EXECUTIVE BOARD

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OFFICIAL RECORDS

OF THE

WORLD HEALTH ORGANIZATION

No. 96

EXECUTIVE BOARD

TWENTY- FOURTH SESSION

GENEVA, 1 and 2 JUNE 1959

RESOLUTIONS ANNEXES

WORLD HEALTH ORGANIZATION

PALAIS DES NATIONS GENEVA

October 1959

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ABBREVIATIONS

The following abbreviations are used in the Official Records of the World Health Organization:

ACC - Administrative Committee on Co- ordination

CCTA - Commission for Technical Co- operation in Africa South of the Sahara CIOMS - Council for International Organizations of Medical Sciences

ECAFE - Economic Commission for Asia and the Far East

ECE - Economic Commission for Europe ECLA - Economic Commission for Latin America FAO - Food and Agriculture Organization IAEA International Atomic Energy Agency ICAO - International Civil Aviation Organization

ICITO - Interim Commission of the International Trade Organization ILO - International Labour Organisation (Office)

ITU - International Telecommunication Union OIHP - Office International d'Hygiène Publique PAHO Pan American Health Organization PASB

- Pan American Sanitary Bureau

TAB Technical Assistance Board TAC Technical Assistance Committee

UNESCO - United Nations Educational, Scientific and Cultural Organization

UNICEF - United Nations Children's Fund

UNKRA - United Nations Korean Reconstruction Agency

UNRWA United Nations Relief and Works Agency for Palestine Refugees UNTAA - United Nations Technical Assistance Administration

WFUNA - World Federation of United Nations Associations

WMO - World Meteorological Organization

PRINTED IN SWITZERLAND

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NOTE

This volume contains the resolutions (with relevant annexes) of the twenty-fourth session of the Executive Board, which was convened in accordance with resolution EB23.R85, adopted by the Board at its twenty -third session.

In accordance with the instructions of the Board, the minutes of the Board have been sent in mimeographed form to Member governments.

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EXPLANATORY NOTE

In this volume the resolutions are reproduced in the serial order in which they were adopted. However, in order to facilitate the use of the volume in conjunction with the Handbook of Resolutions and Decisions, they have been grouped by title in the table of contents under the subject- headings of the Handbook. The fifth edition of the Handbook -which is indexed both by subject and by resolution symbol - contains most of the resolutions adopted up to and including the Twelfth World Health Assembly and the twenty- fourth session of the Executive Board.

The following reference list of sessions of the Health Assembly and Executive Board shows the resolution symbol applicable to each session and the Official Records volume in which the resolutions were originally published.

First World Health Assembly Executive Board, First Session Executive Board, Second Session Executive Board, Third Session

Held

24 June - 24 July 1948 16 -28 July 1948

25 October - 11 November 1948 21 February - 9 March 1949

Resolution symbol

- -

-

Official Records No.

13 14 14 17

Second World Health Assembly 13 June - 2 July 1949 WHA2.- 21

Executive Board, Fourth Session 8 -19 July 1949

-

22

Executive Board, Fifth Session 16 January - 2 February 1950

-

25

Third World Health Assembly 8 -27 May 1950 WHA3.- 28

Executive Board, Sixth Session 1 -9 June 1950 EB6.R- 29

Executive Board, Seventh Session 22 January - 5 February 1951 EB7.R- 32

Fourth World Health Assembly 7 -25 May 1951 WHA4.- 35

Executive Board, Eighth Session 1 -8 June 1951 EB8.R- 36

Executive Board, Ninth Session 21 January - 4 February 1952 EB9.R- 40

Fifth World Health Assembly 5 -22 May 1952 WHA5.- 42

Executive Board, Tenth Session

29 May - 3 June 1952

EB10.R- 43

Executive Board, Eleventh Session 12 January - 4 February 1953 EB11.R- 46

Sixth World Health Assembly 5 -22 May 1953 WHA6.- 48

Executive Board, Twelfth Session 28 -30 May 1953 EB 12. R- 49

Executive Board, Thirteenth Session 12 January - 2 February 1954 EB13.R- 52

Seventh World Health Assembly 4 -21 May 1954 WHA7.- 55

Executive Board, Fourteenth Session 27 -28 May 1954 EB14.R- 57

Executive Board, Fifteenth Session 18 January - 4 February 1955 EB 15. R- 60

Eighth World Health Assembly 10 -27 May 1955 WHA8.- 63

Executive Board, Sixteenth Session 30 May 1955 EB16.R- 65

Executive Board, Seventeenth Session 17 January - 2 February 1956 EB17.R- 68

Ninth World Health Assembly 8 -25 May 1956 WHA9.- 71

Executive Board, Eighteenth Session 28 -30 May 1956 EB18.R- 73

Executive Board, Nineteenth Session 15 -30 January 1957 EB19.R- 76

Tenth World Health Assembly 7 -24 May 1957 WHA10.- 79

Executive Board, Twentieth Session 27 -28 May 1957 EB20.R- 80

Executive Board, Twenty -first Session 14 -28 January 1958 EB21.R- 83

Eleventh World Health Assembly 28 May - 13 June 1958 WHA11.- 87

Executive Board, Twenty- second Session 16 -17 June 1958 EB22.R- 88

Executive Board, Twenty -third Session 20 January - 3 February 1959 EB23.R- ⁹¹

Twelfth World Health Assembly 12 -29 May 1959 WHAl2.- 95

Executive Board, Twenty- fourth Session 1 -2 June 1959 EB24.R- 96

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Index to Resolutions: page 63

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Page

Mental Health

EB24.R11

Expert Committee on Mental Health: Seventh Report (Social Psychiatry and

Community Attitudes) ⁶

EB24.R18 Report of the Study Group on Mental Health Problems of Automation ^. ^. 7

Nutrition

EB24.R13 Joint FAO /WHO Expert Committee on Food Additives: Third Report ^. ^. 6

ENVIRONMENTAL SANITATION

EB24.R2 EB24. R29

Expert Committee on Insecticides : Ninth Report (Specifications and Chemistry of Pesticides)

Special Account for Community Water Supply Programme

EDUCATION AND TRAINING

EB24.R12

Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel: Seventh Report (Preventive Aspects in the Teaching of

Pathology)

