e r m e e t i n g on this topic w a s c o n v e n e d . 1.2 T h e r e p o r t
T h e C o m m i t t e e e v a l u a t e d a c o n s i d e r a b l e a m o u n t of t o x i c o l o g i c a l data a n d a l s o r e v i e w e d the p o s s i b l e e f f e c t of i r r a d i a t i o n of food f r o m the n u t r i t i o n a l , c h e m i c a l a n d m i c r o b i o l o g i c a l p o i n t s of v i e w . U n c o n d i t i o n a l a c c e p t a n c e of the f o l l o w i n g i r r a d i a t e d foods w a s r e c o m m e n d e d b y the E x p e r t C o m m i t t e e : p o t a t o , w h e a t , c h i c k e n , p a p a y a a n d s t r a w b e r r i e s .
T h r e e f o o d items - r i c e , fresh c o d a n d r e d f i s h , a n d o n i o n s - w e r e g i v e n p r o v i s i o n a l a p p r o v a l a n d in these cases the C o m m i t t e e r e q u e s t e d t h a t f u r t h e r d a t a be p r o v i d e d . T h e e v a l u a t i o n of the data on the w h o l e s o m e n e s s of i r r a d i a t e d m u s h r o o m s w a s n o t f o u n d to be e n t i r e l y s a t i s f a c t o r y and a d e c i s i o n b a s e d on the e v a l u a t i o n w a s d e f e r r e d to a later d a t e . 1•3 T h e r e c o m m e n d a t i o n s
(i) T h e C o m m i t t e e r e c o g n i z e d the n e e d for f u r t h e r r e s e a r c h on the i r r a d i a t i o n of a n u m b e r of foods a n d on r e l a t e d m a t t e r s . It r e c o m m e n d e d t h a t , w h e n the r e s u l t s of such w o r k are f o r t h c o m i n g , F A O , I A E A a n d W H O s h o u l d give c o n s i d e r a t i o n to the e s t a b l i s h m e n t of an i n t e r s e c r e t a r i a t m e c h a n i s m for k e e p i n g u n d e r c o n s t a n t r e v i e w p r o g r e s s in the f i e l d of f o o d i r r a d i a t i o n a n d for c o n v e n i n g f u r t h e r m e e t i n g s of e x p e r t s to e v a l u a t e data a t a p p r o p r i a t e t i m e s .
(ii) T h e C o m m i t t e e s u g g e s t e d t h a t , in v i e w of the a d v a n c e s in k n o w l e d g e in the f i e l d of food i r r a d i a t i o n as r e v i e w e d in this r e p o r t , f u t u r e e v a l u a t i o n s of the w h o l e s o m e n e s s of i n d i v i d u a l i r r a d i a t e d foods s h o u l d take into c o n s i d e r a t i o n a l l r e l e v a n t data o b t a i n e d f r o m tests on a n a l o g o u s i r r a d i a t e d foods a n d on r e p r e s e n t a t i v e food c o n s t i t u e n t s . 1.4 I m p l i c a t i o n s for the O r g a n i z a t i o n ' s p r o g r a m m e
A s r e c o m m e n d e d , the three s e c r e t a r i a t s of F A O , I A E A a n d W H O w i l l k e e p p r o g r e s s on the w h o l e s o m e n e s s of i r r a d i a t e d food u n d e r r e v i e we T h e r e p o r t of the J o i n t E x p e r t C o m m i t t e e w i l l be s u b m i t t e d to the C o d e x A l i m e n t a r i u s C o m m i s s i o n for a p p r o p r i a t e a c t i o n w i t h r e g a r d to food s t a n d a r d s . A f u r t h e r m e e t i n g of the J o i n t E x p e r t C o m m i t t e e s h o u l d be c o n v e n e d in 1980 to r e v i e w n e w d a t a .
1 W H O T e c h n i c a l R e p o r t S e r i e s , N o . 6 0 4 , 1 9 7 7 . 2 W H O T e c h n i c a l R e p o r t S e r i e s , N o . 4 5 1 , 1 9 7 0 .
EBól/3 page 3 1 • 5 Comments
FAO and IAEA have a legitimate interest in stimulating the use of irradiation for the preservation of food to cover the increasing world n e e d . Present research is aimed at
assessing whether the irradiation process affects the wholesomeness of the product. In order to safeguard the interests of public h e a l t h , the Joint Expert Committee recommended for 1980 should be held in conjunction with W H O .
2 . HEALTH NEEDS OF ADOLESCENTS Report of a WHO Expert Committee Geneva， 28 September - 4 October 1 9 7 61
2•1 Background information
The previous Expert Committee on the Health Needs of Adolescents met in 1964.2 The main objectives of the 1976 Expert Committee were to review the health needs of adolescents in the context of changing social patterns in different environmental settings；
to identify health problems related to physical and psychosocial development； to formulate technical recommendations and guidelines for the promotion of health and well-being and the provision of health care with the active involvement of the community, including adolescents；
to examine the implications of the above for the training of health personnel； and to recommend research priorities to acquire a better understanding of emerging problems facing the adolescents of today.
An Expert Committee on Child Mental Health and Psychosocial Development, which met in Geneva from 9 to 15 November 1976^ and focused its attention specifically on child mental health including that of adolescents, complemented the discussions and recommendations of the Expert Committee on Health Needs of Adolescents (see under section 5 b e l o w ) .
2.2 The report
The report discusses the problems of the health and well-being of adolescents on a worldwide b a s i s , with specific reference to developing countries. It stresses that, despite
cultural differences, there are certain fundamental characteristics of the early part of adolescence that are universal: rapid physical growth, changes in psychosocial functions, and completion of sexual development. It describes adolescence as a period of gradual transition from childhood to a d u l t h o o d , the age range 10-20 years appearing to cover this period.
The sources of disease, disability and suffering are summarized, and causative and risk factors examined; health problems are placed in their social context； attention is drawn to special problems that have recently emerged and ways in which the situation might be improved by innovations in health services, combined with changes in education and social services•
Also discussed are the education and training of health and related personnel dealing with adolescents•
Emerging problems and perspectives are given emphasis in relation to shifting patterns of employment and unemployment, decreasing physical exertion (as technology continues to provide labour-saving devices), changes in education, and changes in the role of women and in relation- ships within the family. The Committee felt that decision-makers should be alerted to the likelihood that such changes would have consequences for adolescent development and h e a l t h .
1 WHO Technical Report S e r i e s , N o . 609, 2 WHO Technical Report Series, N o . 308, 3 WHO Technical Report Series, N o . 613,
1977.
19 65.
1977.
EBól/з page 4
2•3 The recommendations
T h e E x p e r t C o m m i t t e e m a d e r e c o m m e n d a t i o n s s p e c i f i c a l l y a d d r e s s e d to n a t i o n a l g o v e r n m e n t s a n d to W H O in the f o l l o w i n g m a i n a r e a s :
S e r v i c e s
- E a c h g o v e r n m e n t s h o u l d d e v e l o p a n a t i o n a l p o l i c y a n d plan i n v o l v i n g v a r i o u s s e c t o r s , i n c l u d i n g h e a l t h , e d u c a t i o n , t r a i n i n g , e m p l o y m e n t , a n d s o c i a l s e r v i c e s for a d o l e s c e n t s , w i t h i n the c o n t e x t of o v e r a l l n a t i o n a l p l a n s for s o c i o e c o n o m i c d e v e l o p m e n t .
- S p e c i f i c a t t e n t i o n s h o u l d be p a i d by g o v e r n m e n t s a n d W H O to a p p r o p r i a t e l e g i s l a t i o n . - A d o l e s c e n t s should p a r t i c i p a t e a c t i v e l y in d e c i s i o n - m a k i n g i n v o l v i n g their h e a l t h n e e d s . - A p r o p e r u n d e r s t a n d i n g of the s p e c i a l p h y s i c a l a n d p s y c h o s o c i a l n e e d s of a d o l e s c e n t s is e s s e n t i a l to e f f e c t i v e c a r e .
- E x i s t i n g s e r v i c e s , p a r t i c u l a r l y those for p r i m a r y h e a l t h care of a d o l e s c e n t s , should be b a s e d on local n e e d s , p r i o r i t i e s , a n d life s t y l e s .
E d u c a t i o n and t r a i n i n g
- I n the t r a i n i n g of m e d i c a l s t u d e n t s a n d o t h e r h e a l t h w o r k e r s , due c o n s i d e r a t i o n should be given to the h e a l t h n e e d s of a d o l e s c e n t s .
- T h e r e s h o u l d be close c o l l a b o r a t i o n by e d u c a t i o n a n d h e a l t h a u t h o r i t i e s in the r e v i s i o n of s c h o o l c u r r i c u l a to include e d u c a t i o n in family l i f e , r e s p o n s i b l e p a r e n t h o o d , a n d s e x . P a r e n t s s h o u l d be a c t i v e l y i n v o l v e d , and teachers s h o u l d be s p e c i f i c a l l y p r e p a r e d to p r o m o t e a b e t t e r u n d e r s t a n d i n g of the h e a l t h - r e l a t e d n e e d s of a d o l e s c e n t s .
