WORLD HEALTH ASSEMBLYapps.who.int/iris/bitstream/10665/85824/1/Official...WORLD HEALTH ASSEMBLY...

OFFICIAL RECORDSOF THE

WORLD HEALTH ORGANIZATION

No. 184

TWENTY -THIRDWORLD HEALTH ASSEMBLY

GENEVA, 5 -22 MAY 1970

PART IRESOLUTIONS AND DECISIONS

ANNEXES

WORLD HEALTH ORGANIZATION

GENEVA

August 1970

The following abbreviations are used in the Official Records of the World Health Organization:

ACABQ

ACC

CIOMS

ECA

ECAFE

ECE

ECLA

FAO

IAEA

IARC

ICAO

ILO

IMCO

IT

PAHO

PASB

UNCTAD -UNDP/SF -UNDP/TA -UNESCO

UNICEF

UNIDO

UNRWA

WFUNA

WMO

Advisory Committee on Administrative and Budgetary Questions

Administrative Committee on Co- ordination

Council for International Organizations of Medical Sciences

Economic Commission for Africa

Economic Commission for Asia and the Far East

Economic Commission for Europe

Economic Commission for Latin America

Food and Agriculture Organization of the United Nations

International Atomic Energy Agency

International Agency for Research on Cancer

International Civil Aviation Organization

International Labour Organisation (Office)

Inter -Governmental Maritime Consultative Organization

International Telecommunication Union

Pan American Health Organization

Pan American Sanitary Bureau

United Nations Conference on Trade and Development

United Nations Development Programme, Special Fund component

United Nations Development Programme, Technical Assistance component

United Nations Educational, Scientific and Cultural Organization

United Nations Children's Fund

United Nations Industrial Development Organization

United Nations Relief and Works Agency for Palestine Refugees in the Near East

World Federation of United Nations Associations

World Meteorological Organization

The designations employed and the presentation of the material in the Official Records of the World HealthOrganization do not imply the expression of any opinion whatsoever on the part of the Director -Generalconcerning the legal status of any country or territory or of its authorities, or concerning the delimitation ofits frontiers.

PRINTED IN SWITZERLAND

The Twenty -third World Health Assembly, held at the Palais des Nations, Geneva,from 5 to 22 May 1970, was convened in accordance with resolution EB44.R15 of the ExecutiveBoard (forty-fourth session) .

The proceedings of the Twenty -third World Health Assembly are being published in twoparts. The resolutions, with annexes, are contained in this volume. The records of plenaryand committee meetings will be published, along with the list of participants, agenda and othermaterial, in Official Records No. 185.

In this volume the resolutions appear in the order in which they were adopted. To facilitate the use of the volume in conjunctionwith the Handbook of Resolutions and Decisions, they have been grouped by title in the table of contents under the subject headingsof the Handbook. There is also, beneath each resolution, a reference to the section of the Handbook containing previous resolutionson the same subject. The tenth edition of the Handbook contains most of the resolutions adopted up to and including the Twenty -first World Health Assembly and the forty -third session of the Executive Board. The following reference list of sessions of the HealthAssembly and Executive Board shows the resolution symbol applicable to each session and the Official Records volume in which theresolutions were originally published.

First World Health AssemblyExecutive Board, First SessionExecutive Board, Second SessionExecutive Board, Third Session

Second World Health AssemblyExecutive Board, Fourth SessionExecutive Board, Fifth Session

Held

24 June - 24 July 194816 -28 July 194825 October - 11 November 194821 February - 9 March 194913 June - 2 July 19498 -19 July 194916 January - 2 February 1950

Resolutionsymbol

---

WHA2:--

OfficialRecords No.

13141417212225

Third World Health Assembly 8 -27 May 1950 WHA3.- 28Executive Board, Sixth Session 1 -9 June 1950 EB6.R- 29Executive Board, Seventh Session 22 January - 5 February 1951 EB7.R- 32

Fourth World Health Assembly 7 -25 May 1951 WHA4.- 35Executive Board, Eighth Session 1 -8 June 1951 EB8.R- 36Executive Board, Ninth Session 21 January - 4 February 1952 EB9.R- 40

Fifth World Health Assembly 5 -22 May 1952 WHAS.- 42Executive Board, Tenth Session 29 May - 3 June 1952 EB10.R- 43Executive Board, Eleventh Session 12 January - 4 February 1953 EB11.R- 46

Sixth World Health Assembly 5 -22 May 1953 WHA6.- 48Executive Board, Twelfth Session 28 -30 May 1953 EB12.R- 49Executive Board, Thirteenth Session 12 January 2 February 1954 EB13.R- 52

Seventh World Health Assembly 4 -21 May 1954 WHA7.- 55Executive Board, Fourteenth Session 27 -28 May 1954 EB14.R- 57Executive Board, Fifteenth Session 18 January - 4 February 1955 EB15.R- 60

Eighth World Health Assembly 10 -27 May 1955 WHA8.- 63Executive Board, Sixteenth Session 30 May 1955 EB16.R- 65Executive Board, Seventeenth Session 17 January - 2 February 1956 EB17.R- 68

Ninth World Health Assembly 8 -25 May 1956 WHA9.- 71Executive Board, Eighteenth Session 28 -30 May 1956 EB18.R- 73Executive Board, Nineteenth Session 15 -30 January 1957 EB19.R- 76

Tenth World Health Assembly 7 -24 May 1957 WHA10.- 79Executive Board, Twentieth Session 27 -28 May 1957 EB20.R- 80Executive Session 14 -28 January 1958 EB21.R- 83

Eleventh World Health Assembly 28 May - 13 June 1958 WHA11.- 87Executive Board, Twenty -second Session 16 -17 June 1958 EB22.R- 88Executive Board, Twenty -third Session 20 January - 3 February 1959 EB23.R- 91

Twelfth World Health Assembly 12 -29 May 1959 WHAl2.- 95Executive Board, Twenty -fourth Session 1 -2 June 1959 EB24.R- 96Executive Board, Twenty -fifth Session 19 January - 1 February 1960 EB25.R- 99

Thirteenth World Health Assembly 3 -20 May 1960 WHA13.- 102Executive Board, Twenty -sixth Session 25 October - 4 November 1960 EB26.R- 106Executive Board, Twenty- seventh Session 30 January - 2 February 1961 EB27.R- 108

Fourteenth World Health Assembly 7 -24 February 1961 WHA14.- 110Executive Board, Twenty -eighth Session 29 May - 1 June 1961 EB28.R- 112Executive Board, Twenty -ninth Session 15 -26 January 1962 EB29.R- 115

Fifteenth World Health Assembly 8 -25 May 1962 WHA15.- 118Executive Board, Thirtieth Session 29 -30 May 1962 EB30.R- 120Executive Board, Thirty -first Session 15 -28 January 1963 EB31.R- 124

Sixteenth World Health Assembly 7 -23 May 1963 WHA16.- 127Executive Board, Thirty -second Session 27 -28 May 1963 EB32.R- 129Executive Board, Thirty -third Session 14 -24 January 1964 EB33.R- 132

Seventeenth World Health Assembly 3 -20 March 1964 WHA17.- 135Executive Board, Thirty -fourth Session 26 -29 May 1964 EB34.R- 137Executive Board, Thirty -fifth Session 19 -28 January 1965 EB35.R- 140

Eighteenth World Health Assembly 4 -21 May 1965 WHA18.- 143Executive Board, Thirty -sixth Session 24 -25 May 1965 EB36.R- 145Executive Board, Thirty- seventh Session 18 -28 January 1966 EB37.R- 148

Nineteenth World Health Assembly 3 -20 May 1966 WHA19.- 151Executive Board, Thirty- eighth Session 23 -24 May 1966 EB38.R- 153Executive Board, Thirty -ninth Session 17 -27 January 1967 EB39.R- 157

Twentieth World Health Assembly 8 -26 May 1967 WHA20.- 160Executive Board, Fortieth Session 29 -30 May 1967 EB40.R- 162Executive Board, Forty -first Session 23 January - 1 February 1968 EB41.R- 165

Twenty -first World Health Assembly 6 -24 May 1968 WHA21.- 168Executive Board, Forty- second Session 27 -28 May 1968 EB42.R- 170Executive Board, Forty -third Session 18 -28 February 1969. EB43.R- 173

Twenty- second World Health Assembly 8 -25 July 1969 WHA22.- 176Executive Board, Forty -fourth Session 28 -29 July 1969 EB44.R- 178Executive Board, Forty -fifth Session 20 -29 January 1970 EB45.R- 181

Twenty -third World Health Assembly 5 -22 May 1970 WHA23.- 184Executive Board, Forty -sixth Session 25 -26 May 1970 EB46.R- 186

Index to resolutions : page 95

CONTENTS

RESOLUTIONS AND DECISIONS

Resolutions on Programme Page

GENERAL DIRECTIVES AND GUIDING PRINCIPLES

General Programme of Work covering a Specific PeriodWHA23.59 General Programme of Work covering a Specific Period 32

MALARIA

Malaria EradicationWHA23.12 Measures taken in pursuance of the Revised Global Strategy of Malaria Eradication 6

COMMUNICABLE DISEASES

Virus and Rickettsial DiseasesWHA23.34 Present Problems of Yellow Fever in Africa 16

SmallpoxWHA23.46 Smallpox Eradication Programme 24

Epidemiological Surveillance and QuarantineWHA23.57 Reservations to the International Health Regulations 31

WHA23.58 Disinsection of Aircraft 32

ENVIRONMENTAL HEALTH

WHA23.60 Human Environment 34

Community Water SupplyWHA23.36 Community Water Supply 18

VECTOR BIOLOGY AND CONTROL

WHA23.33 Research on Alternative Methods of Vector Control 16

PUBLIC HEALTH SERVICES

WHA23.49 Research on the Organization of Community Health Services 25

WHA23.61 Basic Principles for the Development of National Health Services 34

HEALTH PROTECTION AND PROMOTION

WHA23.32 Health Consequences of Smoking 15

Social and Occupational HealthWHA23.47 Occupational Health: Miners 24

-V -

Page

Cancer

WHA23.23 Amendments to the Statute of the International Agency for Research on Cancer 12

EDUCATION AND TRAINING

WHA23.35 Training of National Health Personnel 18

PHARMACOLOGY AND TOXICOLOGY

Drug Safety and Monitoring

WHA23.13 International Monitoring of Adverse Reactions to Drugs 7

WHA23.48 Drug Efficacy 25

Drug Dependence

WHA23.42 Drug Dependence 22

Food Additives

WHA23.50 Health Hazards of Food Additives 26

Pharmaceuticals

WHA23.45 Quality Control of Drugs 23

SUPPLIES AND EQUIPMENT

WHA23.19 Advances from the Working Capital Fund for the Provision of Emergency Suppliesto Member States 10

REPORTS AND EVALUATION

Annual Report of the Director -General

WHA23.9 Annual Report of the Director -General for 1969 5

Assessment of World Health Situation

WHA23.24 Fourth Report on the World Health Situation 12

Resolutions on Programme and Budget

CONSIDERATION AND APPROVAL OF PROGRAMME AND BUDGET ESTIMATES

WHA23.37 Effective Working Budget and Budget Level for 1971 19

WHA23.51 Appropriation Resolution for the Financial Year 1971 27

WHA23.55 Programme and Budget Estimates for 1971: Voluntary Fund for Health Promotion 30

WHA23.62 General Order of Magnitude of the Budget for 1972 36

Resolutions concerning the World Health Assembly and the Executive Board

WORLD HEALTH ASSEMBLY

Time and Place

WHA23.28 Selection of the Country in which the Twenty- fourth World Health Assembly willbe held 14

Method of Work

WHA23.1 Method of Work of the Health Assembly 1

- VI -

Rules of Procedure

WHA23.2 Amendments to the Rules of Procedure of the World Health Assembly to facilitatethe Work of the Assembly

Page

2

EXECUTIVE BOARD

Membership of the Board

WHA23.3 Election of Members entitled to designate a Person to serve on the Executive Board 3

Summary Records, Resolutions and Reports

WHA23.54 Reports of the Executive Board on its Forty- fourth and Forty -fifth Sessions . . 30

Resolutions on Regional Matters

INDIVIDUAL REGIONS

AfricaWHA23.16 Additional Housing for the Staff of the Regional Office for Africa, and Extension

of the Regional Office Building 9

Eastern Mediterranean

WHA23.30 Implementation of Resolution WHA7.33 14

Resolutions on Constitutional and Legal Matters

AMENDMENTS TO THE CONSTITUTION

WHA23.29 Acceptance of Amendments to the Constitution of WHO 14

MEMBERSHIP

Decisions concerning Individual States and Territories

WHA23.11 Admission of New Members and Associate Members 6

Resolutions on Financial and Administrative Matters

FINANCIAL MATTERS

Assessments and Contributions

WHA23.20 Scale of Assessment for 1971 10

WHA23.6 Status of Collection of Annual Contributions and of Advances to the Working CapitalFund 4

WHA23.39 Members in Arrears in the Payment of their Contributions to an Extent which mayinvoke Article 7 of the Constitution 20

Working Capital Fund

WHA23.8 Review of the Working Capital Fund 4

Trust Funds and Special Accounts established under Financial Regulation 6.6

WHA23.56 Special Account for Servicing Costs 31

WHA23.14 Real Estate Fund 8

WHA23.15 Appropriation to the Real Estate Fund 9

- VII -

Page

Accounts and External Audit

WHA23.5 Financial Report on the Accounts of WHO for the Year 1969 and Report of theExternal Auditor 3

WHA23.38 Consideration of the Desirability and Feasibility of the Establishment of a Groupof Representatives of Member States to consult with the External Auditor on hisExamination of the Financial and Administrative Procedures of WHO . . . 20

STAFF MATTERS

Pension Fund

WHA23.21 Annual Report of the United Nations Joint Staff Pension Board for 1968 . . 11

WHA23.22 Appointment of Representatives to the WHO Staff Pension Committee 12

WHO HEADQUARTERS

Separate WHO Building

WHA23.18 Headquarters Accommodation: Report on Financing 10

WHA23.7 Headquarters Accommodation: Future Requirements 4

WHA23.17 Acquisition of Additional Land at Headquarters 9

ORGANIZATIONAL STUDIES

WHA23.25 Review of the Organizational Study on Co- ordination with the United Nations andthe Specialized Agencies 13

WHA23.26 Future Organizational Study by the Executive Board 13

Resolutions on Co- ordination and External Relations

UNITED NATIONS AND RELATED AGENCIES

General

WHA23.44 Study of the Capacity of the United Nations Development System 23

WHA23.40 Co- ordination with the United Nations, the Specialized Agencies and the InternationalAtomic Energy Agency on Programme Matters 21

WHA23.27 Co- ordination with the United Nations, the Specialized Agencies and the InternationalAtomic Energy Agency on Administrative, Budgetary and Financial Matters . 14

WHA23.31 Second Report of the Ad Hoc Committee of Experts to examine the Finances ofthe United Nations and the Specialized Agencies: Progress Report on Implemen-tation 15

Social and Economic Matters

WHA23.41 Human Rights 21

WHA23.43 Second United Nations Development Decade 22

Co- operation with the United Nations on Other Subjects

WHA23.52 Health Assistance to Refugees and Displaced Persons in the Middle East 28

Resolutions on Miscellaneous Matters

AWARDS

Léon Bernard Foundation

WHA23.4 Award of the Léon Bernard Foundation Medal and Prize 3

- VITI -

Page

Dr A. T. Shousha FoundationWHA23.10 Award of the Dr A. T. Shousha Foundation Medal and Prize 6

MEDICAL LAW AND ETHICS; HUMANITARIAN QUESTIONS

WHA23.53 The Rapid Prohibition of Chemical and Bacteriological (Biological) Weapons . 29

Procedural Decisions

(i) Composition of the Committee on Credentials 37

(ii) Composition of the Committee on Nominations 37

(iii) Verification of Credentials 37

(iv) Election of Officers of the Twenty -third World Health Assembly 38

(v) Election of Officers of the Main Committees 38

(vi) Establishment of the General Committee 38

(vii) Adoption of the Agenda 38

ANNEXES

1. Reports of the Léon Bernard Foundation Committee:1. Financial Report on the Léon Bernard Foundation Fund 41

2. Report of the Léon Bernard Foundation Committee on its Meeting of 26 January 1970. . 41

2. Reports of the Dr A. T. Shousha Foundation Committee :1. Financial Report on the Dr A. T. Shousha Foundation Fund 422. Report of the Dr A. T. Shousha Foundation Committee on its Meeting of 27 January 1970 42

3. Financial Report on the Accounts of WHO for 1969 and Report of the External Auditor: First Reportof the. Ad Hoc Committee of the Executive Board 43

4. Members in Arrears in the Payment of their Contributions to an Extent which may invoke Article 7of the Constitution :1. Second Report of the Ad Hoc Committee of the Executive Board 45

2. Report by the Director -General 46

5. Headquarters Accommodation:1. Future Requirements 47

2. Financing of Headquarters Building 48

6. Real Estate Fund 49

7. Second Report of the Ad Hoc Committee of Experts to examine the Finances of the United Nationsand the Specialized Agencies : Implementation of Recommendations 50

8. WHO Pilot Research Project for International Drug Monitoring 54

9. Research on Alternative Methods of Vector Control 68

10. Study of the Capacity of the United Nations Development System 77

11. Summary of Budget Estimates for the Financial Year 1 January - 31 December 1971 79

12. Consideration of Reservations to the International Health Regulations: Report of the Working Groupappointed by Committee B 83

Index to Resolutions and Decisions 95

- IX -

RESOLUTIONS AND DECISIONS

WHA23.1 Method of Work of the Health Assembly

The Twenty -third World Health Assembly,

Having considered the recommendation of the Executive Board concerning the method of work ofthe Health Assembly,'

1. DECIDES that :(1) the terms of reference of Committee A shall be to:

(a) hear the comments and recommendations of the Executive Board as presented by its represen-tative concerning:

(i) whether the budget estimates are adequate to enable the World Health Organization tocarry out its constitutional functions, in the light of the current stage of its development;(ii) whether the annual programme follows the general programme of work approved by theHealth Assembly;(iii) whether the programme envisaged can be carried out during the budget year; and(iv) the broad financial implications of the budget estimates, with a general statement of theinformation on which any such considerations are based;

(b) hear the comments and recommendations of the Director -General;

(c) recommend the amount of the effective working budget;(d) examine in detail the operating programme;(e) recommend the Appropriation Resolution, after inserting the amounts in the sections for theoperating programme in the text of the resolution as reported by Committee B;(f) after the Health Assembly has approved the Appropriation Resolution for the ensuing year,and after hearing the reviews of the Director -General, recommend the general order of magnitudefor the budget for the second ensuing year, for the orientation of the Director -General in the prepa-ration of his proposed programme and budget for that year; and

(g) study such other items as are referred to it by the Health Assembly;

(2) the terms of reference of Committee B shall be to:

(a) review the financial position of the Organization, including:(i) the Financial Report and the Report of the External Auditor for the previous financial year;(ii) the status of contributions and advances to the Working Capital Fund; and(iii) the status of the Assembly Suspense Account and any other funds that have a bearing onthe financial position of the Organization;

(b) recommend the scale of assessment;

(c) recommend the Working Capital Fund resolution, when necessary, including the amount inwhich the Fund shall be established;

(d) review the parts of the budget dealing with the estimates other than for the operating pro-gramme and report thereon to Committee A;(e) consider the text of the Appropriation Resolution, insert the amount for appropriation sectionsother than the operating programme and report thereon to Committee A; and(f) study such other items as are referred to it by the Health Assembly;

' See Of Rec. Wld 111th Org., 181, resolution EB45.R28 and Annex 13.

- 1 --

2 TWENTY -THIRD WORLD HEALTH ASSEMBLY, PART I

(3) when items (a), (b), (e) and (f) under paragraph (1) are being considered in Committee A, there shallnot be a meeting of Committee B, and when item (d) under paragraph (2) is being considered in Com-mittee B, there shall not be a meeting of Committee A;

(4) items (b) and (c) under paragraph (1) shall not be considered by Committee A until Committee Bhas completed the work on items (a) and (b) of paragraph (2); and, finally,

(5) if, exceptionally, the physical facilities at a session of the Health Assembly do not permit the debateon the Annual Report of the Director -General to take place in plenary meeting, the review of the AnnualReport (excluding the annual Financial Report) shall take place in Committee A and shall be added tothe terms of reference of that committee;

2. FURTHER DECIDES that technical discussions shall continue to be held at the end of the first week of theAssembly and that neither main committee shall meet during that time, nor during plenary meetings of theHealth Assembly;

3. REITERATES the appeal made by the Executive Board in operative paragraph 1 of its resolution EB43.R45to speakers to limit the length of their interventions in main committees; and

4. REQUESTS the Executive Board to review the revised method of work of the Health Assembly in thelight of the experience gained and to report to the Twenty- fourth World Health Assembly.

Handb. Res., 10th ed., 4.1.3 First plenary meeting, 5 May 1970

WHA23.2 Amendments to the Rules of Procedure of the World Health Assembly to facilitate the Work ofthe Assembly

The Twenty -third World Health Assembly

ADOPTS the following amendments to its Rules of Procedure:

Rule 34

The main committees of the Health Assembly shall be:

(a) Committee A -to deal predominantly with programme and budget matters;(b) Committee B -to deal predominantly with administrative, financial and legal matters.In addition to these two main committees, the Health Assembly may establish such other main com-

mittees as it may consider necessary.

The Health Assembly, after consideration of the recommendations of the Board and the General Com-mittee, shall allocate items of the agenda to the two main committees in such a way as to provide anappropriate balance in the work of these committees.

The chairmen of these main committees shall be elected by the Health Assembly after consideration ofthe report of the Committee on Nominations.

Rule 52

The reports of all committees established to consider items of the agenda shall, before being submittedto a plenary meeting, be referred to the General Committee, or to a drafting committee appointed by it, forco- ordinating. Such reports, including draft resolutions, shall, after being examined by the General Com-mittee, be distributed, in so far as practicable, at least twenty -four hours in advance of the plenary meetingat which they are to be considered, unless the General Committee decides, on procedural grounds, to referthe report or the draft for re- examination to the competent committee. Such reports, including draft reso-lutions annexed thereto, shall not be read aloud in the plenary meeting, unless the President decides otherwise.

Handb. Res., 10th ed., 4.1.4 First plenary meeting, 5 May 1970

RESOLUTIONS AND DECISIONS 3

WHA23.3 Election of Members entitled to designate a Person to serve on the Executive Board


Having considered the nominations of the General Committee,'

ELECTS the following as Members entitled to designate a person to serve on the Executive Board: Austria,Ethiopia, France, Kenya, Laos, Nicaragua, Saudi Arabia and the Union of Soviet Socialist Republics.

Handb. Res., 10th ed., 4.2.1 Ninth plenary meeting, 13 May 1970

WHA23.4 Award of the Léon Bernard Foundation Medal and Prize


1. NOTES the reports of the Léon Bernard Foundation Committee; 2

2. ENDORSES the unanimous proposal of the Committee for the award of the Léon Bernard FoundationMedal and Prize for 1970;

3. AWARDS the Medal and Prize to Dr Arcot L. Mudaliar; and

4. PAYS TRIBUTE to Dr Arcot L. Mudaliar for his unremitting service and outstanding achievements in thefield of public health and social medicine.

Handb. Res., 10th ed., 9.1.2.2 Ninth plenary meeting, 13 May 1970

WHA23.5 Financial Report on the Accounts of WHO for the Year 1969 and Report of the External Auditor


Having examined the Financial Report of the Director -General for the period 1 January to 31 December1969 and the Report of the External Auditor for the same financial period, as contained in Official RecordsNo. 183;

Having considered the report 8 of the Ad Hoc Committee of the Executive Board on its examinationof these reports; and

Noting with satisfaction that the External Auditor has included in his written report to the HealthAssembly substantive comments on the administration and management of the Organization,

1. REQUESTS the External Auditor, in accordance with operative paragraph 2 of resolution WHA22.4, topresent more detailed comments on the management and administration of the World Health Organization;

2. REQUESTS the Director -General to undertake so far as possible all necessary measures to distribute ingood time to Member States the Financial Report and the Report of the External Auditor; and

3. ACCEPTS the Director -General's Financial Report and the Report of the External Auditor for thefinancial year 1969.

Handb. Res., 10th ed., 7.1.10.3 Tenth plenary meeting, 14 May 1970(Committee B, first report)

1 For report of the General Committee, see Off. Rec. Wld Hlth Org., 185.2 See Annex 1.3 See Annex 3.


WHA23.6 Status of Collection of Annual Contributions and of Advances to the Working Capital Fund


1. NOTES the status, as at 30 April 1970, of the collection of annual contributions and of advances to theWorking Capital Fund, as reported by the Director -General;

2. CALLS THE ATTENTION of Members to the importance of paying their annual contributions as early aspossible in the Organization's financial year, in order that the approved annual programme can be carriedout as planned;

3. URGES Members in arrears to make special efforts to liquidate their arrears during 1970; and

4. REQUESTS the Director -General to communicate this resolution to Members in arrears and to drawattention to the fact that continued delay in payment could have serious financial implications for theOrganization.


WHA23.7 Headquarters Accommodation : Future Requirements


Noting the report of the Director -General on headquarters accommodation: future requirements; 1 and

Having regard to the discussion on this matter which took place at the Twentieth World Health Assemblyand at the forty -fifth session of the Executive Board,

1. EXPRESSES its continuing concern that the necessary additional land be acquired as quickly as possible,since this is the requisite first step toward the planning of additional office accommodation for headquarters;and

2. REQUESTS the Director -General to report further to the Executive Board at its forty- seventh session andto the Twenty- fourth World Health Assembly.


WHA23.8 Review of the Working Capital Fund


Having considered the recommendations of the Executive Board on the Working Capital Fund,2

A1. DECIDES that:

(1) Part I of the Working Capital Fund, composed of advances assessed on Members, shall remainestablished in the amount of US $5 000 000, to which shall be added the assessments of any Membersjoining the Organization after 30 April 1965;

(2) the advances to the Working Capital Fund shall be assessed on the basis of the 1971 scale of assess-ment, adjusted to the nearest US $100; the assessment for Part I shall be reviewed at five -year intervals;

(3) the additional advances shall be due and payable prior to 31 December 1971; and

I. See Annex 5, part 1.2 See Of Rec. Wld Hlth Org., 181, resolution EB45.R18 and Annex 11.


(4) the credits due to Members shall be refunded on 1 January 1971 by applying these credits to anycontributions outstanding on that date, or to the 1971 assessments;

2. REQUESTS the Member States concerned to provide in their national budgets for payment of additionaladvances before 31 December 1971;

B

1. DECIDES that Part II of the Working Capital Fund shall for the year 1971 be established at US $6 000 000;

2. DECIDES also that Part II of the Working Capital Fund shall thereafter be financed by appropriations bythe Health Assembly from casual income as recommended by the Executive Board after considering thereport of the Director -General; these appropriations shall be voted separately from the appropriation forthe relevant budget year;

C

L. AUTHORIZES the Director -General to advance from the Working Capital Fund:

(1) such funds as may be necessary to finance the annual appropriations pending receipt of contributionsfrom Members; sums so advanced shall be reimbursed to the Working Capital Fund as contributionsbecome available;

(2) such sums as may be necessary to meet unforeseen or extraordinary expenses and to increase therelevant appropriation sections accordingly, provided that not more than US $250 000 is used for suchpurposes, except that with the prior concurrence of the Executive Board a total of US $2 000 000 maybe used; and(3) such sums as may be necessary for the provision of emergency supplies to Member States on areimbursable basis; sums so advanced shall be reimbursed to the Working Capital Fund when paymentsare received from the Member States; provided that the total amount so withdrawn shall not exceedUS $100 000 at any one time, and provided further that the credit extended to any one Member shallnot exceed US $25 000 at any one time; and

2. REQUESTS the Director -General to report annually to the Health Assembly:

(1) all advances made under the authority vested in him to meet unforeseen or extraordinary expensesand the circumstances relating thereto, and to make provision in the estimates for the reimbursementof the Working Capital Fund except when such advances are recoverable from other sources; and(2) all advances made under the authority of paragraph C 1(3) for the provision of emergency suppliesto Member States, together with the status of reimbursement by Members;

D

REQUESTS the Executive Board to review the Working Capital Fund at its first session in 1971 and tosubmit a report to the Health Assembly.