RESEARCH

4 10

6

EB24.R27 Special Account for Medical Research 9

EXPERT ADVISORY PANELS AND COMMITTEES

EB24.R15 Appointments to Expert Advisory Panels and Committees 7

Resolutions on Programme and Budget

CONSIDERATION AND APPROVAL OF PROGRAMME AND BUDGET ESTIMATES

Reports on Allotments Issued

EB24.R26 Allotments Issued as at 31 May 1959 ⁹

Resolutions concerning the World Health Assembly and Executive Board WORLD HEALTH ASSEMBLY

Time and Place

EB24.R23 Date and Place of the Thirteenth World Health Assembly 8

Technical Discussions

EB24.R21 Subject for Technical Discussions at the Fourteenth World Health Assembly . . 8

EB24.R28 Appointment of General Chairman of Technical Discussions at the Thirteenth

World Health Assembly 10

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Page

EXECUTIVE BOARD Sessions of the Board

EB24.R24 Date and Place of the Twenty -fifth Session of the Executive Board 9

Method ^of Work

EB24.R1 Procedure for the Consideration by the Executive Board of the Director -General's

Proposed Programme and Budget Estimates 3

EB24.R5 Standing Committee on Administration and Finance 4

Resolutions on Constitutional and Legal Matters

TRANSFER OF FUNCTIONS AND ASSETS

Office International d'Hygiène Publique

EB24.R7 Membership of the Committee on Arrears of Contributions in respect of the Office

International d'Hygiène Publique 5

Resolutions on Financial and Administrative Matters FINANCIAL MATTERS

Sources of Additional Income for the Regular Budget

EB24.R9 Membership of the Committee on Gifts or Bequests 5

WHO HEADQUARTERS

EB24.R30 Headquarters Accommodation 10

Resolutions on Co- ordination and External Relations UNITED NATIONS AND ITS AGENCIES

Co- operation with UNICEF

EB24.R8 Membership of the UNICEF /WHO Joint Committee on Health Policy ^. ^. ^. ⁵ EB24.R19 Terms of Reference of the UNICEF /WHO Joint Committee on Health Policy ^. 7 NON- GOVERNMENTAL ORGANIZATIONS

Procedure for Examination ^ofApplications for Admission to Official Relations

EB24.R6 Membership of the Standing Committee on Non -governmental Organizations ^. 5

Miscellaneous Resolutions

EB24.R22 International Health and Medical Research Year ⁸

AWARDS

Léon Bernard Foundation

EB24.R10 Membership of the Léon Bernard Foundation Committee 6

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Page

ANNEXES

1. List of Members and Other Participants ¹⁵

2. Officers of the Executive Board and Membership of Committees and Working Parties 18

3. Review of BCG Vaccination Programmes 19

4. Selection of Subject for Technical Discussions at Fourteenth World Health Assembly 51

5. Report on Allotments Issued as at 31 May 1959 52

6. Headquarters Accommodation 61

Index to Resolutions 63

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AGENDA'

[EB24/1 Rev. 1 - 30 May 1959]

1. Adoption of the agenda

2. Election of Chairman, Vice -Chairmen and Rapporteurs

3. Procedure for the consideration by the Executive Board of the Director -General's proposed programme and budget estimates

COMMITTEES

4. Committees of the Executive Board: Replacement of members whose term of office on the Board has expired

(a) Standing Committee on Administration and Finance

(b) Standing Committee on Non -governmental Organizations

(c) Committee on Arrears of Contributions in respect of OIHP

(d) Committee on Gifts or Bequests

5. UNICEF /WHO Joint Committee on Health Policy

(a) Terms of reference

(b) Replacement of members whose term of office on the Executive Board has expired

6. Léon Bernard Foundation Committee: Replacement of member whose term of office on the Executive Board has expired

PROGRAMME

7. Review of BCG vaccination programmes

8. Report on appointments to expert advisory panels and committees

9. Reports of expert committees:

9.1 Expert Committee on the International Pharmacopoeia: sixteenth report

9.2 Expert Committee on Insecticides: ninth report (Specifications and Chemistry of Pesticides)

9.3 Expert Committee on Cancer: first report (Histopathology of Lung Tumours)

9.4 Expert Committee on Organization of Medical Care : second report (Role of Hospitals in Ambula- tory and Domiciliary Medical Care)

9.5 Expert Committee on Mental Health: seventh report (Social Psychiatry and Community Attitudes) 9.6 Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel:

seventh report (Preventive Aspects in the Teaching of Pathology)

9.7 Joint FAO /WHO Expert Committee on Food Additives : third report

1Adopted by the Board at its first meeting, ¹ June 1959

1

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EXECUTIVE BOARD, TWENTY- FOURTH SESSION

10. Reports of study groups:

10.1 Study Group on Immunological and Haematological Surveys 10.2 Study Group on Diarrhoeal Diseases

10.3 Study Group on Mental Health Problems of Automation

11. Appointment of the General Chairman for the technical discussions to be held at the Thirteenth World Health Assembly

12. Selection of the subject for the technical discussions to be held at the Fourteenth World Health Assembly

13. International Health and Medical Research Year

14. Organizational study on publications

WORLD HEALTH ASSEMBLY AND EXECUTIVE BOARD

15.

Date and place of the Thirteenth World Health Assembly

16. Date and place of the twenty -fifth session of the Executive Board

ADMINISTRATIVE AND FINANCIAL MATTERS

17. Headquarters accommodation

18. Malaria Eradication Special Account

19. Report on allotments issued as at 31 May 1959

SUPPLEMENTARY ITEMS

1. Intensified WHO medical research programme

2. Environmental sanitation

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INTRODUCTION

The twenty- fourth session of the Executive Board was held in the Palais des Nations, Geneva, on 1 and 2 June 1959.

The election at the Twelfth World Health Assembly (May 1959) of six Member States entitled to designate persons to serve on the Executive Board, in place of those whose term of office had expired,' resulted in the following new composition of the Board:

Designating country Unexpired term

of office Designating country Unexpired term

of office

Afghanistan 1 year Luxembourg 3 years

Australia 1 year Nepal 3 years

Brazil 2 years Peru 3 years

Federal Republic of Germany 1 year Sudan 3 years

France 2 years Union of Soviet Socialist Republics 2 years

Guatemala 2 years United Arab Republic 1 year

Iran 2 years United States of America 1 year

Ireland 3 years Venezuela 3 years

Liberia 1 year Viet Nam 2 years

Professor E. J. Y. Aujaleu was elected Chairman. The other officers elected were as follows: Vice -Chairmen, Professor M. Etemadian and Dr H. M. Penido; Rapporteurs, Dr D. Castillo and Dr A. J. Metcalfe. The list of members will be found in Annex 1 of this volume and the membership of the committees in Annex 2.