- V o c a t i o n a l g u i d a n c e s h o u l d b e e x p a n d e d a n d r e l e v a n t s c h o o l c u r r i c u l a should be r e v i e w e d w i t h this in m i n d .
R e s e a r c h
- E x i s t i n g r e s e a r c h s h o u l d be r e v i e w e d a n d a n a l y s e d w i t h s p e c i a l r e f e r e n c e to the parti- c u l a r p h y s i c a l a n d p s y c h o s o c i a l n e e d s a n d p r o b l e m s of a d o l e s c e n t s .
- S u r v e y s should be m a d e a m o n g y o u n g p e o p l e of their v i e w s on their e d u c a t i o n a n d t r a i n i n g , v o c a t i o n a l g u i d a n c e , h e a l t h n e e d s a n d s e r v i c e s , a n d h e a l t h e d u c a t i o n .
- R e s e a r c h should be c o n d u c t e d to d i s c o v e r a safe a n d a c c e p t a b l e c o n t r a c e p t i v e for a d o l e s c e n t s that w i l l n o t h a m p e r their growth a n d d e v e l o p m e n t or their s u b s e q u e n t f e r t i l i t y .
- S t u d i e s s h o u l d be m a d e on the r e l a t i o n s h i p s b e t w e e n h e a l t h , n u t r i t i o n a l s t a t u s , a n d b e h a v i o u r d u r i n g a d o l e s c e n c e on the one h a n d , a n d s u b s e q u e n t m a j o r h e a l t h p r o b l e m s of a d u l t
life on the o t h e r .
2 • 4 I m p l i c a t i o n s for the O r g a n i z a t i o n ' s p r o g r a m m e
T h e r e p o r t p r o v i d e s p r a c t i c a l g u i d e l i n e s that relate d i r e c t l y to the O r g a n i z a t i o n1 s p r o g r a m m e s in family h e a l t h , m a t e r n a l a n d child h e a l t h , n u t r i t i o n , h e a l t h e d u c a t i o n , m e n t a l h e a l t h , o c c u p a t i o n a l h e a l t h , a n d h e a l t h l e g i s l a t i o n . T h e e m p h a s i s on the n e e d for j o i n t a c t i o n in e d u c a t i o n a l , h e a l t h , a n d e m p l o y m e n t a c t i v i t i e s h a s i m p l i c a t i o n s for c o l l a b o r a t i o n b e t w e e n U N E S C O , ILO a n d W H O .
EBÓl/з page 5 The emphasis on the specific needs of a d o l e s c e n t s , particularly in rural and in rapidly urbanizing areas in m a n y developing countries, the impact of their health problems for the future adult population, and their role in community and family self-reliance, indicate areas of special concern for WHO in technical cooperation with its Member States. This w i l l be particularly true for the various programmes related to primary health care and for those concerned with the training of young health and related p e r s o n n e l , arid also workers in relevant social sectors.
2.5 Comments
This report w i l l be of practical use to those interested and working in the various fields related to adolescents. It has already been used to stimulate interest in a number of
countries, for instance, C u b a , M e x i c o , and the Philippines. Some of the research recommenda- tions have already been implemented: for instance, a WHO research programme on adolescent reproductive health has been initiated. Countries are being sounded for their interest in a cross-cultural survey of health care and educational material relevant to the health of adolescents.
3 . ADVANCES IN VIRAL HEPATITIS
Report of the WHO Expert Committee on Viral Hepatitis
G e n e v a , 11-16 October 1 9 7 61 “
3.1 Background information
Viral hepatitis is a serious worldwide public health p r o b l e m . This has long been recognized by W H O , and various meetings on the subject have been convened in order to draw attention to the importance of the disease and to discuss the best possible ways of controlling it. Until recently, efforts were hampered by the limited knowledge of its etiology and
epidemiology. During the past few y e a r s , h o w e v e r , considerable progress has been made in our understanding of both viral hepatitis A and В, and it has become increasingly necessary to review the rapidly accumulating knowledge and to make recommendations on the application of this knowledge for better control of the disease.
3.2 The report
The Committee suggested a simplified nomenclature and terminology for hepatitis v i r u s e s , their antigens and antibodies - a subject which has in the past been rather c o n f u s e d .
Clinical manifestations, laboratory findings, arid the biochemical and biophysical properties of both hepatitis A and В viruses were briefly reviewed.
The main body of the report deals with the epidemiology of the disease in different geographical a r e a s , ethnic and social groups, and w i t h methods for the detection of hepatitis A virus and various hepatitis В antigens and antibodies. The immunology and immunopathology of the disease, w i t h emphasis on the role of cell-mediated immunity, are also c o v e r e d .
Furthermore it is recorded that, thanks to significant progress in specific diagnosis of the disease, a new type of hepatitis unrelated to either hepatitis A or В has been recognized.
This new type is now the most common form of post-transfusion hepatitis in some areas• Other problems of blood transfusion services, high-risk groups of patients and hospital s t a f f ,
occupational h a z a r d s , and also the application of control measures are described.
Studies involving the propagation of the virus in tissue cultures and noil-human primates are m e n t i o n e d . It is pointed out that experimental animal models of infection w i t h hepatitis A and В virus facilitate the study of the infectivity of both a g e n t s , and also the evaluation
1 WHO Technical Report S e r i e s , N o . 602, 1977.
E B 6 1 / 3 p a g e 6
of the s a f e t y a n d e f f e c t i v e n e s s of r e c e n t l y p r e p a r e d e x p e r i m e n t a l h e p a t i t i s В v a c c i n e s . S t u d i e s on p a s s i v e i m m u n i z a t i o n a g a i n s t the d i s e a s e and the f i r s t p r o m i s i n g a t t e m p t s at t h e r a p y b y i n t e r f e r o n a r e a l s o c o v e r e d in the r e p o r t . T h e s u g g e s t e d role of h e p a t i t i s В v i r u s in p r i m a r y liver c a r c i n o m a o f f e r s h o p e t h a t t h r o u g h i m m u n i z a t i o n the i n c i d e n c e n o t o n l y o f h e p a t i t i s В b u t a l s o of this f o r m of c a n c e r m a y p o s s i b l y be r e d u c e d .
3•3 T h e r e c o m m e n d a t i o n s
N u m e r o u s i m p o r t a n t r e c o m m e n d a t i o n s w e r e m a d e , b o t h for future r e s e a r c h a n d for the a p p l i c a t i o n of c u r r e n t k n o w l e d g e in the c o n t r o l of the d i s e a s e . The C o m m i t t e e c o n s i d e r e d that it w a s i m p o r t a n t for g o v e r n m e n t h e a l t h s e r v i c e s to i n t r o d u c e m o r e s e n s i t i v e l a b o r a t o r y t e c h n i q u e s for d i a g n o s i s a n d s c r e e n i n g b l o o d d o n o r s for h e p a t i t i s В s u r f a c e a n t i g e n (HBsAG);
a n d t h a t b l o o d f o u n d to c o n t a i n this a n t i g e n s h o u l d n o t be u s e d for t r a n s f u s i o n s .
C o n s e q u e n t l y , s p e c i a l e m p h a s i s is p l a c e d on the o r g a n i z a t i o n of t r a i n i n g c o u r s e s in d i a g n o s t i c t e c h n i q u e s in d i f f e r e n t p a r t s of the w o r l d u n d e r the a u s p i c e s of W H O . H e a l t h s e r v i c e s should a l s o a t t e m p t to e n s u r e the r e p o r t i n g of a l l a c u t e h e p a t i t i s cases by age a n d s e x , a n d to i n s t i t u t e d i f f e r e n t i a l r e p o r t i n g of types А, В, a n d o t h e r s .
R e c o m m e n d a t i o n s w e r e m a d e for the p r e p a r a t i o n a n d s t a n d a r d i z a t i o n of r e a g e n t s a n d in p a r t i c u l a r the p r e p a r a t i o n of i n t e r n a t i o n a l s t a n d a r d s for h e p a t i t i s A a n d В i m m u n o g l o b u l i n s that a r e to be u s e d for p r o p h y l a c t i c p u r p o s e se G u i d e l i n e s for the p r e p a r a t i o n of e x p e r i m e n t a l h e p a t i t i s В v a c c i n e s i n c l u d e s a f e t y c r i t e r i a .
3•4 I m p l i c a t i o n s for the O r g a n i z a t i o n fs p r o g r a m m e
T h e C o m m i t t e e ' s d e l i b e r a t i o n s s h o u l d r e s u l t in d i r e c t t e c h n i c a l c o o p e r a t i o n a n d in p r o v i s i o n of a p p r o p r i a t e i n f o r m a t i o n at c o u n t r y a n d r e g i o n a l levels on the i m p l e m e n t a t i o n of r e c o m m e n d a t i o n s , p a r t i c u l a r l y t h o s e a i m i n g a t the s t r e n g t h e n i n g of p u b l i c h e a l t h c o n t r o l m e a s u r e s . T h e p r o g r a m m e s h o u l d a l s o include the o r g a n i z a t i o n of i n t e r n a t i o n a l s e m i n a r s , t r a i n i n g c o u r s e s , a n d v a r i o u s c o l l a b o r a t i v e s t u d i e s for the p r o m o t i o n of w o r l d w i d e r e s e a r c h e f f o r t s on v i r a l h e p a t i t i s .