WHA23.9 Annual Report of the Director -General for 1969


Having reviewed the Report of the Director -General on the work of the World Health Organizationduring 1969,1

1. NOTES with satisfaction the manner in which the programme was planned and carried out in 1969, inaccordance with the established policies of the Organization; and

2. COMMENDS the Director -General for the work accomplished.

Handb. Res., 10th ed., 1.16.1 Tenth plenary meeting, 14 May 1970

1 Off Rec. Wld Hlth Org., 180.


WHA23.10 Award of the Dr A. T. Shousha Foundation Medal and Prize


1. NOTES the reports of the Dr A. T. Shousha Foundation Committee;1

2. ENDORSES the unanimous proposal of the Committee for the award of the Dr A. T. Shousha FoundationMedal and Prize for 1970;

3. AWARDS the Medal and Prize to Dr Sabih Al- Wahbi; and

4. PAYS TRIBUTE to Dr Sabih Al -Wahbi for his most significant contribution to public health in the geo-graphical area in which Dr A. T. Shousha served the World Health Organization.

Handb. Res., 10th ed., 9.1.3.2 Tenth plenary meeting, 14 May 1970

WHA23.11 Admission of New Members and Associate Members


DECIDES to defer consideration of the participation of the German Democratic Republic until the Twenty -fourth World Health Assembly.

Handb. Res., 10th ed., 6.2.1 Eleventh plenary meeting, 14 May 1970

WHA23.12 Measures taken in pursuance of the Revised Global Strategy of Malaria Eradication


Having considered the report of the Director -General on measures taken in pursuance of the revisedglobal strategy of malaria eradication adopted by the Twenty- second World Health Assembly in resolutionWHA22.39;

Recognizing the importance of close collaboration between governments and the assisting agencies inreviewing malaria eradication programmes to determine the future course of action best suited to the specificrequirements of each country;

Realizing that malaria constitutes a major public health problem in many tropical countries whereeradication is at present impracticable, and that there is an urgent need to reduce its ravages and to facilitatethe promotion of socio- economic development;

Realizing the importance of research for finding new weapons and for evolving rational methods ofcontrolling malaria, as well as for improving diagnostic and treatment techniques and methods of vectorcontrol applicable to various specific epidemiological situations; and

Realizing further that safe, effective and inexpensive insecticides are essential for the effective controlof malaria,

1. NOTES with satisfaction the action taken and the progress made in the implementation of resolutionWHA22.39 on the revised strategy of malaria eradication;

2. APPRECIATES the active collaboration of both multilateral and bilateral agencies in assisting governmentsin the reviews of their malaria eradication programmes;

1 See Annex 2.


3. EMPHASIZES the need to initiate malaria control schemes within the general health services where eradi-cation is at present impracticable and to increase the assistance of WHO and other international agenciesto such schemes;

4. REITERATES the need to intensify both fundamental and applied research for the furtherance of theobjective of malaria eradication;

5. STRESSES the need for more comprehensive training of malariologists in order to implement the newstrategy of malaria eradication in the context of countries' socio- economic development plans;

6. URGES the countries manufacturing insecticides to continue to make available to the developing countriesinsecticides for malaria control; and

7. REQUESTS the Director -General to continue to keep the World Health Assembly and the Executive Boardinformed of the development of the programme following the revised strategy of malaria eradication.

Handb. Res., 10th ed., 1.2.2 Twelfth plenary meeting, 16 May 1970(Committee A, first report)

WHA23.13 International Monitoring of Adverse Reactions to Drugs


Having examined the report of the Director -General on the WHO pilot research project for internationaldrug monitoring and the future development of this activity; 1

Recalling resolutions WHA15.41, WHA16.36, WHA17.39, WHAI8.42, WHA19.35 and WHA20.51;

Emphasizing the importance to all Member States of establishing an international system for monitoringadverse reactions to drugs; and

Convinced of the urgent need to develop an operational system for the international monitoring of adversereactions to drugs,

1. NOTES with satisfaction that the pilot phase of the project will shortly have been satisfactorily completedand that voluntary contributions have been pledged which will ensure support for the project until the endof 1970;

2. REITERATES its appreciation to the Government of the United States of America for the financial supportfor the pilot phase and to the other Member States collaborating in that stage of the project;

3. REQUESTS the Director -General to develop the activities of the project into a primary operational phaseaimed at the establishment of an international system for monitoring adverse reactions with provision foralerting Member States in cases of urgency, in accordance with resolution WHA16.36, and to report to theWorld Health Assembly;

4. REQUESTS the Director -General to explore the possibility of financing the project from sources other thanthe regular budget, bearing in mind the views expressed in the discussion at the Twenty -third World HealthAssembly;

5. DECIDES that, subject to paragraph 4 above:

(a) the project shall be financed for 1971 first by postponing the addition of US $100 000 to theRevolving Fund for Teaching and Laboratory Equipment for Medical Education and Training, andsecondly by withdrawing the balance from the Working Capital Fund, and the Director -General shallbe requested to reimburse the Working Capital Fund up to US $245 000 from any operational savingsthat could be effected under the regular budget for 1971;

1 See Annex 8.


(b) provision be made for 1972 and subsequent years for the necessary financing of the project by meansof the regular budget; and

6. DECIDES that, as soon as the necessary arrangements can be made, the project shall be based at WHOheadquarters in Geneva.

Handb. Res., 10th ed., 1.10.1; 7.1.6.3 Twelfth plenary meeting, 16 May 1970(Committee A, first report)

WHA23.14 Real Estate Fund


Recalling the provisions of part II of resolution WHA15.15;

Having considered the report of the Director -General concerning the establishment of a Real EstateFund and its financing and the disestablishment of the existing Revolving Fund for Real Estate Operations; 1and

Having considered the recommendations of the Executive Board,1

1. DECIDES that:

(i) a new Real Estate Fund be established and the Revolving Fund for Real Estate Operations bedisestablished;

(ii) the assets and liabilities of the disestablished Revolving Fund for Real Estate Operations be trans-ferred to the Real Estate Fund;(iii) the Real Estate Fund be credited with receipts of rentals relating to real estate operations and thatadditional credits in the Fund be built up gradually by the use of available casual income;

(iv) interest earned on the investments of the Fund be credited to the Fund;(v) the Fund may be used to meet the costs of:

(a) the maintenance, repairs of and alterations to houses for staff;(b) major repairs of and alterations to the Organization's existing office buildings;(c) the construction of buildings or extensions to existing buildings; and(d) the acquisition of land which may be required;

2. DECIDES that replenishments of, or increases in, the Fund shall be made by appropriations by the HealthAssembly from casual income; these appropriations shall be voted separately from the appropriation for therelevant budget year;

3. AUTHORIZES further the Director -General to use the Fund to finance:

(i) the maintenance, repairs of and alterations to houses for staff;(ii) major repairs of and alterations to the Organization's existing office buildings, provided that suchuse of the Fund is reported to the session of the Executive Board following the transactions; and(iii) the acquisition of land and construction of buildings or building extensions, provided that, unlessthe Health Assembly has previously indicated its wishes, specific authorization from the WorldHealth Assembly is obtained before contracts for these purposes are entered into; and

4. REQUESTS the Executive Board to review the Fund at three -year intervals, the first review to be undertakenat its first session in 1973.

Handb. Res., 10th ed., 7.1.7; 7.1.6.2 Twelfth plenary meeting, 16 May 1970(Committee B, second report)

1 See Of Rec. Wld Hlth Org., 181, resolution EB45.R19 and Annex 12.


WHA23.15 Appropriation to the Real Estate Fund


Having considered the report of the Director- General concerning the amount required at this time tobe appropriated to the Real Estate Fund,'

1. DECIDES to appropriate to the Real Estate Fund an amount of US $3 000 000; and

2. DECIDES further that this appropriation shall be financed by:

US $1 333 665 of miscellaneous income available as at 31 December 1969;

US $ 537 921 of cash accumulated in the Assembly Suspense Account as at 30 April 1970;

US $1 128 414 from the surplus of Part II of the Working Capital Fund on 1 January 1971.

Handb. Res., 10th ed., 7.1.7 Twelfth plenary meeting, 16 May 1970(Committee B, second report)

WHA23.16 Additional Housing for the Staff of the Regional Office for Africa, and Extension of the RegionalOffice Building


Having regard to the provisions of operative paragraph 3 of resolution WHA23.14; and

Noting the plan presented by the Director -General to the Executive Board at its forty -fifth session 2for the construction at Brazzaville of additional housing for staff of the Regional Office for Africa andextension of the Regional Office building,

AUTHORIZES the Director -General to proceed with the proposed construction according to the planpresented, to the extent' that funds are available in the Real Estate Fund.

Handb. Res., 10th ed., 5.2.1.2; 5.2.1.3; 7.1.7 Twelfth plenary meeting, 16 May 1970(Committee B, second report)

WHA23.17 Acquisition of Additional Land at Headquarters


Having regard to the provisions of operative paragraph 3 of resolution WHA23.14; and

Having regard to the discussions which took place at the Twentieth World Health Assembly, at the forty -fifth session of the Executive Board and at the current Assembly concerning the need to acquire additionalland at headquarters,

AUTHORIZES the Director -General to acquire suitable additional land at headquarters by purchase orother means.

Handb. Res., 10th ed., 7.3.2.2; 7.1.7 Twelfth plenary meeting, 16 May 1970(Committee B, second report)

1 See Annex 6.a See Of Rec. Wld Hlth Org., 181, 185.


WHA23.18 Headquarters Accommodation : Report on Financing


Noting the report of the Director -General 1 on the outcome of the second litigation with the contractorfor the main works of the headquarters building involving additional payments to the contractor ofSw.fr. 3 032 295 plus the Organization's share of the costs of the arbitral tribunal and related fees,

1. AUTHORIZES the Director -General to transfer from the Real Estate Fund to the Headquarters BuildingFund such sums as are necessary to meet these expenses; and

2. RECOGNIZES that in consequence the authorized total cost for the headquarters building reflected inresolution WHA20.11 is correspondingly amended.

Handb. Res., 10th ed., 7.3.2.1 Twelfth plenary meeting, 16 May 1970(Committee B, second report)

WHA23.19 Advances from the Working Capital Fund for the Provision of Emergency Supplies to Member States


NOTES the report of the Director -General on the provision of emergency supplies to Member States,2presented in accordance with the requirements of resolution WHA18.14.

Handb. Res., 10th ed., 1.14.1 Twelfth plenary meeting, 16 May 1970(Committee B, third report)

WHA23.20 Scale of Assessment for 1971

The Twenty -third World Health AssemblyDECIDES that the scale of assessment for 1971 shall be as follows :

Member Scale Member(percentage)

Afghanistan 0 04 CeylonAlbania 0 04 ChadAlgeria 0 09 ChileArgentina 0 84 ChinaAustralia 137 Colombia

Scale(percentage)

0 050.040 213 60018

Austria 0 51 Congo, Democratic Republic of 0 05Bahrain 0 02 Costa Rica 0 04Barbados 0 04 Cuba 0 17Belgium 0.99 Cyprus 0 04Bolivia 0 04 Czechoslovakia 0 83Brazil 0 80 Dahomey 0 04Bulgaria 0 16 Denmark 0 56Burma 0 05 Dominican Republic 0 04Burundi 0 04 Ecuador 0 04Byelorussian SSR 0 46 El Salvador 0 04Cambodia 0 04 Ethiopia 0 04Cameroon 0 04 Federal Republic of Germany 6 30Canada 2.72 Finland 0.44Central African Republic 004 France 5 39

1 See Annex 5, part 2.2 The report stated that: the advance of US $13 521 made in 1968 to Burma had been repaid in 1969; the advance of US $3404

made in 1968 to the Democratic Republic of the Congo had been repaid in 1970; and an advance of US $8700 had been authorizedby the Director- General for the provision of emergency supplies to Uganda in 1969 and repaid in 1970.


Member

Gabon

Scale(percentage)

004

Member(percentage)

Pakistan

Scale

0 33Ghana 0 07 Panama 004Greece 0 26 Paraguay 004Guatemala 0 05 People's Republic of the Congo 004Guinea 0 04 Peru 0 09Guyana 0 04 Philippines 0 30Haiti 0 04' Poland 1 32Honduras 0 04 Portugal 0 14Hungary 0 47 Qatar 0 02Iceland 0 04 Republic of Korea 0 11India 1 56 Romania 0 32Indonesia 0 30 Rwanda 004Iran 0 20 Saudi Arabia 0 05Iraq 0 06 Senegal 0.04Ireland 0 15 Sierra Leone 0 04Israel 0 18 Singapore 0 05Italy 2 91 Somalia 004Ivory Coast 004 South Africa 0 47Jamaica 0 05 Southern Rhodesia 0 02Japan 3 40 Southern Yemen 004Jordan 0 04 Spain 0 83Kenya 0 04 Sudan 0 05Kuwait 0 06 Sweden 1 12Laos 0 04 Switzerland 0 77Lebanon 0 05 Syria 004Lesotho 0 04 Thailand 0 12Liberia 004 Togo 004Libya 0 04 Trinidad and Tobago 0 04Luxembourg 0 05 Tunisia 0.04Madagascar 004 Turkey 0 31Malawi 004 Uganda 0 04Malaysia 0 10 Ukrainian SSR 1 73Maldives 004 Union of Soviet Socialist Republics 13 13Mali 004 United Arab Republic 0 18Malta 004 United Kingdom of Great Britain and NorthernMauritania 0 04 Ireland 5 95Mauritius 0 04 United Republic of Tanzania 0 04Mexico 0 78 United States of America 30 87Monaco 004 Upper Volta 0 04Mongolia 0 04 Uruguay 0 08Morocco 0 09 Venezuela 0 40Nepal 0 04 Viet -Nam 0 06Netherlands 1 04 Western Samoa 0 04New Zealand 0 32 Yemen 004Nicaragua 004 Yugoslavia 0 36Niger 0 04 Zambia 0.04Nigeria 0 13Norway 0 39 Total 100.00

Handb. Res., 10th ed., 7.1.2.1 Twelfth plenary meeting, 16 May 1970(Committee B, third report)

WHA23.21 Annual Report of the United Nations Joint Staff Pension Board for 1968


NOTES the status of the operation of the Joint Staff Pension Fund as indicated by the annual report forthe year 1968 and as reported by the Director -General.



WHA23.22 Appointment of Representatives to the WHO Staff Pension Committee


RESOLVES that the member of the Executive Board designated by the Government of France be appointedas member of the WHO Staff Pension Committee, and that the member of the Board designated by theGovernment of Ethiopia be appointed as alternate member, the appointments being for a period of three years.


WHA23.23 Amendments to the Statute of the International Agency for Research on Cancer


Considering the amendments to Articles VIII.1, VIII.3 and VIII.4 of the Statute of the InternationalAgency for Research on Cancer, adopted by the Governing Council at its seventh session; and

Considering the provisions of Article X (Amendments) of the Statute of the Agency,

ACCEPTS the following amendments to the Statute of the Agency:

Article VIII.1

The administrative services and permanent activities of the Agency shall be financed by annualcontributions by each Participating State.

Article VIII.3

The level or levels of annual contributions shall be determined by the Governing Council.

Article VIII.4

Any decision to change the level or levels of annual contributions shall require a two -thirds majorityof the members of the Governing Council who are representatives of Participating States.

Handb. Res., 10th ed., 1.7.6.2 Fourteenth plenary meeting, 19 May 1970(Committee B, fourth report)

WHA23.24 Fourth Report on the World Health Situation


Noting the fourth report on the world health situation prepared by the Director -General in pursuanceof resolution WHA19.52,

I

1. THANKS Member States and Associate Members for their assistance in providing material for this fourthreport; and

2. REQUESTS Member States and Associate Members to submit before 30 June 1970 any additional infor-mation or amendments they wish to include in the fourth report;

II

1. REQUESTS the Director- General to prepare for the Twenty- seventh World Health Assembly the fifthreport on the world health situation covering the period 1969 to 1972 and to draw up an outline of the contentof the report for the guidance of Member States in the preparation of their contributions; and


2. INVITES Member States and Associate Members to provide, as a further step towards fulfilment of theirobligations under Article 61 of the Constitution, information for the preparation of this fifth report;

III

REQUESTS the Director -General to prepare after an interval of two years a supplement to the fourthreport on the world health situation, which should contain:

(a) amendments to and expansion of previously published information; and

(b) a review of a special topic of general interest.

Handb. Res., 10th ed., 1.16.4.1 Fourteenth plenary meeting, 19 May 1970(Committee B, fourth report)

WHA23.25 Review of the Organizational Study on Co- ordination with the United Nations and the SpecializedAgencies


Having considered the organizational study on co- ordination with the United Nations and the special-ized agencies prepared by the Executive Board,1

1. CONCURS in the finding of the Executive Board that co- ordination with the United Nations, the special-ized agencies and the International Atomic Energy Agency has proved, over the years, a necessary means forthe Organization to fulfil its own aims and to contribute effectively to the attainment of the common objectivesof the United Nations system;

2. EXPRESSES its agreement with the other conclusions set forth in operative paragraph 2 of resolutionEB45.R34 of the Executive Board; and

3. REQUESTS the Director -General to continue his participation in co- ordination arrangements of the UnitedNations system with a view to assuring the Organization's full contribution to the overall effort to attain forall peoples the full enjoyment of their economic, social and human rights.

Handb. Res., 10th ed., 7.4 Fourteenth plenary meeting, 19 May 1970(Committee B, fourth report)

WHA23.26 Future Organizational Study by the Executive Board


Having considered the recommendation of the Executive Board in its resolution EB45.R16 on thesubject of the next organizational study,

1. DECIDES that the next subject of study shall be " Medical literature services to Members "; and

2. REQUESTS the Executive Board to report to the Twenty- fourth World Health Assembly on the progressof the study.

Handb. Res., 10th ed., 7.4 Fourteenth plenary meeting, 19 May 1970(Committee B, fourth report)

1 Off. Rec. Wld Hlth Org., 181, Annex 4.


WHA23.27 Co- ordination with the United Nations, the Specialized Agencies and the International AtomicEnergy Agency on Administrative, Budgetary and Financial Matters


Having considered resolutions EB45.R33 and EB45.R35 on co- ordination with other organizations inthe United Nations system on administrative, budgetary and financial matters and on the reports of theJoint Inspection Unit; and

Having heard the reports of the representative of the Executive Board and of the Director -General onthe subject,

ACCEPTS the report and conclusions of the Executive Board.

Handb. Res., 10th ed., 8.1.1.4 Fourteenth plenary meeting, 19 May 1970(Committee B, fifth report)

WHA23.28 Selection of the Country in which the Twenty- fourth World Health Assembly will be held


Considering the provision of Article 14 of the Constitution with regard to the selection of the country orregion in which the next Health Assembly will be held,

DECIDES that the Twenty- fourth World Health Assembly shall be held in Switzerland.


WHA23.29 Acceptance of Amendments to the Constitution of WHO


NOTES the report of the Director -General on the situation regarding the possibilities for the acceptanceof amendments to the Constitution of the World Health Organization.

Handb. Res., 10th ed., 6.1 Fourteenth plenary meeting, 19 May 1970(Committee B, fifth report)

WHA23.30 Implementation of Resolution WHA7.33


Noting the report 1 of the Director -General on the implementation of resolution WHA7.33; and

Recalling the provisions of resolution WHA22.28,

1. COMMENDS the Director -General and the Regional Director for the Eastern Mediterranean for theirefforts to give full effect to the above -mentioned resolutions, and requests all concerned to continue theirefforts to resolve the difficulties; and

2. REQUESTS the Director -General in the event of any new developments in this matter to submit a reportto a future Assembly.


1 Off Rec. Wld Hlth Org., 181, Annex 8.


WHA23.31 Second Report of the Ad Hoc Committee of Experts to examine the Finances of the United Nationsand the Specialized Agencies : Progress Report on Implementation


Having considered the report by the Director- General 1 on progress in the implementation of the recom-mendations 2 in the second report of the Ad Hoc Committee of Experts to examine the Finances of the UnitedNations and the Specialized Agencies;

Recalling the provisions of resolutions EB37.R43, WHA19.30, EB39.R42, WHA20.22, EB41.R40,WHA21.32, WHA21.33, EB43.R38 and EB45.R36;

Considering that the Health Assembly, at its current session, has dealt with recommendation 21; and

Noting that the Director -General is studying further the feasibility of establishing broad long -termfinancial indicators (part of recommendation 29), and will report thereon to the forty- seventh session of theBoard,

1. CONSIDERS that the Organization has dealt with all those recommendations not requiring inter -agencyconsultations;

2. NOTES that the Director -General is continuing to co- operate in the further inter -agency study of recom-mendations 4, 24 and 26, and expresses the hope that these studies will be completed as rapidly as possible; and

3. REQUESTS the Director -General to submit to the Secretary -General of the United Nations, in accordancewith General Assembly resolution 2475 (XXIII), a full and detailed report on the progress made by theOrganization since his last report, in 1968, in the implementation of the recommendations in the secondreport of the Ad Hoc Committee and the decisions adopted thereon by the Health Assembly and the ExecutiveBoard.


WHA23.32 Health Consequences of Smoking


Having considered the report of the Director -General;

Recalling the resolutions on this subject adopted by the Executive Board, the Directing Council of thePan American Health Organization /Regional Committee for the Americas, and the Regional Committeefor Europe;

Conscious of the serious effects of smoking in promoting the development of pulmonary and cardiacdisease, including bronchopulmonary cancer, chronic bronchitis, emphysema and ischaemic heart disease;

Being aware that bronchopulmonary cancer is at present increasing in all countries of the world whererecords are available in a form which permits assessment;

Holding that health agencies must now demonstrate their concern for the reduction of the main causalfactor in diseases related to smoking; and

Considering that smoking of tobacco during meetings may constitute a nuisance to non -smokers,

RESOLVES that:

(1) all those present at meetings of the Assembly and its committees be requested to refrain fromsmoking in the rooms where such meetings are held;

1 See Annex 7.2 Reproduced in Off. Rec. Wld Hlth Org., 165, Annex 11.


(2) the Director -General be requested:

(a) to consider the desirability of making the subject for World Health Day " The health conse-quences of smoking," on the earliest possible occasion;(b) to call the attention of all Members and Associate Members to the report on limitation ofsmoking and to suggest that the advantages of applying the recommendations on pages 19 and 20of that report 1 should be considered in all countries;(c) to consider convening an expert group to recommend further action that might be taken todiscourage smoking;

(d) to examine to what extent and by what educational methods young people might be persuadednot to begin smoking;

(e) to bring to the attention of FAO the need for studying crop substitution in tobacco- producingcountries;

(f) to report to the Executive Board at its forty- seventh session and to the Twenty- fourth WorldHealth Assembly on the action proposed and the financial consequences for the Organization.

Handb. Res., 10th ed., 1.7 Fourteenth plenary meeting, 19 May 1970(Committee A, second report)

WHA23.33 Research on Alternative Methods of Vector Control


Recognizing:

(a) that vector -borne diseases are public health problems of temperate and tropical climates, ofdeveloped and developing States;

(b) that the traditional chemical methods of control of disease vectors add to the burden placed uponour environment; and

(c) that the control of the vector is the most effective method of controlling the transmission of manydifferent diseases that may blind, cripple, and kill millions,

1. COMMENDS the Director -General on the excellent report on alternative methods of vector control; 2 and

2. RECOMMENDS that the Director -General take into account the proposed plan of work in the formulationof the regular budget for 1972.


WHA23.34 Present Problems of Yellow Fever in Africa


Having considered the report of the Director- General on present problems of yellow fever in WestAfrica and the report of the working party established to discuss these problems in detail,

1. REALIZES the gravity of the situation in 1969 when outbreaks occurred in five countries, and realizesalso that there is a considerable risk of further outbreaks occurring during and after the next rainy season;

1 For these recommendations, see " Smoking and health," reproduced in WHO Chronicle, 24, 365.2 See Annex 9.


2. STRESSES that yellow fever in West Africa is a problem which is of deep concern not only to Africancountries but also to countries in all continents, particularly those in which potential insect vectors are present;

3. DRAWS attention to the lack of fundamental knowledge of the animal reservoirs and vectors of the virus,and of other epidemiological and epizootical aspects of the disease;

4. APPRECIATES that many of the countries at risk do not have at present sufficient resources to set upadequate vaccination programmes for the more than 16 million persons (mainly infants and children) whoshould be vaccinated with 17D vaccine within the next few months, or for emergency vector control operations;

5. NOTES that yellow fever vaccines prepared from the 17D strain are highly effective and that a singleinjection will protect for at least ten years, but recognizes that further research on the thermostability of thevaccine is required;

6. NOTES with satisfaction the actions undertaken by WHO in 1969 and its establishment of a mechanismfor emergency action upon the occurrence of yellow fever epidemics;

7. EMPHASIZES that WHO also plays a role of primary importance in establishing effective co- ordination ofthe programmes of the countries concerned and of contributions from outside countries and agencies; and

8. RECOMMENDS :

(i) that each country in the yellow -fever endemic areas of Africa should establish a scheme for theimmediate investigation of suspected cases and for rapidly informing WHO;

(ii) that the health authorities of the countries in the endemic areas of Africa should, with all possiblespeed, and without waiting for further cases to occur, establish effective vaccination programmes in co-operation with neighbouring countries in the following order of priority:

(a) immediate vaccination of presumed susceptible age -groups in districts peripheral to areaswhere epidemics have recently occurred;

(b) vaccination of presumed susceptible age -groups in areas where ecological conditions arefavourable to the spread of infection; and

(c) vaccination of presumed susceptible age- groups in large centres of population;

(iii) that health authorities in countries in the endemic areas should plan to include yellow fever vacci-nation in all routine immunization programmes for newcomers by birth or immigration;

(iv) that countries outside the endemic areas of Africa should consider to what extent they could:

(a) contribute without delay supplies, viz. vaccines, vaccination equipment and refrigerators,insecticides and equipment for their application, as well as means of transport sufficient to meetthe requirements of the immediate situation; and

(b) contribute to the long -term programme referred to in sub -paragraph (viii) ;

(v) that WHO should immediately establish in Africa a unit which, in collaboration with the authoritiesin the countries concerned, would ensure the collection and rapid dissemination of epidemiologicalinformation, would undertake the assessment of the probable nature and extent of the risk of spread ofdisease when cases first occur, would act as a centre of information on bilateral assistance, and wouldensure that areas where the need is greatest should be able to obtain at any particular time theresources they require;

(vi) that emergency schemes for vector control be set up in areas at special risk;

(vii) that production laboratories be encouraged or assisted not only to increase the quantity of vaccineavailable, but also to improve its quality; and


(viii) that a long -term internationally co- ordinated programme of research on the natural history of yellowfever in Africa should be undertaken under the auspices of WHO.

Handb. Res., 10th ed., 1.3.5; 1.3.9 Fourteenth plenary meeting, 19 May 1970(Committee A, second report)

WHA23.35 Training of National Health Personnel


Having considered resolution EB45.R29 of the forty -fifth session of the Executive Board, pursuant toresolution WHA21.20 of the Twenty -first World Health Assembly,

1. THANKS the regional committees which have carried out the analysis of the problem of training profes-sional and auxiliary health personnel in their own regions, and urges the other regional committees to under-take this study at their next sessions;

2. REQUESTS the Director -General to prepare a report based on these regional analyses for the considerationof the Executive Board;

3. REQUESTS the Executive Board to carry out a general evaluation of the experience accumulated by theWorld Health Organization, taking into account the conclusions reached by the regional committees on thetraining of professional and auxiliary health personnel; and

4. REQUESTS the Director -General:

(a) to present to the World Health Assembly, in the light of the discussions of the Executive Board, areport on any concrete measures that the World Health Organization might appropriately take toassist further the training of national health personnel of all levels, including the methodology employedin such training; and

(b) to urge Members of each region to formulate a minimum standard of curriculum for training pro-grammes for health personnel, taking into consideration the needs of the region.