In the course of the session the Board adopted the resolutions which follow.

RESOLUTIONS

EB24.R1 Procedure for the Consideration by the Executive Board of the Director -General's Proposed Programme and Budget Estimates

The Executive Board,

Having considered the procedure for the consideration by the Board of the Director -General's proposed programme and budget estimates; and

Considering that the present procedure for review by the Board of the Director -General's proposed programme and budget estimates is satisfactory and has greatly facilitated the work of the Executive Board and of the World Health Assembly,

DECIDES that no change be made in this procedure.

First meeting, 1 June 1959 1 The retiring members were those designated by Canada, India, Italy, Mexico, Tunisia, and the United Kingdom of Great Britain and Northern Ireland.

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4 EXECUTIVE BOARD, TWENTY- FOURTH SESSION

EB24.R2 Expert Committee on Insecticides: Ninth Report (Specifications and Chemistry of Pesticides) The Executive Board

1. NOTES the ninth report of the Expert Committee on Insecticides (Specifications and Chemistry of Pesticides) ;

2. THANKS the members of the Committee for their work; and

3. AUTHORIZES publication of the report.

First meeting, 1 June 1959

EB24.R3 Expert Committee on Cancer: First Report (Histopathology of Lung Tumours) The Executive Board

1. NOTES the first report of the Expert Committee on Cancer ( Histopathology of Lung Tumours);

EB24.R4 Expert Committee on Organization of Medical Care: Second Report (Role of Hospitals in Ambula- tory and Domiciliary Medical Care)

The Executive Board

1. NOTES the second report of the Expert Committee on Organization of Medical Care (Role of Hospitals in Ambulatory and Domiciliary Medical Care);

3. AUTHORIZES publication of the report.'

EB24.R5 Standing Committee on Administration and Finance The Executive Board,

Recalling resolutions EB16.R12, EB21.R44 and EB24.R1,

1. APPOINTS Dr R. Baidya and Mr H. Olivero as members of the Standing Committee on Administration and Finance for the duration of their terms of office on the Executive Board, in addition to Dr H. van Zile Hyde, Dr A. J. Metcalfe, Dr M. O. Shoib, Dr J. N. Togba and Professor V. M. Zhdanov, already members of the Standing Committee;

2. DECIDES that, if any member of this committee is unable to attend its meetings, his successor or the alternate member of the Board designated by the government concerned, in accordance with Rule 2 of the Rules of Procedure of the Executive Board, shall participate in the work of the Committee; and

3. DECIDES that the Standing Committee shall meet prior to the twenty -fifth session of the Board, to enable it to present a preliminary report early in the session so that the Board may discuss the report and formulate its final comments to the Health Assembly, in accordance with Article 55 of the Consti- tution.

Second meeting, 1 June 1959

1 Wld Hlth Org. techn. Rep. Ser., 1959, 176

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RESOLUTIONS 5

EB24.R6 Membership of the Standing Committee on Non -governmental Organizations The Executive Board

1. APPOINTS Dr A. Habernoll, Dr H. van Zile Hyde and Dr L. Molitor as members of the Standing Committee on Non -governmental Organizations for the duration of their terms of office on the Executive Board, in addition to Dr Le- Cuu -Truong and Dr A. H. Radji, already members of the Standing Com- mittee; and

2. DECIDES that, if any member of this committee is unable to attend, his successor or the alternate member of the Board designated by the government concerned, in accordance with Rule 2 of the Rules of Procedure of the Executive Board, shall participate in the work of the Committee.

EB24.R7 Membership of the Committee on Arrears of Contributions in respect of the Office International d'Hygiène Publique

The Executive Board

1. APPOINTS Dr A. O. Abu Shamma and Dr J. Muñoz Puglisevich (replaced by his alternate, Dr C.

Gordillo -Zuleta, at the twenty- fourth session of the Executive Board) as members of the Committee on Arrears of Contributions in respect of the Office International d'Hygiène Publique for the duration of their terms of office on the Executive Board, in addition to Dr Gholam Farugk, already a member of the Committee;

EB24.R8 Membership of the UNICEF /WHO Joint Committee on Health Policy The Executive Board

APPOINTS as members of the UNICEF /WHO Joint Committee on Health Policy Dr H. M. Penido and Dr J. D. Hourihane, and as alternates Dr J. Muñoz Puglisevich (replaced by his alternate, Dr C.

Gordillo -Zuleta, at the twenty- fourth session of the Executive Board) and Dr Le- Cuu -Truong; the WHO membership of the Committee being now as follows : Members - Dr J. D. Hourihane, Dr H. M. Penido, Dr M. O. Shoib, Dr J. N. Togba, Professor V. M. Zhdanov; Alternates - Dr Le- Cuu -Truong, Dr J. Muñoz Puglisevich.

EB24.R9 Membership of the Committee on Gifts or Bequests The Executive Board,

Considering resolution EB13.R34,

1. APPOINTS Dr A. O. Abu Shamma as member of the Committee on Gifts or Bequests for the duration of his term of office on the Executive Board, in addition to Dr Gholam Farugk and Dr A. Habernoll, already members of the Committee; and

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EB24.R10 Membership of the Léon Bernard Foundation Committee The Executive Board,

In accordance with the Statutes of the Léon Bernard Foundation,

ELECTS Dr D. Castillo and Dr A. ^J.

Metcalfe as members of the Léon Bernard Foundation

Committee for the duration of their terms of office on the Executive Board.