3•5 C o m m e n t s
T h e m e e t i n g of the E x p e r t C o m m i t t e e on V i r a l H e p a t i t i s w a s o p p o r t u n e a n d r e s u l t e d in a v e r y u s e f u l e x c h a n g e of v i e w s on this i m p o r t a n t s u b j e c t . The r e p o r t a n d its r e c o m m e n d a t i o n s a r e a s i g n i f i c a n t c o n t r i b u t i o n to the b e t t e r u n d e r s t a n d i n g of b o t h t h e o r e t i c a l a n d p r a c t i c a l p r o b l e m s , a n d u n d o u b t e d l y r e p r e s e n t a v a l u a b l e d o c u m e n t w h i c h w i l l f a c i l i t a t e f u r t h e r p r o g r e s s in the c o n t r o l of the d i s e a s e in b o t h d e v e l o p i n g a n d d e v e l o p e d c o u n t r i e s .
4 . C H E M O T H E R A P Y O F S O L I D T U M O U R S R e p o r t of a W H O E x p e r t C o m m i t t e e G e n e v a , 1 - 5 N o v e m b e r 1 9 7 61 ^ 4 . 1 B a c k g r o u n d i n f o r m a t i o n
T h e r e a r e five m a i n k i n d s of t r e a t m e n t of c a n c e r today： s u r g e r y , r a d i o t h e r a p y ,
c h e m o t h e r a p y , e n d o c r i n o t h e r a p y , a n d p o s s i b l y i m m u n o t h e r a p y . T h e a i m of a l l these types of t r e a t m e n t is to d e s t r o y , r e m o v e or n e u t r a l i z e a l l m a l i g n a n t cells to a c h i e v e cure of the p a t i e n t . C h e m o t h e r a p y is s t e a d i l y b e c o m i n g m o r e a n d m o r e i m p o r t a n t , n o t o n l y from the point of v i e w o f a d j u v a n t t h e r a p y , b u t a l s o f r o m the p o i n t of v i e w of c u r a t i v e t h e r a p y .
1 W H O T e c h n i c a l R e p o r t S e r i e s , No。 611， 1 9 7 7 .
t h a t an e x p e r t c o m m i t t e e s h o u l d be c o n v e n e d to d r a f t p a t i e n t m a n a g e m e n t g u i d e l i n e s s p e c i f i c m a l i g n a n t sites；
(3) t h a t , in s p i t e of m a n y s u c c e s s e s in c a n c e r c h e m o t h e r a p y , t h e m u l t i d i s c i p l i n a r y a p p r o a c h in c a n c e r t h e r a p y s h o u l d b e s t r o n g l y e m p h a s i z e d w h e r e v e r p o s s i b l e； a n d t h a t t r a i n i n g p r o g r a m m e s in m e d i c a l o n c o l o g y in M e m b e r c o u n t r i e s s h o u l d be s u p p o r t e d ;
(4) t h a t b i l a t e r a l r e l a t i o n s h i p s b e t w e e n c a n c e r c e n t r e s in d e v e l o p i n g c o u n t r i e s a n d t h o s e in d e v e l o p e d c o u n t r i e s s h o u l d b e s u p p o r t e d b y W H O；
(5) t h a t , b e a r i n g in m i n d the d u p l i c a t i o n of e f f o r t a n d d i f f e r i n g d e m a n d s for i n f o m a - t i o n r e q u i r e d b y the v a r i o u s n a t i o n a l d r u g r e g i s t r a t i o n a u t h o r i t i e s , W H O s h o u l d a s a m a t t e r of u r g e n c y a t t e m p t to d e t e r m i n e h o w the i n f o r m a t i o n r e q u i r e d b y r e g i s t r a t i o n
a u t h o r i t i e s can b e s t b e s t a n d a r d i z e d so t h a t a u n i f o r m set of r e q u i r e m e n t s c a n be e v o l v e d ; (6) that W H O s h o u l d d e v e l o p m e t h o d s w h e r e b y the m o s t i m p o r t a n t d r u g s (as l i s t e d in A n n e x 2 of the r e p o r t ) c a n b e m a d e m o r e e a s i l y a v a i l a b l e in a l l c o u n t r i e s .
1 W H O T e c h n i c a l R e p o r t S e r i e s , N o . 2 3 2 , 1 9 6 2 . 2
D a v i d , W# & L a r i o n o v , L . F . , P r o g r e s s in c h e m o t h e r a p y of c a n c e r , B u l l e t i n of the W o r l d H e a l t h O r g a n i z a t i o n， 30: 327 ( 1 9 6 4 ) .
3
B r û l é , G•， E c k h a r d t , S . J . , H a l l , Т. С. & W i n k l e r , A•， D r u g t h e r a p y of c a n c e r ’ W o r l d H e a l t h O r g a n i z a t i o n , 1 9 7 3 .
. EBól/з p a g e 7
T h e f i r s t e x p e r t c o m m i t t e e o n t h i s s u b j e c t w a s c o n v e n e d in 1 9 6 1 , ^ a n d its r e p o r t w a s l a t e r u p d a t e d in 19 6 5 I n 1 9 7 3 W H O p u b l i s h e d the b o o k l e t D r u g T h e r a p y of C a n c e r ) w h i c h w a s c o n c e r n e d w i t h p r a c t i c a l t h e r a p y a n d h a s b e e n u s e d in v e r y m a n y p l a c e s a s t e a c h i n g m a t e r i a l , for e x a m p l e in t h e c o u r s e s o n c h e m o t h e r a p y of the I n t e r n a t i o n a l U n i o n A g a i n s t C a n c e r .
T h e d e v e l o p m e n t of c a n c e r c h e m o t h e r a p y h a s b e e n q u i t e r a p i d a n d , a s s e v e r a l r e q u e s t s h a d b e e n r e c e i v e d to u p d a t e i n f o r m a t i o n on the s i t u a t i o n in an u n b i a s e d b u t c o n c i s e f o r m , a n E x p e r t C o m m i t t e e on C h e m o t h e r a p y of S o l i d T u m o u r s w a s c o n v e n e d in G e n e v a in N o v e m b e r 197 6 .
B e c a u s e of the v a s t a m o u n t of i n f o r m a t i o n a v a i l a b l e on c h e m o t h e r a p y of l y m p h o m a s a n d l e u k a e m i a s , t h i s E x p e r t C o m m i t t e e d e a l t o n l y w i t h s o l i d t u m o u r s .
T h e m a i n o b j e c t i v e of the E x p e r t C o m m i t t e e w a s to give a c o n c i s e o v e r v i e w of p r a c t i c a l p o s s i b i l i t i e s for the d r u g t r e a t m e n t of s o l i d c a n c e r s , i n d i c a t i n g a l s o t h e c o m p o u n d s a n d c o m b i n a t i o n s m o s t o f t e n u s e d for t r e a t m e n t .
4 . 2 T h e r e p o r t
T h e r e p o r t d e s c r i b e s the l i m i t s of p r e s e n t m e t h o d s of t r e a t m e n t . It o u t l i n e s the m o s t i m p o r t a n t b a s i c c o n c e p t s in c a n c e r t h e r a p y in g e n e r a l , w i t h p a r t i c u l a r e m p h a s i s 011 t h e b a s i c c o n c e p t s of d r u g t r e a t m e n t . T h e l a r g e s t p a r t of the r e p o r t d e a l s w i t h c h e m o t h e r a p e u t i c a p p r o a c h e s to p a r t i c u l a r c a n c e r s i t e s i n c l u d i n g a l l t h o s e c a n c e r s w h i c h h a v e , o r w h i c h s h o w , the h i g h e s t i n c i d e n c e r a t e s in a l l c o u n t r i e s . P a r t i c u l a r a t t e n t i o n w a s p a i d to e n s u r i n g t h a t w e 1 1 - r e c o g n i z e d c o m p o u n d s o r i g i n a t i n g in a n y p a r t of the w o r l d w e r e i n c l u d e d in the p o s s i b i l i -
t i e s for t r e a t m e n t . A s m a l l s e c t i o n of the r e p o r t d e a l s w i t h c l i n i c a l t r i a l s t r a t e g i e s , e v a l u a t i o n t e c h n i q u e s in c a n c e r t h e r a p y , a n d n e w a p p r o a c h e s w h i c h c a n be e n v i s a g e d e i t h e r b y e x p e r i m e n t a l c a n c e r c h e m o t h e r a p y o r as a r e s u l t of b a s i c c a n c e r r e s e a r c h .