WHA23.36 Community Water Supply


Having considered the progress report of the Director -General on the community water supply pro-gramme;

Noting the progress achieved to date by Member States in various regions, particularly in the Region ofthe Americas;

Welcoming the increasing assistance to Member States from such sources as the United Nations Develop-ment Programme, the United Nations Children's Fund, bilateral aid programmes and international andregional financing agencies towards achieving the health objectives of the community water supply pro-gramme, particularly the support given in connexion with rural water supply programmes;

Believing that, on a worldwide basis, the progress in implementing the community water supply pro-gramme in relation to the needs is too slow to meet these needs within the foreseeable future;

Recognizing that water supply developments, particularly in urban areas, can be placed largely on aself -sustaining financial basis;


Noting that WHO has generated considerable additional external financing for community watersupplies;

Understanding that external financing continues to be available to increase the rate of implementationof water supply projects, provided sound projects can be developed;

Re- emphasizing the long -range nature of the community water supply programme and its vital role inthe improvement and maintenance of health;

Reaffirming the recommendations included in resolutions WHA19.50 and WHA21.36; and

Recognizing further that the attainment of WHO targets for the Second United Nations DevelopmentDecade, as stated in the Director -General's report to the Twenty -third World Health Assembly, may requirefor a period a doubling of annual rates at which new acceptable projects, rural and urban, are achieved,

1. NOTES the report of the Director -General, and endorses the general principles and programme therein;

2. RECOMMENDS to Member States :

(i) that they intensify their efforts to identify community water supply problems as an essential firststage in national water supply development;

(ii) that they give high priority in their development plans to programmes for the provision of commu-nity water supply and sewerage;(iii) that they continue to strengthen co- ordination between ministries of health and such other ministriesor governmental bodies as may be responsible for the planning and implementation of community watersupply and sewerage programmes; and(iv) that they take full advantage of the assistance obtainable from multilateral and bilateral agenciesfor the implementation of water supply and sewerage programmes; and


(i) to pursue co- operative activities with Member States, research institutions and multilateral andbilateral agencies for the stimulation and promotion of community water supply research and develop-ment programmes;(ii) to intensify assistance to Member governments in the development of community water supply sothat those governments may make use of the maximum amount of assistance from external financingresources to establish acceptable projects within the WHO targets proposed for the Second UnitedNations Development Decade; and(iii) to report on the financial consequences of the programme for WHO to the Twenty- fourth WorldHealth Assembly.

Handb. Res., 10th ed., 1.4.3 Fourteenth plenary meeting, 19 May 1970(Committee A, second report)

WHA23.37 Effective Working Budget and Budget Level for 1971


DECIDES that:

(1) the effective working budget for 1971 shall be US $73 230 000;

(2) the budget level shall be established in an amount equal to the effective working budget as providedin paragraph (1) above, plus the assessments represented by the Undistributed Reserve; and


(3) the budget for 1971 shall be financed by assessments on Members after deducting:(i) the amount of US $1 268 624 available by reimbursement from the Technical Assistance com-ponent of the United Nations Development Programme;(ii) the amount of US $1 000 000 available as casual income for 1971.

Handb. Res., 10th ed., 2.1 Fourteenth plenary meeting, 19 May 1970(Committee A, third report)

WHA23.38 Consideration of the Desirability and Feasibility of the Establishment of a Group of Representativesof Member States to consult with the External Auditor on his Examination of the Financial andAdministrative Procedures of WHO


Having considered resolution EB45.R14 adopted by the Executive Board following its consideration ofthe desirability and feasibility of the establishment of a group of representatives of Member States to consultwith the External Auditor on his examination of the financial and administrative procedures of WHO,

CONCURS in the recommendations and conclusions of the Executive Board.

Handb. Res., 10th ed., 7.1.10 Fifteenth plenary meeting, 21 May 1970(Committee B, sixth report)

WHA23.39 Members in Arrears in the Payment of their Contributions to an Extent which may invoke Article 7of the Constitution


Having considered resolution EB45.R25 of the Executive Board and the report of its Ad Hoc Committeeon Members in arrears in the payment of their contributions to an extent which may invoke Article 7 of theConstitution;

Noting with regret and concern that the Dominican Republic, Haiti and Paraguay are in arrears tosuch an extent that it is necessary for the Assembly to consider, in accordance with Article 7 of the Constitu-tion, whether or not the voting privileges of these Members should be suspended;

Having considered the explanations given by the Permanent Representative of the Dominican Republicon the situation in that country in his communication to the Director -General; 2 and

Noting that neither Haiti nor Paraguay is present at the Twenty -third World Health Assembly,

1. DECIDES not to suspend the voting privileges of the Dominican Republic at the Twenty -third WorldHealth Assembly, in the light of the assurances received in the letter of 12 May 1970 from the representativeof this country;

2. APPRECIATES the assurance provided by the Government of Haiti concerning a payment to be made on19 May 1970; 2 and

3. REQUESTS the Director -General to communicate this resolution to the three Members concerned and tocontinue his efforts to obtain payment of their outstanding arrears.

Handb. Res., 10th ed., 7.1.2.4 Fifteenth plenary meeting, 21 May 1970(Committee B, sixth report)

1 See Annex 4, part 1.2 See Annex 4, part 2.


WHA23.40 Co- ordination with the United Nations, the Specialized Agencies and the International AtomicEnergy Agency on Programme Matters


Noting the rapid developments in human activities which are resulting in the appearance of situationsthat are a source of concern from the health viewpoint;

Considering that the situations thus created are leading to the setting -up of various bodies, some ofwhich are actively participating in the solution of health problems; and

With the aim of preventing the unwarranted dispersal or overlapping of effort,

1. CONFIRMS that the World Health Organization is the United Nations body specifically competent to dealwith health problems;

2. AFFIRMS the importance of the co- ordinating role which the World Health Organization should play; and

3. REQUESTS the Director -General to continue his efforts with a view to preventing the proliferation ofuncoordinated health activities and, further, to ensure the leading role of WHO in the field of health.

Handb. Res., 10th ed., 8.1.1.3 Fifteenth plenary meeting, 21 May 1970(Committee B, sixth report)

WHA23.41 Human Rights


1. RECALLS the long- standing co- operation between the World Health Organization and the United NationsCommission on Human Rights;

2. FURTHER recalls resolution 2450 (XXIII) adopted by the United Nations General Assembly, whichrequested the Secretary- General, with the co- operation, inter alia, of the executive heads of the competentspecialized agencies, to prepare a study of problems in connexion with human rights arising from develop-ments in science and technology;

3. NOTES that the Director -General transmitted to the United Nations a preliminary memorandum on " theprotection of the human personality and its physical and intellectual integrity, in the light of advances inbiology, medicine, and biochemistry ";

4. REAFFIRMS that the right to health is a fundamental human right;

5. CONSIDERS that the health aspect of human rights in the light of scientific and technological progress iswithin the competence of the World Health Organization; and


(a) to reaffirm to the Secretary -General of the United Nations the Organization's willingness to under-take responsibility for the preparation of a document dealing with the health aspects of human rights inthe light of scientific and technological developments; and

(b) to study further the implications of this matter for the Organization and to report to the ExecutiveBoard at a future session.



WHA23.42 Drug Dependence


Noting with great concern the extensive and serious public health problems resulting from the self -administration of dependence -producing drugs, in particular among the younger age -group;

Recalling resolutions WHA1 8.47, WHA20.42, WHA20.43 and WHA21.42 concerning certaindependence -producing drugs not under international control;

Noting that the Economic and Social Council has decided 1 to convene in 1971 a plenipotentiary confer-ence to adopt a Protocol on Psychotropic Substances;

Considering that a decision on the control of a substance liable to abuse to the extent of constituting apublic health problem must be based primarily on medical judgement as to both its dependence- producingproperties and therapeutic usefulness; and

Convinced that there is an urgent need at local, national and international levels to implement improvedpreventive, treatment and rehabilitation measures,

1. RECOMMENDS that the World Health Organization should encourage and assist the development ofimproved preventive, treatment and rehabilitation programmes and the pursuit of needed knowledge in thefield of drug dependence;

2. URGES Member States to promote preventive, therapeutic, rehabilitative and research programmes inthis field; and

3. REQUESTS the Director- General:

(i) to develop means for the international collection and exchange of data on the prevalence andincidence of drug dependence, and on the human and environmental factors associated therewith;

(ii) to ensure that the constitutional responsibilities of the World Health Organization are effectivelydischarged in international programmes for the control of the abuse of dependence -producing drugs;

(iii) to seek, without excluding the possibility of establishing a standing committee, the most effectiveprocedures for examining the various factors involved of a medical, scientific and social nature and forenabling the Organization to receive all useful advice concerning the need to restrict the availability ofany drug on the grounds of its liability to misuse; and(iv) to report to the Executive Board and to the Twenty- fourth World Health Assembly on developmentsin this matter.

Handb. Res., 10th ed., 1.10.2; 8.1.2 Fifteenth plenary meeting, 21 May 1970(Committee B, sixth report)

WHA23.43 Second United Nations Development Decade


Having considered the Director -General's report on co- ordination with the United Nations, the special-ized agencies and the International Atomic Energy Agency on programme matters affecting the activities ofthe World Health Organization;

Mindful of the increasing need in developing and developed countries for accelerated health improvementin the Second United Nations Development Decade; and

Recalling resolutions WHA20.52, WHA20.53 and WHA22.55,

1 Economic and Social Council resolution 1474 ( XLVIII).


1. NOTES with satisfaction the Director -General's report on co- ordination with other organizations of theUnited Nations system on programme matters; and

2. REQUESTS the Director- General to continue to co- operate with other organizations of the United Nationssystem in the formulation of the international strategy for the Second United Nations Development Decadeand in the related activities, and to report to the Executive Board and to each World Health Assembly to beheld during the Second Development Decade on the action pursued and progress made in the health compo-nent of the international strategy for the Second Development Decade.


WHA23.44 Study of the Capacity of the United Nations Development System


Having considered the progress report of the Director -General 1 on the Study of the Capacity of theUnited Nations Development System;' and

Having noted the comments of the Inter -Agency Consultative Board and the report of the Administra-tor of the United Nations Development Programme thereon, as well as the progress report of the GoverningCouncil ° on its special session,

1. REAFFIRMS its belief that country programming as proposed by the capacity study recommended by theAdministrator of the United Nations Development Programme and endorsed by the Governing Councilcan constitute a vital and valuable means of meeting the needs of countries and of planning technicalassistance;

2. REITERATES the readiness of the Organization to advise on the planning of the health sector of countryprogrammes;

3. REQUESTS the Director -General to continue to participate as and when necessary in discussions on thecapacity of the United Nations development system; and

4. REQUESTS the Director -General to report on the subject to the Executive Board at its forty- seventhsession and to the Twenty- fourth World Health Assembly.


WHA23.45 Quality Control of Drugs


Recalling resolution WHA22.50;

Having examined the report of the Director -General on the quality control of drugs;

Noting that several Member States already have or are taking steps towards implementing a controlsystem and certification scheme in line with the recommendations in resolution WHA22.50; and

1 See Annex 10.2 UNDP document DP /5.3 UNDP document DP /6.' UNDP document DP /7.5 UNDP document DP /L /128.


Stressing the need for further information from Member States on the implications at the national levelof the adoption of the recommendations,

1. CONGRATULATES the Director -General on his report;

2. INVITES Member States to inform the Director -General of steps taken with respect to resolutionWHA22.50 and their possible administrative implications, including suggestions for improvement of thetexts on " Good Practices in the Manufacture and Quality Control of Drugs " and the certificationscheme;1 and

3. REQUESTS the Director -General to continue to review in the light of information obtained the requirementsfor Good Practices in the Manufacture and Quality Control of Drugs and the certification scheme, and toreport to the Twenty- fourth World Health Assembly.

Handb. Res., 10th ed., 1.10.4.1 Fifteenth plenary meeting, 21 May 1970(Committee A, fourth report)

WHA23.46 Smallpox Eradication Programme


Having examined the Director -General's report on the smallpox eradication programme submitted tothe Executive Board at its forty -fifth session,

ENDORSES the recommendations of the Executive Board contained in its resolution EB45.R20.

Handb. Res., 10th ed., 1.3.6 Fifteenth plenary meeting, 21 May 1970(Committee A, fourth report)

WHA23.47 Occupational Health : Miners


In accordance with the basic principles of the Constitution of the World Health Organization,

Considering that the fundamental objective of any government plan is to ensure the well -being of thepopulation, and that health is the essential factor that should govern all human activities;

Considering that there is a relationship between the work of the World Health Organization and thatof governments in defence of the health of the people by means of specific programmes;

Considering that, while on the one hand countries are engaged in transforming their socio- economicstructures so as to guarantee their inhabitants a living standard compatible with human dignity and satisfyingthe requirements of genuine social justice, on the other hand to do this it is necessary at the same time to solveserious occupational health problems, especially in some countries, in the mining industry, in co- ordinationwith other activities; and

Considering that this situation should be rapidly corrected by a combined effort of States and interna-tional organizations by means of studies, the establishment of standards and recommendations, as wellas extensive technical assistance which would enable this problem to be overcome,

1. RECOMMENDS that the Director- General of the World Health Organization, in accordance with Article 70of the Constitution, consult with the Director -General of the International Labour Organisation so that theycan together draw up a joint programme for the purpose of:

1 Reproduced in Of Rec. Wld filth Org., 176, Annex 12.


(a) studying the working conditions of mine workers in all their aspects, especially in relation to thelength of the working day;

(b) proposing general standards, suitable for each geographical and sociological region, which canserve as a technical basis for specific legislation in this field, intended to prevent the serious diseasesprevalent among mine workers; and

2. REQUESTS the Director - General of the World Health Organization to submit to the next World HealthAssembly for consideration a draft programme for the implementation of this recommendation.

Handb. Res., 10th ed., 1.7.2. Fifteenth plenary meeting, 21 May 1970(Committee A, fourth report)

WHA23.48 Drug Efficacy

The Twenty-third World Health Assembly,

Recalling resolutions WHA15.41, WHA16.36 and WHA17.39 of the Fifteenth, Sixteenth and Seven-teenth World Health Assemblies on the importance of communicating to WHO any decision to refuse theapproval of a new drug, or to withdraw or restrict the availability of a drug already in use if such decision istaken as a result of serious adverse reactions, and requesting the Director -General to transmit immediatelyto Member States the information received;

Acknowledging the value of information distributed through this intergovernmental information systemso far;

Noting that it is not only the serious adverse reactions caused by drugs that must be taken into consid-eration as factors detrimental to the health of the individual, but also their inefficacy; and

Noting also that ineffective drugs are wasteful of individual and public economic resources,

1. INVITES all Member States to communicate to WHO any final decision made by national health author-ities to withdraw or restrict the availability of a drug already in use if the decision is taken because of lackof substantial evidence of effectiveness in relation to its toxicity and the purpose for which it is used; and

2. REQUESTS the Director- General to disseminate these decisions in addition to decisions taken as a resultof serious adverse reactions, as specified in resolution WHA16.36.

Handb. Res., 10th ed., 1.10.1 Fifteenth plenary meeting, 21 May 1970(Committee A, fourth report)

WHA23.49 Research on the Organization of Community Health Services


Believing that the health of a community calls for a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity of individuals of that community;

Emphasizing that optimum development of the population structure requires environmental conditionswhich are favourable to the health of all individuals in the community;

Considering that to secure the health of the population and its optimum development it is necessary:

(i) to assess the health status of the population and its development;(ii) to assess and promote environmental conditions conducive to health;


(iii) to devise methods and means both for the promotion of health of all people and the preventionof disease, disability and infirmity; and

(iv) to organize facilities for the prevention of disease and for medical care and rehabilitation for thecommunity according to its need;

Bearing in mind that the proper organization and development of health services for the communityrequire not only the appropriate human resources and financial means but also continuous scientific evaluationof the organization and activities of the services provided; and

Believing that research into the assessment of health and the evaluation of services should be carried outin countries with different social systems and different levels of economic development,

REQUESTS the Director -General to review the WHO research programme in this field so as to ensure thatappropriate priority is given to the study and development of the most appropriate systems for the organi-zation of community health services, and to report on this subject to the World Health Assembly.

Handb. Res., 10th ed., 1.6 Fifteenth plenary meeting, 21 May 1970(Committee A, .fifth report)

WHA23.50 Health Hazards of Food Additives


Being concerned about the potential hazards of food additives to the consumer;

Aware of the increasing research done on toxicity of food additives;

Having noted the intensive publicity commonly given by the lay press to questions of safety of foodadditives and the widespread repercussions which follow action by any country to limit or prohibit the useof a generally used food additive;

Noting that the matter was raised at the forty -fifth session of the Executive Board; and

Agreeing that there is an urgent need for rapid dissemination of the results of toxicity research on foodadditives, including the results and consequences of evaluation of such studies,

1. REQUESTS Member States:

(i) to communicate immediately to WHO any decision to limit or prohibit the use of a food additive;and

(ii) to supplement as soon as possible such information with the data in support of the decision taken;and

2. REQUESTS the Director -General, where such action would be useful:

(i) to transmit immediately to Member States information received under paragraph 1;

(ii) to take expeditious steps to evaluate any significant new evidence of toxicity of a specific foodadditive, including if necessary the convening of a meeting of experts, where appropriate in consultationwith FAO; and

(iii) to distribute promptly to Member States any conclusions of such a meeting.

Handb. Res., 10th ed., 1.10.3 Fifteenth plenary meeting, 21 May 1970(Committee A, fifth report)


WHA23.51 Appropriation Resolution for the Financial Year 1971 1

A.


DECIDES to appropriate for the financial year 1971 an amount of US $86 857 764 as follows:

Appropriation Purpose of AppropriationSection

PART I: ORGANIZATIONAL MEETINGS

1. World Health Assembly2. Executive Board and its Committees3. Regional Committees

Total - Part 1

AmountUS $

541 984235 950126 900

904 834

PART II: OPERATING PROGRAMME.

4. Programme Activities 60 856 277

5. Regional Offices 6 294 976

6. Expert Committees 216 800

Total - Part I I 67 368 053

PART III: ADMINISTRATIVE SERVICES

7. Administrative Services 4 448 413

Total - Part III 4 448 413

PART IV: OTHER PURPOSES

8. Headquarters Building: Repayment of Loans 508 700

Total - Part TV 508 700

Effective Working Budget (PARTS I, II, III AND IV) 73 230 000

PART V: STAFF ASSESSMENT

9. Transfer to Tax Equalization Fund 8 888 931

Total Part V 8 888 931

PART VI: RESERVE

10. Undistributed Reserve 4 738 833

Total - Part VI 4 738 833

TOTAL - ALL PARTS 86 857 764

1 See Annex 11.


B. Amounts not exceeding the appropriations voted under paragraph A shall be available for the paymentof obligations incurred during the period 1 January to 31 December 1971, in accordance with the provisionsof the Financial Regulations.

Notwithstanding the provisions of this paragraph, the Director -General shall limit the obligations tobe incurred during the financial year 1971 to the effective working budget established by the World HealthAssembly, i.e. Parts I, II, III and IV.

C. The appropriations voted under paragraph A shall be financed by contributions from Members afterdeduction of:

(i) reimbursement from the Technical Assistance component of the United NationsDevelopment Programme in the amount of US $ 1 268 624

(ii) assessments on new Members from previous years in the amount of US $ 21 565

(iii) miscellaneous income in the amount of US $ 978 435

Total US $ 2 268 624

thus resulting in assessments against Members of US $84 589 140. In establishing the amounts of contri-butions to be paid by individual Members, their assessments shall be reduced further by the amount standingto their credit in the Tax Equalization Fund, except that the credits of those Members whose nationals, staffmembers of WHO, are required to pay taxes on their WHO emoluments shall be reduced by the estimatedamounts of such tax reimbursements to be made by the Organization.

Handb. Res., 10th ed., 2.1 Fifteenth plenary meeting, 21 May 1970(Committee A, fifth report)

WHA23.52 Health Assistance to Refugees and Displaced Persons in the Middle East


Mindful of the principle that the health of all peoples is fundamental to the attainment of peace andsecurity;

Having considered the Director -General's report of 1 May 1970, and the annual report of the UnitedNations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA);

Recalling resolutions WHA21.38 and WHA22.43 on health assistance to refugees and displaced personsin the Middle East; and

Noting with grave concern that the refusal to abide by the Fourth Geneva Convention of 12 August 1949relative to the protection of civilian persons in time of war, as well as the refusal to apply United Nationsresolutions regarding the refugees and displaced persons, continue to cause immense sufferings to the lifeand health of the inhabitants of the occupied territories as well as the refugees and the displaced persons inthe Middle East,

1. REAFFIRMS resolutions WHA21.38 and WHA22.43 on health assistance to refugees and displaced persons;

2. DEEMS it necessary, for the protection of the life and physical and mental health of the refugees anddisplaced persons, that they be immediately afforded their right to return to their homes, in accordance withthe relevant resolutions of the United Nations;

3. CALLS UPON Israel, for the safeguarding of the life and the physical and mental health of the inhabitantsof the occupied territories, to abide by its obligations under the Fourth Geneva Convention of 12 August 1949relative to the protection of civilian persons in time of war;


4. EXPRESSES its appreciation to the Director -General of WHO, the Director of Health of UNRWA and tothe specialized and other organizations that provide assistance to the refugees, displaced persons and theinhabitants of the occupied territories in the Middle East; and


(a) to issue a worldwide appeal to governments and humanitarian organizations to make availableto the International Committee of the Red Cross material and human aid to the inhabitants of theoccupied territories;

(b) to take all other effective measures in his power to safeguard health conditions amongst refugees,displaced persons and the inhabitants of the occupied territories in the Middle East; and(c) to report to the Twenty- fourth World Health Assembly on the implementation of this resolution.

Handb. Res., 10th ed., 8.1.4.2 Fifteenth plenary meeting, 21 May 1970(Committee B, seventh report)

WHA23.53 The Rapid Prohibition of Chemical and Bacteriological (Biological) Weapons


Guided by the principles of the Constitution of the World Health Organization;

Recalling the danger hanging over mankind as a result of the ever -continuing work to develop newforms of chemical and bacteriological (biological) weapons, and also as a result of their stockpiling;

Expressing its profound anxiety in regard to the cases that are recurring of the use of chemical meansof waging warfare;

Bearing in mind resolution WHA20.54 in which the World Health Assembly has already expressed itsdeep conviction that scientific achievements, particularly in the field of biology and medicine - that mosthumane science - should be used only for mankind's benefit, but never to do it any harm;

Taking into account the terms of resolution 2603 (XXIV) adopted by the General Assembly of theUnited Nations at its twenty- fourth session, which stated that the prospects for general and complete dis-armament under strict and effective international control and hence for peace throughout the world wouldbrighten significantly if the development, production and stockpiling of chemical and bacteriological(biological) agents intended for purposes of war were to end and if they were eliminated from all militaryarsenals;

Noting with approval the report of the Director -General of WHO and a group of consultants on thedisastrous consequences for human health to which the use of chemical and bacteriological (biological)weapons could lead, a report which was transmitted to the Secretary -General of the United Nations inaccordance with paragraph 2 of the operative part of resolution WHA22.58, adopted by the Twenty- secondWorld Health Assembly; 1

Drawing attention to the fact that the question of prohibiting the development, production and stock-piling of all forms of chemical and bacteriological (biological) weapons is very closely linked with the problemof the protection of the human environment against pollution; and

Declaring that the use not only of chemical and bacteriological (biological) weapons but also of anychemical and bacteriological (biological) agents for the purposes of war might lead to a disturbance of eco-logical processes which in its turn would menace the existence of modern civilization,

1. PROPOSES that the Director- General should continue to co- operate with the Secretary -General of theUnited Nations with a view to promoting the rapid prohibition of the development, production and stock-piling of chemical and bacteriological (biological) weapons and ensuring their destruction;

1 Report subsequently published as Health aspects of chemical and biological weapons, World Health Organization (1970), Geneva.


2. APPEALS once more to the governments of countries which have not yet ratified the Geneva Protocol of17 June 1925 to accede to that important and highly humane international agreement in the nearest possiblefuture;

3. EMPHASIZES the need for the rapid prohibition of the development, production and stockpiling of chemicaland bacteriological (biological) weapons and the destruction of stocks of such weapons as a necessary measurein the fight for human health;

4. CALLS UPON all medical associations and all medical workers to consider it their moral and professionalduty to give every possible assistance to the international movement directed towards the complete prohibitionof chemical and bacteriological (biological) means of waging war; and

5. REQUESTS the Director -General to transmit this resolution to the Secretary -General of the United Nationsand also to distribute it among Member States and a wide medical public.

Handb. Res., 10th ed., 9.2; 8.1.1 Fifteenth plenary meeting, 21 May 1970(Committee B, seventh report)

WHA23.54 Reports of the Executive Board on its Forty- fourth and Forty -fifth Sessions


1. NOTES the reports of the Executive Board on its forty -fourth L and forty -fifth 3 sessions;

2. COMMENDS the Board on the work it has performed; and

3. REQUESTS the President of the Twenty -third World Health Assembly to convey the thanks of the Assemblyto those members of the Executive Board who will be completing their terms of office immediately after theclosure of the current session of the Health Assembly.

Handb. Res., 10th ed., 4.2.5.2 Fifteenth plenary meeting, 21 May 1970

WHA23.55 Programme and Budget Estimates for 1971: Voluntary Fund for Health Promotion


Having considered the programmes planned to be financed in 1971 from the Voluntary Fund for HealthPromotion, as shown in Annex 3 to Official Records No. 179,

1. NOTES that the programmes are complementary to the programmes included in the regular budget ofthe Organization;

2. NOTES further that the programmes conform to the general programme of work for the period 1967 -1971 3and that the research programmes are in accordance with advice received by the Director -General from theAdvisory Committee on Medical Research; and

3. REQUESTS the Director -General to implement the programmes planned for 1971 to the extent to whichfunds become available.

Handb. Res., 10th ed., 2.1 Sixteenth plenary meeting, 22 May 1970(Committee A, sixth report)

1 Off: Rec. Wld Hlth Org., 178.2 Off. Rec. Wld Hlth Org., 181, 182.3 Off Rec. Wld Hlth Org., 143, Annex 3.


WHA23.56 Special Account for Servicing Costs


Having considered the estimates included in Official Records No. 179, Annex 4, for personnel and otherservices to be financed from the Special Account for Servicing Costs, and the report of the Executive Boardthereon; 1 and

Recalling resolution EB37.R26 noting the establishment of the Special Account for Servicing Costsand its uses in accordance with the report submitted to the Board at its thirty- seventh session,2 which enablesthe Director -General, as needs arise, to use the funds at his discretion,

I . NOTES that the provision for the support services required for programmes to be carried out from sourcesother than the regular budget and the Technical Assistance component of the United Nations DevelopmentProgramme will need to be adjusted to take account of the nature and scope of such programmes; and

2. RECOGNIZES that the Director -General is responsible for providing the support services to be financedfrom the Special Account for Servicing Costs essential for the effective implementation of the programmesto be carried out from sources other than the regular budget and the Technical Assistance component of theUnited Nations Development Programme.

