Dear Colleagues,

I am delighted to be with you all here at this landmark event in Thailand, a country that has contributed so much to health research.

Scientific knowledge is at the core of our collective effort to advance health - whether we work in communities nationally, regionally or globally.

Knowledge improves health through three basic mechanisms:

• by leading to better technologies;

• by creating the basis for health-promoting life-styles; and

• by providing an evidence-base for policy-making.

They all need to be mobilized for us to meet the challenges we face today. Our first challenge is to reduce excess mortality, morbidity and disability, especially in poor and marginalized populations.

There is unprecedented political commitment to reducing world poverty. New knowledge has demonstrated the substantial economic losses faced by poor communities due to conditions such as HIV infection, malaria, and reproductive ill-health. Many Heads of State recognize that the good health of their nations is key to human development and economic growth.

There is a growing consensus: First - equitable health outcomes are essential for global prosperity and the well being of societies. Second - better health is key to reducing poverty, particularly among the nearly 3 billion people in our world who live on less than US$ 2 per day.

Health is starting to take its rightful place at centre stage of development action: we must make a massive effort to respond to this challenge.

Knowledge and technologies have helped develop tools for tackling conditions of poverty. But we need more knowledge on the determinants of illness and ways in which people respond. We need research into means for tackling the conditions - new drugs and commodities, strategies for health promotion, illness prevention and treatment, and efficient systems through which those in need can access what is available. This is urgent, as much of what has been developed is just not accessible to those who need it. And the power of the available tools may well diminish as pathogens learn to resist our response.

Colleagues,

Our second challenge is to promote healthy lifestyles and reduce factors that pose risks to human health. Knowledge, generated through research, helps us to understand people's life experiences, as well as options for environmental protection and lifestyle changes that result in better health and well-being. Knowledge is vital to help us make sense of popular perceptions about possible risks to well-being - unsafe food or sexual behaviour, radiation and non-communicable disease.

New knowledge has demonstrated how tobacco use is growing in developing countries and how young people in these countries take up the habit. The world woke up to a frightening reality: a devastating global epidemic of tobacco use now threatening the developing world. We also have the knowledge about how to control this threat. As we speak, nations are preparing to work on a Global Treaty that will help put the knowledge into practice.

Our third challenge is to develop health systems that equitably improve health outcomes, respond to people's legitimate demands and which are financially fair. Knowledge must guide all of our attempts to improve health systems so they better benefit the people they serve. It should reflect people's experience of illness and their interactions with carers, describe the operation of their health systems and reveal the impact of alternative health policies in different settings.

Our fourth challenge is to promote an effective health dimension to social, economic, environmental and development policy. The effectiveness of all efforts to improve health - whether through health systems or risk reduction - will depend on the ways in which broader policy and institutional environments are developed and expressed. This calls for policy research that analyses what has happened in different political and economic contexts.

We face a fifth, and different kind of, challenge. How do we deal with knowledge that is relevant to the public's health. Is it a private good, to be traded in markets, closely guarded, tightly protected and used to enrich its owners? Or is it a global public good, openly available to all who need it and make good use if it? Currently there is an imbalance and under-provision of knowledge goods within poorer communities and countries.

One of the remits of the Commission on Macroeconomics & Health , chaired by Jeffrey Sachs, is to examine options for investing in the production and use of new knowledge for addressing current and future health challenges. One of the Commission’s six working groups will examine the impact of intellectual property rights on innovation, the incentives for developing new products relevant to the health of poorer societies, and ways to protect intellectual property while safeguarding public health. Another group is examining institutional mechanisms which will promote increased investment in international public goods.

The ownership of knowledge and intellectual property is, inevitably, the subject of intense political debate. There are signs of change. A recent communication of the European Commission, discussed last month at a well-attended Round Table in Brussels, indicate a convergence of interest from those responsible for Research, Trade, Health and Development to improve equity in access to knowledge, products and services which will benefit health.

Colleagues,

Much of the knowledge and understanding we need has to be produced through research: the conduct of research is thus a critical element of all actions to promote better health. So, too, is the rapid and widespread application of research results, and universal access to its benefits.

These realities were appreciated when the World Health Organization was founded in 1948, and given its mandate on behalf of the peoples and nations of the world. This included the "promotion and conduct of research in the field of health". The general principles of WHO's research functions were established in 1949, and the Advisory Committee on Health Research in 1959.

Since then WHO has played a key role in many international health movements. Primary Health Care. The control - and rolling back - of malaria. The control and stopping of tuberculosis. Controlling leprosy, river blindness, leishmaniasis and other communicable diseases. The expansion of immunization and the integrated management of childhood illness. The eradication of smallpox. The promotion of reproductive health and safer pregnancy. Health care in complex emergencies. Improving access to essential medicines and technologies. Responding to HIV infection, and seeking ways to intensify the world’s response to the epidemic. Reducing disability, and supporting those who are less able. Safe blood and better mental health. Improving the nutrition of infants and young children. Tobacco control. The impending eradication of polio. Environmental health.

