Dear Members of the Scientific and Technical Advisory Committee,

It is a pleasure for me to welcome you to WHO at a time which combines continuity and change.

Continuity, because so much of what WHO has been doing for the health of so many is worth while pursuing. TDR is a prime example of this. It is an example of world class expertise. It is an example of what the best of partnerships can bring to the advancement of technology, medicines and alleviation of suffering.

Change because the world around us is changing and because WHO as an Organization needs to reposition itself to make a real difference for global health.

We are changing to better focus our work, to get better synergies between related activities, to forge closer relations with our Member States, to devise more effective partnerships with others.

We are changing to better cope with a mandate which Member States tend to increase, whereas the resources remain restricted.

We are changing because any organization needs to constantly work to become better – more effective – more passionate.

Among your documents you will find a description of our new structure, based on clusters. We have grouped the previous individual programmes into nine clusters – and then we have turned what used to be more than 50 programmes into 32 departments.

TDR is located at the heart of the Communicable Diseases Cluster.

The mission of the cluster is as simple as it is daunting: to reduce the impact of communicable diseases worldwide by leading the global effort in prevention, control, surveillance and research.

Its mandate is broad, ranging from monitoring the emergence of new, sometimes unknown, diseases to the possible eradication of those against which we have efficient tools and strategies. It is a major challenge. Communicable diseases remain the most common cause of death in the world. Of the 52 million deaths worldwide per year, an estimated one-third are due to infectious diseases. And we have all the evidence to say that the main burden of communicable disease is carried by the poor. WHO – committed to the cause of equity and the fight against poverty – has to maintain the fight against communicable diseases as a key priority.

Of particular concern to us are the tropical diseases. Some call these indigent diseases as they mainly affect the poor and do not get the attention they deserve.

Our ambition is to do what we can to change that. The 24-year history of TDR tells the story of how three international agencies, the World Bank, the United Nations Development Programme, and WHO, jointly with other loyal partners, have worked together to improve the health of those affected by tropical diseases. TDR is rightly regarded as one of WHO's success stories. You are a major player in that story. As TDR's highest scientific committee, you have had a crucial role in keeping the programme alive and dynamic, setting and updating its priorities and direction.

TDR is indeed a special programme. Twenty-four years is no age. It is still active and forward-looking, very relevant and, in fact, crucial, to meet the challenges posed by tropical diseases.

All of these qualities will be needed, because there are major tasks ahead.

Let us first review the current setting:

• WHO's reorganization has created an atmosphere that favours change, and we are fully committed to promote changes that will make a difference where it matters - the health conditions of disease endemic countries. Let us take advantage of this change process to strengthen the impact of our efforts also in TDR's area.
• TDR has undergone its 3rd External Review, which made suggestions on how to make this successful Programme even better. At the request of its Joint Coordinating Board, TDR is working on a new Strategic Plan with a long-term vision to guide the Programme in the next years, incorporating the suggestions of the External Review.

As you know, TDR has two basic goals:

Research and training for disease control - a simple, clear and relevant mandate, is as needed and as valid today as it was 24 years ago.

We desperately need new and better tools, tools that are effective, appropriate and affordable, and we desperately need to increase the scientific capacity of the countries that suffer the toll of tropical diseases.

Let me give you some examples. You know I have selected malaria and tuberculosis as priorities among the communicable diseases. Since July we have launched the Roll Back Malaria project and the Stop TB Initiative.

• In relation to malaria, our target is to halve its burden through interventions adapted to local needs, and reinforcement of the health sector of the affected countries. This is a formidable task which will require concentrated efforts to radically improve the health systems of the poorest countries on earth - and to cope with the problem of increasing resistance to the available drugs.
• The situation is also very serious with regard to the spread of tuberculosis. Drug resistance is spreading, some countries are facing problems in relation to the implementation of the DOTS strategy, and the association of tuberculosis with HIV/AIDS is cause of great concern.