4 . 3 T h e r e c o m m e n d a t i o n s
T h e r e c o m m e n d a t i o n s m a d e b y the E x p e r t C o m m i t t e e m a y b e s u m m a r i z e d a s f o l l o w s :
(1) t h a t a s i m i l a r e x p e r t c o m m i t t e e on the c h e m o t h e r a p y of h a e m a t o l o g i c a l m a l i g n a n c i e s s h o u l d be c o n v e n e d ;
E B Ó l / 3 page 8
4.4 Implications for the Organization 1 s programme
M o s t of the implications for the Organization's programme w i l l be clear from the recommendations mentioned a b o v e . In this context, these are quite appropriate to some components of the long-term programme of international cooperation in cancer research and to the WHO medium-term cancer p r o g r a m m e , with its emphasis on the country level and its particular concern for developing countries.
4.5 Comments
A large number of comprehensive books on cancer chemotherapy, usually written by several a u t h o r s , have been published; they are quite expensive and v o l u m i n o u s , and rapidly become out of d a t e . The need for a c o n c i s e , as far as possible u n b i a s e d , more or less authoritative publication was desirable, taking into account all the proven facts - a n d , in f a c t , requests had been made to WHO to update the information on this s u b j e c t . The Expert Committee responded to this need by p r o d u c i n g , in its report, a booklet of moderate size (106 pages) offering practical a d v i c e . It can be used for postgraduate and undergraduate training, and for the courses in chemotherapy which are organized in m a n y countries and by international organizations such as the International Union Against Cancer (UICC) or o t h e r s .
5 . CHILD MENTAL HEALTH AND PSYCHOSOCIAL DEVELOPMENT Report of a WHO Expert Committee
G e n e v a , 9-15 November 19761 5•1 Background information
Child mental health and psychosocial development are among the central concerns of the new programme in mental h e a l t h . Approximately one-third of the world's population -
1300 million - is under the age of 15; 80% of them live in developing countries. Between
57o
and 15% of all children aged 3-15 years are affected by persistent and socially handicapping mental disorders. Mental health services are meagre or completely lacking in most developing c o u n t r i e s , where the stresses of rapid social c h a n g e , such as urbanization and industrialization, have exacerbated children 1 s mental health problems. Furthermore, psychosocial factors have to be taken into account in solving other urgent problems such as m a l n u t r i t i o n , communicable diseases and inadequate health care delivery in these countries.Expert committee meetings have recently been convened which dealt with the Organization of Mental Health Services in Developing C o u n t r i e s N e w Trends and Approaches in the Delivery of Maternal and Child Health Care in Health S e r v i c e s，3 and Health Needs of Adolescents.^ The primary objectives of this meeting therefore were to review the current state of knowledge, define concrete methods of applying it, and recommend action to improve child mental health and prevent psychosocial problems in children.
5.2 The report
The Committee focused its attention on psychosocial development, frequently encountered mental health problems, and measures to prevent mental disorders in children or improve
delivery of care to those sick. In view of previous arid concurrent w o r k on mental retardation, epilepsy and organic brain syndromes, these conditions were not specifically discussed although they constitute a major health problem in childhood.
1 WHO Technical Report Series, N o . 613， 1977.
2 WHO Technical Report S e r i e s , N o . 5 6 4 , 1975.
3 WHO Technical Report S e r i e s , N o . 600, 1976.
4 WHO Technical Report S e r i e s , N o . 609, 1977 (see also section 2 of the present report).
EB61/3 page 9
T h e C o m m i t t e e r e v i e w e d s o c i o d e m o g r a p h i c data r e l e v a n t to c h i l d d e v e l o p m e n t a n d h e a l t h , i n c l u d i n g those r e l a t i n g to p r o c e s s e s such as u r b a n i z a t i o n , m i g r a t i o n and f a m i l y b r e a k d o w n . E p i d e m i o l o g i c a l a n d d e v e l o p m e n t a l f e a t u r e s w e r e d i s c u s s e d w i t h r e f e r e n c e to d e t e r m i n i n g p r e v a l e n c e f i g u r e s . T h e d i s t i n c t i o n w a s m a d e b e t w e e n n o r m a l c h i l d h o o d p r o b l e m s a n d m e n t a l d i s o r d e r s in that the latter d i f f e r in s e v e r i t y a n d the e x t e n t to w h i c h they i m p e d e o v e r a l l p s y c h o s o c i a l d e v e l o p m e n t , i . e . , t h e y are m u l t i p l e , p e r s i s t e n t , and s o c i a l l y h a n d i c a p p i n g . P r o b l e m s of a s s e s s m e n t , d i a g n o s i s a n d c l a s s i f i c a t i o n w e r e d i s c u s s e d , i n c l u d i n g the r e c e n t w o r k of W H O , e . g . , the m u l t i a x i a l c l a s s i f i c a t i o n s c h e m e for c h i l d r e n , a n d n e w c a t e g o r i e s forc h i l d r e n ' s m e n t a l d i s o r d e r s in the I n t e r n a t i o n a l C l a s s i f i c a t i o n of D i s e a s e s .
B i o l o g i c a l , c o g n i t i v e , e c o l o g i c a l and social f a c t o r s i n f l u e n c i n g p s y c h o s o c i a l d e v e l o p m e n t w e r e e v a l u a t e d on the b a s i s of r e c e n t f i n d i n g s , a n d p a r t i c u l a r l y the e f f e c t s of s o c i a l c h a n g e on m e n t a l h e a l t h .
A n o t h e r m a j o r a r e a w h i c h w a s r e v i e w e d in depth c o n c e r n s the e f f e c t s of v a r i o u s f a c t o r s r e l a t e d to p a t t e r n s of u p b r i n g i n g : q u a l i t y of p a r e n t / c h i l d interaction； p a r e n t a l p e r s o n a l i t y c h a r a c t e r i s t i c s (including p a r e n t a l m e n t a l disorder)； i n t r a f a m i l i a l r e l a t i o n s h i p s； day-care；
r e s i d e n t i a l care； h o s p i t a l i z a t i o n ; s c h o o l i n g ; a d o p t i o n a n d foster h o m e p r o c e d u r e s .
C u r r e n t data r e g a r d i n g d a y - c a r e w a s d i s c u s s e d , p a r t i c u l a r l y in v i e w of the c h a n g i n g r o l e of w o m e n in m a n y s o c i e t i e s and the increase in s i n g l e - p a r e n t f a m i l i e s . T h e C o m m i t t e e
c o n c l u d e d t h a t , c o n t r a r y to w h a t w a s b e l i e v e d in the p a s t , c h i l d r e n a r e n o t i n e v i t a b l y d a m a g e d b y r e c e i v i n g d a y - c a r e o u t s i d e the h o m e or b y h a v i n g m o t h e r s w h o go out to w o r k ; i n d e e d , g o o d q u a l i t y d a y - c a r e can h a v e p o s i t i v e p s y c h o s o c i a l b e n e f i t s for a l l c h i l d r e n a n d e s p e c i a l l y for those from s e r i o u s l y d i s a d v a n t a g e d or d i s o r d e r e d h o m e s .
In a d d i t i o n to d i s c u s s i n g f a c t o r s that tend to d a m a g e p s y c h o s o c i a l d e v e l o p m e n t , the C o m m i t t e e d i s c u s s e d in d e t a i l the i n f l u e n c e s that f a c i l i t a t e n o r m a l d e v e l o p m e n t a n d the c i r c u m s t a n c e s t h a t e n a b l e c h i l d r e n to d e v e l o p n o r m a l l y in spite of s t r e s s , d e p r i v a t i o n a n d s o c i a l d i s a d v a n t a g e . It s t r e s s e d t h a t , w h e r e a s r e s e a r c h tends to focus on m e n t a l d i s e a s e , p r i o r i t y s h o u l d be given to r e s e a r c h on m e n t a l h e a l t h .
T h e C o m m i t t e e e x a m i n e d the p a t t e r n s of e x i s t i n g s e r v i c e s for p r o b l e m s of p s y c h o s o c i a l d e v e l o p m e n t , p a r t i c u l a r l y a v a i l a b l e r e s o u r c e s a n d p a t t e r n s of care in d e v e l o p i n g c o u n t r i e s . It w a s n o t e d that as long as m e n t a l h e a l t h s e r v i c e s a r e v e r y l i m i t e d t h r o u g h o u t the w o r l d , it w o u l d be u n r e a l i s t i c a n d - m o r e i m p o r t a n t - i n a p p r o p r i a t e to r e c o m m e n d that the s o l u t i o n lies o n l y in i n c r e a s i n g the n u m b e r of s p e c i a l i s t s a n d s p e c i a l i n s t i t u t i o n s . On the c o n t r a r y , the p r o m o t i o n of h e a l t h y d e v e l o p m e n t a n d e f f e c t i v e c a r e for m e n t a l h e a l t h p r o b l e m s s h o u l d be the r e s p o n s i b i l i t y of a l l w h o h a v e c o n t a c t w i t h c h i l d r e n . M u l t i p l e p o s s i b i l i t i e s for a c t i o n w e r e t h e r e f o r e i d e n t i f i e d - n o t o n l y in the m e n t a l h e a l t h s e c t o r , b u t in g e n e r a l h e a l t h c a r e , s o c i a l w e l f a r e , e d u c a t i o n and the j u d i c i a r y , as w e l l as for m e m b e r s of the f a m i l y a n d the c o m m u n i t y and for v o l u n t e e r o r g a n i z a t i o n s .