EB24.R11 Expert Committee on Mental Health: Seventh Report (Social Psychiatry and CommunityAttitudes) The Executive Board

1. NOTES the seventh report of the Expert Committee on Mental Health (Social Psychiatry and Community Attitudes) ;

3. AUTHORIZES publication of the report.1

EB24.R12 Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel:

Seventh Report (Preventive Aspects in the Teaching of Pathology) The Executive Board

1. NOTES the seventh report of the Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel (Preventive Aspects in the Teaching of Pathology);

3. AUTHORIZES publication of the report.2

Second meeting, 1 June 1959 EB24.R13 Joint FAO /WHO Expert Committee on Food Additives: Third Report

The Executive Board

1. NOTES the third report of the Joint FAO /WHO Expert Committee on Food Additives;

2. THANKS the members of the Committee for their work;

3. EXPRESSES appreciation to the Food and Agriculture Organization for its collaboration; and

EB24.R14 Expert Committee on the International Pharmacopoeia: Sixteenth Report The Executive Board

1. NOTES the sixteenth report of the Expert Committee on the International Pharmacopoeia; and

2. THANKS the members of the Committee for their work.

1 Wld Hlth Org. techn. Rep, Ser., 1959, 177 2 Wld Hlth Org. techn. Rep. Ser., 1959, 175

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RESOLUTIONS 7

EB24.R15 Appointments to Expert Advisory Panels and Committees The Executive Board

NOTES the report of the Director - General on appointments to expert advisory panels and committees.

Second meeting, 1 June 1959 EB24.R16 Report of the Study Group on Immunological and Haematological Surveys

The Executive Board

1. NOTES the report of the Study Group on Immunological and Haematological Surveys; and

2. THANKS the members of the Study Group for their work.'

EB24.R17 Report of the Study Group on Diarrhoeal Diseases The Executive Board

1. NOTES the report of the Study Group on Diarrhoeal Diseases; and

2. THANKS the members of the Study Group for their work.

Second meeting, 1 June 1959 EB24.R18 Report of the Study Group on Mental Health Problems of Automation

The Executive Board

1. NOTES the report of the Study Group on Mental Health Problems of Automation; and

2. THANKS the members of the Study Group for their work.2

Third meeting, 2 June 1959 EB24.R19 Terms of Reference of the UNICEF /WHO Joint Committee on Health Policy

Having considered the preliminary report of the Director - General on the terms of reference of the UNICEF /WHO Joint Committee on Health Policy,

NOTES the report.

Third meeting, 2 June 1959 EB24.R20 Review of BCG Vaccination Programmes

Having considered the preliminary report of the Director - General on the review of BCG vaccination programmes,3

1. NOTES the report; and

2. REQUESTS the Director -General to present a further report on the evaluation of the internationally assisted BCG mass vaccination programmes to the twenty -fi.fth session of the Executive Board.

Third meeting, 2 June 1959 1 Wld filth Org. techn. Rep. Ser., 1959, 181

2 Wld Hlth Org. techn. Rep. Ser., 1959, 183 3 Annex 3

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EB24.R21 Subject for Technical Discussions at the Fourteenth World Health Assembly The Executive Board,

Having considered the report of the Director - General on the question of technical discussions at the Fourteenth World Health Assembly; ¹ and

Taking into account resolution WHA10.33, paragraph (3), of the Tenth World Health Assembly on technical discussions at future World Health Assemblies,

DECIDES that the subject to be discussed during the Fourteenth World Health Assembly shall be

" Recent advances in tuberculosis control ".

Third meeting, 2 June 1959

EB24.R22 International Health and Medical Research Year The Executive Board,

Considering that the Twelfth World Health Assembly requested the Executive Board and the Director - General to present a full report on the holding of an International Health and Medical Research Year to the Thirteenth World Health Assembly (resolution WHAl2.28),

1. REQUESTS the Director -General to obtain the suggestions of Member States and Associate Members on the question and to ask the regional committees to discuss it at their next sessions and submit any comments or suggestions they would wish to make; and for this purpose supply to the governments and regional committees the necessary documentation on the debates which took place at the Twelfth World Health Assembly and at the twenty -third and twenty- fourth sessions of the Executive Board;

further

2. REQUESTS the Director -General to submit to the Executive Board at its twenty -fifth session a report on the replies he has obtained and on the suggestions he would recommend the Board to elaborate for the Thirteenth World Health Assembly related to the subject of an International Health and Medical Research Year, including its goals, programme, time -table and material resources.

EB24.R23 Date and Place of Thirteenth World Health Assembly The Executive Board,

Having noted resolution WHAl2.45 on the place of the Thirteenth World Health Assembly; and Considering the provisions of Articles 14 and 15 of the Constitution,

DECIDES:

(1) that the Thirteenth World Health Assembly shall be held in the Palais des Nations, Geneva;

and

(2) that, subject to consultation with the Secretary - General of the United Nations, this Assembly shall start on Tuesday, 3 May 1960.

1 Annex 4

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RESOLUTIONS

EB24.R24 Date and Place of the Twenty -fifth Session of the Executive Board The Executive Board

1. DECIDES to hold its twenty -fifth session in the Palais des Nations, Geneva, commencing on Tuesday, 19 January 1960; and further

2. DECIDES that its Standing Committee on Administration and Finance shall meet in the same place, commencing on Tuesday, 12 January 1960.

EB24.R25 Malaria Eradication Special Account The Executive Board,

Having considered the report of the Director - General on the Malaria Eradication Special Account;

and

Having considered resolution WHAl2.15,

1. NOTES the report of the Director - General on the Malaria Eradication Special Account;

2. THANKS the donors which have contributed to the Malaria Eradication Special Account in the interval since the twenty -third session of the Executive Board; and

3. REQUESTS the Director - General to submit a report on the status of the Malaria Eradication Special Account at its twenty -fifth session.

EB24.R26 Allotments Issued as at 31 May 1959 The Executive Board

NOTES the report of the Director - General on the allotments issued under regular funds and the Malaria Eradication Special Account as at 31 May 1959.1

EB24.R27 Special Account for Medical Research The Executive Board,

Having considered resolution WHAl2.17 adopted by the Twelfth World Health Assembly and in particular paragraph 10 thereof,

1. DELEGATES to the Chairman of the Board the authority to accept contributions to the Special Account for Medical Research provided the Director - General has determined that such contributions can be utilized in the programme; and

2. REQUESTS the Director - General to report to each session of the Board the contributions accepted between sessions of the Board under the authority delegated.