In each case WHO's contribution has been based on the creation of knowledge, putting that knowledge to the test, applying it through the development of health systems - as well as through health promotion and targeted programmes. WHO has also encouraged focused research by national, regional and international bodies.

One of these foci has, of course, been effective therapies and preventive measures for priority health problems. But another is the operational issues encountered in community-level and national responses to people's health care needs. Research has responded to both challenges.

Scientists in WHO's regional and Geneva offices have worked closely with researchers within developing countries, linking them with Colleagues, from industrialized countries.

We see a continuing need to strengthen national capacities for health research, particularly in poorer countries. A range of interests have a stake in setting the agenda. They include policymakers, researchers, civil society and consumer groups.

Despite intensive advocacy by many of us, the overall level of investments in knowledge relevant to poor people's health are still minute compared with the extent and complexity of the problems to be tackled. WHO has used its own funds to support programmes. To fill critical gaps, WHO has established partnerships to support programmes of research and product development,.

Two of the most effective of these programmes are the UNDP /World Bank/WHO Special Programme for Training & Research in Tropical Diseases (TDR) and the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP). Both are well known for promoting and strengthening excellent research in tropical diseases and reproductive health in many developing countries. They are also renowned for their efficient use of funds.

Ten years ago, the Commission on Health Research for Development started its work. The Commissioners presented their landmark report Health Research – Essential Link to Equity at the Nobel Conference in Stockholm. A truly visionary document. Several of the Commissioners are with us today. The report has been championed by the Council on Health Research for Development as it helped national authorities establish capacity for research to guide health policy, and locate funds to support it. The Global Forum for Health Research, established in 1996, has helped focus international attention on the benefits of new knowledge and technologies in tackling global health priorities.

Shortly after I became the Director General of WHO in 1998, we reported that many of the health achievements of the 20th century were the result of advances in scientific knowledge. Based on a recent estimate that there was a $20 return for every dollar invested, we concluded that the economic case was good. We concluded that further investment was essential.

During the last few years several new global research initiatives have been set up - to assess risks, to develop vaccines, to find new treatments, and to assess different preventive measures. Typically these involve basic science, clinical and social science researchers. Most are partnerships that involve both public and private sector entities, foundations alongside research institutions.

Later today I will be participating in the launch of one of these new initiatives - the Global Alliance for Anti-TB Drug Development, which brings together WHO, national institutions in South Africa and in the US, as well as the Rockefeller Foundation. Some years ago we saw the establishment of the International AIDS Vaccine Initiative: strongly supported by WHO and UNAIDS, it has made impressive progress at great speed. Late last year the Medicines for Malaria Venture began. Building on pioneering work by TDR, it offers a sustainable mechanism for the professional discovery, development and commercialisation of affordable new antimalarial drugs. And the Global Alliance for Vaccines and Immunization has as one of its objectives the acceleration of research and development efforts for vaccines and related products specifically needed by developing countries.

At the same time, more resources for research are needed within countries, so that national health research contributes knowledge that is relevant both to national, as well as global, agendas. The research must be of high scientific quality as well as relevant - whether research techniques are drawn from the biomedical, social, political or managerial sciences. Sustaining both excellence and relevance is not easy. Hence the continuing need to strengthen national capacity for research.

Given the scarcity of funds for research, disagreements about priority and emphasis are inevitable. The way forward involves careful analysis of the issues, and a response that contributes to relevance and excellence in the conduct of research for health - particularly for the health of poor people.

It also involves the creation of networks that minimize the barriers between different research disciplines and the distance between the laboratory and the field. Indeed, in good research programmes this distance is shrinking rapidly and interdisciplinary barriers have been eroded. That is as it should be. Many research networks are also designed to stimulate national or regional research capacity - such as the Multilateral Initiative on Malaria, set up to support malaria research capacity within Africa, and SEAMEO TROPMED, a network based in SE Asia.

Colleagues,

In 1999 I initiated a study of research and development for international health. WHO staff worked with an external board to identify elements of a new strategy for more effective and concerted action:

WHO will continue to monitor emerging trends in knowledge generation and tracking resource flows for research. This will enable us to offer strategic visions for health research so that it adds to the evidence base necessary for priority setting and formulation of the policies.