5.3 T h e r e c o m m e n d a t i o n s
T h e C o m m i t t e e!s r e c o m m e n d a t i o n s fell into four groups : p r e v e n t i o n , t r e a t m e n t , e v a l u a t i o n , and p l a n n i n g at c o u n t r y l e v e l .
P r e v e n t i o n
T h e C o m m i t t e e e n d o r s e d p r e v i o u s r e c o m m e n d a t i o n s that m a t e r n a l a n d c h i l d care s e r v i c e s s h o u l d be e x t e n d e d ; n u t r i t i o n a l s t a n d a r d s r a i s e d ; i m m u n i z a t i o n a g a i n s t the c o m m o n i n f e c t i o n s of c h i l d h o o d d i s e a s e s p r o v i d e d ; h a b i l i t a t i o n a n d r e h a b i l i t a t i o n o f f e r e d ; a n d h o u s i n g , s c h o o l s a f e t y and s a n i t a r y f a c i l i t i e s i m p r o v e d . T h e s e g e n e r a l h e a l t h a n d s o c i a l s e r v i c e m e a s u r e s w o u l d h a v e a m a j o r impact on the p r e v e n t i o n of m e n t a l d i s o r d e r in c h i l d h o o d . H e a l t h e d u c a t i o n
p r o g r a m m e s s h o u l d include i n f o r m a t i o n on p s y c h o s o c i a l d e v e l o p m e n t in o r d e r to i n c r e a s e the a w a r e n e s s and a b i l i t i e s of a l l those w h o h a v e r e s p o n s i b i l i t y for the w e l f a r e of c h i l d r e n , i n c l u d i n g p a r e n t s , t e a c h e r s , p h y s i c i a n s , p o l i c e and nurses； the c o n t i n u i t y of p a r e n t f i g u r e s
EB61/3 page 10
s h o u l d be e n c o u r a g e d in f a m i l i e s a n d p r o v i d e d for w h e n s t a f f i n g m e d i c a l a n d e d u c a t i o n a l i n s t i t u t i o n s , a n d e s t a b l i s h i n g a d o p t i o n a n d f o s t e r p a r e n t p r o c e d u r e s . H o s p i t a l i z a t i o n of c h i l d r e n s h o u l d be a v o i d e d w h e n e v e r possible； if it is n e c e s s a r y , p a r e n t s should h a v e u n l i m i t e d a c c e s s to the c h i l d .
T r e a t m e n t
T r e a t m e n t r e s o u r c e s s h o u l d be d e v e l o p e d at c o m m u n i t y level a n d there s h o u l d be an
a d e q u a t e s y s t e m of r e f e r r a l a n d s u p p o r t . U s e s h o u l d be m a d e of e x i s t i n g services； a n d h e a l t h w o r k e r s a l r e a d y p r o v i d i n g p o p u l a t i o n c o v e r a g e , f a m i l y m e m b e r s , v o l u n t e e r w o r k e r s a n d o t h e r
c o m m u n i t y m e m b e r s s h o u l d r e c e i v e a p p r o p r i a t e t r a i n i n g . E v a l u a t i o n
In o r d e r to e v a l u a t e s u c c e s s a n d to f a c i l i t a t e p l a n n i n g , the C o m m i t t e e r e c o m m e n d e d r e g u l a r c o l l e c t i o n of a s m a l l set of data a n d o p e r a t i o n a l r e s e a r c h . T h e n e e d for c o n t i n u i t y of e v a l u a t i o n a n d m o n i t o r i n g w a s s t r e s s e d .
P l a n n i n g
C o u n t r i e s n e e d to h a v e a n a t i o n a l p o l i c y for c h i l d m e n t a l h e a l t h w h i c h r e c o g n i z e s the i n t e r a c t i o n s b e t w e e n m e n t a l h e a l t h a n d p h y s i c a l h e a l t h . E a c h c o u n t r y s h o u l d e s t a b l i s h an i n t e r s e c t o r a l c o o r d i n a t i n g g r o u p at the n a t i o n a l level to d e v e l o p such a p o l i c y . Such groups s h o u l d a l s o be d e s i g n a t e d at r e g i o n a l a n d l o c a l l e v e l w i t h i n c o u n t r i e s . To p r o v i d e t e c h n i c a l s u p p o r t to the d e v e l o p m e n t of c o u n t r y p r o g r a m m e s , m u l t i d i s c i p l i n a r y r e s e a r c h a n d t r a i n i n g c e n t r e s s h o u l d be e s t a b l i s h e d w i t h i n c o u n t r i e s for the study of c h i l d m e n t a l h e a l t h and the t r e a t m e n t of m e n t a l d i s o r d e r s .
5 . 4 I m p l i c a t i o n s for the O r g a n i z a t i o n ' s p r o g r a m m e
T h e C o m m i t t e e ' s r e p o r t i n d i c a t e s p a r t i c u l a r areas in w h i c h W H O can c o o p e r a t e w i t h c o u n t r i e s to improve c h i l d m e n t a l h e a l t h a n d p s y c h o s o c i a l d e v e l o p m e n t . T h e s e include f o r m u l a t i o n of n a t i o n a l h e a l t h policies； p r o v i s i o n of i n f o r m a t i o n n e c e s s a r y for a p p r o p r i a t e l e g i s l a t i v e m e a s u r e s； d e v e l o p m e n t of i n n o v a t i v e e d u c a t i o n a l a n d t r a i n i n g p r o g r a m m e s for
p a r e n t s , g e n e r a l a n d p r i m a r y h e a l t h w o r k e r s , t r a d i t i o n a l h e a l t h p r a c t i t i o n e r s a n d the c o m m u n i t y ; c o o r d i n a t i o n of c r o s s - c u l t u r a l r e s e a r c h in a r e a s i d e n t i f i e d as p r i o r i t y by countries； and d e v e l o p m e n t o f a c o m m o n l y a c c e p t a b l e a n d a p p l i c a b l e c l a s s i f i c a t i o n of m e n t a l c o n d i t i o n s in c h i l d r e n , h e a l t h a n d s o c i a l i n d i c a t o r s , a n d s i m p l e m e t h o d s of i n f o r m a t i o n c o l l e c t i o n .
W H O , in c o o r d i n a t i o n w i t h n o n g o v e r n m e n t a l o r g a n i z a t i o n s a n d a g e n c i e s of the U n i t e d N a t i o n s s y s t e m , s h o u l d p l a y an i m p o r t a n t r o l e in the e s t a b l i s h m e n t of r e s e a r c h a n d t r a i n i n g
c e n t r e s . S i n c e e f f o r t s in the p a s t h a v e o f t e n been i n d e p e n d e n t r a t h e r than s y n e r g i s t i c a n d s c a r c e r e s o u r c e s h a v e been u s e d in s u b o p t i m a l w a y s , n e w m e c h a n i s m s such as a s t a n d i n g a d v i s o r y c o m m i t t e e on c h i l d m e n t a l h e a l t h a n d p s y c h o s o c i a l d e v e l o p m e n t a n d n a t i o n a l c o o r d i n a t i n g b o d i e s w i l l n e e d to be d e v e l o p e d .
5.5 C o m m e n t s
T h e C o m m i t t e e i d e n t i f i e d m a j o r c o n s t r a i n t s to the i m p l e m e n t a t i o n of r e l e v a n t p r o g r a m m e s a n d m a d e p r a c t i c a l a n d s p e c i f i c r e c o m m e n d a t i o n s that can be u s e f u l in d e v e l o p i n g w o r k at c o u n t r y l e v e l a n d in W H O1 s c o o p e r a t i o n w i t h c o u n t r i e s in this r e s p e c t .
It d i d n o t , h o w e v e r , c o n s i d e r in d e t a i l d i s o r d e r s such as the o r g a n i c brain d i s o r d e r s , e p i l e p s y a n d m e n t a l r e t a r d a t i o n . F u r t h e r m o r e , since to deal w i t h m e n t a l h e a l t h p r o b l e m s of c h i l d r e n r e q u i r e s c o n s i d e r a t i o n of the h e a l t h of the family as a w h o l e , it w i l l n o w be n e c e s s a r y to e x a m i n e w a y s in w h i c h the r e c o m m e n d a t i o n s m a d e and the p r o g r a m m e s p r o p o s e d fit
i n t o f a m i l y h e a l t h p r o g r a m m e s a t c o u n t r y l e v e l . A l s o , f u r t h e r w o r k w i l l be n e c e s s a r y to d e v e l o p m e t h o d s s u i t a b l e for e v a l u a t i o n of such b r o a d - b a s e d p r o g r a m m e s , for e f f e c t i v e coopera- tion b e t w e e n c o u n t r i e s f a c i n g s i m i l a r p r o b l e m s , a n d for a c o n c e n t r â t ion of r e s e a r c h e f f o r t s on the m o s t s o c i a l l y r e l e v a n t t o p i c s .