Annex 5

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10 EXECUTIVE BOARD, TWENTY -FOURTH SESSION

EB24.R28 Appointment of General Chairman of Technical Discussions at the Thirteenth World Health Assembly

Having considered the communication from the President of the Twelfth World Health Assembly nominating Professor V. M. Zhdanov, of the Union of Soviet Socialist Republics, as General Chairman of the technical discussions at the Thirteenth World Health Assembly; and

In accordance with resolution WHA10.33, paragraph (6),

1. APPROVES this nomination; and

2. REQUESTS the Director - General to invite Professor Zhdanov to accept this appointment.

Fourth meeting, 2 June 1959

EB24.R29 Special Account for Community Water Supply Programme The Executive Board,

Having considered resolution WHAl2.48 adopted by the Twelfth World Health Assembly and in particular paragraphs III.1 and 2,

1. NOTES the establishment of the Special Account for Community Water Supply Programme;

2. DELEGATES to the Chairman of the Board the authority to accept contributions to this special account, provided the Director - General has determined that such contributions can be utilized in the programme;

and

3. REQUESTS the Director -General to report to each session of the Executive Board the contributions accepted between sessions of the Board under the authority delegated.

EB24.R30 Headquarters Accommodation The Executive Board,

Having regard to the authorities and responsibilities for headquarters accommodation delegated to it by the Twelfth World Health Assembly in resolution WHAl2.12;

Having considered the building site which the Canton of Geneva generously proposes to place at the disposal of the Organization;

Having examined the rules and programme proposed by the Director - General for the architectural competition;

Having considered the names of various architects who might be invited to serve on the jury for the architectural competition and on the expert committee to suggest persons to be invited to compete; and Having noted that the World Health Organization has made an investment in the Palais des Nations which included a grant by the Swiss authorities intended to facilitate WHO's accommodation in Geneva,

1. APPROVES the proposed building site, and requests the Director -General to present to the Executive Board at its twenty -fifth session the text of an agreement to be effected between the Organization and the Swiss authorities with regard to the terms under which the land would be made available;

2. APPROVES the rules and programme for the architectural competition proposed by the Director - General as amended;

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RESOLUTIONS 11

3. ACCEPTS the list of architects proposed by the Director - General to be invited to serve on the jury of the competition and authorizes the Director -General to supplement this list should this become necessary;

4. ACCEPTS the list of architects proposed by the Director- General to be invited to serve on the expert committee to suggest architects or firms of architects to participate in the competition and authorizes the Director - General to supplement this list should this become necessary; and

5. REQUESTS the Director -General to bring to the attention of the Secretary -General of the United Nations resolution WHAl2.12, document EB24/21,1 and this resolution, and to invite the Secretary - General to present to the appropriate bodies of the United Nations for consideration the matter of suitable reimbursement to WHO for its investment in the Palais des Nations.

1 Reproduced in Annex 6, together with the report of the Working Party on Headquarters Accommodation set up by the Board

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ANNEXES

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Annex 1

LIST OF MEMBERS AND OTHER PARTICIPANTS

1. MEMBERS, ALTERNATES AND ADVISERS

Professor E. J. Y. AUJALEU, Director - General of Health, Ministry of Public Health and Population, Paris, Chairman

Professor M. ETEMADIAN, Under - Secretary of State, Ministry of Health, Teheran (Alternate to Dr A. H. Radji), Vice- Chairman

Dr H. M. PENIDO, Superintendent, Special Public Health Service, Rio de Janeiro,

Vice - Chairman

Dr D. CASTILLO, Assistant to the Director of Public Health, Caracas, Rapporteur Adviser:

Dr D. ORELLANA, Adviser for International Health, Caracas Dr A. J. METCALFE, Director -General of Health, Canberra, Rapporteur

Adviser:

Miss M. MCPHERSON, Second Secretary, Permanent Mission of Australia to the European Office of the United Nations, Geneva Dr A. O. ABU SHAMMA, Deputy Director, Ministry of Health, Khartoum Dr R. BAIDYA, Director of Health Services, Kathmandu

Dr G. FARUGK, Ambassador of Afghanistan to the Federal Republic of Germany Adviser:

Dr M. OMAR, Director - General, Public Health Institute, Ministry of Health, Kabul

Dr C. GORDILLO -ZULETA, Co- ordinator of Public Health Programmes; Permanent Delegate to International Health Organizations, Ministry of Health and Social Welfare, Lima (Alternate to Dr J. Muñoz Puglisevich) Dr A. HABERNOLL, Chief, Section of Hygiene, Federal Ministry of the Interior, Bonn

Dr J. D. HOURIHANE, Deputy Chief Medical Adviser, Department of Health, Dublin Alternate:

Mr T. J. BRADY, Assistant Secretary, Department of Health, Dublin

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Designated by

France Iran Brazil

Venezuela

Australia

Sudan Nepal Afghanistan

Peru

Federal Republic of Germany Ireland

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Dr H. van Zile HYDE, Assistant to the Surgeon General for International Health, Washington, D.C.

Advisers:

Mr A. PUHAN, Director, Office of International Administration, Department of State, Washington, D.C.

Mr L. WYATT, Office of International Economic and Social Affairs, Department of State, Washington, D.C.

Dr LE- Cuu- TRUONG, Director - General of Health and Hospitals, Saigon Adviser:

Mr Buu -KINH, Adviser, Embassy of Viet Nam, Paris Dr L. MOLITOR, Director of Public Health, Luxembourg

Mr H. OLIVERO, Adviser, Ministry of Health and Welfare, Guatemala City Dr M. O. SHOIB, Director of International Health, Ministry of Public Health,

Province of Egypt, Cairo

Dr J. N. TOGBA, Director -General, National Public Health Service, Monrovia Alternate:

Mr J. D. LAWRENCE, Ambassador of Liberia to France Professor V. M. ZHDANOV, Deputy Minister of Health, Moscow

Adviser:

Mr F. A. KUKAREKO, First Secretary, Ministry of Foreign Affairs, Moscow

Switzerland

Designated by

United States of America

Republic of Viet Nam

Luxembourg Guatemala United Arab Republic Liberia

Union of Soviet Socialist Republics

2. GOVERNMENT REPRESENTATIVES ATTENDING UNDER RULE 3 OF THE RULES OF PROCEDURE

Item 17 of the Agenda: Headquarters Accommodation Mr G. FRIEDRICH, Chief, Building Service, Department of Public Works, Geneva

3. REPRESENTATIVES OF THE UNITED NATIONS AND ITS AGENCIES United Nations

Mr C. A. REHLING, External Relations Officer, European Office

United Nations Children's Fund

Sir Herbert BROADLEY, Representative of UNICEF in the United Kingdom

Technical Assistance Board

Mr J. R. SYMONDS, Liaison Officer in Europe

International Labour Organisation

Dr S. FucHs, Occupational

Safety and Health

Division

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ANNEX 1 17

4. REPRESENTATIVES OF INTERGOVERNMENTAL ORGANIZATIONS International Committee of Military Medicine and Pharmacy League of Arab States

