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Polity
Published: 17 May 2010
WHO: Chan: Address by the Director-General of the World Health Organisation, at the 63rd World Health Assembly, Geneva (17/05/2010)
Date: 17/05/2010
Source: The World Health Organisation
Title: WHO: Chan: Address by the Director-General of the World Health Organisation, at the 63rd World Health Assembly, Geneva


Mister President, honourable ministers, excellencies, distinguished
delegates, Dr Mahler, ladies and gentlemen,

Public health must never cease to learn from its successes, and its
failures.

Thirty years ago, the World Health Assembly declared that "the world and all
its people have won freedom from smallpox". That official death certificate
for an ancient scourge marked an unprecedented achievement in the history of
public health. It provided dramatic proof of the power of collective action
to improve the human condition in a permanent way.

This is worth remembering at a time when the international community is
engaged in the most ambitious attack on human misery in history, with just
five years left until 2015.

Smallpox eradication was a single-disease initiative. That killing,
blinding, disfiguring disease never had a cure. The cornerstone of the
campaign was prevention at a time when most health systems around the world
were designed to deliver curative care.

An initiative that broke every single chain of virus transmission in every
corner of the world was the ultimate example of universal coverage. This
tells us what collective action for a common cause can achieve.

Among its many legacies, the eradication campaign spawned the Expanded
Programme on Immunization at a time when less than 20% of children in the
developing world were covered by immunization programmes.

Throughout the 1980s, the so-called "lost decade for development", the
expansion of childhood immunization was a robust and inspiring success story
in the midst of an oil crisis, a recession, a crushing debt crisis, and
structural adjustment programmes that slashed national spending for social
services, including health. This reminds us of how greatly health can suffer
from polices made in other sectors.


The point I want to make is this. As we enter the second decade of the 21st
century, and the homestretch for reaching the Millennium Development Goals,
we need to draw on every lesson, every approach, instrument, and innovative
way of raising funds or collaborating together, from heads of state to civil
society. We have little time left, and little space for unproductive
debates. We need to move forward fast.

We need horizontal and we need vertical approaches. We need to scale up the
delivery of commodities, and we need to strengthen the fundamental
capacities that allow us to do so. We need coherence in policies, within and
beyond the health sector, and we need complementarity of efforts.

Reaching the health-related Goals is not about national averages. It is
about reaching the poor, who are almost invariably the hardest to reach.
This is the challenge, and the measure of success.

The Millennium Development Goals promote health as part of an overarching
strategy for poverty reduction. To put it bluntly, if we miss the poor, we
miss the point.

We have a long way to go, especially for maternal and newborn mortality, and
we welcome the efforts being made, on multiple fronts, to accelerate
progress in this area. But let us take heart from what has already been
achieved.

Success in public health nearly always saves lives. But it also has symbolic
value. Recent progress tells us that when the international community is
fully committed to a goal, creative solutions can be found and obstacles,
including financial ones, can be overcome.

Since the start of this century, the number of under-five childhood deaths
dropped below the 10 million mark for the first time in nearly six decades,
and then dropped again to below 9 million.

The number of people in low- and middle-income countries receiving
antiretroviral therapy for AIDS moved from under 200,000 in late 2002, to 3
million, then beyond 4 million, an achievement unthinkable a decade ago.

The rate of people newly ill with tuberculosis peaked and then began a slow
but steady decline. For the first time in decades, we are seeing signs that
the steadily deteriorating malaria situation might be turned around.

Progress in controlling the neglected tropical diseases continued to make
impressive strides. By the end of 2008, some 670 million people had been
reached with preventive chemotherapy for at least one of these diseases.
Cases of guinea worm disease are at their lowest level ever, now confined to
only four countries.

I think we can conclude: increased investment for health development is
working.

Like the smallpox eradication campaign, the drive to reach the Millennium
Development Goals has already left some legacies that benefit public health
across the board. Let me mention a few.

First, the Millennium Declaration and its Goals turned thinking about
development upside down. For a long time, factors such as access to safe
water and sanitation, literacy rates, infant and young child mortality, and
maternal mortality were regarded as indicators of a country's level of
socioeconomic development.

According to the logic at that time, living conditions and health status
would gradually improve as economies developed and prosperity increased.
That happened, of course, but frequently not to the benefit of society's
poorest and most marginalized people. All too often, economic growth has
meant wealth creation for some, and increased poverty for others.

The Goals turned this thinking around. Instead of waiting for living
conditions and health status to gradually improve, the Goals called for a
direct attack on the conditions and diseases that anchor people in poverty.
This was put forward as the best, and probably the fastest, route to
equitable and more balanced progress.

Indicators of development became engines for development. A quest for
economic development became a quest for social development. The report of
the Commission on Social Determinants of Health has taken this thinking many
steps forward.

Second, the Goals changed thinking about aid effectiveness, as reflected in
the Paris Declaration and the Accra Agenda for Action. An almost fashionable
scepticism about the value of aid, with blame placed on weak capacities and
governance in recipient countries, was replaced by recognition that the
policies and behaviours of donors could also be at fault. Accountability for
results must be mutual.

Good aid honours the priorities, capacities and responsibilities of
recipient governments to their citizens. Good aid aims to eliminate the very
need for aid. It does so by investing in the capacities and the
infrastructures needed to move towards self-reliance.

If aid does not explicitly aim for self-reliance, the need for aid will
never end. For obvious reasons, breaking the cycle of dependence on aid
contributes to equity among nations in a fundamental way.

Third, the drive to reach the health-related Goals unleashed the best of
human creativity, bringing a host of innovations for improving health,
especially among the poorest.


The list is long: the GAVI Alliance, the Global Fund, UNITAID, new
partnerships to develop medicines and vaccines for diseases of the poor,
advance market commitments as an incentive for industry, a finance facility
for immunization, a facility to reduce the costs of malaria drugs, and the
International Health Partnership as a new way of working within countries.
We have all contributed in some way to these innovations for international
health cooperation.

The trend continues. Earlier this year, the Bill and Melinda Gates
Foundation launched the Decade of Vaccines by pledging $10 billion over the
next ten years to help deliver existing vaccines and develop new ones.

This commitment is most welcome. Vaccines are one of the best life-saving
buys on offer, preventing an estimated 2 to 3 million deaths each year. WHO
and UNICEF, in close collaboration with the Gates Foundation, countries, and
partners, are initiating a process to define the ambitions and scope of this
Decade of Vaccines.

The momentum that has been growing since the start of this century must
continue. Last month, WHO launched simultaneous immunization weeks in more
than 100 countries. These events are building public and professional
awareness of the value of immunization as well as saving lives.

You will be well aware of the setbacks that occur when people decide that
vaccines are risky, unnecessary, or even part of a conspiracy. This has been
a problem for measles, for the uptake of pandemic vaccines, and most
especially for polio.

Vaccines touch your agenda at several points. You will be considering
accelerated action to reduce deaths from pneumonia, the feasibility of
measles eradication, and the prevention of hepatitis B virus infection
through immunization of infants.

As requested by the 61st Health Assembly, you will also be considering an
aggressive new strategic plan to complete polio eradication. The plan
incorporates several new strategies that respond to different transmission
dynamics in different settings, make use of a new bivalent vaccine, and
address head-on the problem of international spread