Handb. Res., 10th ed., 7.1.7 Sixteenth plenary meeting, 22 May 1970(Committee A, sixth report)

WHA23.57 Reservations to the International Health Regulations


Having considered a report 3 on the rejections and reservations to and comments on the InternationalHealth Regulations 4 submitted by governments,

1. ADOPTS the report;

2. REQUESTS the Director -General to transmit it to all governments;

3. REQUESTS the Director -General to prepare, as soon as possible after the entry- into -force of the Regulations,a statement for the information of governments, showing:

(1) those governments which are bound by the Regulations without reservation or with reservationssubmitted by them and accepted by the Health Assembly;

(2) those governments which are not bound by the Regulations by virtue of rejection or of a reservationwhich has not been accepted by the Health Assembly and which has not been withdrawn by the govern-ment concerned;

4. REQUESTS the Director -General to transmit the comments on the text of the Regulations to the Committeeon International Surveillance of Communicable Diseases; and

5. REQUESTS the Director -General within the next three years to consult with countries in the yellow -feverendemic zones as originally delineated by WHO in the International Sanitary Regulations,5 as well as in thereceptive areas, in order that the infected areas might be accurately defined.

Handb. Res., 10th ed., 1.3.9.3 Sixteenth plenary meeting, 22 May 1970(Committee B, eighth report)

1 Off. Rec. Wld Hlth Org., 182, 96.2 O ff. Rec. Wld Hlth Org., 148, Annex 13.3 See Annex 12.4 Adopted by the Twenty -second World Health Assembly in its resolution WHA22.46.6 World Health Organization (1966) International Sanitary Regulations: third annotated edition, Geneva, pp. 89 -90.


WHA23.58 Disinsection of Aircraft


Having considered the difficulties which have arisen concerning the installation of the vapour disin-section system in operating aircraft in terms of resolution WHA21.51 adopted by the Twenty -first WorldHealth Assembly on 24 May 1968; and

Reaffirming the advantages of the vapour disinsection system,

1. URGES that action be taken by the Organization in collaboration with the International Civil AviationOrganization to resolve these difficulties as soon as possible and report back to the Twenty- fourth WorldHealth Assembly;

2. DECIDES that the effective date for initiation of implementation of vapour disinsection be postponed and,subject to solution of the technical difficulties, shall be 31 December 1971; and

3. RECOMMENDS to Members:

(i) that in the interim period the " blocks away " disinsection method and aerosol disinsection on theground on arrival be the approved methods for aircraft disinsection;(ii) that every effort be made by health administrations to ensure that during this interim period the" blocks away " method is applied effectively.

Handb. Res., 10th ed., 1.3.9.5 Sixteenth plenary meeting, 22 May 1970(Committee B, eighth report)

WHA23.59 General Programme of Work covering a Specific Period


Having considered the stage reached in the preparation of the fifth general programme of work for aspecific period, and the recommendations of the forty -fifth session of the Executive Board on the subject;

Recalling the conclusions of the technical discussions at the Eighteenth World Health Assembly on thenecessity for long -term planning of health programmes;

Confirming resolution WHA21.49 on long -term planning in the field of health, resolution EB43.R19on the importance of the integration of national, regional and global planning in the development of theprogramme of the Organization on a long -term basis, and resolution WHA22.53 stressing that realistic long-term planning of WHO's programme is dependent in large measure upon methodical health planning at thenational level, and recognizing the necessity of preserving flexibility to adjust programmes in the light ofchanges affecting the needs of the Organization and its Members;

Recalling also resolution WHA22.53, part I, operative paragraph 9, requesting the Director -Generalto ask Member States to send to WHO their observations and recommendations on questions of long -termplanning in the field of health and the establishment of a new general programme of work of WHO; and

Taking into consideration that these observations and recommendations will be considered by the regionalcommittees in September 1970,

1. DECIDES to extend by one year the fourth general programme of work of WHO;

2. DEEMS it necessary to prepare the fifth general programme of work of the Organization covering theperiod 1973 -1977 inclusive, taking into account the changes of priorities in national and international healthproblems and possible new trends in WHO's work which have emerged in recent years;

1 See Of Rec. Wld Hlth Org., 181, resolution EB45.R5 and Annex 7.


3. DEEMS it also necessary to proceed to the extent possible to prepare long -term projections and forecastsof the work of the Organization covering a more protracted period, with due regard to the forecast ofscientific, technological, social and economic development up to the end of the twentieth century being pre-pared by a number of countries and international organizations, also to the desirability of defining the mostprobable lines of development of medical research and practice and the possible role of the Organization inresolving major world health problems in the future;

4. DRAWS special attention to the following important functions of the Organization laid down by itsConstitution and in the decisions of previous Health Assemblies, which must be taken into account in thepreparation of the fifth general programme and of long -term projections and forecasts for the work of theOrganization:

(a) analysis and evaluation of information on the state of health of the world population and on environ-mental health (the preservation and improvement of which are vital to the health and life of the presentgeneration and of future generations), with a view to identifying general trends in the world healthsituation and to evolving a strategy in regard to the most promising ways of developing health servicesand medical science;

(b) study of the methodology of the planning, organization and socio- economic analysis of differenthealth systems and services of different countries and the preparation of realistic recommendations onthe best ways in which they might develop, taking into account the importance of the development anduse of cost -effectiveness and cost -benefit analyses in the field of health;

(c) preparation of international agreements, conventions and regulations on the most important healthproblems, including questions of environmental health, the importance and implications of which gobeyond individual countries or groups of countries and have a direct bearing on the protection andpromotion of health in all the countries of the world;

(d) formulation of recommendations on the establishment of standards, norms, uniform technicalspecifications and nomenclatures for chemical, physical, immunological and other substances, compoundsand preparations used in international and national health programmes;

(e) co- ordination of research on the most urgent and important problems of biology, medicine and publichealth being carried on by national and international scientific institutions, with a view to making thatresearch as effective as possible;

(f) identification of the most rational and effective ways of helping Member States to develop theirown health systems and, first and foremost, to train national health personnel at all levels, provisionof such assistance within the organizational and financial framework of the Organization and its Consti-tution, and participation in the co- ordination of such assistance from all sources; and

(g) aiming at securing the greatest participation possible of the countries of the world in the work ofthe Organization;

5. REQUESTS the Director -General, taking into account both the debates during the Twenty -third WorldHealth Assembly and the guidance of this resolution, and drawing upon such consultant services as he maydeem advisable, to prepare a report for the forty- seventh session of the Executive Board for its considerationin the preparation of the fifth general programme of work and the long -term projections; and

6. REQUESTS the Executive Board:

(i) in preparing the fifth general programme of work, to consider inter alia the desirability of devotingmore attention to standards, in the light of Article 21 of the Constitution;

(ii) to consider machinery for the formulation and discussion of proposals on the establishment of long-term projections and forecasts of the work of the Organization; and

(iii) to report on these matters to the Twenty- fourth World Health Assembly.

Handb. Res., 10th ed., 1.1.1; 1.1.1.3 Sixteenth plenary meeting, 22 May 1970(Committee B, eighth report)


WHA23.60 Human Environment

The Twenty -third World Health :Assembly,

Recalling the principles enunciated in the Constitution, including the definition of health;

Recalling resolution 2581 (XXIV) of the United Nations General Assembly, which invites the specializedagencies, the International Atomic Energy Agency and the Advisory Committee on the Application of Scienceand Technology to Development to collaborate closely with the Secretary- General of the United Nations inthe preparations for the Conference in Stockholm in 1972 and to assist, as appropriate, in the work of thePreparatory Committee;

Recalling further the responsibility of the Organization to promote, in co- operation with other specializedagencies where necessary, the improvement of the various aspects of environmental health;

Recognizing that the World Health Organization should continue its leading role in the prevention andcontrol of environmental factors adversely affecting human health;

Recalling further Article I of the Agreement between the United Nations and the World Health Organi-zation, which provides: " The United Nations recognizes the World Health Organization as the specializedagency responsible for taking such action as may be appropriate under its Constitution for the accomplishmentof the objectives set forth therein ";

Recalling as well Article IV of the Agreement between the United Nations and the World Health Organi-zation, which provides for full co- operation between WHO and the United Nations; and

Bearing in mind resolution WHA22.57 concerning the United Nations Conference on the HumanEnvironment to be held in 1972,

1. EXPRESSES its growing concern that the consequences of factors in the environment are adversely affectingthe conditions of human health;

2. REQUESTS the Director -General to develop, and submit to the Twenty- fourth World Health Assembly,a long -term programme for environmental health including, in so far as may be found practicable, a pro-gramme for a worldwide system of surveillance and monitoring in close collaboration with national andinternational efforts, determination of priorities of programmes in environmental sanitation within theSecond United Nations Development Decade, and also for establishing a code of environmental health,together with the financial implications to WHO of such a programme; and

3. EXPRESSES the wish that in this respect due consideration should be given to the effect of water, soil, foodand air pollution, noise and other environmental factors harmful to human health, and to the need for theestablishment of environmental health criteria, guidelines for preventive measures, and methods of determin-ing priorities and allocating resources based on health problems and needs in both developing and developedcountries.

Handb. Res., 10th ed., 1.4; 8.1.2 Sixteenth plenary meeting, 22 May 1970(Committee A, seventh report)

WHA23.61 Basic Principles for the Development of National Health Services


Recalling that the attainment by all peoples of the highest possible level of health is the main long -termobjective of the World Health Organization as envisaged by its Constitution, and that the most importantcondition for this is the development of efficient national health systems in all countries;

Noting the successes achieved by many countries in the development of national health systems andalso the numerous problems and difficulties faced by the developing health services in various countries, asreflected in the reports on the world health situation;


Emphasizing once more that one of the most important tasks for the governments of all countries is thecarrying out of combined measures for the protection and constant improvement of health and for promotingas far as possible the active co- operation of the population in this field;

Recalling resolutions WHA17.20, WHA20.53, WHA21.49 and EB39.R35, and again expressing itsconviction that the development of public health should form an integral part of overall national plans forsocial and economic development in each country;

Confirming the conclusions of resolution WHA20.48, arising from the organizational study of theExecutive Board on co- ordination at the national level in relation to the technical co- operation field programmeof the Organization, to the effect that it is the prime responsibility of governments to co- ordinate not onlytheir own programmes but also the aid they receive from external sources;

Noting the extensive work done by WHO to study the experience gained in developing public healthservices under various geographical, ethnic and socio- economic conditions, as reflected in the publicationscommemorating the twentieth anniversary of the World Health Organization; and

Considering that the optimum development of the national health services in any country requires theutilization of the collective experience in the development of health services gained in all the countries of theworld, and believing that study of that experience with a view to utilizing it under the specific conditionsobtaining in various countries is one of the main tasks of the World Health Organization,

1. BELIEVES that among the most effective principles for the establishment and development of nationalhealth systems are those which have been confirmed by experience in a number of countries and are set outbelow :

(1) the proclamation of the responsibility of the State and society for the protection of health of thepopulation, to be based on putting into effect a complex of economic and social measures which directlyor indirectly promote the attainment of the highest possible level of health, through the establishment ofa nation -wide system of health services based on a general national plan and local planning, and throughthe rational and efficient utilization, for the needs of the health services, of all forces and resourceswhich society at the given stage of its development is able to allocate for those purposes;

(2) the administration of rational training of national health personnel at all levels as a basis for thesuccessful functioning of any health system, and the recognition by all medical workers of their highdegree of social responsibility to society;

(3) the development of health services primarily on the basis of extensive measures to foster the pre-ventive approach both for the community and the individual which will require the integration of curativeand preventive services in all medical and health establishments and services, emphasizing the protectionof health of mothers and children who embody the future of every country and of the whole of mankind,and the establishment of effective control over the condition of the environment as a source of healthand life to present and future generations;

(4) the provision for the whole population of the country of the highest possible level of skilled, uni-versally available preventive and curative medical care, without financial or other impediments, bysetting up an appropriate system of curative, preventive and rehabilitative services;

(5) the extensive application in every country of the results of progress in world medical research andpublic health practice, with a view to ensuring conditions that will make it possible to obtain maximumeffectiveness from all health measures taken; and

(6) the health education of the public and participation of wide sections of the population in the carrying -out of all public health programmes, as an expression of the personal and collective responsibility ofall members of society for protecting human health; and

2. RECOMMENDS Member countries, having regard to their own historical, social, economic and otherconditions, to take these principles into account in establishing their health services and systems.

Handb. Res., 10th ed., 1.6 Sixteenth plenary meeting, 22 May 1970(Committee A, seventh report)


WHA23.62 General Order of Magnitude of the Budget for 1972


Having considered the report of the Director -General and Appendix 8 1 to the Proposed Regular Pro-gramme and Budget Estimates for the Financial Year 1 January to 31 December 1971, which contains atentative projection for 1972;

Having heard the statements of the Director -General concerning the future general programme develop-ments of the Organization and the trends of increase in costs of the services provided by the Organization;

Recognizing that, if no unusual events occur, the annual increase in costs of the Organization formaintaining the activities at the same level as the preceding year requires an increase in each effective workingbudget of between 4 and 5 per cent. ;

Desirous of making available sufficient funds to allow for an orderly increase in the services to be providedby the Organization to its Members, and particularly to the developing countries, in the gradual achievementof the Organization's objective under Article 1 of the Constitution; and

Conscious of the provisions of Articles 34 and 55 of the Constitution,

RECOMMENDS to the Director -General that as a general orientation in preparing his proposed programmeand budget estimates for 1972 he should, taking account of the views expressed by delegations during the dis-cussions at the Twenty -third World Health Assembly, propose an increase in the programme such as willgive a budget increase of an order of magnitude of about 10 per cent., provided that no unusual and unforeseendevelopments occur which would result in additional resources being required by the Organization, andprovided further that the budgetary results of any decisions by other organs of the United Nations systemof organizations over which the World Health Organization does not exercise control, but with which it isexpected to comply, shall be added to the general order of magnitude.

Handb. Res., 10th ed., 2.1 Sixteenth plenary meeting, 22 May 1970(Committee A, eighth report)

1 Off Rec. Wld Hith Org., 179, XLVIII.


PROCEDURAL DECISIONS

(i) Composition of the Committee on Credentials

The Twenty -third World Health Assembly appointed a Committee on Credentials consisting of delegatesof the following twelve Members: Australia, Bulgaria, Cameroon, Canada, Cyprus, Denmark, Luxembourg,Monaco, Nepal, Peru, Saudi Arabia, Uganda.

First plenary meeting, 5 May 1970

Composition of the Committee on Nominations

The Twenty -third World Health Assembly appointed a Committee on Nominations consisting ofdelegates of the following twenty -four Members: Argentina, Colombia, Czechoslovakia, Ethiopia, France,Ghana, Guyana, India, Italy, Ivory Coast, Kenya, Libya, Malaysia, Malta, New Zealand, Nicaragua, Norway,Pakistan, Senegal, Thailand, Tunisia, Union of Soviet Socialist Republics, United Kingdom of GreatBritain and Northern Ireland, United States of America.

First plenary meeting, 5 May 1970

(iii) Verification of Credentials

The Twenty -third World Health Assembly recognized the validity of the credentials of the followingdelegations :

Members

Afghanistan, Albania, Algeria, Argentina, Australia, Austria, Barbados, Belgium, Bolivia, Brazil,Bulgaria, Burma, Burundi, Cambodia, Cameroon, Canada, Central African Republic, Ceylon, Chad, Chile,China, Colombia, Congo (Democratic Republic of), Costa Rica, Cuba, Cyprus, Czechoslovakia, Dahomey,Denmark, Dominican Republic, Ecuador, El Salvador, Ethiopia, Federal Republic of Germany, Finland,France, Gabon, Ghana, Greece, Guatemala, Guinea, Guyana, Honduras, Hungary, Iceland, India,Indonesia, Iran, Iraq, Ireland, Israel, Italy, Ivory Coast, Jamaica, Japan, Jordan, Kenya, Kuwait, Laos,Lebanon, Lesotho, Liberia, Libya, Luxembourg, Madagascar, Malawi, Malaysia, Mali, Malta, Mauritania,Mauritius, Mexico, Monaco, Mongolia, Morocco, Nepal, Netherlands, New Zealand, Nicaragua, Niger,Nigeria, Norway, Pakistan, Panama, People's Republic of the Congo, Peru, Philippines, Poland, Portugal,Republic of Korea, Romania, Rwanda, Saudi Arabia, Senegal, Sierra Leone, Singapore, Somalia, SouthernYemen, Spain, Sudan, Sweden, Switzerland, Syria, Thailand, Togo, Trinidad and Tobago, Tunisia, Turkey,Uganda, Union of Soviet Socialist Republics, United Arab Republic, United Kingdom of Great Britainand Northern Ireland, United Republic of Tanzania, United States of America, Upper Volta, Uruguay,Venezuela, Viet -Nam, Western Samoa, Yemen, Yugoslavia, Zambia.

Associate Members

Bahrain, Qatar.Sixth, ninth and thirteenth plenarymeetings, 7, 13 and 18 May 1970


(iv) Election of Officers of the Twenty -third World Health Assembly

The Twenty -third World Health Assembly, after considering the recommendations of the Committeeon Nominations, elected the following officers:

President: Professor H. Ayé (Ivory Coast);Vice- Presidents: Dr P. D. Martínez (Mexico), Dr A. Majali (Jordan), Mr S. C. Chua (Singapore),Dr Damdinghin Tumendelger (Mongolia), Dr Esther Ammundsen (Denmark).

Second plenary meeting, 5 May 1970

(v) Election of Officers of the Main Committees

The Twenty -third World Health Assembly, after considering the recommendations of the Committeeon Nominations, elected the following officers of the main committees:

COMMITTEE A: Chairman, Dr M. A. Aldea (Romania);

COMMITTEE B: Chairman, Dr W. E. Ravenna (Uruguay).


The main committees subsequently elected the following officers:

COMMITTEE A: Vice -Chairman, Dr P. K. Duraiswami (India); Rapporteur, Dr F. Urcuyo (Nicaragua),later, Dr D. Castillo (Venezuela);

CoMMIrrEE B: Vice -Chairman, Dr C. K. Hasan (Pakistan); Rapporteur, Dr B. Kourouma (Guinea).

(vi) Establishment of the General Committee

The Twenty -third World Health Assembly, after considering the recommendations of the Committeeon Nominations, elected the delegates of the following fourteen countries as members of the General Com-mittee: Central African Republic, France, Ghana, Kuwait, Malaysia, Peru, Senegal, Syria, Thailand, Trinidadand Tobago, Uganda, Union of Soviet Socialist Republics, United Kingdom of Great Britain and NorthernIreland, United States of America.


(vii) Adoption of the Agenda

The Twenty -third World Health Assembly adopted the provisional agenda prepared by the ExecutiveBoard at its forty -fifth session, with the deletion of three items, the inclusion of two supplementary items,and the reallocation of certain items to the main committees.

Third plenary meeting, 6 May 1970

1 For agenda as adopted, see Of Rec. WId HIM Org., 185.

ANNEXES

Annex 1

REPORTS OF THE LÉON BERNARD FOUNDATION COMMITTEE

1. FINANCIAL REPORT ON THELEON BERNARD FOUNDATION FUND

[A23/3 - 24 March 1970]

The Léon Bernard Foundation Committee met on26 January 1970 under the chairmanship of ProfessorI. Moraru, and noted the following situation of theFund, presented by the Director -General of the WorldHealth Organization as Administrator of the LéonBernard Foundation:

Sw. fr.

Balance on 1 January 1969 17 847.70

Receipts

Interest earned in 1969 986.80

18 834.50Disbursements nil

18 834.50

Less :

Capital of the Foundation 17 000.00

Accumulated surplus as at 31 December 1969 . . . 1 834.50

The Committee further noted that the Fund's finan-cial situation was able to cover the expense of awardinga prize in 1970.

The Committee was also informed that the 1969Committee of the Léon Bernard Foundation, havingnoted that the Fund's financial situation had not beenable to cover the expenses of awarding a prize onseveral occasions (1956, 1959, 1960, 1961, 1963, 1965and 1969), felt that, as the award of the prize was tohonour an individual and to stimulate and encouragework in the field of social medicine, it might be usefulto consider awarding the Léon Bernard FoundationPrize annually as an incentive for workers in that field;and in order to enable the awarding of an annual prize,suggested that the following possibilities be explored:

(1) increasing the capital of the Foundationthrough an appeal for voluntary contributions;

I See resolution WHA23.4.

(2) transferring from other sources such as casualincome an amount of money to cover the deficitbetween the accumulated annual surplus and theamount requested to cover the expense of awardinga prize every year;

(3) reviewing the investment portfolio with theobjective of providing a higher rate of interest.

After reviewing the situation, the Director -Generaladopted the third possibility and, in order to takeadvantage of the present high interest rates on timedeposits, has modified the portfolio by selling a partof the holdings and by placing the proceeds on interest -earning deposit with WHO. This action will ensurea sufficient amount of interest to enable the Committeeto make annual awards for as long as interest rates donot drop below the level of 7 per cent.

The Committee endorsed this action.

2. REPORT OF THE LEON BERNARD FOUNDATIONCOMMITTEE ON ITS MEETING OP 26 JANUARY 1970

[A23/2 - 24 March 1970]

The Léon Bernard Foundation Committee met on26 January 1970 in conformity with the Statutes of theLéon Bernard Foundation under the chairmanship ofProfessor I. Moraru, to propose to the Twenty -thirdWorld Health Assembly a candidate for the award ofthe Léon Bernard Foundation Prize in 1970. TheCommittee noted the replies received to the Director -General's letter of 20 October 1969 requesting nomi-nations, and examined the documentation received insupport of the proposed candidates.

The Committee decided not to consider the nomi-nations which arrived after 1 December 1969, theclosing date given in the Director -General's letter.

The Committee was impressed by the exceptionalmerit of each of the candidates proposed, the highstandard of their qualifications and their contributionto social medicine, the alleviation of human sufferingand the development of international health.

The Committee eventually decided unanimously torecommend to the World Health Assembly that theLéon Bernard Foundation Prize be awarded in 1970to Dr A. L. Mudaliar.

- 41 --


During almost half a century of active service in thefield of medicine, Dr Mudaliar has worked withoutstanding success in the fields of obstetrics andgynaecology, education and health administration,social medicine and international health. During histerm of office as Vice -Chancellor of the University ofMadras for 27 years, Dr Mudaliar made a lastingcontribution to the improvement of the level ofmedical education in India. His many reports and

books have benefited a great number of health workersin India and abroad.

During his distinguished career, Dr Mudaliar wasinfluential in the planning and organization of healthservices in India. The perseverance with which heachieved what he set out to do, in spite of great diffi-culties, has been a source of inspiration to workers inthe field of social medicine and international healthall over the world.

Annex 2

REPORTS OF THE DR A. T. SHOUSHA FOUNDATION COMMITTEE 1

1. FINANCIAL REPORT ON THEDR A. T. SHOUSHA FOUNDATION FUND

[A23/5 - 24 March 1970]

The Dr. A. T. Shousha Foundation Committeemet on 27 January 1970 under the chairmanship ofDr J. Anouti. The financial situation of the Fund waspresented by the Director -General of the World HealthOrganization, as Administrator of the Dr A. T.Shousha Foundation, as follows:

1. Capital AccountUss

Foundation capital at 31 December 1968 . . . 26 267.09Donations received in 1969:

Mauritania 408.16

Foundation capital at 31 December 1969 . . . 26 675.25

US $ Us$2. Revenue Account

Accumulated surplusat 31 December 1968 682.13

Revenue

Interest earned in 1969 1 787.71 2 469.84

Expenditure1969 Award:

The late Dr M. K. Afridi (Sw. fr. 1000) . 231.48

Accumulated surplus at 31 December 1969 . . . 2 238.36

(or Sw. fr. 9 669.70)

The Committee noted that the financial situationwas able to cover the award of the prize in 1970.

1 See resolution WHA23.10.

2. REPORT OF THE DR A. T. SHOUSHA FOUNDATIONCOMMITTEE ON ITS MEETING OF 27 JANUARY 1970

[A23/4 - 24 March 1970]

The Dr A. T. Shousha Foundation Committeemet on 27 January 1970 in conformity with the Statutesof the Dr A. T. Shousha Foundation. The Committeeelected Dr J. Anouti as Chairman of the meeting.

The Committee reviewed the replies received fromMember States of the geographic area in whichDr A. T. Shousha served the World Health Organ-ization, and from the former recipient of the prize,together with the supporting documentation.

The Committee decided to recommend to the WorldHealth Assembly that the Dr A. T. Shousha Prize for1970 be awarded to Dr Sabih Al- Wahbi.

Dr Al -Wahbi has had an outstanding career in thepublic health services in his country and in the inter-national health field. During his 40 years of activeservice he was influential in organizing the basic healthservices with an adequate system of co- ordinationbetween preventive and curative medicine. This helpedto improve the standard of medical care and publichealth services in Iraq. He established the first NursingCollege and initiated the establishment of the secondMedical College in the country.

One of Dr Al- Wahbi's significant contributions tothe health problems in the geographical area in whichDr A. T. Shousha served the Organization was thesuccessful implementation of the mass campaignagainst "Bejel" in Iraq. The project served as a goodexample for a similar subsequent campaign against thesame disease in the Syrian Arab Republic. Its suc-cessful results stimulated the undertaking of otherprojects for the control of endemic syphilis in a numberof countries in the Eastern Mediterranean Region.

ANNEX 3 43

Annex 3

FINANCIAL REPORT ON THE ACCOUNTS OF WHO FOR 1969AND REPORT OF THE EXTERNAL AUDITOR 1

[A23 /AFL /12 -7 May 1970]

FIRST REPORT OF THE AD Hoc COMMITTEE OF THE EXECUTIVE BOARD

1. At its forty -fifth session, the Executive Board, inresolution EB45.R43, established an Ad Hoc Com-mittee consisting of Sir William Refshauge, DrB. Juricic and Professor J. F. Goossens to considerthe Financial Report on the accounts of the Organi-zation for 1969 and the Report of the External Auditorand, in accordance with Financial Regulation 12.4,to submit to the Twenty -third World Health Assembly,on behalf of the Board, such comments as it deemeednecessary.

2. The Committee met on 4 May 1970. Sir WilliamRefshauge was unable to attend. Dr B. D. B. Laytonwas appointed in accordance with paragraph 3 ofresolution EB45.R43 by the Chairman of the Board toserve on the Ad Hoc Committee. Dr B. Juricic waselected Chairman.

3. The Committee reviewed the Financial Report ofthe Director -General for 1969 and the Report of theExternal Auditor, as contained in Official RecordsNo. 183.

4. The Committee noted that during 1969 theOrganization had obligated $61 686 546, or 99.3 percent. of the effective working budget, leaving a budgetsurplus of $435 154. The total assessment on Membersfor 1969 was $59 046 750, of which $50 465 083 hadbeen collected. This amount, together with otherincome for the 1969 budget, brought total income to$53 540 033. The resultant cash deficit for 1969 was$8 146 513, which was covered by an advance fromthe Working Capital Fund, pending receipt of contri-butions. At 30 April 1970 $6 752 096 of this amountof contributions outstanding had been received andcredited to the Working Capital Fund. The balanceof the cash deficit, amounting to $1 394 417, whichremains to be reimbursed to the Working Capital Fund,is expected to be received during the remainder of 1970.

5. The Committee noted with satisfaction the com-ments of the External Auditor in paragraphs 7, 8 and9 of his report 2 on his examination of the electronic

1 See resolution WHA23.5.2 Off. Rec. Wld Hlth Org.,1183, 111.

data processing of the payroll in WHO, on the ade-quacy of the allotment system as a means of controllingbudgetary expenditures, and on the grants, bequestsand gifts received by the Organization for specificpurposes. With particular reference to the payrollexamination, the Committee was informed that during1969 the Organization had installed an integratedpersonnel payroll application on its computer, whichhad been subject to an examination in depth by theExternal Auditor and his own specialized staff in thisfield. As regards the examination of the allotmentcontrol system, the External Auditor was supplied, athis request, with representative samples of allotmentsand comparative schedules showing amounts budgetedand allotments and subsequent revisions against them,as well as the obligations incurred. The Committeealso noted that the substantive and satisfactorycomments on these important aspects of financialprocedures and control had been made under hisexisting terms of reference. In this connexion theCommittee recalled the discussions which had takenplace at the Twenty- second World Health Assemblyconcerning the external audit, and the resolution ofthe Assembly, WHA22.4, which requested the ExternalAuditor, " in accordance with paragraph 5 of the' Principles to govern the audit procedures of theWorld Health Organization ', to include in his reports,beginning with his examination of the accounts for1969, substantive comments on the administration andmanagement of the Organization ".

