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Distinguished
Ambassadors,
Mission
Representatives,
Thank you very much for this invitation today. It
is indeed timely. Between now and the World Health Assembly in May, I
have three visits scheduled - to Egypt, Kenya and Nigeria.
At the end of this month I shall be in Cairo for
the opening of our new Regional Office building for the Eastern
Mediterranean Region, and for the regular meeting with all of our
Regional Directors worldwide. Our previous facilities in Alexandria
became too small and the World Health Assembly decided that a move was
required. I should like to express my appreciation to the host
government, Egypt, for the generous support it has given, and also to
a number of other donors in the region. I know that we will be
able to give a more efficient service from the new premises.
The following week, Nairobi will be the
location for the meeting of the Executive Heads of the UN system,
chaired by the Secretary-General, namely the ACC. It is an important
meeting. We will be taking forward our co-ordination work on following
up on the Millennium Summit and the Millennium Declaration.
One of the items for review will be the General
Assembly’s own request on Millennium follow-up relating to Africa It
asked us "to strengthen the broad range of its engagement in
Africa, with a view to intensifying support for poverty eradication
and sustainable development, for combating diseases and pandemics and
for the process of conflict prevention and the consolidation of
democracy".
Our main objective will be to ensure that the many
inter-agency processes in support of African development reinforce
each other and lead to tangible results.
I will also be launching our activities for World
Health Day in Kenya on 4 April. I want to thank the Ambassador and the
Government who have worked hard with us to establish a first class
programme.
Our advocacy effort will concentrate on reducing
stigma associated with mental ill health and on raising awareness
about the many effective, affordable treatments that are available but
underused, both in developing and industrialized countries.
By opening up Kenya’s main mental hospital to the
public for the first time, the government will be spreading the
message that sums up our concerns for mental health: Stop Exclusion -
Dare to Care. We hope and believe it will be a warm and forceful
celebration of these principles.
This year’s World Health Report will also focus
on mental health. It will give a comprehensive review of what we know:
about the current and future global burden of mental ill health and
neurological disorders; about the effectiveness of prevention and the
availability and restraints to treatment; and about the policies
needed to ensure that stigma and discrimination is broken down and
effective prevention and treatment are put in place and funded.
Through our concerted efforts this year, I am
hopeful that we will have taken important steps toward a future when
all communities will give mental health the same priority and respect
as physical aspects of health.
Then, on the 25th of April, I will be in
Abuja to mark the first ever African Malaria Day and then to
attend the OAU Summit on HIV/AIDS and other infectious diseases in
Africa.
This will be a very important meeting. The stakes
are high. The direction of this Summit will play an important role in
determining the discussion in the UN General Assembly’s Special
Session on HIV/AIDS in June. I am pleased to announce to you that WHO
will be providing substantial support to the conference in response to
the request from the OAU. I have discussed the matter with
Dr Samba, our Regional Director and I can announce today that
together we will contribute $500,000 to the costs of the summit.
Much has happened in the world since President
Obasanjo hosted the malaria summit a year ago. Through President
Obasanjo and other African leaders’ tireless efforts, the world has
begun to realize the need to drastically scale up its effort against
infectious diseases.
This realization lead to clear commitments by the
G8 leaders in Okinawa in July last year and by the European Union in
September. We are getting clear indications that these commitments
will be followed up with a substantial increase in resources for
health. Intense activity has been initiated in OECD member capitals as
in African ones on how best to invest the expected new funds to ensure
effective health outcomes.
We need to invest strongly in malaria prevention
and treatment. We have tools that work. There has been some progress
in reducing the price and increasing the availability of impregnated
bed nets, but we need to see more work on this front. We need to
develop new tools - in particular combination drugs that can combat
resistance in the short-term and new drugs that can be effective when
existing drugs gradually lose their effectiveness. For example, last
week there was announcement that we will be working with Glaxo
Smith-Kline on the new combination therapy LAPDAP.