EB61/3 page 11 6 . WHO EXPERT COMMITTEE ON BIOLOGICAL STANDARDIZATION
T w e n t y - e i g h t h R e p o r t
G e n e v a 3 1 6 - 2 2 N o v e m b e r 1 9 7 6 1 6 • 1 B a c k g r o u n d i n f o r m a t i o n
T h e t w e n t y - e i g h t h m e e t i n g o f t h e W H O E x p e r t C o m m i t t e e o n B i o l o g i c a l S t a n d a r d i z a t i o n c o n t i n u e d t h e w o r k of e s t a b l i s h i n g i n t e r n a t i o n a l s t a n d a r d s a n d r e f e r e n c e p r e p a r a t i o n s . T h e m a i n e m p h a s i s w a s p l a c e d o n t h o s e r e q u i r e d for b l o o d p r o d u c t s a n d r e l a t e d s u b s t a n c e s .
6 . 2 T h e r e p o r t
(1) I n t e r n a t i o n a l s t a n d a r d s， i n t e r n a t i o n a l r e f e r e n c e p r e p a r a t i o n s a n d i n t e r n a t i o n a l u n i t s (a) A n t i b i o t i c s
T h e C o m m i t t e e n o t e d t h a t t h e I n t e r n a t i o n a l R e f e r e n c e P r e p a r a t i o n o f S p e c t i n o m y c i n h a d b e e n e s t a b l i s h e d a n d t h e u n i t d e f i n e d . It a l s o n o t e d t h a t p r o g r e s s w a s b e i n g m a d e in t h e c o l l a b o r a t i v e a s s a y of c a n d i c i d i n a n d t o b r a m y c i n , a n d t h a t t h e r e w a s n o f u r t h e r n e e d for t h e e s t a b l i s h m e n t of r i s t o c e t i n a n d r i s t o c e t i n В a s r e f e r e n c e p r e p a r a t i o n s .
(b) A n t i g e n s
T h e C o m m i t t e e c o n f i r m e d t h e u n i t a g e o f t h e I n t e r n a t i o n a l R e f e r e n c e P r e p a r a t i o n of C a r c i n o e m b r y o n i c A n t i g e n； n o t e d t h e p r o g r e s s m a d e in t h e r e p l a c e m e n t of t h e
I n t e r n a t i o n a l S t a n d a r d for D i p h t h e r i a T o x o i d , A d s o r b e d , a n d for T e t a n u s T o x o i d , A d s o r b e d ; a n d n o t e d a l s o t h e i n v e s t i g a t i o n s i n t o t h e n e e d for a r e f e r e n c e p r e p a r a t i o n o f t e t a n u s t o x i n a s w e l l a s a p u r i f i e d p r o t e i n d e r i v a t i v e of b o v i n e t u b e r c u l i n for v e t e r i n a r y u s e . (c) A n t i t o x i n s
T h e C o m m i t t e e rioted t h e n e e d for t h e r e p l a c e m e n t o f t h e I n t e r n a t i o n a l S t a n d a r d for C l o s t r i d i u m b o t u l i n u m T y p e В A n t i t o x i n .
(d) B l o o d p r o d u c t s a n d r e l a t e d s u b s t a n c e s
T h e C o m m i t t e e n o t e d t h e r e p o r t o f t h e W H O W o r k i n g G r o u p o n t h e S t a n d a r d i z a t i o n of H u m a n B l o o d P r o d u c t s a n d R e l a t e d S u b s t a n c e s , w h i c h h a d m a d e r e c o m m e n d a t i o n s c o n c e r n i n g m a n y a s p e c t s o f s t a n d a r d i z a t i o n in t h i s f i e l d .
I t e s t a b l i s h e d t h e I n t e r n a t i o n a l S t a n d a r d s for A n t i - c I n c o m p l e t e B l o o d T y p i n g S e r u m ; B l o o d C o a g u l a t i o n F a c t o r V I I I； B l o o d C o a g u l a t i o n F a c t o r I X ; a n d t h e I n t e r n a t i o n a l R e f e r e n c e P r e p a r a t i o n s o f P l a s m i n , T h r o m b o p l a s t i n ( H u m a n , C o m b i n e d ) , A n c r o d , a n d A n t i - D I m m u n o g l o b u l i n； t h e u n i t s w e r e d e f i n e d for e a c h o f t h e s e p r e p a r a t i o n s . T h e C o m m i t t e e n o t e d t h a t W H O h a d e s t a b l i s h e d a F l u o r e s c e i n I s o t h i o c y a n a t e - c o n j u g a t e d S h e e p A n t i - H m n a r i I m m u n o g l o b u l i n a s a n I n t e r n a t i o n a l S t a n d a r d , a n d n o t e d a l s o t h e n e e d for
r e f e r e n c e p r e p a r a t i o n s o f A n t i - ( A + B ) , A n t i - C a n d A n t i - E b l o o d t y p i n g s e r a a s w e l l a s for a n t i - h e p a t i t i s В i m m u n o g l o b u l i n a n d a n t i - v a r i c e l l a i m m u n o g l o b u l i n .
(2) R e q u i r e m e n t s for B i o l o g i c a l S u b s t a n c e s
(a) R e q u i r e m e n t s for m e n i n g o c o c c a l p o l y s a c c h a r i d e v a c c i n e
T h e C o m m i t t e e n o t e d t h e t e c h n i c a l d e v e l o p m e n t s in t h e p r o d u c t i o n a n d t e s t i n g of m e n i n g o c o c c a l p o l y s a c c h a r i d e v a c c i n e s a n d a p p r o v e d t h e a p p r o p r i a t e a m e n d m e n t s to t h e W H O R e q u i r e m e n t s for t h e c o n t r o l of t h i s v a c c i n e .
1
WHO Technical Report Series, N o . 610， 1977.
EBÓl/З page 12
(b) Requirements for rubella vaccine (live)
The Committee agreed that Requirements for live rubella vaccine were needed because of the use of the vaccine in m a n y countries. International Requirements based on the experience gained from a number of countries were adopted by the Committee。
(c) Requirements for Brucella melitensis strain R e v . 1 vaccine (live)
The Committee agreed that in view of the pathogenicity of Brucella melitensis for h u m a n s , who m a y become infected from sheep or goats，the immunization of these anima Is for the eradication of the disease is important. The Committee adopted the
International Requirements for the production and control of this vaccine.
(d) Requirements for antibiotic susceptibility discs
The Committee agreed that there was an urgent need for the standardization of the techniques being used for measuring the sensitivity of pathogenic organisms to
antibiotics# Requirements which included suggested techniques for the preparation and quality control of the discs used for this purpose w e r e therefore adopted by the
Committee.
6•3 The recommendations
In addition to recommending that work should continue towards establishing international r e f e r e n c e m a t e r i a l s , the Committee agreed that comprehensive requirements for the control of b l o o d products and related substances should be formulated. Furthermore, as several
international societies were offering help to the programme, there was a need for guidelines on the establishment of international reference m a t e r i a l s . The establishment of
a thromboplastin as an international reference preparation had emphasized the need for g u i d a n c e on its correct use when setting up of a service for oral anticoagulant control.
The revised List of Biological Substances was approved and it was recommended that it should be brought up to date at regular intervals.
6.4 Implications for the Organization's programme
The part played by international reference materials in the establishment of quality c o n t r o l of biologicals，especially for vaccines, antibiotics, hormones and blood products3 is a p p r e c i a t e d by more countries today than in the p a s t . The Expanded Programme on Immunization
and the emphasis on self-reliance by the developing countries has placed greater emphasis on t h e need for quality control， in which reference materials play an essential role.
In order to assist the Expanded Programme on Immunization, manuals on the production and q u a l i t y control of diphtheria, tetanus and pertussis vaccines have been produced, and the b u i l d i n g s , staffing and equipping of production and quality control facilities are being d e s i g n e d .
7 . PESTICIDE RESIDUES IN FOOD
Report of the 1976 Joint Meeting of the FAO Panel of Experts on Pesticide Residues and the Environment and the WHO Expert Group on Pesticide Residues
R o m e , 22-30 November 1 9 7 61
7.1 Background information
This Joint Meeting was one of a series of such meetings held by the WHO Expert Committee on Pesticide Residues and the FAO Panel of Experts on the U s e of Pesticides in A g r i c u l t u r e , to
evaluate possible hazards to man arising from the occurrence of residues of pesticides in food.
1 WHO Technical Report S e r i e s , N o . 612， 1977.
EBÓl/З p a g e 13 7.2 T h e r e p o r t
T h e 1976 J o i n t M e e t i n g r e v i e w e d t o x i c o l o g i c a l a n d a g r i c u l t u r a l d a t a on c e r t a i n o r g a n o p h o s p h o r u s p e s t i c i d e s , c a r b a m a t e s a n d other p e s t i c i d e s。 E i g h t p e s t i c i d e s w e r e r e - e v a l u a t e d in the light of n e w d a t a . G e n e r a l p r o b l e m s of t o x i c i t y w e r e a l s o d i s c u s s e d .
