| 21 Mai 2013
Mister President, Excellencies, honourable ministers, distinguished delegates, ladies and gentlemen,
Ten years ago, the World Health Assembly met under a cloud of anxiety.
SARS, the first severe new disease of the 21st century, was spreading
explosively along the routes of international air travel, placing any
city with an international airport at risk of imported cases.
By early July of that year, less than four months after the first global
alerts were issued, WHO could declare the outbreak over. Rarely has the
world collaborated, on so many levels, with such a strong sense of
shared purpose.
Experiences during the SARS outbreak sparked extensive revisions of the
International Health Regulations. These revisions gave the world a
greatly strengthened legal instrument for detecting and responding to
public health emergencies, including those caused by a new disease.
We are dealing with two new diseases right now.
Human infections with a novel coronavirus, from the same family as SARS,
were first detected last year in the Eastern Mediterranean Region. To
date, 41 cases, including 20 deaths, have been reported.
Though the number of cases remains small, limited human-to-human
transmission has occurred and health care workers have been infected.
At the end of March, China reported the first-ever human infections with
the H7N9 avian influenza virus. Within three weeks, more than 100
additional cases were confirmed. Although the source of human infection
with the virus is not yet fully understood, the number of new cases
dropped dramatically following the closing of live poultry markets.
I thank China for collecting and communicating such a wealth of
information, and for collaborating so closely with WHO. Chinese
officials have promptly traced, monitored, and tested thousands of
patient contacts, including hundreds of health care workers.
At present, human-to-human transmission of the virus is negligible.
Influenza viruses constantly reinvent themselves. No one can predict the
future course of this outbreak.
These two new diseases remind us that the threat from emerging and
epidemic-prone diseases is ever-present. Constant mutation and
adaptation are the survival mechanisms of the microbial world. It will
always deliver surprises.
Going forward, we must maintain a high level of vigilance. I cannot
overemphasize the importance of immediate and fully transparent
reporting to WHO, and of strict adherence to obligations set out in the
International Health Regulations.
As was the case ten years ago, the current situation demands
collaboration and cooperation from the entire world. A threat in one
region can quickly become a threat to all.
Ladies and gentlemen,
The debate on the place of health in the post-2015 development agenda
continues to intensify. The Millennium Development Goals strongly
influenced resource flows. Competition among multiple sectors for a
place in the new agenda is fierce.
I ask Member States to do everything they can to ensure that health occupies a high place on the new agenda.
Health contributes to and benefits from sustainable development and is a
measurable indicator of the success of all other development policies.
Investing in the health of people is a smart strategy for poverty
alleviation. This calls for inclusion of noncommunicable diseases and
for continued efforts to reach the health-related MDGs after 2015.
At the same time, I want to assure you that efforts to reach the
health-related Millennium Development Goals have accelerated during
these last thousand days.
This is especially true for women’s and children’s health, and this is
especially encouraging. Accelerating efforts to reach these two goals
means accelerating efforts to overcome some long-standing barriers to
service delivery.
A new Integrated global action plan for the prevention and control of
pneumonia and diarrhoea was released by WHO and UNICEF last month. The
plan focuses on the use of 15 highly effective interventions. Each one
can save lives. When the 15 are put to work together, this is powerhouse
that can revolutionize child survival.
The newest vaccines and best antibiotics are included, but so are some
time-tested basics, like breastfeeding, good nutrition in the first 1000
days, soap, water disinfection, sanitation, and the trio of vitamin A,
oral rehydration salts, and zinc.
Equally impressive are the ingenious delivery solutions, worked out by
front-line workers, for reaching the poor and hungry children who are
most at risk.
I find this integrated delivery approach an exciting way to move
forward. The tremendous success in controlling the neglected tropical
diseases clearly tells us that integrated strategies can stretch the
impact of health investments.
Ladies and gentlemen,
I am most pleased to inform you that well over 9 million people living
with HIV in low- and middle-income countries are now seeing their lives
improved and prolonged by antiretroviral therapy. This is up from
200,000 people just eleven years ago. This is the fastest scale-up of a
life-saving intervention in history.