6. In paragraph 12 of his report, the External Auditorhad indicated that a letter dealing with certain ques-tions resulting from the audit had been addressed tothe Assistant Director -General responsible for adminis-tration and finance. The Committee had before it thecontents of the letter as well as the reply sent by theOrganization to the External Auditor. The Committeenoted with satisfaction the replies given by the Assis-tant Director -General.

7. In considering the Statement of Assets and Liabili-ties of the Organization as at 31 December 1969, theCommittee noted that the Executive Board SpecialFund, established in 1954 at $100 000, and which wasset up in compliance with Article 58 of the Constitution,


had not been used in the past several years. It alsonoted that the size of the Fund is not sufficiently largeto meet important emergencies. However, the Director -General, either on his own authority or with the priorconcurrence of the Executive Board, has the possibilityof resorting to the use of the Working Capital Fundto meet unforeseen and extraordinary expenses.

8. In the course of its review, the Committee raisedquestions about the Terminal Payments Account. Itwas recalled that the Account had been established bythe Director -General in 1964 and its establishmentreported to the thirty -fifth session of the ExecutiveBoard in 1965 in accordance with Financial Regulation6.6. As noted in the Director -General's report dated27 November 1964 to the Executive Board,1 the Di-rector- General had established the Account becausehe considered it prudent to make provision over aperiod of time for the considerable amount of terminalentitlements which were building up as a liability ofthe Organization towards its staff. The Director -General recognized that a staff member during histotal service with WHO may serve on programmesfinanced from different sources of funds. It was there-fore necessary to establish a financial procedure toensure that each programme and source of fundswould bear its appropriate share of the final payment ofterminal entitlements to the staff member. In order toachieve this, and for reasons of sound financial man-agement, the Terminal Payments Account was es-tablished. It was funded initially with the balanceavailable in the Service Benefit Account and later bybudgetary provisions calculated as a percentage ofsalary to be transferred to the Account. A percentageof salaries is transferred to this account from all sourcesof funds, including the regular budget, United NationsDevelopment Programme funds, the Voluntary Fundfor Health Promotion, and trust and reimbursablefunds. The Committee noted that the TerminalPayments Account is not yet at the level which wouldbe required to meet all outstanding obligations. Oncean adequate level has been reached the percentage tobe applied will be reviewed from time to time to ensurethat credits to the Account are sufficient both tooffset expenditures from the Account and provide fora gradual growth of the Account to meet its total

1 Off. Rec. Wld Hlth Org., 140, Annex 13.

requirement, which, at the present level of operations, isestimated to be $10 million. However, this requirementmay become larger as terminal payments costs increase.At the present time the Account is used to pay onlyrepatriation grants and pension fund validations. Thelatter will gradually decrease, but it is expected even-tually to meet all other terminal payments from theAccount, namely repatriation travel and householdremoval, and accrued annual leave. The followingtable shows the net annual increase and the balanceof the Account for the years 1964 through 1969, withappropriate references to the annual Financial Reportsof the Organization :

OfficialRecords

No. Page

Financial Reportfor the year

Net annualincrease

US $

Balance of Account

US $

134 23. 1963 1 059 332*142 23 1964 90 081 1 149 413150 22 1965 523 166 1 672 579159 20 1966 1 040 130 2 712 709167 19 1967 1 058 146 3 770 855175 19 1968 706 614 4 477 469183 25 1969 1 228 739 5 706 208

Transferred from Service Benefit Account.

9. Following its examination of the Financial Reporton the accounts of the Organization for 1969, and theReport of the External Auditor thereon, the Committeedecided to recommend to the Twenty -third WorldHealth Assembly the adoption of the followingresolution:


Having examined the Financial Report of theDirector -General for the period 1 January to 31 De-cember 1969 and the Report of the External Auditorfor the same financial period, as contained inOfficial Records No. 183 ; and

Having considered the report of the Ad HocCommittee of the Executive Board on its examin-ation of these reports;

Noting with satisfaction that the External Auditorhas included in his written report to the HealthAssembly substantive comments on the administra-tion and management of the Organization,

ACCEPTS the Director -General's Financial Reportand the Report of the External Auditor for the finan-cial year 1969.

ANNEX 4 45

Annex 4

MEMBERS IN ARREARS IN THE PAYMENT OF THEIR CONTRIBUTIONSTO AN EXTENT WHICH MAY INVOKE THE PROVISIONS OF ARTICLE 7

OF THE CONSTITUTION

1. SECOND REPORT OF THE AD Hoc COMMITTEE OF THE EXECUTIVE BOARD

1. At its forty -fifth session, the Executive Board, inresolution EB45.R43, established an Ad Hoc Commit-tee consisting of Sir William Refshauge, Dr B. Juricicand Professor J. F. Goossens. The Committee, inaccordance with resolution EB45.R25, was to " con-sider all the circumstances involving those Memberswhich, at the time of its meeting", prior to the Twenty -third World Health Assembly, " remain in arrears inthe payment of their contributions to an extent whichmay invoke Article 7 of the Constitution, and tosubmit to the Twenty -third World Health Assemblyon behalf of the Board such recommendations as itdeems desirable ".

2. The Committee met on 4 and 8 May 1970. SirWilliam Refshauge was unable to attend. Dr B. D. B.Layton was appointed in accordance with paragraph3 of resolution EB45.R43 by the Chairman of theBoard to serve on the Ad Hoc Committee. Dr B.Juricic was elected Chairman.

3. The Committee considered the report of theDirector -General and took note of the situation con-cerning Members in arrears. It requested the Director -General to communicate on its behalf with thoseMembers concerning whose arrears no informationhad been received in reply to the Director -General'sprevious communications.

4. Accordingly, a cable was sent which requestedthose Members to pay their arrears, or, if they wereunable to do so, to communicate the difficulties theywere experiencing in making such payments.

5. The Committee at its meeting on 8 May 1970 wasinformed that payments had been received fromBolivia, El Salvador and Peru. It noted that thepayment by Bolivia of US $25 541, by Peru ofUS $100 880 and by El Salvador of US $23 170resulted in these countries no longer being in arrearsto an extent which might invoke the provisions ofArticle 7 of the Constitution.

[A23 /AFL /16 -8 May 1970]

6. Taking account of the above payments, the posi-tion concerning Members in arrears to an extent whichmight invoke the provisions of Article 7 of the Con-stitution is shown in the Appendix to this report.

7. A communication from Uruguay indicates thatpayment of its 1968 contribution is in process, which,when received, is sufficient to result in Uruguay nolonger being in arrears to an extent which might invokethe provisions of Article 7 of the Constitution.

The Committee considers that this communicationis a firm indication of Uruguay's intent to settle itsarrears for 1968.

8. A communication from Haiti proposes a settle-ment of its arrears and current contributions starting in1970 which is similar to the arrangements proposed byHaiti in 1966 and accepted by the Nineteenth WorldHealth Assembly in its resolution WHA19.29. TheCommittee does not see any reason for amending thedecision taken in 1966; it suggests that the HealthAssembly may wish to request Haiti to implementthat decision.

9. With reference to the arrears of Southern Rhodesia,the Committee recalled that a communication dated22 May 1969 had been received by the Director -General from the Department of Health and SocialSecurity of the United Kingdom, and had been pre-sented to the Twenty- second World Health Assemblywhen it considered the same subject. This communi-cation stated, inter alla, that " Financial transactionsbetween the Organization and the regime (includingthe payment of contributions) have been suspended ".In view of this situation of continuing non -paymentof the contribution of Southern Rhodesia, the Com-mittee invited the Director -General to study the futuretreatment of the assessment of Southern Rhodesia,and to submit a report to the forty- seventh session ofthe Executive Board.

10. The Ad Hoc Committee expressed its concern1 See resolution WHA23.39. that some Members continue to be in arrears to an


extent which made it necessary for the Board and theHealth Assembly to consider this matter. They recog-nized that some Members had made an effort tosettle their arrears prior to the consideration by theHealth Assembly of this subject. The Committeerequested the Director -General to report to the HealthAssembly any further payments or communicationsreceived.

11. The Ad Hoc Committee suggests that CommitteeB of the Health Assembly request the Director -Generalto send on its behalf cables to the Dominican Republic,Haiti and Paraguay urging settlement of their art earswithout delay and that they reply by cable as soon aspossible so that the Committee may take definitiveaction on this matter no later than Monday, 18 May1970.

Appendix

Amounts due

Member Instalment Instalment Instalment1965 1966 1967 on arrears

payablein 1967

1968 on arrearspayablein 1968

1969 on arrearspayablein 1969

Total

Uss US$ Us$ US$ Uss Us$ Uss US$ US$

Dominican Republic . . . 16 610 a 17 410 21 320 - 23 170 - 25 140 - 103 650Haiti b - - 14 585 a 3 367 23 170 3 367 25 140 3 367 72 996Paraguay - 19 130 a - 23 170 - 25 140 - 67 440Southern Rhodesia e . . . - -- 10 660 - 11 590 - 12 580 - 34 830Uruguay d - - - - 52 140 - 50 280 - 102 420

a Balance of contribution.b See resolution WHA19.29.c Associate Member.d See para. 7 of the above report.

2. REPORT BY THE DIRECTOR -GENERAL

1. A remittance of US $52 140 was received fromUruguay on 12 May 1970, in payment of its contri-bution for 1968. As a result of this payment, Uruguayis no longer in arrears to an extent which might invokethe provisions of Article 7 of the Constitution.

2. As requested by Committee B of the Twenty -thirdWorld Health Assembly, the Director -General sent onits behalf cables to the Dominican Republic, Haitiand Paraguay urging settlement of their arrears with-out delay, and requested them to reply by cable assoon as possible so that the Committee may takedefinitive action on this matter no later than Monday,18 May 1970.

3. The Director - General has received a letter dated12 May 1970 from the Permanent Delegation of theDominican Republic to the International Organi-zations in Geneva (see section 1 of the Appendix tothis report). In view of the assurances given by the

[A23/AFL/16 Add.1 - 18 May 1970]

Permanent Representative of the Dominican Republicin his communication of 12 May 1970, the Director -General intends to pursue the matter with that MemberState.

4. The Director -General has also received a cablefrom the Government of Haiti dated 16 May 1970(see section 2 of the Appendix). As will be seen fromthat communication, the Government of Haiti hasgiven a firm indication that payment of the 1969contributions will be made on 19 May 1970.

5. No reply has been received from Paraguay inresponse to the cable which the Director -General sentat the request of Committee B

6. As regards Haiti and Paraguay, it will be noted thatneither Member has a representative at the Twenty -third World Health Assembly and therefore the ques-tion of voting rights does not arise.

ANNEX 5 47

Appendix

1. Letter, dated 12 May 1970, from the Permanent Delegationof the Dominican Republic to the International Organizationsin Geneva, to the Director -General of the World HealthOrganization (translation from the Spanish)

With reference to telegram No. 2291 of 11 May 1970, addressedto the Secretary of State for Public Health and Social Welfareof the Dominican Republic, with a copy to this PermanentDelegation, and containing the information that Committee Bof the Twenty -third World Health Assembly, now meeting inthis city, has requested payment of the arrears of contributionsto the Organization before Monday, 18 May 1970, I have toreport as follows:

The Dominican Republic is at present going through an agi-tated period of general elections which will culminate nextSaturday on 16 May 1970. As a result, for some time past diffi-culties have been occurring within the administrative servicesof the Republic in the normal processing of correspondence, andI therefore do not think that there will be any reply to the requestcontained in your telegram before the time limit indicated in it.

I am sure that, as soon as the country emerges from the presentexceptional period, the in- coming government will take all nec-essary steps to enable the Dominican Republic to fulfil itscommitments to the World Health Organization.

2. Telegram, dated 16 May 1970, from the Minister of ForeignAffairs, Republic of Haiti, to the Director -General of theWorld Health Organization (translation from the French)

Reference cable 11 May Director -General concerning contri-butions Haiti to WHO we renew for any necessary purposes ourassurance that payment contributions for year 1969 will be madeTuesday, 19 May 1970. Refer Committee concerning termspayment arrears to previous letter addressed to WHO. On behalfGovernment of Haiti beg Committee of Twenty -third Assemblyto consider efforts for solvency despite unfavourable economicconditions and to guarantee by their decision the right of thedelegation of Haiti to vote.

Annex 5

HEADQUARTERS ACCOMMODATION

REPORTS BY THE DIRECTOR -GENERAL

1. FUTURE REQUIREMENTS

1. The Health Assembly will wish to take note ofthe discussion which took place at the forty -fifthsession of the Executive Board with regard to futurerequirements for headquarters accommodation.2 Thiswas part of the discussion under the Executive Boardagenda item " Revolving Fund for Real Estate Oper-ations ". The Board adopted resolution EB45.R19,which is for consideration of the World HealthAssembly under agenda item 3.11.

2. The discussion in the Board was based upon thereport of the Director- General to the Board whichappears as Annex 12, pages 184 to 189, of OfficialRecords No. 181, of which the Appendix, on pages187 to 189, records in condensed form the discussionwhich had taken place at the Twentieth World HealthAssembly regarding the provision of additional officeaccommodation at headquarters.

3. As is reflected in this record, the major concern atthe Twentieth World Health Assembly was that the

1 See resolution WHA23.7.2 Summary records of the forty -fifth session of the Executive

Board (EB45 /SR /7 Rev. 1, pp. 106 -110 and 115 -118; EB45 /SR /8Rev. 1, pp. 124 -125).

[A23 /AFL /9 -6 May 1970]

Organization proceed as expeditiously as possible tothe acquisition of additional land necessary for theconstruction of a permanent extension of the head-quarters building, together with provision, if possible,of space for further temporary office accommodationpending the construction of an additional permanentbuilding.

4. In complying with the terms of resolutionWHA22.18, the Director -General can at this momentonly report that negotiations with regard to the acqui-sition of additional land are still proceeding. Certainrecent developments give hope that the Organizationmay be able to acquire some additional land this year,thus permitting the Director -General to begin theplanning of the construction project. Hopefully, thismay include an area for a further temporary buildingin the interim, which will now certainly be required inview of the long delay in beginning the planning of anadditional permanent construction.

5. The Director - General expects that he will be ableto make a more specific report to the Executive Boardat its forty -seventh session and to the Twenty -fourthWorld Health Assembly.


2. FINANCING OF HEADQUARTERS BUILDING'

1. The Standing Committee of the Executive Boardon Headquarters Accommodation, which was estab-lished pursuant to the terms of resolution WHA13.46,was informed at its fourteenth session in January 1967 2of a second litigation which had been initiated againstthe Organization by the Compagnie française d'Entre-prises (CFE), the contractor for the main works of theheadquarters building. In accordance with the termsof the General Conditions of Contract applicable toall contracts for the construction of the headquartersbuilding, the claim had been referred for arbitrationto an arbitral tribunal in the same manner as for thefirst litigation initiated by this company. (The con-clusion of the first litigation had been a matter reportedto the Standing Committee on Headquarters Accom-modation at the same fourteenth session.2)

2. In May 1967, the Twentieth World HealthAssembly had before it a report on the estimated finalcost of the building project 3 presented by the Ad HocCommittee of the Executive Board which met justprior to the Assembly. Annexed to that report wasa report by the Director -General of which the lastparagraph read:

The Director -General feels that he should againstress that this figure makes no allowance for thesecond litigation concerning the construction costsintroduced by the Compagnie française d'Entreprises,a litigation which is still under examination by thearbitration tribunal established to examine it;pending judgement in this case, the Organization isnot assuming liabilities on this account.

3. In the consideration of this report by the Com-mittee on Administration, Finance and Legal Matters,at the Twentieth World Health Assembly, there wasan extended discussion of this litigation and it wasrecognized that the Organization could only await theoutcome of the arbitration procedure which was inprogress.4 As is reflected in the several references tothis arbitration, the Director -General consistentlymaintained before the arbitral tribunal that the claimsof the company were unfounded.

4. Because of the complexity of the issues involved,the arbitral tribunal has several times requested theextension of its mandate in order to allow additionaltime for it to arrive at a decision. The tribunal hasnow finally rendered its award on 30 April 1970. The

1 See resolution WHA23.18.2 Off. Rec. Wld Hlth Org., 157, 39.3 Off Rec. Wld Hlth Org., 160, 40.4 Off. Rec. Wld Hlth Org., 161, 428 -432.

[A23 /AFL /l l -6 May 1970]

award is a very lengthy technical document, and is notannexed. In summary, the arbitrators, while rejectingthe major part of the contentions of the Compagniefrançaise d'Entreprises (CFE), have concluded that oncertain technical points the company has a legitimateclaim for additional payments. Thus, whereas thecompany claimed approximately Sw.fr. 8 000 000, thetribunal has awarded Sw.fr. 2 445 015. Interest on theamount, at the rate of 5 per cent., to 1 May 1970,amounts to a further Sw.fr. 587 280. The WHO shareof the cost of the arbitration itself represents Sw.fr.17 360.20 and the Organization will in addition havefees to pay to its own member of the tribunal and tothe attorney whom it engaged to present its case, theprecise amounts of which are not yet known.

5. The arbitration procedure provided for in theGeneral Conditions of Contract was established inrecognition of the Organization's immunity from legalprocess under the terms of the agreement with the hostgovernment. Having voluntarily submitted, for thisreason, to the creation of such an arbitration ma-chinery, the Organization has no alternative at thispoint but to accept the outcome of the application ofsuch a procedure. The award of the arbitral tribunaltherefore represents a commitment of the Organization.It is considered fortunate that the judgement of thetribunal is available at an appropriate time to berepotted to the Health Assembly, to enable it to con-sider the financial consequences.

6. As reflected in the report to the Twentieth WorldHealth Assembly,3 no provision was made in theHeadquarters Building Fund to meet the cost of anysuch award, since the Organization did not acknow-ledge that the claims of the company should be recog-nized. It is now necessary to consider how the con-sequences of this judgement will be financed. TheAssembly will have for consideration under agendaitem 3.11 a recommendation of the Director -General,endorsed by the Executive Board at its forty -fifthsession, to establish a Real Estate Fund for the financ-ing of all the Organization's real estate operations.

7. The payment of the arbitration award to the CFEand related expenses is a part of the total cost ofconstructing the headquarters building and thus a realestate item. The Director -General therefore suggeststhat this obligation be met by transfer from the pro-posed Real Estate Fund to the Headquarters BuildingFund of the amount of this arbitration award, to-gether with the amount of WHO's share of the cost ofthe arbitration and the related fees. Such a procedure

ANNEX 6 49

will involve transferring credits to the HeadquartersBuilding Fund only to the extent which finally provesnecessary when all the costs are known and will thusfacilitate the closing of the Headquarters BuildingFund in this financial year.

8. The Assembly will wish to recognize that, inauthorizing the credits to meet these outstandingobligations, it is amending the provisions of resolutionWHA20.11 in which the authorized cost of the head-quarters building was established at Sw.fr. 63 500 000.

Annex 6

REAL ESTATE FUND 1

REPORT BY THE DIRECTOR -GENERAL

1. Having considered a report by the Director -General concerning the establishment of a Real EstateFund,* the Executive Board at its forty -fifth sessionadopted resolution EB45.R19, which includes a re-commended resolution for adoption by the Twenty -third World Health Assembly. Paragraph 1 of thelatter resolution reads, inter alia:

DECIDES that:

(i) a new Real Estate Fund be established and theRevolving Fund for Real Estate Operations bedisestablished;

(ii) the assets and liabilities of the disestablishedRevolving Fund for Real Estate Operations betransferred to the Real Estate Fund;(iii) the Real Estate Fund be credited with receiptsof rentals relating to real estate operations and thatadditional credits in the Fund be built up graduallyby the use of available casual income;

(iv) interest earned on the investments of the Fundbe credited to the Fund;

Paragraph 2 reads as follows:

DECIDES that replenishments of, or increases in,the Fund shall be made by appropriations by theHealth Assembly from casual income; these appro-priations shall be voted separately from the appropri-ation for the relevant budget year.

2. The Executive Board did not make any recom-mendation on the amount of casual income whichmight be initially appropriated by the Health Assemblyto the Fund.

3. In his report to the Executive Board,* the Director -General pointed to the problems facing the Organi-

1 See resolution WHA23.15.* Off. Rec. Wld Hith Org., 181, Annex 12.

[A23 /AFL /14 -7 May 1970]

zation in providing the financing of urgent real estaterequirements, and he proposed that " the HealthAssembly authorize an initial transfer to the Fundof the balance of casual income available at 31 De-cember 1969 after providing $1 000 000 of such incometo help finance the 1971 budget ".

4. When the Executive Board at its forty -fifth sessiondiscussed the amount of casual income to be used tohelp finance the proposed programme and budgetestimates for 1971, the Director -General, inter alia,stated that " he recognized that, if the Health Assemblyadopted the recommendation of the Board in itsresolution EB45.R18, there would be an excess in theWorking Capital Fund on 1 January 1971 of $1 136 560,which could revert to casual income or could be usedfor other appropriate purposes. He was similarlyaware of the fact that after providing $1 000 000 ofthe casual income available at 31 December 1969there would remain an estimated balance of $1 257 300.As he had explained to the Board, there were urgentrequirements to be met from the proposed RealEstate Fund and he hoped that, if the Twenty -thirdWorld Health Assembly agreed to the establishment ofthat fund, it would authorize the transfer of boththese amounts as initial credits to the Real EstateFund, the demands on which, even in the periodbetween the present Board and the Twenty -thirdWorld Health Assembly, might be quite considerable." *

5. The Director -General's report under agenda item3.12.1, Headquarters accommodation: future re-quirements,* recalls the continuing urgent problemof acquisition of land to permit the planning of aproject to construct additional permanent officeaccommodation. It also refers to the now evidentneed for a second temporary building to provideoffice space pending the completion of a permanent

8 Off Rec. Wld Hith Org., 182, 99, para. 12.4 See Annex 5, part 1.


structure. Funds for these purposes are likely to beneeded in 1970 and 1971.

6. In his report under agenda item 3.12.2, Head-quarters accommodation: report on financing,1 theDirector -General is proposing that the cost to theOrganization as a consequence of the judgement of thetribunal on the second litigation between the Organi-zation and the contractor for the main works of theheadquarters building should be met from the RealEstate Fund, conditional upon the Health Assemblyproviding sufficient credits to that fund.

7. As indicated in the Director -General's report tothe Executive Board,2 the requirements for additionalhousing for staff of the Regional Office for Africa areparticularly urgent and an estimated amount of $845 000will be needed for this purpose in 1970. In addition, anestimated amount of $385 000 will be needed in 1971 tobegin the first stage of a further extension to the Regio-nal Office building in Brazzaville. An extension of theRegional Office building for South -East Asia will alsobe necessary to meet additional space requirements

foreseen by 1972. According to tentative plans forsuch an extension, the cost is estimated at $110 000.The report of the Director -General also referred topotential needs of other regional offices, the costs ofwhich cannot now be determined.

8. To meet part of the costs referred to in the aboveparagraphs 5, 6 and 7 from the Real Estate Fund,the Director -General recommends that the HealthAssembly appropriate an amount of $3 000 000 to theReal Estate Fund, after providing $1 000 000 to helpfinance the 1971 budget. The amount of $3 000 000can be derived from the following sources : miscel-laneous income available at 31 December 1969 of$1 333 665; accumulated cash in the AssemblySuspense Account as at 30 April 1970 of $537 921; andthe balance of $1 128 414 from the surplus of Part IIof the Working Capital Fund which will becomeavailable on 1 January 1971, should the HealthAssembly adopt the resolution recommended by theExecutive Board in its resolution EB45.R18 to beconsidered by the Assembly under agenda item 3.10.1,Review of the Working Capital Fund.

Annex 7

SECOND REPORT OF THE AD HOC COMMITTEE OF EXPERTS TO EXAMINETHE FINANCES OF THE UNITED NATIONS AND THE SPECIALIZED AGENCIES :

IMPLEMENTATION OF RECOMMENDATIONS 3

PROGRESS REPORT BY THE DIRECTOR - GENERAL

1. Background Information

1.1 The Executive Board at its forty -fifth session inresolution EB45.R36 requested " the Director - Generalto submit to the Twenty -third World Health Assemblya full report on the implementation of the recommen-dations of the Ad Hoc Committee and the decisionsadopted thereon by the Health Assembly and Exe-cutive Board ".

1.2 When the Director -General reported to the forty -first session of the Executive Board 4 on the progressin implementing the recommendations in the secondreport of the Ad Hoc Committee of Experts to examine

1 See Annex 5, part 2.2 Off. Rec. Wld Hlth Org., 181, Annex 12.3 See resolution WHA23.31.4 Off. Rec. Wld Hlth Org., 165, Annex 11.

[A23 /4FL /8 Rev. 1 -7 May 1970]

the Finances of the United Nations and the SpecializedAgencies, the summary of the position in WHOconcerning the 52 recommendations b of the Ad HocCommittee was as follows :

A. Recommendations already D. Recommendations for con -in operation: 1, 2, 3, 5, 6, sideration by the Executive7, 8, 9, 11, 12, 13, 14, 16, Board: 10, 15, 21, 30 (part),17, 18, 19, 20, 22, 27, 28, 32 (part), 33 (part).30 (part), 32 (part), 33(part), 36,(part).

37, 40, 42, 43 E. Recommendations for con-sideration by the World

B. Recommendations requiringfurther inter- agency study: F. Recommendations not di-4, 24, 26, 43 (part). rected to, or requiring

C. Recommendation under action by, WHO: 23, 31,study by the Director- 34, 35, 38, 39, 44, 45, 46,General: 29. 47, 48, 49, 50, 51, 52.

Health Assembly : 25, 41.

6 Recommendations identified by the same numbers as inOff. Rec. Wld Hlth Org., 165, Annex 11.

ANNEX 7 51

1,3 The Executive Board, after having consideredthe report of the Director- General, adopted resolu-tion EB41.R40 in which the Board noted: " thatrecommendations 23, 27 (b), 31, 34, 35, 38, 39, 44, 45,46, 47, 48, 49, 50, 51 and 52 are either not directedto, or do not require action by, the World HealthOrganization ". The Board also considered " thatrecommendations 1, 2, 3, 5, 6, 7, 8, 9, 11, 12, 13, 14,16, 17, 18, 19, 20, 22, 27(a), 28, 30, 36, 37, 4.0 and 42are already fully in operation in WHO, and thatrecommendation 43 is partly in operation, pendinga more precise definition of certain terms in thisrecommendation ".

1.4 Of the recommendations identified as not thenin full operation in WHO, the following have sincebeen found not acceptable by the Board or the HealthAssembly:

1.4.1 The Executive Board decided to maintaincertain practices developed to meet the special needsof WHO and that no changes therefore needed to bemade in the policies and procedures of the WorldHealth Organization concerning recommendations 10,15, 32 and 33.

1.4.2 With regard to recommendations 25 and 41,the Committee on Administration, Finance and LegalMatters reported to the Twenty -first World HealthAssembly 1 that " in the course of the discussion onitem 3.4- Proposed amendments to Articles 13, 14,15, 16, 26, 34, 55 and 29 of the Constitution -the co-proposers of the amendments that had been sub-mitted to the Director - General under the provisionsof Article 73 of the Constitution informed the Com-mittee that they wished to withdraw the amendments ".The draft resolution incorporating these amendmentswas considered as not requiring further discussion andthe World Health Assembly accepted the report ofthe Committee, thereby retaining annual programmesand budgets and annual Health Assemblies.