T h e C o m m i t t e e w a s concerned, a b o u t the e f f e c t s of i m p u r i t i e s in the t e c h n i c a l p r o d u c t . T h e n a t u r e a n d c o n t e n t of i m p u r i t i e s in the t e c h n i c a l p r o d u c t m a y i n f l u e n c e the t o x i c o l o g i c a l p r o p e r t i e s a n d m a y b e e x p e c t e d to v a r y w i t h the m e t h o d of s y n t h e s i s or m a n u f a c t u r e . It w a s t h e r e f o r e c o n s i d e r e d i m p o r t a n t to h a v e a v a i l a b l e to the M e e t i n g d e t a i l s of the m a j o r
i m p u r i t i e s p r e s e n t in the t e c h n i c a l p r o d u c t so a s to a l l o w a f u l l t o x i c o l o g i c a l e v a l u a t i o n a n d e v a l u a t i o n of the r e s i d u e d a t a .
A n a d d i t i o n a l p r o b l e m in c o n n e x i o n w i t h the t e s t i n g of the t e c h n i c a l p r o d u c t is that of t h e t e s t i n g of f o r m u l a t i o n s . S u b s t a n c e s u s e d in f o r m u l a t i o n s m a y show t o x i c e f f e c t s in t h e i r own r i g h t , a l o n e or in a s s o c i a t i o n w i t h the t e c h n i c a l p r o d u c t . T h e i r t e s t i n g m a y p r o v i d e a d d i t i o n a l s u p p o r t i n g data on the t o x i c o l o g i c a l a s p e c t s。
S p e c i f i c a l l y , if the b a s i c t o x i c o l o g y of t h e a c t i v e c o m p o u n d is a l t e r e d by the f o r m u l a t i o n , or b y c h a n g e s in the p u r i t y of the t e c h n i c a l p r o d u c t in c u r r e n t u s e , f u r t h e r s t u d i e s should b e p e r f o r m e d w i t h the n e w p r o d u c t to c o n f i r m the i n i t i a l t o x i c o l o g i c a l e v a l u a t i o n .
7e3 T h e r e c o m m e n d a t i o n s
(1) B e c a u s e t h e full t o x i c o l o g i c a l e v a l u a t i o n of the e x t e n s i v e r a n g e of s u b s t a n c e s i n v o l v e d in the f o r m u l a t i o n of p e s t i c i d e s is e x t r e m e l y d i f f i c u l t , t h e M e e t i n g
r e c o m m e n d e d that n a t i o n a l a u t h o r i t i e s s h o u l d p a y c a r e f u l a t t e n t i o n to this p r o b l e m。 (2) B e c a u s e of c o n c e r n a b o u t the i m b a l a n c e b e t w e e n the r e s i d u e d a t a a n d t o x i c o l o g i c a l data for t h o s e c o m p o u n d s for w h i c h n o a c c e p t a b l e d a i l y i n t a k e c o u l d b e a l l o c a t e d
(section 2.3 of the r e p o r t ) , the g e n e r a t i o n of the r e l e v a n t t o x i c o l o g i c a l d a t a s h o u l d b e e n c o u r a g e d a s far a s p o s s i b l e .
(3) In the i n t e r e s t s of p u b l i c h e a l t h a n d a g r i c u l t u r e , a n d in v i e w of the n e e d s of the C o d e x C o m m i t t e e on P e s t i c i d e R e s i d u e s , j o i n t m e e t i n g s on p e s t i c i d e r e s i d u e s s h o u l d c o n t i n u e to be h e l d a n n u a l l y .
7e4 I m p l i c a t i o n s for the O r g a n i z a t i o n 1 s p r o g r a m m e
B u d g e t a r y p r o v i s i o n h a s been m a d e for c o n v e n i n g the J o i n t M e e t i n g on P e s t i c i d e R e s i d u e s on a n a n n u a l b a s i s .
W i t h r e g a r d to the n e e d to g e n e r a t e r e l e v a n t t o x i c o l o g i c a l d a t a , the s t u d y c a l l e d for b y r e s o l u t i o n W H A 3 0 . 4 7 ( E v a l u a t i o n of the e f f e c t s of c h e m i c a l s on h e a l t h ) w i l l t a k e t h i s p r o b l e m into a c c o u n t .
7.5 C o m m e n t s
T h e i n c r e a s i n g a m o u n t of t o x i c o l o g i c a l d a t a to be e v a l u a t e d is s l o w i n g down t h e
e v a l u a t i o n of p e s t i c i d e r e s i d u e s a n d , a l t h o u g h t h e m o s t i m p o r t a n t o n e s h a v e been evaluated，
t h e m a j o r i t y of p e s t i c i d e s in use h a v e n o t yet b e e n e v a l u a t e d b y F A O a n d W H O . T h e a b o v e - m e n t i o n e d r e s o l u t i o n , a n d the s u b s e q u e n t study w h i c h is u n d e r w a y , s h o u l d e n a b l e t h e O r g a n i z a t i o n to d e v e l o p w a y s a n d m e a n s of e x p e d i t i n g the e v a l u a t i o n of p e s t i c i d e r e s i d u e s .
E B 6 1 / 3 p a g e 14
8 . U S E O F I O N I Z I N G R A D I A T I O N A N D R A D I O N U C L I D E S ON H U M A N B E I N G S F O R M E D I C A L R E S E A R C H , T R A I N I N G , A N D N O N M E D I C A L P U R P O S E S
R e p o r t of a W H O E x p e r t C o m m i t t e e G e n e v a , 1 - 8 M a r c h 1 9 7 71
8 • 1 B a c k g r o u n d i n f o r m a t i o n
G u i d a n c e h a s f r e q u e n t l y been r e q u e s t e d from W H O on h o w to d e a l w i t h the p r o b l e m of i n t e n t i o n a l e x p o s u r e of h u m a n b e i n g s to r a d i a t i o n d u r i n g m e d i c a l r e s e a r c h , a n d h o w to e x e r c i s e a p p r o p r i a t e c o n t r o l over such r a d i a t i o n e x p o s u r e , in the light of t h e H e l s i n k i D e c l a r a t i o n of 1 9 6 4 , a s a m e n d e d in T o k y o in 1 9 7 5 . In a d d i t i o n , it w a s d e s i r a b l e to h a v e r e l e v a n t p r i n c i p l e s e s t a b l i s h e d for the d e l i b e r a t i o n s of the S e c r e t a r i a t C o m m i t t e e on R e s e a r c h i n v o l v i n g H u m a n S u b j e c t s ( S C R I H S ) d e a l i n g w i t h p r o j e c t s s u p p o r t e d by W H O . T h e w o r k of the E x p e r t C o m m i t t e e f o l l o w e d a I A E A / W H O c o n s u l t a t i o n h e l d in 1972 on the same t o p i c , the r e p o r t o f w h i c h h a s been w i d e l y d i s t r i b u t e d a n d h a s s e r v e d a s a b a c k g r o u n d p a p e r for a n u m b e r of r e c o m m e n d a t i o n s on n a t i o n a l l e v e l s . T h e w h o l e s u b j e c t w a s r e v i e w e d in the light of c u r r e n t t r e n d s of t h o u g h t , s t a r t i n g w i t h the 1972 r e p o r t , a n d the d i s c u s s i o n s h i g h l i g h t e d e t h i c a l p r o b l e m s a r i s i n g f r o m the i r r a d i a t i o n of p e o p l e in m e d i c a l r e s e a r c h a n d t e a c h i n g ; the a s s e s s m e n t of the r i s k s involved； p r i n c i p l e s of controls； s p e c i a l p o p u l a t i o n groups； a n d t h e i n t e n t i o n a l i r r a d i a t i o n of p e o p l e for n o n m e d i c a l p u r p o s e s , such a s i n s u r a n c e a n d s e c u r i t y p u r p o s e s .
8.2 T h e r e p o r t
T h e r e p o r t d e a l s o n l y w i t h that c o m p o n e n t of r a d i a t i o n e x p o s u r e of h u m a n i n d i v i d u a l s w h i c h is i n v o l v e d in their d e l i b e r a t e e x p o s u r e in the c o u r s e of m e d i c a l r e s e a r c h , in m e d i c a l
t e a c h i n g , a n d in v a r i o u s o t h e r p r o c e d u r e s w h i c h a r e n o t d i r e c t l y r e l a t e d to h u m a n h e a l t h r e q u i r e m e n t s . It d i s c u s s e s the b i o l o g i c a l e f f e c t s from the d i f f e r e n t s o u r c e s of ionizing r a d i a t i o n , e t h i c a l p r i n c i p l e s in r e l a t i o n to the d e l i b e r a t e i r r a d i a t i o n of h u m a n s ,
s u r v e i l l a n c e m e t h o d s a n d the r e s p o n s i b i l i t y of the i n v e s t i g a t o r , the n e e d s for c o n t r o l of s u c h r e s e a r c h p r o j e c t s b y e t h i c s c o m m i t t e e s , a n d the u s e s of i o n i z i n g r a d i a t i o n for r a d i a t i o n
in e d u c a t i o n a n d t r a i n i n g . It a l s o c o n s i d e r s the u s e of i o n i z i n g r a d i a t i o n for a d m i n i s t r a t i v e p u r p o s e s , i n c l u d i n g i m m i g r a t i o n r e g u l a t i o n s , i n s u r a n c e , c o m p e n s a t i o n c l a i m s , a n d the
i r r a d i a t i o n of i n d i v i d u a l s for s e c u r i t y r e a s o n s or c o m m e r c i a l p u r p o s e s .