We are also examining the effectiveness of
medicines traditionally used for malaria treatment, and are supporting
the development of effective vaccines to tackle malaria, HIV and other
priority problems.
Over the past year, we have seen some heartening
developments in the effort against tuberculosis. Last October, we
launched the Global Alliance for TB Drug Development which will
finance development of much-needed new TB drugs, with a special focus
on simplifying and shortening the treatment regime. Shortly, we will
also launch a new partnership, the Global TB Drug Facility, which will
enable the poorest among the 20 TB priority countries to better access
needed drugs in order to expand their DOTS coverage.
We have also seen new support for national
immunization programmes, and for the introduction of new vaccines,
through the Global Alliance for Vaccines and Immunization.
The greatest change, however, has taken place in
the work to stem the HIV/AIDS epidemic.
We have been witnessing an unprecedented effort,
driven by committed people from governments, nongovernmental
organizations, UN agencies and the private sector, to dismantle the
obstacles that are preventing essential drugs from reaching the
millions who need them.
Popular outrage, political will, market forces and
the best science are enabling the pursuit of a fundamental principle
of public health: the supply of essential medicines on the basis of
need rather than on the ability to pay.
A year ago, when WHO, UNAIDS and other UN Agencies,
embarked on a joint effort with 5 leading pharmaceutical companies,
the prices of medicines needed to slow the progression of AIDS were
far beyond what most Africans, Latin Americans and Asians, or their
governments, could afford. At a cost of $10,000 to $15,000 per person
year the drugs were out of reach.
Today, antiretroviral combination drug therapies
have become available to African countries for around $1000 dollars
per patient per year - a tenth of what they used to be.
True, such prices are still beyond what almost any
African health system and most patients are able to spend. But it must
not stop here. We must ensure that not only HIV/AIDS drugs but all
essential medicines and vaccines are accessible to all. It will take
time, but we must make sure that no moment is wasted.
All of us would take the view that an effective
regime for international trade is one which allows countries to
implement workable systems that secures people's basic needs -
including their health needs - while respecting intellectual property.
We can only make this happen through political negotiation and legal
process. That is what is happening, now: I welcome the increased
public attention being given to the limited access to health care to
prevent and treat priority conditions within Africa.
Yes, the process is difficult. Along the road,
there will be disputes about how trade agreements are to be
interpreted. There will be challenges to those national drug policies
which seek to change the ways in which patent rights are applied.
These can only be solved by testing their limits through a legal
process: this is costly and frustrating to all concerned, but the
stakes are very high indeed.
Over the past weeks, we have seen the beginnings of
just one such legal process - in South Africa.
The World Health Organization (WHO) strongly
supports the 1996 South African National Drug Policy, whose objectives
are "to ensure an adequate and reliable supply of safe,
cost-effective drugs of acceptable quality to all citizens of South
Africa and the rational use of drugs by prescribers, dispensers and
consumers."
WHO worked closely with the South African
Government in the formulation of this policy and has actively assisted
South Africa in implementing the policy. WHO fully supports the policy
as being consistent with long-standing WHO views on national drug
policies, access to essential drugs, drug quality, safety and
efficiency, and rational use of drugs.
WHO fully supports the intent of the 1997 Medicines
Act 90, which is to operationalize key elements of the National Drug
Policy, including generic substitution, greater competition in public
drug procurement, improved drug quality, and more rational use of
medicines. We recognize that language within parts of the act is seen
as a challenge by some companies. During the past few years we have
worked with the different interests involved as numerous attempts have
been made to find a way forward that is acceptable to all.
Unfortunately, negotiations have so far failed to
achieve any agreement. 39 pharmaceutical companies have challenged
parts of the 1997 Medicines Act 90, contending that the law would
destroy patent protections by giving the health minister overly broad
powers to produce, or import more cheaply, versions of drugs still
under patent.
