It is a particular pleasure to address you this morning. We meet as representatives of the Executive Boards and secretariats of UNICEF, UNFPA and WHO, to work together on how to make progress on reducing maternal mortality, fostering adolescent health and development, preventing mother-to-child transmission of HIV/AIDS, and delivering immunization services.

Much of this second session of the Coordinating Committee on Health will be devoted to reviewing how the Programme of Action, which was adopted five years ago at the International Conference on Population and Development in Cairo, has been implemented in these areas. ICPD+5 has given us an opportunity to take stock, and to build on the achievements of the Special Session of the United Nations General Assembly in June-July of this year. After many preparatory meetings and long negotiations, the General Assembly was able to adopt by consensus a document on the Key actions to be taken to move ahead on the Programme of Action. This Committee will look more closely at the Key actions document under agenda item 7.

In so doing CCH will be continuing its tradition of ensuring that the major United Nations Conferences of the 1990s have a real impact. Past sessions have devoted considerable attention to the goals of the 1990 World Summit for Children. In the future, CCH may well be invited to reflect on the outcome of the 1995 World Summit for Social Development and the World Conference on Women. This is important work: making sure that international conferences make an impact, not on paper, but by action in countries.

As WHO's Director-General, I have made coordination and partnerships with sister organizations of the United Nations system a priority. In May of this year, I announced to the World Health Assembly that WHO was ready to join the United Nations Development Group. Since then, WHO has worked with the funds, programmes and agencies that make up UNDG - including UNICEF and UNFPA - to support the United Nations Development Assistance Framework process in countries. We see UNDAF not just as a way of harmonizing the work of UN agencies, but also as a step towards more meaningful collaboration with other development partners, including NGOs and the private sector.

In April of this year, I met here at WHO with Nafis Sadik and senior staff of UNFPA; and in July, with Carol Bellamy and senior staff of UNICEF. Together we looked for ways to work more closely and effectively together, particularly at country level.

Among the results of the recent collaboration by WHO, UNICEF and UNFPA have been:

• Guidelines for planning and programming in adolescent health, developed with UNAIDS and the World Bank;
• A joint WHO/UNICEF/UNFPA statement reviewing evidence on the effect of antiretroviral drugs on mother-to-child transmission.
• At the end of October, the launch in New York of the Joint WHO/UNICEF/UNFPA/ World Bank Statement on Reduction of maternal mortality.

That same day I chaired the first Board meeting of the Global Alliance for Vaccines and Immunization.

We will shortly take up the item on Reduction of maternal mortality and morbidity. We all believe that it is simply unacceptable at the end of the twentieth century for women to continue to suffer and die as a result of complications related to pregnancy and childbirth. We know what works and what does not work to reduce maternal mortality. Women must have access to skilled assistance during pregnancy and childbirth. And they must be able to reach a functioning health care facility when complications arise.

After 12 years of experience in Safe Motherhood activities, some 600 000 women - more than one woman every minute - still die from complications related to pregnancy or childbirth. These complications also contribute to more than 3 million infant deaths within the first week of life, and another 3 million stillbirths.

As we all know, there is an enormous disparity between rich and poor: 98% of all maternal deaths occur in developing countries. In some developing countries, 1 in 10 women die from a pregnancy-related cause. In industrialized countries, on average 1 in 4000 women die. We must do better as a matter of urgency, and this Committee will hear proposals on how we can move ahead.

In the area of Adolescent health and development, the figures give a sense of scale. Of the 6 billion people in the world today, almost half are under 25 years of age, and 1 billion are between the ages of 15 and 24. These young people need our support to protect themselves from disease and to develop in the best possible way.

To make a major impact on the health and development of adolescents worldwide, we must give priority attention to five key health issues for the 10 to 19-year old:

• Sexual and reproductive health, to reduce early, unwanted or unsafe sex, reduce adolescent pregnancy and abortion, and prevent infections, including HIV/AIDS.
• Substance abuse, with a special focus on tobacco. 150 million of today's young people who already smoke cigarettes will die of tobacco-related causes.
• Mental health of adolescents, in both developed and developing countries, particularly depression and the growing epidemic of suicide.
• Injury, often associated with violence, affecting many young lives, and
• Adolescent Nutrition, a largely neglected area.

A strategy is needed that focuses on adolescent development. All adolescents should have access to information, be trained in life skills, receive counselling when they need it, live in a safe and supportive environment, and have access to youth-friendly and competent health services. These are the pillars of the joint WHO/UNICEF/UNFPA programming framework for adolescent health and development.

By far the most significant source of HIV infection in children below the age of 10 is mother-to-child transmission. By the end of this year, 3 million children will have died of AIDS and 1 million more will be living with HIV. One in 10 of those newly infected by HIV in 1998 was a child. And 9 out of 10 of all HIV-infected babies were born in Africa.

A policy is jointly being developed on using antiretroviral drugs in public health programmes, especially in Africa. Proposals for a global initiative to attack mother-to-child transmission from the point of view of WHO, UNICEF and UNFPA, and within the framework of UNAIDS, will be put forward during the meeting.

When immunization services reach the poor who need them most, they can protect the most vulnerable from vaccine-preventable disease in a cost-effective way. We estimate that 3.5 million lives - or over one fourth of the excess mortality of the poor - could be saved each year by existing vaccines and vaccines expected to be available in the next few years. Nearly a million children die each year from measles, half of them in Africa. Fifty-seven countries have yet to eliminate neonatal tetanus.

In the face of these data, immunization coverage has actually been stagnating or even declining in some countries. Vaccines are not being introduced quickly enough in developing countries. Indeed, the gap between poor and rich countries has been widening: up to 11 vaccines are readily available in the USA, while in Malawi only 6 antigens are in use. Not enough resources are devoted to research and development of vaccines against diseases of public health importance in developing countries.

Progress with eradicating polio has been impressive, thanks to the global partnership of multilaterals, bilaterals and the private sector. But we are in the middle of a crisis in the supply of polio vaccine. To make up the critical shortfall, we shall tomorrow launch an unprecedented joint appeal for $50 million for oral polio vaccine. And we still need the political commitment of polio-endemic and donor countries to eradicating polio by the end of the year 2000. Collaboration between WHO, UNICEF, and other partners, including UNFPA, will continue to be critical to immunization against vaccine-preventable diseases.

Among the challenges, we can enjoy some good news. The Global Alliance for Vaccines and Immunization - GAVI - began with an initiative of the President of the World Bank. Carol Bellamy and I have made personal and institutional commitments to it. So have foundations, vaccine-producing industries and other public sector institutions. The Alliance will be launched early next year by a $750 million grant from the Bill and Melinda Gates Foundation.

Today, we invite you as members of CCH to give us the benefit of your experiences and lessons to be learned from best practices. The documents before you today have been prepared jointly by staff of the three organizations. They represent a common view of where we stand and how we might move forward. We welcome your comments on the roles and functions of each organization, as we explore how each best can make its contribution to achieve our common goal.