8.3 T h e r e c o m m e n d a t i o n s
S u r v e i l l a n c e is n e c e s s a r y over the u s e s of ionizing r a d i a t i o n of h u m a n s for p u r p o s e s n o t d i c t a t e d b y c l i n i c a l i n d i c a t i o n s . A s a g e n e r a l p o l i c y , a n y r e s e a r c h p r o j e c t i n v o l v i n g h u m a n s u b j e c t s s h o u l d be r e v i e w e d b e f o r e the start of the p r o j e c t b y an ethics c o m m i t t e e to d e t e r m i n e t h e e x t e n t to w h i c h t h e p r i n c i p l e s of m e d i c a l e t h i c s w o u l d be o b s e r v e d , c o n s i d e r i n g t h e r a d i a t i o n d o s e i n v o l v e d . F o u r c a t e g o r i e s of r a d i a t i o n e x p o s u r e w e r e d e f i n e d a c c o r d i n g t o t h e d o s e a n d p o t e n t i a l r i s k i n v o l v e d .
In r e s p e c t of m e d i c a l t e a c h i n g , the C o m m i t t e e r e c o m m e n d e d that the t e a c h e r s should take t h e r e s p o n s i b i l i t y for r e s t r i c t i n g to t h e m i n i m u m a d d i t i o n a l i r r a d i a t i o n d u e to t e a c h i n g r e q u i r e m e n t s。
In r e s p e c t of i r r a d i a t i o n for n o n m e d i c a l p u r p o s e s , the C o m m i t t e e r e c o m m e n d e d that
d e l i b e r a t e i r r a d i a t i o n of h u m a n s s h o u l d n e v e r b e c a r r i e d out for c o m m e r c i a l or a d m i n i s t r a t i v e p u r p o s e s a n d t h a t , w h e n e v e r p o s s i b l e , i r r a d i a t i o n for n o n m e d i c a l r e a s o n s s h o u l d b e c a r r i e d o u t o n l y w h e n it is f u l l y j u s t i f i e d a n d u n a v o i d a b l e in the case of the p a r t i c u l a r i n d i v i d u a l . T h e free c o n s e n t of t h e s u b j e c t c o n c e r n e d is c o n s i d e r e d a b s o l u t e l y n e c e s s a r y .
T h e C o m m i t t e e a l s o c o n s i d e r e d it d e s i r a b l e that g u i d e l i n e s on the r a d i a t i o n d o s e s i n v o l v e d in t y p i c a l a p p l i c a t i o n s s h o u l d be m a d e a v a i l a b l e to e t h i c s c o m m i t t e e s in order to f a c i l i t a t e t h e r e v i e w of p r o j e c t s .
1 W H O T e c h n i c a l R e p o r t S e r i e s , N o。 611， 1 9 7 7 .
E B 6 1 / 3 p a g e 15 8.4 I m p l i c a t i o n s for the O r g a n i z a t i o n ' s p r o g r a m m e
T h e r e p o r t w i l l s e r v e as a basis for the d e l i b e r a t i o n s of e t h i c s c o m m i t t e e s for m e d i c a l r e s e a r c h p r o j e c t s i n v o l v i n g i o n i z i n g radiation， i n c l u d i n g the S e c r e t a r i a t C o m m i t t e e on R e s e a r c h i n v o l v i n g H u m a n Subjects； a n d for future r e c o m m e n d a t i o n s by W H O on the d e l i b e r a t e e x p o s u r e of h u m a n s to r a d i a t i o n other than for c l i n i c a l r e a s o n s . It w i l l h e l p W H O to c o l l a b o r a t e w i t h n a t i o n a l a u t h o r i t i e s in e s t a b l i s h i n g s y s t e m s of c o n t r o l for d e l i b e r a t e e x p o s u r e to r a d i a t i o n . D r a f t i n g a n d e d i t i n g of the g u i d e l i n e s m e n t i o n e d in the last p a r a g r a p h u n d e r " R e c o m m e n d a t i o n s " , a b o v e , m a y h a v e to be c o n s i d e r e d .
9 . T H E S E L E C T I O N OF E S S E N T I A L D R U G S R e p o r t of a W H O E x p e r t C o m m i t t e e G e n e v a , 17-22 O c t o b e r 1977 9 • 1 B a c k g r o u n d i n f o r m a t i o n
W i t h i n the n e w p r o g r a m m e on drug p o l i c i e s a n d m a n a g e m e n t , a c o n s u l t a t i o n on e s s e n t i a l d r u g s w a s c o n v e n e d in 1976 a n d the r e p o r t on t h e c o n s u l t a t i o n w a s w i d e l y c i r c u l a t e d t o r e g i o n a l o f f i c e s , e x p e r t s , p u b l i c h e a l t h o f f i c i a l s , a n d n o n g o v e r n m e n t a l o r g a n i z a t i o n s in o f f i c i a l r e l a t i o n s w i t h W H O . It w a s then m a d e a v a i l a b l e to the E x p e r t C o m m i t t e e , t o g e t h e r w i t h t h e c o m m e n t s r e c e i v e d a n d lists of e s s e n t i a l drugs from s e v e r a l c o u n t r i e s .
9.2 T h e r e p o r t
H a v i n g stated that the e x t e n t to w h i c h c o u n t r i e s i m p l e m e n t s c h e m e s , or e s t a b l i s h lists o f e s s e n t i a l d r u g s , is a n a t i o n a l p o l i c y d e c i s i o n , the r e p o r t o u t l i n e s the a d v a n t a g e s of
l i m i t e d drug lists in terms b o t h of e f f e c t i v e n e s s a n d e c o n o m y in h e a l t h c a r e (up to 4 0 % of t h e t o t a l h e a l t h c a r e b u d g e t is spent on drugs in some d e v e l o p i n g c o u n t r i e s ) . T h e d r u g s to b e i n c l u d e d in such lists w o u l d d i f f e r from c o u n t r y to c o u n t r y d e p e n d i n g on m a n y c o n d i t i o n s , b u t t h e lists should i n c l u d e o n l y those d r u g s p r o v e n to b e e f f e c t i v e , to h a v e a c c e p t a b l e s a f e t y , a n d to s a t i s f y the n e e d s of the p o p u l a t i o n . In the case of t h e r a p e u t i c a l l y e q u i v a l e n t d r u g s , the c h e a p e s t e f f e c t i v e p r o d u c t t h a t is a c c e p t a b l e should be s e l e c t e d .
A l i m i t e d list m i g h t n o t p r o v i d e for the n e e d s of e v e r y p e r s o n , but c e r t a i n l y s h o u l d for those o f the v a s t m a j o r i t y .
T h e r e p o r t c o n t a i n s a m o d e l list of a b o u t 200 a c t i v e s u b s t a n c e s w h i c h , in t h e light of t h e b e s t a v a i l a b l e s c i e n t i f i c k n o w l e d g e , a r e i n d i s p e n s a b l e for the h e a l t h care of t h e p o p u l a t i o n . This list can f u r n i s h a b a s i s for c o u n t r i e s to i d e n t i f y their own p r i o r i t i e s a n d to m a k e their own s e l e c t i o n • M o r e limited lists for p r i m a r y h e a l t h care should be drawn u p l o c a l l y . C o n s i d e r a t i o n is g i v e n in the r e p o r t to i n f o r m a t i o n a n d e d u c a t i o n a l a c t i v i t i e s , t o d r u g u t i l i z a t i o n s u r v e y s , a n d to r e s e a r c h a n d d e v e l o p m e n t •
9 . 3 T h e r e c o m m e n d a t i o n s
- W H O should c o n s i d e r the f e a s i b i l i t y of a n a c t i o n p r o g r a m m e of i n t e r n a t i o n a l
c o o p e r a t i o n a i m e d at e x t e n d i n g the a c c e s s i b i l i t y of e s s e n t i a l d r u g s to the largest p o s s i b l e s e g m e n t s of the p o p u l a t i o n .
- W H O s h o u l d c o o p e r a t e w i t h n a t i o n a l h e a l t h a u t h o r i t i e s d e s i r o u s of e s t a b l i s h i n g or i m p r o v i n g lists of e s s e n t i a l d r u g s a n d q u a l i t y a s s u r a n c e s y s t e m s , a n d p r o m o t e e d u c a t i o n a l a c t i v i t i e s on the p r o p e r u s e of t h e s e d r u g s for s p e c i f i c c a t e g o r i e s of h e a l t h p e r s o n n e l a n d a l s o for the p u b l i c .
- T h e p e r i o d i c u p d a t i n g of the m o d e l l i s t , the d i s s e m i n a t i o n of u n b i a s e d i n f o r m a t i o n on e a c h d r u g l i s t e d , a n d the e x c h a n g e of e x p e r i e n c e in the p r a c t i c a l u s e of lists of e s s e n t i a l d r u g s w e r e a l s o r e c o m m e n d e d .