Général- Médecin J. VONCKEN, Secretary - General Dr A. T. SHOUSHA, Supervisor, Health Department International Union for the Protection of Industrial Property

Mr R. WOODLEY, Counsellor, Head of Industrial Property Division

5. REPRESENTATIVES OF NON -GOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONSHIP WITH WHO

Fédération dentaire internationale International Union of Local Authorities

Dr C. L. BOUVIER Mr F. COTTIER

International Conference of Social Work League of Red Cross Societies

Mrs R. S. SMITH Dr Z. S. HANTCHEF, Director, Medico- social Bureau

International Council of Nurses Miss H. NUSSBAUM

Medical Women's International Association

Dr Vera J. PETERSON, Honorary Secretary

International Diabetes Federation World Confederation of Physical Therapy

Mrs G. VERNET Mrs J. V. GIBSON

International Society for Blood Transfusion World Federation of United Nations Associations

Dr R. FISCHER MTS C. E. B. BONNER

International Society for the Welfare of Cripples World Medical Association

Miss A. E. MOSER, Deputy Secretary- General Dr J. MAYSTRE International Union for Child Welfare World Union OSE

Miss A. E. MOSER Dr L. GuRVIC, Honorary Secretary- General

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18 EXECUTIVE BOARD, TWENTY -FOURTH SESSION

Annex 2

OFFICERS OF THE EXECUTIVE BOARD AND MEMBERSHIP OF COMMITTEES AND WORKING PARTIES

1. Officers of the Board

Chairman: Professor E.

J. Y. Aujaleu

Vice -Chairmen: Professor M. Etemadian

Dr H. M. Penido

Rapporteurs: Dr D. Castillo

Dr A. J. Metcalfe

Secretary: Dr M. G. Candau, Director - General 2. Standing Committee on Administration and

Finance

Dr R. Baidya, Dr H. van Zile Hyde, Dr A. J.

Metcalfe, Mr H. Olivero, Dr M. O. Shoib, Dr J. N.

Togba, Professor V. M. Zhdanov

3. Standing Committee on Non -governmental Organ- izations 2

Dr A. Habernoll, Dr H. van Zile Hyde, Dr Le- Cuu- Truong, Dr L. Molitor, Dr A. H. Radji

4. Committee on Arrears of Contributions in respect of the Office International d'Hygiène Publique 3

Dr A. O. Abu Shamma, Dr G. Farugk, Dr J.

Muñoz Puglisevich

5. Committee on Gifts or Bequests 4

Dr A. O. Abu Shamma, Dr G. Farugk, Dr A.

Habernoll

6. UNICEF /WHO Joint Committee on Health Policy 5

WHO members: Dr J. D. Hourihane, Dr H. M.

Penido, Dr M. O. Shoib, Dr J. N. Togba, Professor V. M. Zhdanov

Alternates: Dr Le- Cuu- Truong, Dr J. Muñoz Puglisevich

7. Léon Bernard Foundation Committee 3

The Chairman and Vice - Chairmen of the Board ex officio, Dr D. Castillo, Dr A. J. Metcalfe

8. Working Party on Headquarters Accommodation Mr T. J. Brady (representing Dr J. D. Hourihane),

Dr A. J. Metcalfe, Mr H. Olivero, Mr A. Puhan

(representing Dr H. van Zile Hyde), Dr M. O. Shoib

1 See resolution EB24.R5.

3 See resolution EB24.R7. Dr A. Habemoll had retired from this committee on being appointed to the Standing Committee on Non -governmental Organizations.

4 See resolution EB24.R9. Mr H. Olivero had retired from this committee on being appointed to the Standing Committee on Administration and Finance.

8 See resolution EB24.R10 and the Statutes of the Foundation (Off Rec. Wld Hlth Org. 17, Annex 5 ; resolution WHA3.52 ; and Off. Rec. Wld Hlth Org. 63, Annex 1, section 1).

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ANNEX 3 19

Annex 3

REVIEW OF BCG VACCINATION PROGRAMMES 1

[EB24/5 - 1 May 1959]

PRELIMINARY REPORT BY THE DIRECTOR- GENERAL CONTENTS

Introduction

Part I. Technical Value of BCG Vaccination ^. ^.

1. Degree of Protection obtained by BCG Vaccination

Page 19 20 20

1.2.5 Comments

1.3 Protective Effect of BCG Vaccination estimated from Post -vaccination Tuberculin Sensitivity 1.4 Factors influencing the Degree of Protection ^.

Page 27 27 29

1.1 BCG Controlled Trials ²⁰ ^1.4.1 The Vaccine 29

1.1.1 Trial in North American Indians (Aronson et al.) 20 1.4.2 Selection of People for Vaccination 30 1.1.2 Trial in Adolescent Urban Population (British ^1.5 The Mechanism of Acquired Protection ³¹

Medical Research Council)

1.1.3 Trial in Puerto Rico (United States Public

21 2. Inconveniences and Risks in BCG Vaccination . 33

Health Service) 22 2.1 Local Response to Vaccination 33

1.1.4 Trial in the Southern Part of the United States ^2.2 Local Lymph Node Involvement 34

of America (United States Public Health ^2.3 Haematogenous Dissemination of BCG 34

Service) 23 2.4 Lupus Formation 34

1.1.5 Comments 24 2.5 Fatal Infection with BCG 35

1.2 Circumstantial Evidence 24 2.6 Conclusions 35

1.2.1 Effect of BCG Vaccination in a Major Tuber- _3. Disadvantages of BCG Vaccination in relation to

culosis Epidemic (Hyge) 24 the Tuberculosis Programme ³⁵

1.2.2 Retrospective Study of Effect of BCG Vaccina-

tion in Schoolchildren (Enell) ²⁵ ^4. General Conclusions 36

1.2.3 Follow -up of Mass BCG Vaccination in Germany

(Daelen & Dix) 26 Bibliography 36

1.2.4 Effect of BCG Vaccination in Czechoslovakia Part II. Statistical Data for the UNICEF /WHO-

(Sula) 27 assisted BCG Vaccination Programme . ^. ³⁸

INTRODUCTION

The Director -General submits this preliminary

report in compliance with resolution EB23.R16.