1.5 The World Health Assembly in its resolu-tion WHA21.33 noted " that the Executive Boardhas carefully reviewed the recommendations of theAd Hoc Committee ... and has indicated the status ofeach of the recommendations in the World HealthOrganization ", and requested " the Executive Boardto keep under review and to report, as appropriate, toa future World Health Assembly on additionaldevelopments in the co- ordination of administrative,budgetary and financial matters in the United Nationssystem of organizations ".

1.6 It will be recalled that the Director -General in1968 submitted to the Secretary- General of the United

1 Off. Rec. Wld Hith Org., 169, 574.

Nations and the Secretary- General transmitted to theGeneral Assembly of the United Nations a detailedreport on the progress made by WHO in the imple-mentation of the recommendations in the secondreport of the Ad Hoc Committee and the decisionsadopted thereon by the Health Assembly and theExecutive Board up to that time. In resolution 2475(XXIII), adopted by the General Assembly at itstwenty -third (1968) session, the Secretary -General wasrequested to " continue to encourage and facilitatethe implementation of the recommendations of theAd Hoc Committee by the United Nations, the special-ized agencies and the International Atomic EnergyAgency, and to submit to the General Assembly at itstwenty -fifth session [1970] a full and detailed reportindicating clearly and succinctly in individual sectionsthe extent of progress made by each one of them inimplementing the recommendations of the Ad HocCommittee and, when applicable, the reasons for non -implementation ". It is the Director -General'sintention, therefore, to submit to the Secretary -General a detailed report on the action taken by theOrganization during the time since his last such reportin 1968.

2. Decisions on Recommendations not requiring Inter-agency Consultations, adopted by the HealthAssembly and the Executive Board since 1968

2.1 Recommendation 21: The Ad Hoc Committeerecommended that " the practice whereby someorganizations credit all or part of their miscellaneousincome to their Working Capital Fund should bediscontinued; miscellaneous income should be paidinto the general fund ".

2.1.1 In accordance with the provision of Part Dof resolution WHA18.14 and resolution EB41.R40,the Executive Board at its forty -fifth session consideredrecommendation 21 in connexion with its review ofthe Working Capital Fund.3

2.1.2 In its resolution EB45.R18 the Board considered" that it is in the best interest of the Organization tocontinue to finance a part of the Working CapitalFund from casual income available to the Organi-zation, rather than by additional assessments onMembers " and recommended inter alia to the Twenty -third World Health Assembly that Part II of theWorking Capital Fund " be financed by appropriationsby the Health Assembly from casual income as recom-mended by the Executive Board after considering thereport of the Director -General; these appropriationsshall be voted separately from the appropriation for

a United Nations document A/7124 /Add. 1, Annex VI.3 Off. Rec. Wld Hith Org., 181, Annex 11.


the relevant budget year ". The Assembly will examinethe Board's recommendations on this subject underitem 3.10.1 of its agenda.

2.1.3 The Board in its resolution EB45.R36 consid-ered that it had " made a recommendation to theWorld Health Assembly which bears on recom-mendation 21 ".

2.2 Recommendation 29: In response to therequest of the World Health Assembly in resolu-tions WHA21.32 and WHA21.49, the Director -General reported to the Executive Board at its forty -third session on developments concerning recom-mendation 29, on long -term planning, and recommen-dation 30, on evaluation, under the agenda items con-cerning long -term planning in the field of health andbiennial programming and improvement and strength-ening of the evaluation process.

2.2.1 The Director -General presented to the Boarda programme and budget information system to servethe needs of the Members and Associate Membersof WHO, the World Health Assembly and the Execu-tive Board, as well as the needs of management ofWHO at all levels. The system provides informationon long -term planning in the field of health, biennialprogramming, a progress report on implementationduring the current year and a budget performancereport. The system serves to improve compliancewith recommendations 8, 9 and 29.

2.2.2 The Board at its forty -third session had alsobefore it a proposed revision of the form of reporton allotments issued and obligations incurred duringthe operating year which, inter alia, represents theDirector -General's report to the Executive Board onadjustments within each appropriation section or" line " (recommendation 9).

2.2.3 The Board, after having considered the reportsof the Director -General on long -term planning inthe field of health and biennial programming 1 andproposals for further improvement and strengtheningof the evaluation process in the World Health Organi-zation,a adopted resolution EB43.R19, which con-tained its recommendations to the Twenty- secondWorld Health Assembly.

2.2.4 The recommendations of the Board haveculminated in the Health Assembly's resolutionWHA22.53, in which the Assembly requested theDirector -General, inter alia, to take the necessary stepsto implement the proposals concerning long -termplanning and the improvement and strengthening ofthe evaluation process.

1 Off. Rec. Wld Hlth Org., 173, Annex 11.2 Off Rec. Wld Hlth Org., 173, Annex 12.

2.2.5 The Health Assembly considered that, as afirst step towards achieving this goal, the Director-General should " provide in his annually proposedprogramme and budget estimates additional infor-mation which would, for example, include for 1971:

(i) an appendix containing a summary by majorprogramme heading for 1969, 1970 and 1971 with aprojection for 1972 based on the indication of thegovernments' priorities for future programmes ofWHO assistance as known at the time of the prepa-ration of the programme and budget estimates, andon other factors such as the trends in the require-ments for the major programmes of the Organi-zation; and(ii) an appendix containing a summary by appro-priation section identifying the operating programmeby individual regions and headquarters, regionaloffices, administrative services, etc., for 1969, 1970and 1971, with a projection of the estimates for1972 ".

2.2.6 The Health Assembly also requested theDirector -General to " provide in each annual financialreport information relating to budget performance,and showing in summary tables...

(i) budget estimates, both original and revised, and(ii) actual obligations incurred ".

The Assembly further recognized " the necessity ofpreserving flexibility to adjust programmes in the lightof changes affecting the needs of the Organizationand its Members ".

2.2.7 It will be noted that the information requestedby the Health Assembly (paragraphs 2.2.5 and 2.2.6)has been provided respectively in the Proposed Pro-gramme and Budget Estimates for 1971 (Official RecordsNo. 179) and the Financial Report for the year 1969(Official Records No. 183).

2.2.8 The Director -General was also requested(resolution WHA22.53) " to explore further thefeasibility of providing appropriate long -term financialindicators and report thereon to the forty -fifth sessionof the Executive Board ". In his interim report a tothe Board at its forty -fifth session, the Director -General outlined some of the immediate difficultiesencountered in his endeavours to establish long -termfinancial indicators of international assistance, mostof which are beyond the control of the Organization.The Board, after having considered the Director-

General's report, adopted resolution EB45.R13 inwhich it noted " that this complex subject requiresmore detailed study, including consultations withrecipient governments, which will be carried out

e Off. Rec. Wld Hlth Org., 181, Annex 9.

ANNEX 7 53

through the regional offices and the results consideredby the regional committees ". The Board understoodthat the Director -General will submit a furtherprogress report on this subject to the forty- seventhsession of the Executive Board.

2.3 Recommendation 35: On the invitation of theDirector -General, the United Nations Advisory Com-mittee on Administrative and Budgetary Questions(ACABQ) visited WHO headquarters in May 1969 toreview systematically and in depth the administrativeand management procedures concerning the pro-grammes and budgets of the Organization. TheDirector -General reported to the forty -fifth sessionof the Executive Board that the draft report ofACABQ on its visit to the Organization had beenreceived for verification of the factual data by the WHOSecretariat. The Chairman of ACABQ later agreedthat the Secretariat should update the informationcontained in the draft report so as to reflect variousdecisions taken by the Health Assembly and theBoard after the Committee's visit. The reportof ACABQ is expected to be submitted to theGeneral Assembly of the United Nations at itstwenty -fifth session (1970). The Director -General willreport to the forty- seventh session (early 1971) of theExecutive Board on the report and the commentsthereon by the General Assembly.

3. Progress in the Implementation of the Recommen-dations of the Ad Hoc Committee requiring Inter-agency Consultations

3.1 In its resolutions EB41.R40 and EB43.R38 theExecutive Board noted that the Director -General iscontinuing to co- operate in the further inter -agencystudy of recommendations 4, 24, 26 and 43(ií).

3.2 On recommendation 4, dealing with standardi-zation of budget documents and uniform budgetpresentation, the Board was informed that the studyundertaken by ACABQ with the assistance of anexperienced consultant was considered at a specialsession of the Consultative Committee on Adminis-trative Questions (CCAQ) in September 1969. Basedon the recommendations by the ACABQ consultant,the Committee's conclusions as contained in its reportto the Administrative Committee on Co- ordination(ACC) -which the latter committee endorsed in

October 1969 -were as follows:

(i) that at present the adoption by all agencies ofa uniform budget presentation is not feasible;

(ii) that a final conclusion as to the feasibility ofsuch a move can only be reached after much furtherstudy; and

(iii) that it does appear feasible, however, for theagencies to produce information about their budgetswhich is compatible.

CCAQ recognized that many of the proposals putforward in the body of the report, while admittedlyof a tentative nature, rested on certain assumptionsthat deserved careful consideration by the organi-zations. The Committee decided as a first step to setup a technical working group to consider in detail theprogramme classification and compatible budgetpresentation proposed in the ACABQ study.

In addition to the report made by the consultant toACABQ, Mr Maurice Bertrand of the Joint InspectionUnit had prepared a report on " Programming andbudgets in the United Nations family of organi-zations " which was also to be taken into account bythe working group.

3.2.1 The working group met on 8 and 9 December1969 and from 9 to 13 February 1970. CCAQ metagain from 11 to 20 March 1970 and reviewed indetail the report submitted by the working groupconcerning a proposed new framework of programmeheadings for use in ACC's annual report to theEconomic and Social Council on " Expenditure in theeconomic and social field ". CCAQ agreed that thesedraft classifications should be tested by the differentorganizations before being communicated to theEconomic and Social Council.

3.2.2 At the invitation of CCAQ, Mr McCandless,consultant to ACABQ, and Inspector Bertrand atten-ded that part of the meeting dealing with questionsrelated to their reports.

3.2.3 On the question of programme budgeting,CCAQ noted that most of the organizations hadalready accepted the principle of programme budgetingand that nearly all agencies present at least some partsof their budget on a programme basis, with a trendtowards a greater use of this form of presentation.

3.2.4 On the subject of the degree of detail requiredin the draft and approved budgets, CCAQ was of theopinion that this would vary according to the needsof different organizations and depending on the deci-sions of their governing bodies. It agreed, however,that such details should be kept to the minimumnecessary and decided that this was a matter requiringfurther study. CCAQ also decided that the questionof designing compatible budget annexes should bepart of its work programme during the rest of 1970.

3.2.5 The conclusions of CCAQ were endorsed byACC at its April 1970 session.

3.3 Regarding recommendation 24, on standardi-zation of financial regulations, CCAQ agreed that it


cannot deal thoroughly with this recommendationuntil inter -agency consultations on budget formatsand standardization of nomenclature have advancedmuch further. It was also agreed that the CCAQsecretariat should develop a comparative statement offinancial regulations as they exist in the variousorganizations to serve as background informationwhen CCAQ is in a position to take up the question.

3.4 On recommendation 26, pertaining to standardi-zation of nomenclature, ACC has endorsed agreeddefinitions of 83 terms in English and French.The terms have been translated into Russian andSpanish and are now being reviewed by theorganizations. Upon completion, a glossary will beprepared in the four languages. The CCAQ secretariatis undertaking to identify additional terms which willbe the subject of further inter -agency consultation.

3.5 CCAQ considered at its April 1969 session thepart of recommendation 43 which suggests that thebudgets of the United Nations system of organizationsshould include an annex containing an estimate of

the total expenditure pertaining directly or indirectlyto the costs of conferences and meetings. It agreed thatthe organizations provide such an annex, which wouldcover the costs of all meetings taken together, forpurposes of inter -agency comparison. It did not dealspecifically with the problem of defining and identify-ing indirect costs.

3.5.1 The Director -General reported to the ExecutiveBoard at its forty -fifth session (January 1970) that,while he foresees no difficulty in providing informationon the direct costs of conferences and meetings, hebelieves that it would be difficult and not profitable toattempt to arrive at a meaningful estimate of indirectcosts, and that any attempt to maintain records fromwhich the information could be derived would beexpensive. The Board in its resolution EB45. R36indicated that it agreed " with the Director -General'sproposal that it would not be profitable at present topursue further the implementation of recommendation43(ií), until it has been possible to examine the figuresfor direct costs of conferences and meetings ".

Annex 8

WHO PILOT RESEARCH PROJECT FOR INTERNATIONAL DRUG MONITORING

[A23 /P &B /7 - 1 May 1970]


SUMMARY

I. INTRODUCTION

BackgroundThe purpose of drug monitoringDefinitions

II. THE WHO PILOT PROJECT

Objectives and proceduresParticipating national monitoring centres

CONTENTS

Page

54

565656

Page

The activities of the WHO Drug Monitoring Centre 59Project assessment 63

III. POTENTIAL BENEFITS OF INTERNATIONAL DRUGMONITORING 63

IV. PROPOSALS FOR FUTURE DEVELOPMENT 64

A primary operational phase 6557 Management assessment 6557 Budgetary requirements and financing 67

SUMMARY

(i) The World Health Assembly, in resolutionsWHA19.35 and WHA20.51, requested the Director -General to initiate a pilot research project with theaim óf estaúTishing an international system of monitor-ing adverse reactions to drugs on the basis oi ñfor-


mation derived from national centres, utilizing fundsprovided to that effect by the Government of theUnited States of America.

(ii) The primary objective of drug monitoring foradverse reactions is to identify at the earliest possiblemoment the liability of a drug to produce undesirable

ANNEX 8 55

effects which were not detected during its clinicaltrials. As adverse reactions to drugs may occur inall countries and their early detection requires areporting system covering large populations, there isan obvious need for international co- operation inthat field

(iii) The aim of the WHO pilot project has been toinvestigate the feasibility of an international drugmonitoring system based on case reports of adversereactions to drugs recorded in national centres. TheWHO pilot project was based on a WHO drugmonitoring centre, located in Alexandria, Va.,United States of America. Ten countries which possessestablished centres have agreed to participate in theproject. From the beginning of the operation of theWHO Centre in February 1968 until December 1969,over 24 000 case reports were received from thenational centres.

(iv) The WHO Centre has developed systems forprocessing, recording, storing, linking and retrievingdata provided in the case reports. It has establishedclassifications for drugs and terminologies for recordingadverse reactions. Computer print -outs have beenforwarded to the participating centres with thefollowing types of information: (a) frequency ofreactions recorded for each drug; (b) frequency ofreports on drugs associated with an adverse reaction,including cumulative totals for various periods;(c) condensed data for rapid reference; and (d) drugreference lists. Particular efforts have been madetowards developing signalling programmes to increasethe effectiveness of the system as an early warningdevice.

(v) The project has been kept under continuousreview throughout the pilot phase. A detailed analysisof the results obtained was carried out in September1969 by a meeting including representatives of theparticipating national centres. A meeting of con-sultants in November 1969 was called upon to assessthe results achieved and to make recommendationsas to the possibility and desirability or otherwise offurther developing the activities initiated under theproject.

(vi) As a result of these reviews and consultations, theconclusion was reached that the WHO pilot projecthad satisfactorily fulfilled the tasks assigned to it andthat on the evidence provided a system of inter-national monitoring of adverse reactions to drugs wasfeasible.

(vii) The evaluation of the project further demon-strated that such an international drug monitoringprogramme could yield substantial benefits in related

fields of medicine and public health, e.g., drug safetycontrol, drug dependence, clinical pharmacology andtherapeutics, congenital malformations and humangenetics, international classification of diseases, etc.,as well as for the development of monitoring methodo-logy. Such benefits would not be limited to thecountries directly associated with the programme butwould extend to non -participating countries as well.

(viii) The project could now move into a primaryoperational phase with the objective of adjusting themethodology evolved during the pilot phase to asystem of an operational character. A comprehensiveprogramme assessment should be undertaken prefer-ably no later than three years after the start of theprimary operational phase, to lay down the basis forthe development of a fully operational system.

(ix) The Executive Board at its forty -fifth sessionconsidered a progress report by the Director -Generaland, noting the positive results obtained, recommendedthat the project be so developed as an integral part ofthe programme of the Organization (resolutionEB45.R26).

(x) A cost -effectiveness study of the project wascarried out to evolve a detailed work plan for theprimary operational phase and determine its require-ments and related costs, taking into consideration thealternative locations of the project in Alexandria,Va., USA, as at present, or at WHO headquarters inGeneva. As a result of the study, it was concluded thatfrom the management point of view the systemdeveloped during the pilot phase for processing,recording and retrieving data relating to adversereactions to drugs was sound. It was further foundthat the location of the project in Geneva would beless costly than its location in Alexandria, Va.It is worth noting in this connexion that the computeraspects of the project have been developed in such away as to be compatible with the computer facilitiesavailable at WHO headquarters.

(xi) On the basis of the above, the budgetary require-ments of the proposed primary operational phase havebeen determined for 1970, 1971 and 1972. Ways andmeans of financing the project have been studied andalternative solutions are submitted to the HealthAssembly for its consideration and decision.

(xii) The Director -General wishes to acknowledgethe co- operation shown by the Government of theUnited States of America, and the determinant supportit has given to the pilot phase, as well as the mostvaluable contribution of the national centres both inthe United States of America and in the nine othercountries participating in the project.


I. INTRODUCTION

Background

1. The Twentieth World Health Assembly, havingconsidered a report of the Director -General on inter-national monitoring of adverse reactions to drugs,adopted resolution WHA20.51 in which, inter alia, itrequested the Director -General to take the necessarymeasures to carry out a pilot research project on themodalities of an international system of monitoringadverse reactions to drugs, under a grant from theGovernment of the United States of America, and toreport on its results to the World Health Assembly.The Director -General accordingly submits the follow-ing report on the pilot research project for internationalmonitoring of adverse reactions to drugs.

2. Previous reports on the subject to the EighteenthWorld Health Assembly, which adopted resolutionWHA18.42, and to the Nineteenth World HealthAssembly, which adopted resolution WHA19.35,appraised the requirements of an international pro-gramme for the collection, analysis and disseminationof information on adverse drug reactions and proposedguidelines for its development.' The present report isprimarily aimed at recording and assessing the resultsof the pilot project; but it will, in addition, indicatefurther requirements of the programme if it is devel-oped into full operation, including related costestimates.

3. At its forty -fifth session, the Executive Board,after detailed consideration of a progress report by theDirector- General, adopted resolution EB45.R26. TheBoard noted the positive results attained by theproject and recommended to the Twenty -third WorldHealth Assembly that it be further developed tobecome operational as an integral part of the pro-gramme of the Organization.

The Purpose of Drug Monitoring

4. The rapid growth of drug therapy is widely recog-nized as having produced great benefits to the healthof the community. Less widely realized is the extentto which this has been accompanied by an increase inadverse reactions to drugs, quite often trivial, but anappreciable proportion of which are sufficientlyserious to offset part of the benefits. Eight years ago,the thalicl.&mide tragedy drew the attention of healthaùthorities and of the general public to this problemand its implications. The use of potent drugs inevitably

' Off: Rec. Wld Hlth Org., 148, Annex 11.

carries the risk of drug- induced illness, and possiblydeath, as illustrated by the following quotation:

Perhaps some 5 per cent. of the beds in our generalhospitals are occupied by patients suffering to agreater or less extent from our efforts to treat them.Yet the incidence of adverse reactions to drugs isnot well known and even major reactions often gounrecognized. Indeed one of the urgent tasksconfronting us today is to put such reactions on asound epidemiological basis. Thus their collection,tabulation, and analysis on a national and ulti-mately on an international scale are of greatimportance.'

It follows that medical treatment with any drugdemands a knowledge of its adverse effects as wellas of its therapeutic effectiveness. Incomplete know-ledge of the kind, severity and frequency of adverseeffects of drugs is a major weakness of therapeuticpractice and appreciation of this fact has led to theestablishment in a number of countries of systems ofmonitoring drugs for suspected adverse reactions.

5. The primary objective of drug monitoring foradverse reactions is to identify at the earliest possiblemoment the liability of a drug to produce undesirableeffects which were not detected during its clinical trials.As was pointed out by the WHO Scientific Groupon Mpnitoring Adverse Dru Reactions (in 1964),and again emp asized by the Scienti c Group on i

Principles for the Clinical Evaluation of Drugs,' manyadverse effects of drugs in man are not predictable byexperiments on animals or controlled clinical trials.A systematic follow -up of drugs after their intro-duction into general use is therefore essential.

6. As the problem of adverse reactions to drugsexists in all countriesjínd the early detection of someserious adverse reactions requires reports to be obtai-ned from large populations, the need for internationalco- operation soon became obvious. The report of theDirector -General to the Executive Board at its thirty-

seventh session 1 provided guidelines for the develop-ment of an international project.

Definitions

7. For the purpose of the project the followingdefinitions have been adopted:

2 Dunlop D. (1969) Brit. med. J., 2, 622.3 Wld Hlth Org. techn. Rep. Ser., 1968,_403.

ANNEX 8 57

A drug is defined as any substance administered toman for the prophylaxis, diagnosis or therapy ofdisease, or for the modification of a physiologicalfunction.

An adverse reaction to a drug is defined as one whichis noxious, unintended and occurs at doses normallyused in man.

Drug monitoring is defined as the systematic re-porting, recording and evaluation of adverse reactionsto drugs available with or without prescription. Infor-mation on adverse reactions can be obtained eitherthrough voluntary reporting to designated centres bypractising doctors and hospitals (spontaneous moni-toring), or by epidemiological techniques aimed atsystematic coverage of representative samples of thepatient or of the physician population (intensivemonitoring).

The WHO Pilot Project consists of a feasibilitystudy of the modalities of an international system formonitoring adverse reactions to drugs. It is composedof the WHO Drug Monitoring Centre and the par-ticipating national drug monitoring centres.

The WHO Drug_ Monitoring Centre j&...,the pilotcentre at present located in Alexandria, Va., USA,responsible for the development of the project, onthe basis of a two -way flow of information onadverse reactions to drugs, in relation with nationalcentres.

A National Drug Monitoring Centre is an agency,usually governmental, charged with the responsibilityof monitoring adverse reactions to drugs on a countrybasis.

II. THE WHO PILOT PROJECT

Objectives and Procedures

8. The aim of the project has been to investigate thefeasibility of an international drug monitoring systembased on case reports of adverse reactions to drugsrecorded in national centres according to the followingobjectives:

(a) to assess the feasibility or otherwise of aninternational system of drug monitoring; " `

(b) to develop systems for recording case historiesof adverse reactions to drugs, searches on the typesand patterns of such reactions, and analysis andfeed -back of data to national monitoring centres;

(c) to undertake, on an experimental basis, analysisof in- stored data; and

(d) to study the possible contributions of drugmonitoring to pharmacology and therapeutics.

The functions and procedures deemed necessary forthe achievement of the objectives of the project areshown in Fig. 1 (page 58).

Participating National Monitoring Centres

9. Data essential to the development of the projecthave been provided by 10 countries (Australia, Canada,Czechoslovakia, the Federal Republic of Germany,Ireland, the Netherlands, New Zealand, Sweden, theUnited Kingdom of Great Britain and NorthernIreland, and the United States of America) which haveestablished national drug monitoring centres and haveagreed to participate by forwarding to the WHOCentre case reports of adverse reactions to drugs.

10. For participating national centres, the followingcriteria, as recommended by the WHO Scientific Groupon International Drug Monitoring in 1965, wereadopted:

(a) a designated national organ responsible formonitoring data on suspected adverse drugreactions;

(b) continuity of staff and services for collecting,verifying and transmitting reports of adversereactions;

(c) facilities for examining the validity of reports,and for the detailed study, when necessary, ofreported adverse reactions; and(d) availability of data on, and terminology foridentification of, drugs used nationally, and theability to estimate the extent of drug usage.

11. National monitoring systems depend upon thereporting by physicians of cases of suspected adversereactions to drugs to a national monitoring centre.After careful validation of the data, analyses andfurther investigations are carried out to confirm orrefute the association between a drug and a suspectedreaction. The methods adopted by any nationalcentre for this purpose depend upon conditions withinthe country and vary according to the drug, thereaction and the population at risk.

12. Predictably a wide range of variability in sub-mitted data exists, due to differences in history taking,examination and investigations on the one hand, andin available recording facilities and staff on the other.

STAGE I

PROJECTDIRECTIONGENEVA

PROJECTOBJECTIVESASSIGNED

REPORTINGFORMATASSIGNED

PARTICIPATINGCOUNTRIESIDENTIFIED

OFFICE SPACEAND EQUIPMENTRRANOED

STAFFRECRUITMENTARRANGED

FIG. 1. WHO PILOT RESEARCH PROJECT FOR INTERNATIONAL DRUG MONITORING : EVENT AND PROGRESS CHART

DRUGIDENTIFICATIONLISTSARRANGED 7

INITIALSYSTEMDESIGNED

9

ADVERSEREACTIONDICTIONARYPREPARED

8

FINALPLANAPPROVED

1G

OFFICE INALEXANDRIA.VA. ESTARLISIIEDI

1.7

SENIORPROJECTOFFICERDESIGNATED 14

tPROJECTSTAFFASSIGNED

13

COSTESTIMATESREVIEWED

PUNNINGCHARTDRAWN

11

DRUGREACTIONINPUTSTARTED

STAFFIDENTIFIED

IO

INTERMEDIATEDRUG REACTION

- CODING FORM17

DESIGNED18

STAGE D

REPORTEDINPUT DATADEFINED

19

PLUGIDENTIFICATIONPLANNED

20

ADVERSEREACTIONTERMINOLOGYCONCEPTREVIEWED 21

CODINGORGANIZEDAND STARTED ^-

GUIDE 10PARTICIPATINGCOUNTRIESREVISED 23

tREPORTINGFORMAT -FIRST REVISION

21

BASICOUTPUT DA/ADMUSSED

29

BASICOUTPUT DATALAYOUTDESIGNED 29

OUTPUTLAYOUTSAPPROVED

APPROVEDPROJECT

-4" SCHEDULECARRIED OUT 28

STAGE III

SYSTEM ANALYSIS(a) MASTER FILE(b) TERMINOLOGY(e) PRINT-OUTS

2P

PROGRAMMINGANDTESTING

DATA DELIVERY)OUTPUT DATADRUG & A.R.SUMMARIES 31

RE EVALUATION

STAGE IV

DRUGIDENTIFICATIONNOMENCLATURE

32

PHARMACOLOGICA THERAPEUTICC LASSI-FICATIONS il

DRUG DICTION RCONCEPTESTABLISHED

34

L SYSTEM ANALYSISOF DRUGDICTIONARY

31

DESIGN OFSOME EARLYWARNINGSIGNALS 3G


DRUGREFERENCELIST PREPARED

38

SYSTEM ANALYSISOF SIGNALLINGSYSTEM

39


SIGNALLINGSYSTEM INOPERATION

CONCEPT OFRETRIEVALSYSTEMESTABLISHED

SYSTEMANALYSIS OFRETRIEVALSYSTEM

43


44

SIGNALLING SYSTEMSYSTEM ANALYSISASSESSMENT 4.994' REVIEWAND REVIEW 45

PHARMACEUTICALREVIEW

48

CLINICAL ANDPIARMACOLOGIC

4" REVIEW47

ADVERSEREACTIONTERMINOLOGYREVIEW 48

4 !

49

STATISTICALALA I.YSISOF DATA

50

DOCUMENTATIONREVIEW

51

RESEARCIIPLANNINGMONITORINGSYSTEMS 52

PROJECTPROGRESSREPORT1969 -70

53

NOV. 1967 FEB. 1068 MAR /JUNE 1968 SEPT. 1068 JAN. 1969

I

FEB. 1970

ANNEX 8 59

The WHO Centre has encouraged the acquisition ofdata from all available sources, such as general prac-titioners, specialists, hospitals. In order to ensure adesirable level of uniformity in the presentation ofcase reports, the recommendation of the WHO Scien-tific Group on International Drug Monitoring thatthere should be a basic or minimum content of datawas adopted by the participating national centres.The required content and form of presentation of casereports are described in a " Guide to ParticipatingCountries " and in the " WHO Drug Reaction ReportForm ".