At the request of the South African Department of
Health, WHO has assisted in identifying relevant international legal
expertise to support, and report to, the Government of South Africa.
The court case as you know is now temporarily
suspended. We hope that renewed efforts will be made to resolve the
dispute, and that they will succeed quickly. The only acceptable
result is that all parties work together for a rapid expansion in
equitable access to essential medicines for all South Africans who
need them.
We need to act at the global level too. The new
political environment makes it essential for WTO and WHO to start
developing principles for improving access to essential drugs through
differential pricing along with increased international finance. In
April, the two organizations will host a meeting of an international
group of experts to further develop these principles and possible
solutions: the work will feed in to discussions at the World Health
Assembly.
It would be naive, however, to think that reducing
the prices of medicines is enough to bring all people's access to
health care up to the desired standard. For example, 25 million
persons in Africa are thought to be infected with HIV. 5 million of
them are estimated to need health care that includes anti-retroviral
medication. Currently, only about 10,000 are thought to be receiving
this care. This calls for scaling up access by a factor of 500, using
medicines that cost around $600 per person per year. Similar
calculations suggest the need for a 30-fold scale up in the number of
African's that use insecticide-treated mosquito netting, and are able
to access effective treatment for malarial illness.
Scaling up involves a level of finance and human
effort that is way beyond what African communities and their health
systems can be expected to deliver. To make matters more complex, the
widely reported prospects of cheaper medicines stimulates increased
public demand for care. This puts massive pressure on national
governments and their health ministers. Fortunately, some of this
pressure is beginning to reach the international community.
No matter how low the prices of medicines and
commodities fall, a massive increase in funding is needed to improve
African peoples' access to prevention and care for malaria,
tuberculosis, HIV, together with childhood and maternal illnesses.
Most of this money must come through increased development assistance
as well as debt relief. This has to be new money. Early results from
WHO's Commission on Macroeconomics and Health suggest that it must be
of the order of $10 billion per year. We can’t take from the little
that is already being spent on other development priorities.
To trigger such a massive increase in funding, WHO
is working with officials from developing countries and donor agencies
to develop new systems for efficient handling and monitoring the use
of resources. For example, we are working with countries to help
improve the performance of their health services to prevent and treat
those at risk, and their capacity to purchase medicines and other
commodities, distribute them and ensure they are well used.
I will work with Drs Samba and Gezairy, the WHO
Regional Directors in Harare and Cairo, to ensure WHO leadership in
pursuing these issues as its contribute to tackling the health burden
faced by Africa's people. This applies to our work within countries
and communities, our support for the OAU and other regional groups,
and our participation in the Abuja Summit, the UNGASS for AIDS and
Children later this year and in other global fora.
I hope you will keep an eye on all the critical
issues that are likely to come up before the World Health Assembly,
which is now only two months away. It is not easy given other demands
on your time - such as the Human Rights Commission over the coming
weeks. The Executive Board meetings in January suggest that some of
these issues will attract considerable attention.
I hope that in the budget discussions the main
focus will be on how best to scale up the response to health problems
that most affect the people living in the world's poorest countries. I
would like to see an emphasis on the ways in which WHO can help to
stimulate this effort and can help countries ensure the best possible
use of resources for health - at country and regional levels, as well
as globally.
I am sure that there will be much debate about
strategies for improving access to essential medicines, and about the
response to HIV/AIDS. This will also mean a focus on the strengthening
of health services delivery in developing countries. We anticipate
careful review of the strategy for infant and young child feeding; and
of the need for global surveillance of diseases and the international
health regulations. Such issues are of critical importance to all
countries.
Please do not hesitate to make contact with the
technical departments - individually or collectively - if you need
briefing on any these issues.
I believe we are making progress although the
obstacles are many, and that there is greater reason for optimism on
the tasks ahead. I hope you can share my enthusiasm and optimism for
our task ahead.
Thank you. |