WHO progressively simplified testing and treatment approaches to make it
possible to deliver high-quality care in some of the poorest settings
in the world. Prices dropped dramatically. Treatment regimens became
safer, simpler, and more effective. Sites for testing and treatment
moved closer to people’s homes, and they are trusted and used.
The value of HIV treatment is now well recognized. Where external
funding has levelled off, domestic funding has stepped in to ensure
continued scaling up of treatment. In June, WHO will simplify things
further by issuing revised, consolidated guidelines for the use of
antiretroviral drugs for both HIV treatment and prevention.
For tuberculosis and malaria, recent progress has been encouraging, but
is increasingly threatened by the spread of resistance to mainstay
medicines.
Efforts to stimulate the development of new medical products are
critically important for every country in the world. The spread of
antimicrobial resistance is rendering more and more first-line
treatments useless.
Some observers say we are moving back to the pre-antibiotic era. No.
With few replacements in the pipeline, medicine is moving towards a
post-antibiotic era in which many common infections will once again
kill.
Health care cannot afford a setback of this magnitude. We must
recognize, and respond to, the very serious threat of antimicrobial
resistance.
Last month, I attended the Vaccine Summit in Abu Dhabi. Participants
explored how the Global Vaccine Action Plan can be used as a roadmap to
save more than 20 million lives by 2020 by expanding access to ten
existing vaccines.
Polio eradication was given special attention as a milestone in this
visionary roadmap. A comprehensive eradication and endgame strategy was
issued last month and discussed during the summit. Participants
appreciated the strategy’s many innovations and expressed the view that
it has a very good chance of success.
I agree, but am fully aware of the challenges we face. Insecurity
continues to compromise the eradication effort. We mourn the many polio
workers who have lost their lives trying to deliver vaccines.
Importations continue to threaten polio-free countries. We are today responding to new outbreaks.
Ladies and gentlemen,
Research, evidence, and information are the foundation for sound health
policies, for monitoring the impact, and for ensuring accountability.
They keep us on track.
The World Health Statistics report, issued last week, brings some
extremely good news. The past two decades have seen dramatic
improvements in health in the world’s poorest countries. Progress has
been equally dramatic in narrowing the gaps between countries with the
best and the worst health outcomes.
The Millennium Development Goals, with their emphasis on poverty
alleviation, have unquestionably contributed to these encouraging
trends.
We have a right to be proud of recent achievements, and also of the many
innovative mechanisms and instruments that were created in the drive to
reach the goals. They brought out the very best in human ingenuity and
creativity.
At the same time, I need to remind you that what lies ahead, especially
as we tackle noncommunicable diseases, is not going to be easy.
Today’s health challenges are vastly different from those faced in 2000,
when the Millennium Declaration was signed. Efforts to safeguard public
health face opposition from a different set of extremely powerful
forces.
Many of the risk factors for noncommunicable diseases are amplified by
the products and practices of large and economically important forces.
Market power readily translates into political power.
This power seldom impeded efforts to reach the MDGs.
No PR firms were hired to portray the delivery of medicines for HIV and
TB as interference with personal liberties by the Nanny State, with WHO
depicted as the Mother Superior of all Nannies. No lawsuits were filed
to stop countries from reducing the risks for child mortality.
No research was funded by industry to cast doubt on the causes of
maternal mortality. Mosquitoes do not have front groups and lobbies.
But the industries that contribute to the rise of NCDs do. When public
health policies cross purposes with vested economic interests, we will
face opposition, well-orchestrated opposition, and well-funded
opposition.
WHO will never be on speaking terms with the tobacco industry. At the
same time, I do not exclude cooperation with other industries that have a
role to play in reducing the risks for NCDs.
There are no safe tobacco products. There is no safe level of tobacco
consumption. But there are healthier foods and beverages, and in some
cultures, alcohol can be consumed at levels that do not harm health.
I am fully aware that conflicts of interest are inherent in any
relationship between a public health agency, like WHO, and industry.
Conflict of interest safeguards are in place at WHO and have recently
been strengthened. WHO intends to use these safeguards stringently in
its interactions with the food, beverage, and alcohol industries to find
acceptable public health solutions. WHO will continue to have no
interactions whatsoever with the tobacco industry.
As I said, this is not an easy time ahead. As just one example, not one
single country has managed to turn around its obesity epidemic in all
age groups.