13. From the beginning of the operation of the WHOCentre in February 1968 until December 1969, 24 085case reports were received from national centres (seeFig. 2, page 60) and have provided suitable materialfor methodological studies.

14. In order to accomplish the primary objective,i.e., an early signalling system, the time -lapse betweenthe occurrence of an adverse reaction and its evaluationshould be minimal. Various factors, either separatelyor in combination, could contribute to a time -lapsebetween :

(a) onset of the reaction and its observation by thepatient and /or doctor;

(b) observation of the reaction and reporting tothe national centre;

(c) receipt of the report at the national centre andprocessing in the national centre;

(d) dispatch from the national centre and receiptat the WHO Centre; and

(e) receipt at the WHO Centre, computer recordingand print -out distribution.

A detailed study of the time factors has been under-taken in order to achieve a minimal processing timefor data received.

The Activities of the WHO Drug Monitoring Centre

15. The WHO Centre was established in January 1968in Alexandria, Va., USA, utilizing premises andcomputer facilities provided under a grant from theGovernment of the United States of America. Casereports of adverse reactions recorded in the partici-pating national centres have been received regularlysince March 1968. Systems for processing, recording,storing, linking and retrieving reports have beendeveloped. Computer print -outs containing recordeddata in various forms have been forwarded to nationalcentres.

Coding and Data Processing

16. (a) Drug reaction reports from participatingnational centres are date stamped, arranged bycountry and country serial number, and filed,pending coding.

(b) Data from the reports are transcribed on to aWHO data coding form. When coding takes place,a WHO record number is given to each coding formuniquely identifying the report and its origin.

(c) Once a report has been coded, it is then checkedby the medical section for medical description,clinical assessment and research area coding.

(d) The document set is then passed on to a secondsection for drug data and pharmaceutical checking.

(e) When this stage has been completed, thereports and coding forms are dispatched weekly tothe computer for key punching. The forms areverified to make sure that at least one coding formhas been completed for each report.(f) Reports that present any ambiguity or diffi-culties are recorded in an internal " Review " file,by country, and consultations are held on a regularbasis to elucidate the problem or to decide whetherto request additional information from the nationalcentre.

Adverse Reactions ;Classification and Terminology

17. It is the aim of the WHO Centre to use as fewpreferred adverse reaction terms as possible as de-scriptors in the transcription of the adverse reactionfrom national centre reports. The list of preferredadverse reaction terms is an open -ended documentwith scope for modification in order to reduce orexpand the number of working terms where desirable.To date, 534 adverse reaction descriptors have beenused. These preferred terms are grouped accordingto a system -organ classification. The frequency withwhich they occur in the reports processed is shownin Fig. 3 (page 61).

In February 1969 a revised list of adverse reactionpreferred terms was distributed to the nationalcentres. The new list is based on a two -tier system ofadverse reaction recording in order to group closelyrelated reactions under the same term, e.g., ABORTION,whether complete, missed or threatened, to be in-cluded under ABORTION. In addition, some reductionin the number of preferred terms is being investigated,e.g., SPASTIC PARALYSIS, MONOPLEGIA and HEMIPLEGIAto include spastic par esis, monoparesis and hemi-paresis, respectively.

18. The most complete description available ofreported adverse reaction is desirable from national

FIG. 2. REPORTS RECEIVED IN THE WHO DRUG MONITORING CENTRE, MARCH 1968 - DECEMBER 1969

Dates Australia CanadaCzecho-slovakia

FederalRepublic

ofGermany

Ireland NetherlandsNew

Zealand Sweden

UnitedKingdom of

Great Britainand Northern

Ireland

UnitedStates

of America

Total

Monthly Cumulative

1968March - - - 31 17 - 28 51 - - 127 127April - - 19 18 7 - - 41 - 229 314 441May 59 267 13 16 17 - 39 47 56 183 697 1138June - 169 - 18 13 95 46 36 184 64 625 1 763July 135 183 - 21 - - 38 163 335 91 966 2 729August - 131 10 29 - - 38 44 314 - 566 3 295September 45 158 - 32 22 99 - 54 134 - 544 3 839October 58 127 - - - 21 21 93 399 - 719 4 558November 36 146 - 44 18 - 30 68 - - 342 4 900December 49 - - 44 10 - 31 48 478 85 745 5 645

Total -1968 382 1 181 42 253 104 215 271 645 1 900 652 5 645 -1969January 42 257 25 27 - 196 30 74 404 69 1 124 6 769February - 156 - 46 16 201 131 31 236 239 1 056 7 825March - 149 - - - 245 24 - 397 - 815 8 640April 64 244 - 57 - - - 127 366 776 1 634 10 274May 98 166 - 68 - - - 111 404 187 1034 11 308June - 213 - 102 50 150 50 235 319 12 1 131 12 439July - 277 - 81 22 - - 105 148 1 435 2 068 14 507August 141 226 - 51 9 - 45 165 696 580 1 913 16 420September 76 - 28 61 15 399 - 87 175 967 1 808 18 228October 153 323 - - - 250 55 145 - 1 658 2 584 20 812November 85 - - 71 31 - 50 89 317 1 794 2 437 23 249December - - 14 60 - - 50 104 350 258 836 24 085

Total -1969 659 2 011 67 624 143 1 441 435 1 273 3 812 7 975 18 440 -TOTAL -1968 and 1969 1 041 3 192 109 877 247 1 656 706 1 918 5 712 8 627 24 085 -

Adverse reaction reports per 1000hospital beds 7.7 15.0 0.8 1.4 6.3 18.2 25.4 18.1 12.2 5.1 6.8 -

Adverse reaction reports per 100physicians 66.1 133.0 4.1 9.5 83.7 115.3 220.6 225.1 103.8 31.1 46.3 -

Adverse reaction reports per1 000 000 population 90.2 159.2 7.6 15.2 85.6 133.0 263.8 245.6 104.3 43.8 63.2 -

ON0

ANNEX 8 61

FIG. 3. SYSTEM -ORGAN CLASS DISTRIBUTION OF ADVERSE REACTIONS REPORTED *MARCH 1968 - DECEMBER 1969

All other system -organ classes

Metabolic andnutritional disorders

Respiratory system

Psychiatric disorders

Haematic andlymphatic systems

Skin and appendages

Cardiovascularsystem

Body as awhole

* Based on 13 187 drug reactions reported in 6170 reports tabulated.

centres. This provides for more accuracy in tran-scription to preferred terms, more complete evaluation,and better material for research purposes. The infor-mation already submitted has provided descriptionsof adverse reactions in sufficient detail to allowstudies to be carried out on coding methods by whichthe possible mechanisms, causal relationships andseverity of reactions might be identified.

Drug Terminology

19. In their reports, national centres record drugs inthe following order of preference:

trade or proprietary nameinternational non -proprietary namenational non -proprietary namechemical name (structural formula)

Before a drug trade name is transferred from a drugreaction report to the coding form, the official orselected drug list of the particular country is consultedfor verification of the drug and standard spelling

Nervous system

Gastro -intestinal system

WHO 00413

according to the list. This procedure is followed inevery case to facilitate recording compatibility betweenthe WHO Centre and the national centre. As an ex-ample, hyphens and periods are entered when the druglist so indicates.

20. For non -proprietary names, two preferred sourcesare used -the international non -proprietary names(INN) and the International Pharmacopoeia (IPH).However, this does not preclude the national centresfrom reporting a nationally approved name which isthus entered on the coding form and stored in themaster file. It is then printed in the WHO Centre DrugReference List, cross reference being made to thecorresponding INN name.

21. The Drug Reference List contains any drugsreported in association with adverse reactions. Thislist serves as an alphabetical cross reference for trade,proprietary and non -proprietary drug names, withthose containing the same active ingredients groupedtogether. In order to deal with the problem of recordingdrugs of various origins and composition, seven


designations are used for classifying the type of drugname, as follows :

N = non -proprietary name; T = trade or proprie-tary, single compound; M = mixture (multiplecompound drug) and trade or proprietary name;X = mixture (multiple compound drug) and non -proprietary name (APC); C = component in multiplecompound drug; K = chemical name; R = codenumber or code designation.

22. In maintaining the original drug nomenclaturefor each country, the Drug Reference List compiledby the computer is a useful reference for each partici-pating national centre to identify a drug which mightbe used in another country under a different name.

Classifications for Drug Recording

23. Separate therapeutic and pharmacological classi-fications have been developed for drug recording inthe WHO Centre. The purpose of using a pharmaco-logical as well as a therapeutic classification is toachieve more informative linkages of drug groupswith adverse reactions. Before a drug is assigned to apharmacological class, authoritative references areconsulted. There is computer provision for a total ofsix therapeutic and six pharmacological classes foreach drug.

24. The development of an internationally acceptabledrug and adverse reactions terminology and classifi-cation is under study with the aim of their eventualinclusion in the International Classification of Diseases.

Output Data Presentation

25. From the early stages of the project, considerationhas been given to forward planning of the output sothat the participating centres could make the most ofthe accumulated data. The following documentsillustrating the recording methodology developed bythe WHO Centre have been forwarded to nationalcentres since February 1968:

WHO Centre Adverse Reaction Preferred Terms -Modified Alphabetical Version

WHO Centre Adverse Reaction Preferred Terms

System -Organ Class Version

Therapeutic Classification of Drugs:1st edition Jan. 19692nd edition July 19693rd edition Jan. 1970

Pharmacological Classification of Drugs:1st edition Jan. 19692nd edition July 19693rd edition Jan. 1970

Dispatched

Feb. 1968Feb. 1969Feb. 1970Feb. 1968Jan. 1969Feb. 1970

26. The initial computer programming system hasenabled summarized data on adverse reactions todrugs to be sent to national centres at regular intervals,commencing in March 1969. Based on the constructivereviews received from the national centres, the presen-tation of data was subsequently improved.

Reference Reports contain summarized voluminousinfer rl agon on all drugs and adverse reactions reportedto the system.

Report Type A is drug- oriented and contains in-formation on all reported drugs and adverse reactions,divided into three different time periods and sub -grouped into suspected and other categories. Theinformation is sorted by drug name, system -organclassification and adverse reaction. The drug namecan be the reported name, or grouped under itspreferred name.

Report Type B is complementary to Report Type Aand is adverse -reaction -oriented. It contains infor-mation on all reported drugs and adverse reactions,divided into three different time periods with sub -grouping into suspected and other categories. Theinformation is sorted by system -organ classification,adverse reaction and drug name. The drug name canbe the reported name or grouped under the preferredname.

Report Type C contains summarized data based onReport Type A.

27. Scanning Reports are essentially similar to theabove but in a more concise form and includeadditional information.

Report Type D contains information on drugssuspected of being causally related to an adversereaction, the degree of severity of the reaction, the sexand age -group of the affected patients.

Report Type E contains information on drugsreported in relation to adverse reactions during threedifferent time periods. The number of fatal reactionsrecorded to specific drugs is also included.

Report Type F contains information on reporteddrugs listed by country. The information can begrouped and printed in a number of ways (maximum 54

ways), e.g., by Pharmacologic Classification, Thera-peutic Classification, Preferred Name, Reported Name,and Ingredient for Multiple Ingredient Drug, etc. Thedocument also contains information on the totalnumber of reports, the total number of adversereactions, and frequency of affected system -organgroup, on a country basis.

ANNEX 8 63

28. Signalling Reports. A large part of the computereffort has been devoted to the development of avariety of signalling programmes in order to increasethe effectiveness of the project as an early warningdevice.

This type of report is generated automatically bythe computer whenever the stored data reveal changesin reporting outside certain specified limits. At present,programmes are in operation to signal:

New to the system -to detect drugs, adversereactions, and drug /adverse reaction associationsnewly reported. Whenever, during the updating ofthe master file, the computer detects any of theabove, a signal print -out becomes available. Atpresent, many well -known drug /adverse reactioncombinations are new to the system because of therelatively small files, but as project files are built upthis signal will gain in objective value.

Increased rate of reporting -to detect a " signi-ficant " increase in reporting of a drug, an adversereaction or a drug /adverse reaction combination.When the level of reporting on a drug, expressed asa ratio of the number of reports on a drug to thetotal number of drugs reported for a given timeperiod (or batch of reports), differs significantlyfrom the preceding ratio calculated for anotherperiod of time (or batch of reports), a signal isgenerated by the computer. Similar programmes aredeveloped to signal when a particular adversereaction is increasingly reported or when the numberof reports of a particular drug and adverse reactioncombination increases significantly from one periodof time to another.

Special Search Format and Procedure

29. The WHO Centre is now in a position to produceadditional reports in answer to special search require-ments so that additional data already stored in thecomputer files could be made available to nationalcentres. These search facilities to meet specificinquiries from national centres could be developed inthe early stages of the operational phase of the project.

Computer System Development

30. To meet the objectives of the project, approxi-mately 110 computer programmes have been designed;of these, 68 are used for file maintenance and pro-duction of external reports, the remaining programmesbeing used internally in the WHO Centre. The systemprovides for the inclusion of reports from new partici-pating countries when desired.

Project Assessment

31. All the technical aspects of the project describedabove have been kept under continuous reviewthroughout the pilot phase by the project staff and bythe officers concerned at WHO headquarters, with thehelp of consultants for specific aspects of projectdevelopment.

A meeting of representatives of the participatingnational centres, with the staff of the WHO Centre,was convened in September 1969 to carry out adetailed analysis of the project.

A meeting of consultants in November 1969 wascalled upon to assess the results achieved and to makerecommendations as to the possibility and desirability,or otherwise, of further developing the activitiesinitiated under the pilot project.32. As a result of these reviews and consultations, theconclusion was reached that the WHO pilot projecthad satisfactorily fulfilled the tasks assigned to it andthat, on the evidence provided, a system of inter-national monitoring of adverse reactions to drugs wasfeasible. This conclusion led to practical proposals asto the possibility of setting up an operational interna-tional system for monitoring adverse reactions to drugs.

The progress achieved in specific aspects of the pilotproject was noted by the meeting of consultants, whichacknowledged the satisfactory results obtained in thedevelopment of systems for processing, recording,storing, linking and retrieving reports as well as forthe validation and evaluation of data. Prepareddictionaries of preferred terms for drugs and adversereactions, it was found, were already of considerableassistance to the participating drug monitoring centres.

III. POTENTIAL BENEFITS OF INTERNATIONAL DRUG MONITORING

33. Valuable contributions to health programmes ina number of areas could accrue from an internationaldrug monitoring system.

Drug Safety Control

34. An international drug monitoring programmewith rapid accumulation and dissemination of infor-mation on adverse drug reactions could greatlyaugment and complement the work of the national

drug monitoring centres. It could be of particularbenefit to national centres receiving relatively smallnumbers of reports, which could draw on the dataavailable from the International Centre to supplementtheir own information.

35. Situations may arise in which reports of anadverse reaction to a drug occurring in differentcountries could be appreciated adequately only when


collated at the International Centre. In addition,collated reports, especially those involving new drugsreleased for marketing, would be of considerable valueto both the countries in which the drug is availableand those in which it has not yet been released. Shouldthe International Centre find unequivocal evidence ofa serious drug hazard, all countries should be informedwithout delay, thus enabling them to take the necessaryaction.

36. Non -participating countries are also likely toreceive substantial benefits from an internationalmonitoring system:

(a) Such a system would raise the standards ofsafety in the choice of drugs available on the worldmarket and in their methods of administration. Allcountries stand to gain by the earliest possiblerecognition of hazards encountered in countrieswhich initially use a new drug.

(b) Information on drug reactions can be expectedto lead to improved evaluation of drug safety incountries with national monitoring systems. Infor-mation on decisions taken subsequent to suchevaluation would be brought to the knowledge ofnon -participating countries, as is the practicealready under resolution WHA16.36, which requestsMember States to communicate to WHO decisionsto prohibit or limit the availability of a drug causinga serious adverse reaction.

37. An international programme could providevaluable advice and assistance for the establishment ofnew national centres. The training of specialist staffand exchange of ideas and experience for the develop.ment of further techniques for drug monitoring couldbe promoted.

Clinical Pharmacology

38. Drug monitoring could produce evidence of acause and effect relationship between a drug and anadverse reaction, give the clinical pharmacologist leadsfor the elucidation of the mechanisms of adversereactions and orientate the clinician towards morerational bases for therapeutics and a safer use of drugs.

Drug Dependence

39. Drug dependence is recognized as a seriousadverse reaction to a number of drugs, including thoseused therapeutically. Relevant case reports, particu-larly those associated with new drugs, would be ofinterest to national as well as to international organsconcerned with drug abuse and its control.

Congenital Malformations and Human Genetics

40. The association between the administration ofcertain drugs during pregnancy and congenital mal-formations has been intensively studied. However,the relationship of drugs to several of the morecommonly occurring malformations, e.g., cleft palate,has not been fully determined. There is evidence thatgenetic material in germ cells may be changed by exog-enous influences, including drugs. Reports of ab-normalities compiled in drug monitoring centres andin registries of congenital malformations should belinked for the study of possible relationships betweendrugs and malformations. Certain adverse reactions,such as those occurring within ethnic groups orsuspected of being caused by anomalies of drugmetabolisms, would be of interest in the field of humangenetics.

Monitoring Methodologies in other Fields41. The development of a sound international pro-gramme for drug monitoring can be of considerablemethodological value to surveillance programmes inother fields of public health. Monitoring techniquesof a similar character will be required to assist inelucidating health problems where planned experimen-tation is not feasible and observational techniques onlyare available, to provide systematic inferences onlikely chains of causation within a population, e.g.,genetic and somatic factors, environmental contami-nants (pesticides, exhaust fumes, industrial wastes,radioactive elements), infectious agents (e.g., viruses)and as yet unknown deleterious substances.

International Classification of Diseases42. Terms and classifications for recording theadverse effects of drugs developed on an internationalscale could provide the basis of terminologies forrevised editions of the International Classification ofDiseases.

IV. PROPOSALS FOR FUTURE DEVELOPMENT

43. On the basis of the conclusion that an inter-national drug monitoring system for the processing,storage, recovery and linkage of data on adverse drug

reactions provided by national centres is a practicableundertaking, future development of the project canbe envisaged.

ANNEX 8 65

44. The transmission and recording of reports fromparticipating countries to the WHO Centre, which hasbeen developed on a pilot scale, can be readily adaptedto absorb the total output of each national centre.Computer techniques are now available to handlelarge amounts of data, allowing early review of possibleassociations between drugs and reactions, togetherwith the dissemination of this information to nationalcentres. Experience in the national centres hasdemonstrated the value of monitoring and has dev-eloped the basic techniques of evaluation.

A Primary Operational Phase

45. The project could now move into a primaryoperational phase, the objectives of which would beas follows:

(a) further develop and adjust the methodologyevolved during the pilot phase for an operationalinternational system of monitoring adverse reactionsto drugs utilizing case reports submitted by nationalcentres;

(b) undertake the recording and analysis of sub-mitted data and their feed -back to national centreson an operational basis in order to determinesuitabilit AM usefulness of data presentation;

(c) provide facilities for searches by WHO andthe national centres of stored data;

(d) study the mechanisms by which reports fromadditional drug monitoring centres can be includedin the operation; and

(e) study the contribution of an international drugmonitoring system to national programmes for drugefficacy and safety, research in therapeutics andpharmacology.

46. The WHO Centre has already made considerableprogress in the development of drug reference lists andof recording systems for drugs and adverse reactions.During the primary operational phase, these methodo-logies, together with additional computer programmesfor routine analyses, alerting signals, and special filesearches, can be expanded and adapted to meet therequirements of a fully operational phase.

47. It is anticipated that additional national drugmonitoring centres may be in a position to contributereports to the WHO Centre in the future. Increasingbenefits are likely to accrue from the availability ofinformation on the adverse effects of drugs from awide range of countries.

48. Once the WHO Centre is in the primary oper-ational phase, all countries, including those notparticipating directly, would be able to benefit. Byaugmenting drug safety evaluation in countries withnational monitoring systems, more meaningful infor-mation on drug hazards could be provided by WHO toall its Member States. The speedier accumulation ofevidence that warns all countries of a particular drughazard, and the facilities for effective interchange ofinformation on a range of important and perpetuallychanging problems, should assist all countries toreduce their drug -induced illnesses and deaths.

49. Provision would be made for detailed studies oftechnical development, including the value to nationalcentres of information disseminated during the primaryoperational phase. A comprehensive programmeassessment should be undertaken, preferably no laterthan three years after entering the primary operationalphase, and provide recommendations for the develop-ment of a fully operational system capable of receiving,analysing and disseminating meaningful informationon adverse reactions to drugs to Member countries.

Management Assessment

of ExecutiveBoard the Director -General expressed his intention toundertake a cost -effectiveness study of the project.'The study was carried out with the purpose of establish-ing:

(i) a detailed work plan for the primary oper-ational phase;

(ii) the necessary requirements for implementationof the primary operational phase, e.g., manpower,supplies, equipment, computer time;

(iii) the costing of these requirements, taking intoconsideration the alternative location of the projectin Alexandria, Va., USA, as at present, or at WHOheadquarters, Geneva.

51. The cost -effectiveness study included visits to:

(a) the WHO Drug Monitoring Centre, to performa detailed evaluation of the pilot phase of the project,its system development, workload and staffing, soas to determine the resources required to meet theneeds of a primary operational phase;

(b) two national centres, to gain information con-cerning monitoring systems in operation at thenational level.

' Off. Rec. Wld HIM Org., 182, 54.


Close collaboration was maintained between theproject and WHO headquarters technical and manage-ment staff to ensure that the data used in the studywere sufficient and accurate.

52. The findings and conclusions of the cost -effectiveness study can be summarized as follows:

(a) Systems assessment. It was concluded that,from a management point of view, the systemdeveloped during the pilot phase for processing,recording and retrieving data relating to adversereactions to drugs was sound.

(b) Work plan. The individual activities to beexecuted during a primary operational phase weredetermined, and an organizational plan developed toensure optimum workflow.

(c) Manpower requirements. Based on a detailedworkload study, the following staff would berequired: three medical officers, one scientist, onestatistician, two programmer analysts, two technicalofficers, three technical assistants, one administrativeassistant, two secretaries, one clerk, two key punchoperators.1

1 At present key punch services are provided under the grantfrom the Government of the United States of America.

In addition, a medical officer and a key punchoperator would be required as from 1 January 1972.

It is estimated that no additional staff other thanthose indicated above would be required to processinput up to 5000 adverse reaction case reports permonth. In the event of the number of reportsavailable to the WHO Centre, either from existingor from newly created national centres, exceeding5000 per month, a reassessment of data handlingmethodology would have to be undertaken and staffrequirements determined in the light of such anassessment.

(d) Location of the project. Two possible sites forthe project were considered, i.e., Alexandria,Va., USA, and WHO headquarters, Geneva.

If the project is located in Geneva, its cost wouldbe less. Comparative costs in 1971 and 1972 foreither location are shown in Fig. 4. In addition,consideration should be given to non- quanti-fiable advantages of the location in Geneva,such as easier communication with the nationalcentres and closer relationship with other technicalsectors of WHO headquarters, as well as theavailability of the programme support services atheadquarters. Moreover, the computer system forthe project has been developed to be compatiblewith headquarters' computer facility.

FIG. 4. COMPARATIVE ESTIMATES (1971 AND 1972)FOR CENTRE AT ALEXANDRIA (Va., USA) OR GENEVA

Purpose of expenditure

Estimated costs in

Alexandria (Va., USA) Geneva

1971 1972 1971 1972

US$ US$ US$ US$

Personnel 232 700 259 400 233 200 266 700Duty travel 20 000 20 000 16 000 16 000Consultants

I

12 600 12 600Meetings 26 000

J

26 00014 000 14 000

Communications 12 500 12 500 12 000 12 000Production and distribution of documents 13 500 13 500 12000 12000Rental and maintenance of premises 9 000 9 000Rental and maintenance of equipment 4 000 4 000Office supplies and services 75 000 40000

14400 14400Computer services - -Cost of removal to Geneva 17 800* -

Total 379 700 411 400 345 000 360 700

* Non -recurring costs.

ANNEX 8 67

Budgetary Requirements and Financing

1970

53. As reported to the Executive Board at its forty -fifth session, funds made available through a grantfrom the United States Government for this projectlapse on 9 May 1970. The estimated obligations forcontinuing the project to 31 December 1970 in itspresent location and under the existing arrangementsamount to $156 500. In response to a request to thegovernments of the 10 countries participating in theproject, voluntary contributions amounting to $52 322have been made available to partly finance the continu-ation of this project beyond its expiry date. TheUnited States Government has authorized the useof savings, accrued within the present allocation forthe grant, beyond 9 May 1970 and estimated at$62 317. As a consequence, the shortfall to be foundfrom other sources to finance the continuation ofthe project to the end of 1970 is reduced to an amountof $41 861. The Director -General hopes that volun-tary contributions will be forthcoming to meet thisdeficit.

1971 and 1972

54. On the basis of the technical evaluation of thisproject and on the cost -effectiveness study completedin April 1970, budget estimates for a primary oper-ational phase have been developed and are summarizedin Fig. 4. These take account of the changes in thestaff requirements for 1972, whereby two new posts-one medical officer and one key punch operator -have been provided for as from 1 January 1972. Everyeffort has been made to keep the estimated require-ments for 1971 and 1972 at the minimum level at whichthe project could operate effectively. Fig. 4 showsthe estimated costs for both 1971 and 1972: (a) ifthe project remains in Alexandria, Va., USA; and(b) if it is transferred to Geneva.

Financing for 197155. Recognizing the importance of ensuring thecontinuation of this project, the Director -General hascarefully reviewed his proposed programme and budgetestimates for 1971 as contained in Official RecordsNo. 179 with a view to identifying activities whichmight be postponed, the related funds being divertedto meet at least part of the costs of the project in 1971.The following three possible ways of financing theproject in 1971 are presented by the Director -Generalto assist the Assembly in considering the subject.

Possibility 1

56. Add the total estimated costs of either $379 700(at Alexandria, Va., USA or $345 000 (if transferred

to Geneva) to the Director -General's regular budgetproposals for 1971 as contained in Official RecordsNo. 179.

Possibility 2

57. In accordance with resolution WHA19.7 of theNineteenth World Health Assembly, the Director -General's proposed budget estimates for 1971 includethe last of five instalments of $100 000 to increase thelevel of the Revolving Fund for Teaching and Labora-tory Equipment to a total of $500 000. The Director -General has included an amount of $168 848 in his1971 budget proposals to provide for a phasedimplementation of the Health Assembly's decision(resolution WHA22.11) to further extend in 1971 theuse of the Russian and Spanish languages in theHealth Assembly and the Executive Board.

58. Should the Assembly decide that the imple-mentation of one or both of these items could bepostponed, the remainder of the estimated costs ofthe project could be added to the 1971 programme andbudget estimates as contained in Official RecordsNo. 179. Depending on the location of the project,the amounts to be added to the 1971 budget proposalswould be as follows:

Alexandria (USA)Uss

GenevaUss

Assumed postponement of-

(1) final instalment to RevolvingFund for Teaching and Labo-ratory Equipment 279 700 245 000

(2) extended use of Russian andSpanish languages 210 852 176 152

(3) both items (1) and (2) above . . 110 852 76 152

Any postponements other than those suggested above,or cuts, would affect programme activities, and theDirector -General would accordingly not recommendthem.

Possibility 3

59. Should postponement of the implementation ofone or both of the items referred to in Possibility 2above be decided upon, voluntary contributions couldbe made by the Member States directly participatingin the primary operational phase of the project tocover the balance required for operations in 1971.

Financing for 1972

60. Whichever method the Assembly approves forfinancing the project in 1971, the Director -Generalrequests that the Assembly consider the method offinancing in 1972 and following years and its impli-cations for future budget levels.