We could dramatically change the pattern if new tools became available. For example, recent studies show us the impact new effective tools could have on tuberculosis by the year 2030:

• a new vaccine with 50% efficacy could lower tuberculosis incidence by 36 million cases and mortality by 9 million deaths;
• a single-contact treatment could avert 24 million cases and 11 million deaths;
• active case finding by using mass miniature radiography could save 23 million lives

And let us at this stage only leave to our imagination the far-reaching consequences of a good malaria vaccine.

All our knowledge is about the past – but all our challenges lie in the future. This is what stimulates researchers and scientists to make an extra effort. So let us look briefly into that future.

We are again facing an old dilemma: Should we invest in dreams, such as a malaria vaccine, or should we concentrate our resources on better use of existing tools?

I want to reiterate once more: Research is essential. Decades ago a polio vaccine was also just a dream, and the debate was raging between those idealists who fought for it and those who wanted better iron lungs and rocking beds to alleviate the intense suffering of polio victims. As we approach polio eradication - made possible by the development of effective oral vaccines - we forget how difficult the decision was to keep investing in a dream that no one knew could become a reality.

Let us keep some of the dreams alive.

We definitely need new knowledge to fight tropical diseases. We need to know our enemies better. These are:

• The pathogens that cause the diseases;

• The vectors that transmit them;

• The factors that undermine our defences against infection; and

• The environmental, social, economic and behavioural determinants that help disease propagation.

New knowledge, however, is not enough - we have to transform that knowledge into tools for disease control. We need:

• new and improved drugs, vaccines and diagnostics that can be afforded by the poor;
• new and improved interventions, suitable for adoption by the health systems of poor countries;
• better methods for vector control that do not further exacerbate the environmental situation of our planet.

TDR will be 25 years old next year as we enter a new century – a new millennium. We will commemorate this Jubilee not only with festivities. We will demand that TDR assume new duties, tasks, challenges and responsibilities. To be very direct – to assume more hard work.

TDR's new Strategic Plan, which will guide its future path, will be presented in full to the Joint Coordinating Board this June. It will focus on these new challenges and work with us in developing approaches to undertake them. I count on you to carefully analyse the options presented in the draft plan, discuss their implications and help TDR to make the right choices. Among the options we are proposing is to expand TDR's disease portfolio to include tuberculosis and dengue.

During this meeting, you will be presented with the reasons why we think TDR must expand its mandate to include these two infectious diseases. To me it is clear; carefully expanding the mandate means living up to TDR's achievements. Carefully expanding the mandate means strengthening our ability to make a difference.

We also need your help with another matter. Before I took office, I met with the group of outside experts that conducted the Third External Review. They told me that TDR has worked hard and effectively to accomplish its mandate. And I know that it has done so using only catalytic resources, or seed money.

TDR could do better, and more, if we could mobilise additional funds.

I am fully committed to do what I can to make this happen. In the long run I can think of few more cost-effective investments in health.

• I do so when I ask our Member States not to adopt a budget which decreases our resources and pulls towards a downsizing of WHO and limited ability to deliver the work that the same Member States expect us to do.
• I will do so as we continue to raise money in the belief that WHO can merit a larger share of the voluntary contributions Member States and others are willing to commit to health and development.
• I will do so when I will continue our achievements of the last 8 months and further rationalise the way we operate at Headquarters, Regional and country levels, to save precious resources and to redirect even more funds from administrative areas to our technical work.

Getting more funds and renewed support from Member States, donors and other partners is of course our task - but you do have a share in the effort and responsibility.

Your sound advice is crucial to TDR and the Communicable Diseases cluster - and therefore to WHO. We are partners committed to better world health. Your work, as TDR's top scientific experts, will impact on the Programme's performance and that of WHO.

I am looking forward to receiving your advice. I wish you success in your deliberations, and I wish TDR a bright future, as it approaches its 25 years of existence and as it looks ahead to new challenges and opportunities into a new century.