The UN political declaration on NCDs clearly states that prevention must
be the cornerstone of the global response. I agree. Yet even if
prevention were perfect, we would still have clinical cases of heart
disease, diabetes, cancer, and chronic respiratory disease.
The response to NCDs depends on prevention but also on clinical care
which is cost-effective and financially sustainable. This is another
challenge that lies ahead.
Ladies and gentlemen,
You will be considering three draft global action plans, for
noncommunicable diseases, mental health, and the prevention of avoidable
blindness and visual impairment.
All three plans call for a life-course approach, aim to achieve equity
through universal health coverage, and stress the importance of
prevention. All three give major emphasis to the benefits of integrated
service delivery.
Global strategies and action plans make an important contribution to
international coordination and promote a unified approach to shared
problems.
But sound health policies at the national level matter most.
Public health has known for at least two decades that good health can be
achieved at low cost, if the right policies are in place.
We know this from comparative studies of countries at the same level of
economic development that reveal striking differences in health
outcomes.
Last month, a study from the Rockefeller Foundation revisited this issue
with new data from a number of countries. That study leads me to a
positive conclusion.
Member States, we are doing a lot of things right, on the right track.
According to the study, factors that contribute to good health at low
cost include a commitment to equity, effective governance systems, and
context-specific programmes that address the wider social and
environmental determinants of health. An ability to innovate is also
important.
Specific policies that can make the greatest difference include a
national medicines policy that makes maximum use of generic products,
and a commitment to primary health care and the training of health care
workers.
Above all, governments need to be committed and they need to have a vision set out in a plan.
This is also true for WHO.
The 12th General Programme of Work sets out a high-level strategic
vision for WHO, with priorities and an overall direction. It aims to
make the work of WHO more strategic, more selective, and more effective.
For the first time, the proposed Programme Budget provides a view of all
financial resources, from all sources, thus giving Member States an
opportunity to approve and monitor the budget in its entirety.
Ladies and gentlemen,
We are living in deeply troubled times.
These are times of financial insecurity, food insecurity, job
insecurity, political insecurity, a changing climate, and a degraded
environment that is asked to support more than it can bear.
These are times of armed conflict, hostile threats among nations, acts
of terrorism and mass violence, and violence against women and children.
Large numbers of people are living on edge, fearing for their lives.
Insecurity and conflict mar several parts of the world, endangering the health of large populations.
WHO is aware of reports of assaults on health personnel and health care facilities in conflict situations.
We condemn these acts in the strongest possible terms. Conflict situations sharply increase the need for health care.
The safety of facilities and staff must be sacrosanct.
In these troubled times, public health looks more and more like a
refuge, a safe harbor of hope that allows, and inspires, all countries
to work together for the good of humanity.
This is what you are doing, and we see the results.
Fear of new diseases can unite the world, but so can determination to relieve preventable human misery.
This is what makes public health stand out from other areas of global engagement: the motives, the values, and the focus.
We know we have to influence people at the top, but it is people at the bottom who matter most.
Nothing reflects this spirit better than the growing commitment to universal health coverage.
Universal health coverage reflects the need to maximize health outcomes
for everyone. Everyone, irrespective of their ability to pay, should
have access to the quality health care they need, without risking
financial ruin.
A focus on universal health coverage continues the strong emphasis on
equity and social justice articulated in the Millennium Declaration and
in The Future We Want, the outcome document of the UN Conference on
Sustainable Development.
I am inspired by your commitment to universal coverage. Nothing gives me
greater cause for optimism, or a greater sense of pride and privilege
to work as the head of this agency.
I thank my staff for their dedication, wisdom, and experience. They are unbeatable.
I thank Member States for caring so much about health, nationally and internationally.
I thank them for doing so much to improve the relevance, efficient
performance, and measurable impact of WHO, at all three levels.
We need to keep doing the right things, on the right track. The world’s people depend on this Organization for so much.
And our work creates benefits that extend beyond health.
By increasing fairness in access to care and equity in health outcomes,
our work contributes to social cohesion and stability, and these are
assets for every single country in the world.
I encourage you to keep doing the right things, on the right track. It is my great privilege to support you.
Thank you.