WHO will help to promote and advocate for resources to support relevant, high quality research, We should offer norms and standards for the conduct of research, including ethical frameworks. These are particularly relevant given the globalization of health research, genomics, medical genetics and population genetics, and the widening technology and research gap between industrialized and developing countries. The Global Forum on Bioethics for Research will be meeting immediately after this conference to discuss some of these issues. And we have revived the secretariat committee on research involving human subjects to bring ethics to the forefront of WHO's research responsibilities.

Within all its programmes, WHO will support the better dissemination of knowledge as it becomes available - through synthesis, involving meta-analysis and related techniques; through careful analysis and peer review of new findings; and through the use of modern information technology and telecommunications.

In fact, we have witnessed a growth in the number of hits on the new WHO web site from four million to 12 million per month. Hits from 160 different countries which make it the most visited web-site on health in the world.

WHO will contribute to the effectiveness of regional and global health research efforts. Hence, we will continue work with others, bringing together the health research capacity within countries, within other organizations, and within both public and private entities.

WHO will continue to play a role in research capacity strengthening in developing countries, and in supporting strategic research in key areas where gaps remain.

We have confirmed that Expert Committees are one of the key links between WHO and the scientific community. We will do what we can to ensure that the science is of highest quality and relevance. We are updating the links with WHO collaborating centres and optimizing their important contribution of relevant and quality knowledge.

We have also reviewed the role of the Advisory Committee on Health Research: I am very pleased that Professor Fathalla has agreed to lead this important Committee as it provides strategic advice to WHO on a continuing basis. The Advisory committee has just held its meeting here in Bangkok this past weekend, now with a much-improved balance both of disciplines and gender.

The new strategy that I have described will be led across WHO by focal points in regional offices linked to a revamped Department of Research Policy and Cooperation in Geneva.

Colleagues,

Over the past few years, the health research capacity in many developing countries has improved beyond all recognition. Major new sources of research funding have appeared. There are more international health research initiatives than ever, with diversity of purpose, organization and governance.

This diversity brings new challenges. How to make sure that different groups know what is being done, by whom and how; what results are being obtained; what collaborative processes are being established; what options exist for capacity development and linkage; what needs are emerging; where there are important gaps in the regional or global response? How to make the most efficient and effective use of limited resources available? Above all, how to maintain focus on international health priorities?

WHO sees the value of diversity of organizations performing different functions at various levels and at different parts of the research spectrum. To maximize the advantages of diversity, additional research networks that span national borders will be needed to help the research community contribute better through the sharing of expertise and emerging knowledge.

Alongside this, WHO sees advantages in the better coordination of these diverse research activities, so that the different groups can see themselves responding collectively to the health challenges of today. This co-ordination could draw on the unprecedented powers of modern information, communication and management technologies.

The challenge is to convene the many stakeholders in health research for development in a community, which builds on their existing and growing experience. This will require the initial commitment of groups who are perceived to represent the different stakeholders. Many of them are present here today. It will require the investment of time and energy, and a slim but effective management; it will depend on the trust and self-discipline of participants.

WHO has a responsibility that reflects the interests of all people in its 191 member states. It responds to the wishes of their governments. It represents the international public sector in the health arena. WHO's work also draws extensively on the vision, insights and products of the health research community: this sustains its evidence base. Taken together, WHO's responsibilities and position enable it to act as a value-based global convenor, bringing together the producers, funders and users of health research. WHO is also well placed to catalyze novel actions when these are indicated.

As a convenor for international health research, WHO will strive to help establish a balance between basic and applied research, between biomedical and social disciplines, between the interests of decision makers and researchers, and between global priorities and local imperatives.

Colleagues,

I sincerely hope that this conference will help all of us explore ways in which health research can best achieve specific and measurable results. I hope that the discussions will show ways in which health research can it be organized so that it secures higher investment, contributes best to development policies and finds its right place within international cooperation mechanisms.

Many of us sense that the way forward has to be based on several clear principles. Goodwill, trust and empathy; priority to the better health of the world's poorer communities; a strong political commitment to both health research and its management; and international collaboration within and between regions that is productive and mutually beneficial.

The recognition that knowledge is a global public good implies that all countries stand to benefit equally from its equitable distribution. All countries should share and cooperate in the creation and utilisation of knowledge for the collective benefit of humankind.

Quite simply, the potential rewards of well-organized international health research are inestimable. We need much more knowledge to respond to the challenges faced by the world's people. The production of knowledge has to be focused because our capacity to produce it is, inevitably, limited. The focus will change over the years, both nationally and globally, as needs evolve.

We have a chance, now, to establish better ways of working together, more effective ways of responding to need. We can build on a great history, with extraordinary improvements in our understanding of ill health and substantial health gains for so many people. The hard part is yet to come. Let us build on our success, and turn our aspirations into realities. It is this challenge that stimulates all of us to make the extra effort. I can assure you that WHO is ready and willing to support this effort.