The operative part of the resolution reads:

REQUESTS the Director -General to present to the twenty - fourth session of the Executive Board a report on BCG vaccination programmes including the technical value of such vaccination and its place in tuberculosis control programmes, to the extent it is possible at that time, and to present a further report to the twenty -fifth session.

A considerable part of Part I of the present report

consists of a review of some of the most recent

publications, in which the results of follow -up for a sufficient length of time are given, and on which a technical appraisal of the productive value of BCG vaccination can be based. Only publications dealing

with intradermal vaccination in man have been

reviewed in the present report, as this is the only method to be considered in relation to the UNICEF/

WHO assisted BCG vaccination projects. Publica- 1 See resolution EB24.R20.

tions giving evidence of the protective effect of BCG vaccination in experimental animals are mentioned only briefly, mainly in connexion with the correlation between the protective effect of BCG vaccination and the degree of post- vaccination tuberculin sensitivity.

The inconvenience to the persons vaccinated and the risks directly associated with the vaccination are described mainly on the basis of publications, and a technical appraisal in quantitative terms has been attempted.

The argument often used against BCG vaccination, that it spoils the diagnostic and epidemiological value of the tuberculin test, is discussed.

A report on the lessons which might be learned from the mass vaccination programme will be made later, based on a thorough evaluation of this programme, for which plans have been made.

In Part II of this report, statistical data are given for the UNICEF /WHO -assisted BCG projects.

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20 EXECUTIVE BOARD, TWENTY -FOURTH SESSION PART I. TECHNICAL VALUE OF BCG VACCINATION 1. Degree of Protection obtained by BCG Vaccin-

ation

The question is what degree of protection BCG gives against tuberculosis and, more specifically, whether the degree of protection given by the vaccination is great enough to justify its application on a mass scale as part of the tuberculosis control programme.

1.1 BCG Controlled Trials

A BCG controlled trial is a scientifically planned and conducted study, the most characteristic feature of which is that each person considered eligible for vaccination is, by a random procedure of selection, allocated to one of two groups: vaccinated or controls.

All the people included in the study are then followed for several years for the purpose of discovering the cases of tuberculosis and deaths from tuberculosis which occur, precautions being taken to ensure that the controls and the vaccinated are, in all respects, treated identically. By comparing the annual incidence (attack rate) and the death -rate of tuberculosis in

the two groups -controls and vaccinated -an

expression is obtained for the degree of protection acquired from the vaccination.

The results

of four

such studies have been published:

1.1.1 Trial in North American Indians (Aronson et al.)

This trial, which was started in 1936, included

3008 Indians aged 1 -19 years, living in four reserva-

tions in the United States of America and south-

eastern Alaska. At entry to the trial, all were non- reactors to 0.005 mg of purified protein derivative (PPD), reacting with less than 5 mm to this dose.

As determined by a random procedure, 1551 were vaccinated and 1457 left unvaccinated as controls.

The vaccination was given intradermally with one of thirteen lots of freshly -prepared BCG vaccine, using a dose of 0.1 or 0.15 mg.

The study population was subjected to an initial chest x -ray examination, and four persons, three vaccinated and one control, showing radiological evidence of pulmonary tuberculosis, were excluded.

No efforts were made to prevent exposure to tuber-

culosis; approximately 20 per cent., in both the

vaccinated and the control group, had contact with tuberculosis during the first six years of the study.

Post -vaccination tuberculin sensitivity: 36.7 per cent. of those vaccinated were reactors to the very

low dose of 0.00002 mg of PPD at one year and

47.8 per cent. at two years. For two lots of vaccine, prepared from veal -potato medium instead of

Sauton's medium, the percentage of reactors was

markedly lower -13.8 and 15.6 at one year and

28.3 and 30.5 at two years.

The morbidity from tuberculosis, as judged by annual radiography, was studied for eleven years

(1936- 1947). During this period, definite pulmonary lesions -classified as primary tuberculosis, minimal to far -advanced tuberculosis, miliary tuberculosis and pleural effusion -were observed in 64 (4.1 per cent.) of those vaccinated and 238 (16.4 per cent.) of the control group. Non -tuberculous pulmonary

lesions, on the other hand, were about equally

frequent in the two groups; they occurred in 5 per cent. of the vaccinated persons and in 5.6 per cent.

of the controls.

As shown below, there was no

significant waning of the protective effect of BCG vaccination.

BCG -vaccinated Controls

Observation Cumu- Cumu-

years Number attack^lative Number attack^lative

of cases _rate

per 1000

of cases rate per 1000

1 -6 40 27 174 128.2

7 -11 8 8.2 40 43.7

Total period 48 35.2 214 171.9

The mortality experience of the study population was followed for twenty years. The following table shows the tuberculosis mortality by five -year periods for the vaccinated and the control group.

Observation years

BCG- vaccinated Controls Number of

deaths from tuberculosis

Cumulative death -rate per 10 000

Number of deaths from tuberculosis

Cumulative death -rate per 10 000

1 -5

6 -10 . . .

11 -15 . . .

16 -20 ^. ^. ^.

Total period 4 2 6

1

26 13 38 6

22 27 17 2

151 184 118 14

13 83 68 467

Judging from these figures, the vaccination con- ferred substantial protection for at least fifteen years.

There is some suggestion, however, of a waning of the protective effect after ten years.

The cumulative death -rates from non -tuberculous causes are almost the same among the vaccinated and the controls, 600 and 567 per 10 000 respectively.

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ANNEX 3 21

It is of interest to note that the two lots of vaccine which gave particularly low conversion rates also showed a comparatively low protective effect. These two lots were used in a single reservation -Rosebud Agency -and a comparison of the results obtained in this reservation and in the remainder of the study population is given below.

Vaccinated . Controls . ^.

Rosebud Agency Other agencies

Number of persons

Number of cases

Number deathsof tuber-from culosis

Number of pe sons

Number casesof

Number of deaths

from tuber - culosis

301 299

19 46

4 9

1250 1242

45 192

9 59

In summary, this trial provides considerable evidence that BCG vaccination, even under adverse circumstances such as poor economic conditions and considerable exposure to tuberculosis, can confer

substantial and durable

protection. Tuberculosis

morbidity was reduced by about 75

^per cent.

over a period of eleven years and tuberculosis mortality by about 80 per cent. over a period of

fifteen years.

1.1.2 Trial in Adolescent Urban Population (British Medical Research Council)

This trial deals with the effectiveness of vaccination in adolescents living in urban and suburban areas of highly -developed, industrialized communities.

The study population comprised 56 000 children of school -leaving age (14 -15 years) with a negative

radiograph and no recent contact with tuberculosis.

At entry to the trial- between 1950 and 1952 -22 300 were classified as reactors and 33 700 as non -reactors to tuberculin. This

classification was based on testing with two doses -3 and 100 TU of Old

Tuberculin. Persons with 5 mm or more of induration to either test were regarded as reactors and those with reactions of less than 5 mm to both tests were regarded as non -reactors.

The non -reactors were randomly divided into

control, BCG vaccination and vole -bacillus vaccination groups. The last- mentioned group will not be considered here; it can, however, be stated that its morbidity experience did not differ from that of the BCG vaccination group.

The BCG vaccine was supplied by the Statens

Seruminstitut, Copenhagen. It was given by intradermal injection, using a dose of 0.075 mg.

Representative samples of the vaccinated and

control groups were retested three to five months after vaccination. Eighty -six per cent. of the BCG- vaccinated persons reacted with 5 mm or more to 3 TU of Old Tuberculin.

By June 1956, the date of the latest report, the

trial population had been followed up for an average of four years.' The follow -up has involved annual examinations, including chest radiography. In addition, use has been made of the information available to the local chest clinics and the notification lists of the local medical officers of health. The final assessment of possible cases was made by an in- dependent assessor who had no knowledge of the results of the tuberculin tests and of whether vaccina-

tion had been performed. The results are given

below.

Number participating

in trial

Cases of tuberculosis

In first 21/2 years After more than 21/2 years

Total cases incidence^Annual

per 1000 Known cases incidence^Annual per 1000 *

Negative to 100 TU (unvaccinated) BCG -vaccinated

Vole- bacillus vaccinated

Positive to 3 TU (15 mm or more) Positive to 3 TU (5 -14 mm)

Negative to 3 TU, positive to 100 TU ^. ^. ^. Total study population

13 200 14 100 6 400 7 100 8 700 6 500

64 13 7 52 17 12

1.9 0.4 0.4 2.9 0.8 0.7

49

5

0 21 10

8

2.2 0.3

-

1.9 0.7 0.8

56 000 165 ₉₃

* Preliminary rates

1 A further progress report is expected in the summer of 1959.

(30)

It is seen that the incidence of tuberculosis in

the BCG- vaccinated group is only about one -fifth

of that in the concurrent control group.

Clearly,

BCG vaccination has a marked protective effect

which lasts for at least four years.

Whether there are any significant differences in the form or severity of the disease between the BCG- vaccinated and the controls cannot be determined as yet, the number of cases being too small.

A large part of the total cases -about 50 per cent.

during the first two and a half years and about 40 per cent. during the remainder of the observation period - occurred among the initial reactors. In the above table, the reactors have been classified into three groups according to their degree of sensitivity to tuberculin. It is seen that those with the strongest sensitivity (a reaction of 15 mm or more to 3 TU)

had by far the highest incidence of tuberculosis,

2.9 per 1000 compared with 0.8 and 0.7 in the weaker reactors and 1.9 in the unvaccinated non -reactors.

In this trial, BCG vaccination has been found to be about eighty per cent. effective in adolescents, an age -group presumed to be relatively susceptible to tuberculosis. The protective effect has so far been maintained for about four years.

Also of interest is the effect of BCG vaccination on the incidence of tuberculosis in the total study population. It can be calculated that there would have been 30 cases among the non -reactors during

the first two and a half years if they had all been

vaccinated and 165 cases if none had been vaccinated.

The corresponding figures for the total study popula-

tion would have been 111 and 246 respectively.

Vaccination of all those eligible would thus have

prevented 135 cases, or 55 per cent. of the total.

Without the initial

radiographic screening which eliminated 134 cases, vaccination would have reduced the total case rate by about 35 per cent.

An important point is that this trial, unlike many BCG vaccination programmes, excluded persons with low -grade sensitivity to tuberculin (those negative to 3 TU and positive to 100 TU) from the vaccinated and control groups. It is interesting to note that the follow -up of these weak reactors suggests that they possess considerable resistance to tuberculosis.

Thus, their annual incidence of tuberculosis - 0.7 per 1000 -was only about 40 per cent. of that of the unvaccinated non -reactors. It might therefore be speculated that vaccination may show a less marked effect where the study population includes a large

proportion of persons with low -grade sensitivity.

1.1.3

Trial in Puerto Rico (United States Public

Health Service)

This

trial was carried out on nearly 200 000

children aged 1 -18 years.

The study population

was given a two -dose series of tuberculin tests. The first dose was 1 TU (0.00002 mg) of PPD (RT 19 -21 Statens Seruminstitut, Copenhagen), and the second

dose, given to non -reactors to the first

test, was 10 TU (0.0002 mg) of PPD. Children reacting with 6 mm or more of induration to either the 1 -TU or 10 -TU test were classified as reactors; those with reactions of less than 6 mm to 10 TU were classified as non -reactors.

Excluding those who refused vaccination, the non- reactors were allocated by year of birth to a vaccination and a control group. The composition of the study population according to tuberculin and vaccination status is shown below.

Total persons

Tuberculin - reactors

Tuberculin non -reactors Refusals Controls BCG-

vaccinated

191 827 82 269 31 586 27 338 50 634

A 100 -TU test was given to those allocated to the vaccination and the control groups. About 30 per cent. in both groups were found to be positive to this test (a reaction of 6 mm or more) -an indication that there was a considerable proportion of low -grade tuberculin sensitivity in the study population.

The vaccine for the trial was supplied by the New

York State Department of Health. It was used

within three to five days after preparation, a dose of

0.1 mg in 0.1 ml of diluent being injected intra-

cutaneously.

Post -vaccination tuberculin testing was limited to samples of the vaccinated group. Eighty -nine per cent. were found to have reactions of 6 mm or more to 10 TU one or two years after vaccination.

For the follow -up of the tuberculosis morbidity and mortality experience of the trial population, use was made only of established reporting systems.

Record cards for all persons participating in the trial were made out, against which all death certificates and all reports of cases of tuberculosis were regularly matched.

The results of the first six years of follow -up were as follows :