Annex 9

RESEARCH ON ALTERNATIVE METHODS OF VECTOR CONTROL

[A23 /P &B /3 - 1 April 1970]

REPORT BY THE DIRECTOR - GENERAL

Great successes have been achieved in controllingthe insect vectors of disease during the past 25 yearsby means of the synthetic residual insecticides. Notablywith the aid of DDT, malaria has been eradicatedfrom large areas of the world, and the vectors ofepidemic typhus, yellow fever, onchocerciasis, plagueand other diseases have been strikingly controlled.Organophosphorus and carbamate compounds havebeen developed to replace the organochlorine insecti-cides, notably for filariasis control, although . thisreplacement has not as yet proved economic for themalaria eradication programme. Thus these successesare largely being achieved at the price of addingpersistent chemicals to the environment.

It was for this reason that the Twenty- second WorldHealth Assembly requested the Director -General tostimulate and intensify research on the developmentof alternative methods of vector control (resolutionWHA22.40). WHO is in a particularly good situation

to perform the necessary field experiments to investi-gate alternative methods, since it already has inoperation a number of vector control research unitsin various parts of the world, and this new undertakingcould be fulfilled at a reasonable cost by an expansionof staff and facilities at these units. The Organizationhas also been engaged for nearly a decade in surveyingand identifying biological control agents that mighthave practical application. It also enjoys the closeco- operation of a number of universities and otherinstitutions which are engaged in the basic researchthat is essential for the success of practical fieldexperiments.

The following report presents proposals for neces-sary additional research activities to examine anddevelop alternative methods of vector control. Inorder to obtain an adequate assessment of the possiblemethods, it is estimated that a period of five years isrequired, and the proposals refer to that period.

1. THE GENERAL PROBLEM

Hitherto the control of insect vectors has beenmainly dependent upon chemical means; thus acontrol method that is essentially of a temporarynature has become recurrent and permanent. Suchcontrol operations have been carried on withoutadequate attention to the basic problem, which is oneof vector numbers and their relationships to their hostsand the pathogens they transmit. The increasingresilience of many vectors, due to the development ofinsecticide resistance and the destruction of naturalenemies, has served to aggravate the necessity for moreinsecticides in the environment. It is only now that ithas become self -evident that the study of the basicecology of the vectors should have been first under-taken as the essential background for an enlightenedchoice of the control methods to be selected.

It should be stressed at the outset that alternativesto simply adding chemicals to the environmentdemand an adequate staff sufficiently trained in bio-logical principles and entomological techniques. Theywould increase the demands made by developingcountries on their own intellectual resources, while


economizing on material resources usually obtainableonly by purchase from the developed countries. Thus,alternative methods of control, while they might proveto be more economical in the long run, will certainlybe more arduous. They will require:

(a) adequate and continuous surveillance of vectorand pathogen densities;(b) continuing assessment of the results of thecontrol methods applied; and(e) close attention to detail in applying thesemethods, and in modifying them to meet newsituations as they develop.

A general classification of the alternative methodsavailable would include: (i) biological control, in-volving the use of fish and arthropodan predators,insectan and helminth parasites, and fungal, bacterialor viral diseases of vectors; (ii) genetical control,involving the release of males which have been radio -sterilized, chemosterilized, are of cytoplasmicallyincompatible strains, are sterile hybrids, carry genetictranslocations or have deleterious genes; (iii) traps andattractants; and (iv) hormones and natural toxins.

ANNEX 9 69

In addition there is: (v) environmental sanitation,which more than all the others is closely integratedwith the development and economic well -being of thecountry concerned. All of these categories wereconsidered in detail at a series of informal consultationson alternative methods of vector control, held inDecember 1969, which followed the informal consul-tations on the genetic control of insects of publichealth importance, held in Washington, D.C., in 1968.

In considering biological control in the classicaland restricted sense, it is clear that, although it has along history, trials with specific biological agents forvector control have never been maintained withsufficient staff or for a long enough time to obtain aproper assessment of their capabilities. Geneticalcontrol, on the other hand, is in the forefront ofpresent -day scientific development, and has achievedtwo outstanding successes. The lack of successattained in other experiments might have been avoided

if an adequate ecological background knowledge hadbeen previously obtained. The use of attractants andtraps demands the co- operation of the population toprevent their removal, and great persistence is neces-sary if these agents ate to have a chance of success.Hormones and natural toxins are now coming forwardas prodtícts of promising new lines of research, andthey have the advantage of being naturalistic com-pounds compatible with the environment.

In considering alternative methods of control, theprincipal emphasis must be placed upon the mosquitos,as being vectors of malaria, filariasis and arbovirusdiseases. Attention must also be paid to Glossinatsetse -flies, Triatoma cone -nosed bugs, and Simuliumblackflies as vectors of trypanosomiasis and onchocer-ciasis. Body lice can scarcely be considered as objectsfor biological control, but it is possible that geneticalor biological control may eventually be developed forfleas and ticks.

2. BIOLOGICAL CONTROL

2.1 Predacious Insects

Although ants are predacious on houseflies,Reduvius and Spiniger on triatomine bugs, andnymphs of dragon -flies, stone -flies and certain may-flies on the larvae of Simulium, there are only threegroups of insectan predators worthy of considerationfor use at this time; all of them are predacious on thelarval stage of mosquitos.

2.1.1 Toxorhynchites

This is a genus, comprising some 57 species, of verylarge mosquitos which do not bite and whose larvaeprey on the larvae of other mosquitos. Usually in-habiting tree -holes and other small containers, theyare particularly effective against the larvae of Aedesaegypti and Ae. albopictus. The female distributesher eggs in a number of containers, and her larvaloffspring often succeed in killing, if not devouring,all the mosquito larvae in the container. The speciesT. inornatus was introduced into Fiji in 1931 to controlthe filariasis vector Ae. polynesiensis; beyond the factthat it established itself, nothing could be concludedabout its effect, owing to the lack of pre -release andpost -release ecological surveys.

There are several species of Toxorhynchites suitablefor experiments in mosquito control. The larvae maybe reared in a field insectary, and on a non -living dietif necessary. Maximum production would require thelarvae to be reared separately, since they are canni-balistic, and under these conditions the theoreticalproduction from one original pair would be 36 000

adults in 10 weeks.

The first choice would be the African speciesT. brevipalpis, known to devour 100 -200 Ae. aegyptilarvae at the rate of 30 per day. For example, in anautomobile dump at Dar es Salaam, which is anabundant source of Ae. aegypti, this predator speciesis nearly two -thirds as abundant as its prey at the heightof the rainy season, and in tyres is actually morefrequent than its prey. In Uganda the variety conradtiof this species has been shown to reduce three speciesof culicines by 9 per cent. at the minimum and 61 percent. at the maximum. Another important predatorspecies is T. splendens of South -East Asia, successfullyintroduced into Fiji and Samoa. In Bangkok 10 percent. of the water jars contain this predator, ascompared to 50 per cent. containing Ae. aegypti. Thesefigures concern an equilibrium condition where thepredator is left to go its own way unaided. If largenumbers are artificially bred and applied in an inun-dative release, the results could well be quite striking.

Research proposed

It is recommended that an experiment be carriedout involving Toxorhynchites brevipalpis directedtowards the control of Ae. aegypti. This trial couldbe performed by the WHO East Africa AedesResearch Unit situated in Dar es Salaam, UnitedRepublic of Tanzania. The research, including a pre-release survey, would require a minimum of threeyears. In succeeding years the experiment could berepeated on a larger scale.

It would in addition be necessary for a suitablelaboratory to undertake the development of a tech-


nique for the large -scale production of T. brevipalpisand to advise on its use in the field.

2.1.2 Lutzia

This genus contains about 10 species of fairly largemosquitos that feed only on birds and whose larvaeprey on other mosquito larvae. Inhabiting waterbodies of all sizes, they are suitable for larval controlof Culex fatigans and anopheline mosquitos. Suitablemass -rearing methods must first be developed forLutzia, and if successful they could then be tested bythe Research Unit on the Genetic Control of CulicineMosquitos, recently established in Delhi, India,against C. fatigans and by the Centre Muraz (Organi-zation for Co- ordination and Co- operation in theControl of Major Endemic Diseases), Bobo Dioulasso,Upper Volta, against An. gambiae.

2.1.3 Notonecta

Nymphs and adults of these water -bugs (" back -swimmers ") feed voraciously on mosquito larvae.While it is unlikely that they ever will be artificiallypropagated, they fall in the class of biological controlagents whose elimination is to be avoided and whosemultiplication is to be encouraged.

2.2 Parasitic Insects and Mites

Among the parasitic wasps and flies, none are knownto parasitize mosquitos. Against Triatoma andRhodnius, the vectors of Chagas' disease, the parasiticwasp Telenomus fariai normally accounts for 10 -30 percent. egg mortality in Venezuela. It is now beinginvestigated at the Central University of Venezuela,Caracas, and there seems to be no obstacle to obtain-ing sufficient numbers for field experiments. Thereason why Triatoma rubrofasciata is unimportantin the Indian sub -continent but important in SouthAmerica is now being investigated in Pakistan, underWHO support to the Commonwealth Institute ofBiological Control, in the hope that useful parasitesmay be found. The parasitic mite Pimeliaphilus hasshown promise against triatomines in California, USA.

Against hard ticks (ixodes, Hyalomma and Derma -centor), the nymphal parasite Hunterellus hookeri hasshown promise because of its wide occurrence. Butalthough it gave fairly good results against Derma -centor variabilis in Massachusetts, USA, a large -scaletrial against D. andersoni in Montana conductedbetween 1927 and 1932 met with failure. Tsetse -flieshave yielded about 20 species of parasites, of whichMutilla glossinae is the most important, but nothing isknown of their actual or potential quantitative role.

Against the housefly, several species of the parasiticwasp Spalangia, which attack the pupal stage, have

been liberated in Puerto Rico, Hawaii, Fiji and Guam.Similar wasps of the genus Muscidifurax are effectiveparasites of pupae. Another chalcidoid wasp, Diapriacommoda, has been mass produced for houseflycontrol in Kyoto, Japan. Evidently their success hasbeen limited. At present the most promising arthropodagents for housefly control are the macrochelid mites,which are ectoparasitic on the adults and predaciouson the larvae in their breeding sites.

Research proposed

It is recommended that investigations be made ina laboratory

(1) into the possible effectiveness of several exoticspecies of Spalangia and Muscidifurax parasites forhousefly control;

(2) on insect parasites as agents of biological controlof Triatoma.

2.3 Mermithid Nematodes

Many species of these minute roundworms parasitizeinsect vectors, and their taxonomy has not yet beenproperly worked out. In agricultural entomology, thenematode Neoaplectana glaseri has been mass -produced for control of the Japanese beetle. Themost nematode fór mosquito control is aspecies of Romanomermis, now in culture at the UnitedStates Department of Agriculture laboratory at LakeCharles, La. It parasitizes the larvae of a great rangeof mosquito species, especially Culex fatigans andanophelines. It is easily propagated on laboratorycolonies of Culex, and can be produced as encapsulatedeggs for field release. Ponds inoculated with Romano-mermis in Louisiana have yielded parasitized larvaefor years.

Research proposed

The following are recommended:

(1) that arrangements be made with the EntomologyResearch Division, United States Department ofAgriculture, Lake Charles, La., USA, to perfect thelarge -scale culture of the Romanomermis nematode;

(2) that two field trials be organized to determinethe effectiveness of the nematode, as follows:

(a) at the WHO Aedes Research Unit in Bangkok,Thailand, against Culex fatigans;(b) at the WHO Anopheles Control Research UnitNo. 1, Kaduna, Nigeria, against Anopheles gambiae;

(3) that the effect of an introduction of Romano-mermis made by a WHO consultant on Nauru Islandin 1967 against C. fatigans and Ae. aegypti be assessed.

ANNEX 9 71

2.4 Fungi

2.4.1 Coelomomyces

Many species of this fungus have been foundparasitizing larvae of a great variety of mosquitosin various parts of the world. Resistant sporangia areformed in the killed larvae, and these are the mainsource of new infections; should the infected larvaetransform to adult mosquitos, the fungus can becarried to new breeding sites. The genus Coelomo-myces has been considered to be one of the mostpromising agents for biological control of mosquitos.

In a field trial conducted in 1958 under WHOauspices in the Tokelau Islands of the Pacific Ocean,Nukunono atoll was treated with sporangial suspen-sions of C. stegomyiae obtained from Aedes albopictusin Singapore, with a view to controlling the filariasisvector Ae. polynesiensis on the atoll. By 1960 thecontrol obtained was comparable to that given bydieldrin briquettes on a neighbouring atoll. Thefungus had spread naturally to some new breedingplaces, and the overall infection rate in Ae. polyne-siensis was about five times higher than it had been inthe original Ae. albopictus source in Singapore.

In field experiments conducted in 1967 in the UnitedArab Republic, rice fields were inoculated with deadlarvae of Anopheles pharoensis infected with C.

indicus. The existing populations of An. pharoensisbecame infected in three out of the four fields, but bythe second week the surviving larvae were all un-infected. The difficulty of obtaining new infectionswith C. indicus, which depends on the sporangiagerminating into zoospores, is being exhaustivelystudied in a culture maintained on An. gambiae at theUniversity of Bristol, England, with financial assistancefrom WHO.

At the University of North Carolina, USA, how-ever, it has been possible to maintain good culturesof C. punctatus on the anopheline An. quadrimaculatus,to produce dry sporangial dusts with an eight -monthshelf life, and to study infections in the field. Moreoververy recently at the University of Otago, New Zealand,it has proved possible to produce massive infectionsof Aedes australis with Coelomomyces.

Research proposedThe following research is recommended:

(1) to promote the development of laboratoryproduction methods for Coelomomyces sporangia,and to investigate in detail the infective process withsporangia;(2) to assess the long -term fate of C. stegomyiae onthe Nukunono atoll in the Pacific;(3) to arrange for a field trial to be performed on asuitable island in the Pacific;

(4) a study on the distribution of Coelomomyces inEast and West Africa.

2.4.2 Other Fungi

Species of the genera Beauveria and Entomophthoraare considered promising for the biological controlof houseflies, E. muscae having been used experi-mentally as early as 1914. The fungi known to havea wide spectrum of target hosts among agriculturalinsects include Aspergillus and Metarrhizium aniso-phliae; since they may readily be produced as com-mercial products, assessment of their effect on insectvectors of disease might prove to be profitable. Thefiltrate from cultures of Aspergillus niger, for example,has been found to be quite toxic to Aedes aegyptilarvae.

2.5 Microsporidea

This is an order of spore- forming protozoa thatcontain important parasites of mosquito larvae,notably the genera Nosema, Thelohania and Plisto-phora. These often form persistent infections inlaboratory colonies of mosquitos, and they are trans -ovarially transmitted from one generation to the next.A species of Nosema from Anopheles quadrimaculatusis being developed for production of pure sporesuspensions at the United States Department ofAgriculture laboratory at Gainesville, Fla., USA. Themicrosporidean Plistophora culicis introduced on toNauru Island in 1967 eliminated Culex fatigaras in twoout of the four breeding sites inoculated. A species ofThelohania parasitizing C. salinarius has been distri-buted in the field at Lake Charles, La., but failed toincrease the natural infection rate.

Microsporidea have often featured as agents ofepidemics of disease in laboratory colonies of mos-quitos. They have also been noted to be frequentparasites of species of Simulium blackflies in the field-

Research proposed

The following research is recommended:

(1) examination of the long -term effect of Plisto-phora culicis introduced on Nauru Island in 1967;

(2) examination of the microfauna parasitizinganopheline larvae in a semi -tropical country;

(3) study of the various species of microsporideansparasitizing Simulium in eastern North America,preparatory to studies elsewhere in the world.

2.6 Bacteria

While species of Pseudomonas bacteria present inpolluted water may kill mosquito larvae by their


toxic products, direct bacterial infection is apparently,rare and the commercially produced spores of Bacillusthuringiensis are not an effective larvicide for mos-quitos, although they are for houseflies. However, a*close relative of B. thuringiensis which has two para-sporal bodies per cell has been discovered in Culextarsalis at the University of California, Riverside,USA, and proves to be highly pathogenic to Aedeslarvae. Moreoverr, this organism, called BacillusBA -068, may be cultured on an artificial medium.

Research proposed

The following are recommended:(1) that large quantities of BA -068 be producedby the Department of Biological Control at theabove -mentioned University of California, Riverside,USA;(2) that a field trial be organized to determine theeffectiveness of this organism to control Culex fatigaras.This experiment could be undertaken by the AedesResearch Unit in Bangkok, Thailand.

2.7 Viruses

Virus infections of mosquitos were not discovereduntil 1963. Since then a mosquito iridescent virus(MIV) has been discovered in Aedes taeniorhynchusin Florida, but it is incapable of patently infectingmore than half the larvae. A cytoplasmic polyhedralvirus (CPV) has also been discovered in this species,but it loses its virulence on culture. Recently anuclear polyhedrosis virus (NPV) has been dis-covered in Ae. sollicitans at Lake Charles; this ishighly virulent and can be cultured in Ae. aegypti.At the Alès Cytopathological Station of the Institutnational de la Recherche agronomique, France,an iridescent virus has been discovered in Ae. detritusfrom Tunisia, and this is being cultured in Ae.aegypti cells. Even more promising is a new pox -typevirus discovered in Ae. albimanus from Panama. InCzechoslovakia, an iridescent virus has been discoveredin the blackfly Simulium ornatum.

Research proposed

It is recommended that further laboratory studiesbe made on these and other viruses, especially toensure their establishment in laboratory culture andto investigate the range of mosquito species that aresusceptible and the degree to which they can beinfected.

2.8 Training in Biological Control

Since biological control requires a thoroughknowledge of a large array of pathogenic organisms,the training of workers in this specialized field should

be promoted. This could continue to be centred onthe International Reference Centre for the Diagnosisof Diseases of Vectors located at Ohio State University,Columbus, USA. Ways and means should be ex-plored of extending this training, associated with theidentification of the disease organisms, to othercountries, particularly those where the problems ofvector -borne disease are acute.

Action recommended

It is recommended that students from tropicalcountries be trained at the WHO InternationalReference Centre for the Diagnosis of Discases ofVectors, in Columbus, Ohio, USA.

2.9 Cautionary Considerations

The expert group in the informal consultations onalternative methods of vector control recommendedthat, before any agents are introduced into the aquaticenvironment, the investigators responsible shouldconsult with the appropriate hydrobiological expertsand local authorities.

Moreover, the Expert Committee on Insecticidesin its sixteenth report (1967)1 recommends that anybiological control agent, living or dead, be subjectedto the same searching examination for potentialtoxicity to man as is applied to the synthetic insecti-cides. Each assessment should be made in a laboratorypossessing the specialized knowledge appropriate tothe particular agent.

The possibility that resistance may develop tobiological agents should not be disregarded. Alreadycertain strains of houseflies have developed slightresistance to the toxin of Bacillus thuringiensis in thelaboratory. Certain strains of the honey bee aregenetically resistant to infection by Bacillus larvae,the foulbrood- disease organism. Certain populationsof the larch saw -fly and the alfalfa weevil can neu-tralize, by encapsulating them, internal parasiteswhich normally develop in these species. Moreover,there is always the possibility of a prey speciesdeveloping a change in behaviour which allows it toevade its predator.

Research proposed

It is recommended that investigations be performedin a suitable laboratory on the safety to mammalsof living organisms that might be used for biologicalcontrol.

2.10 Larvivorous Fish

Virtually the only biological agents that are atpresent being applied for the control of mosquitos

.1 Wld Hith Org. techn. Rep. Ser., 1967, 356.

ANNEX 9 73

are predacious fish of minnow size. In fact, theyoffer the greatest promise of all candidate agents forbiological control, and would be well worth theconsiderable expenditure of time and money necessaryto develop them on a scientific basis. The mostimportant species is Gambusia affinis, the so- calledmosquito fish, a native of Texas which was firstintroduced into Hawaii in 1905. The next step wasits introduction into Spain in 1921, and during thefollowing decade, when malaria was being combatedwith-Paris green insecticide, G. affinis was introducedinto countries on all sides of the Mediterranean andBlack Sea. It was also distributed in many areas ofNorth America for culicine control. After sufferinga 20 -year eclipse, owing to the appearance of thechlorinated insecticides, mosquito fish are againcoming into their own in widely scattered areas suchas Hawaii, Iran and New Mexico.

The technology is simple, involving the discoveryand maintenance of ponds yielding a rich and conti-nuous source of supply, and the distribution of thefish from this source in pails or other simple containers.Gambusia affinis thrives in a great variety of watersand temperatures, bearing its young alive and pro-ducing at least five generations a year; the averagedaily consumption of a single mosquito fish is about100 mosquito larvae, and a population at 15 fish persquare metre can achieve complete control whereconditions are favourable; moreover, Gambusia cansurvive in the absence of larvae.

The spectrum of fish species available for mosquitocontrol is now considerably enlarged. The guppy,Poecilia (Lebistes) reticulata, is particularly welladapted to the polluted waters in which the mosquitoCulex fatigans breeds. The zebra minnow, Funduluskansae, can penetrate dense mats of vegetation.Species of Panchax, Notropis, Limia and Mollienesiaare also useful predacious fish and may have their ownparticular optimal situations. Species of Cyprinusand Tilapia that are partly herbivorous have the effectof opening up dense vegetation to allow the access ofthe predacious species to larvae.

The stocking of ponds and swamps in Georgia,USA, with Gambusia in 1925 was concluded to havereduced the density of anopheline larvae by 50 percent. and of culicine larvae by 80 per cent. Recentlythe stocking with Gambusia has been credited withcompletely eliminating ánopheline larvae in a marsh inIran measuring 18 by 12 km. Populations of Lebistes inRangoon, Burma, surviving from introductions of atleast 10 years previously were found in 1968 to be hol-ding the density of Culex fatigans in the pukka drainsdown to a level which, when compared to that in thedrains without fish, indicated 98 per cent. control. Intro-duction of the guppies into new drains resulted in

their establishing themselves but not in their exertingcontrol of the mosquitos, owing to the persistence oflarvae in inaccessible corners.

The use of Gambusia is compatible with the appli-cation of certain insecticides. For example, a 300hectare swamp on Oahu Island, Hawaii, where a densepopulation of mosquito larvae follows the annualrains, is first seeded with Gambusia plus Lebistes andLimia at 500 fish per hectare and then treated threetimes with the organophosphorus insecticide fenthionat 0.25 kg per hectare to allow the fish to establish anascendancy over the larvae, which they succeed inmaintaining unaided for the following 10 months ofthe year. Actually, strains of Gambusia resistant tochlorinated insecticides and tolerant to the organo-phosphorus compounds are extant in Mississippi,USA.

For bodies of water which disappear in the dryseason, such as those in which Anopheles gambiaebreeds in the interior of Africa, it is better to use fishwhich lay eggs that are resistant to desiccation. Suchare the killifishes (annual fish), notably the AfricanNothobranchius guentheri and the South AmericanCynolebias bellotti. One drawback however is thatthey do not multiply during the year after each annualintroduction, since the eggs for the next generationmust await desiccation before hatching.

Research proposed

The following are proposed:

(1) an extensive field trial to assess the effect oflarvivorous fish in controlling An. gambiae andAn. funestus in Africa. This could be undertaken bythe WHO Anopheles Control Research Unit No. 1,in Kaduna, Nigeria. The fish species to be utilizedwould be the live- bearers Gambusia and Poecilia,supplemented with the eggs of annual fishes. Theirability to establish themselves and reduce themosquito larvae would first be assessed in represen-tative water bodies, and then a number of special fishbreeding sites would be established as a source forthe whole area to be treated;

(2) a second extensive field trial for the control ofthe Japanese B encephalitis vector Culex tritaenio-rhynchus together with Culex fatigans in the rice fieldsof northern Taiwan. While Gambusia and Poeciliawould be the fish species tested, an assessment will bemade of the usefulness of carp (Cyprinus carpio) sinceit represents a second edible crop. The experimentalarea should be approximately 75 square kilometres,and the first two years of the experiment should bedevoted to an ecological study of the rice -field fauna


and to developing methods of mass rearing for thearea. The actual experiment, involving repeatedreleases of fish as necessary, and assessment of theCulex larval populations, should then be maintainedfor the next three years. These experiments could beperformed by the WHO Japanese Encephalitis VectorResearch Unit established in Taiwan in 1970;

(3) studies on the choice of species and strains offish suitable for mosquito control in tropical con-ditions. These could be performed by a universitydepartment;

(4) studies on the distribution and availability oflarvivorous fish are required in Africa and the WesternPacific.

3. GENETICAL CONTROL

This method of using insects to eliminate their ownkind is nearly always performed by liberating a certaintype of male that ensures that the female with whichit mates lays sterile eggs. The usual way is to alterthe genetic material of the male (thus producing" sterile males ") by treating them with radiation orchemosterilants. But more recently the " sterile male "principle has been achieved by using sterile interspecieshybrids, strains bearing chromosomal translocations,or strains which are cytoplasmically incompatible.

3.1 Artificially Sterilized Males

3.1.1 Radiosterilized Males

Eradication of the screw -worm from the island ofCuraçao was attained in 1954 five months after initi-ation of releases of radiosterilized male pupae. Sub-sequently the same method eradicated the screw -worm from the peninsular state of Florida, USA,and was highly successful in the continental state ofTexas. Radiosterilized males of the malaria mosquitoAnopheles quadrimaculatus released in two field trialsin Florida were not successful in eradicating thisspecies, apparently because they failed to dispersefrom the release sites and were not sufficiently compe-titive with the wild males in mating. Probably thesame reasons were responsible for the failure of radio-sterilized males of Aedes aegypti in a field experimentnear Pensacola, Fla.

Radiosterilized males of Culex fatigans released inAslatnagar village, India, did achieve some sterilityin the target population, but opposition of the villagersforced the trial to be discontinued before enoughsterile males had been liberated. Accordingly, larger -scale trials with radiosterilized C. fatigans will beundertaken in India by the Research Unit on theGenetic Control of Culicine Mosquitos recentlyestablished in Delhi. A trial in Ceylon, to be supportedby IAEA, has been under consideration for some time.

Experiments are also under way, particularly underthe aegis of IAEA, utilizing radiosterilized males ofTriatoma in Venezuela and of Glossina morsitans inthe Lake Kariba area in Tunisia. Methods for thenecessary large -scale rearing are being perfected in

three laboratories for G. morsitans and at Bristol,England, for G. austeni, since at present it has notproved possible to rear sufficient numbers in labo-ratories close to the field release sites.

3.1.2 Chemosterilized Males

Following upon the success obtained with certainspecies of fruit -flies pretreated with chemosterilantsbefore release, an experiment for the control ofCulex fatigans was undertaken on Seahorse Key, Fla.,in 1968. A mass -production of this mosquito waschemosterilized by allowing the adults to emergethrough tubes coated with tepa, and by the fourthgeneration an 85 per cent. level of sterility had beenachieved on the island. The experiment was repeatedin 1969, this time chemosterilizing the pupae by meansof thiotepa, and within six generations (12 weeks) acomplete disappearance of larvae on the island hadbeen achieved. An extensive trial with chemo-sterilized C. fatigans is therefore planned for theDelhi area.

With houseflies, the principle of autochemosterili -zation has been utilized by exposing corn -meal baitscontaining tepa, metepa or apholate and thus allowingthe flies to sterilize themselves. Very promising resultswere obtained in trials on garbage dumps in Florida,with almost complete sterility (and elimination) beingobtained within about four months. But a moreextensive experiment on a Caribbean island could notachieve eradication by means of chemosterilant baits,largely because there remained harborages for sur-viving flies, such as house kitchens, which were outof bounds to the use of baits.

The principle of autochemosterilization could beapplied to mosquitos once suitable traps and /orsufficiently powerful attractants have been discovered.A light trap has been devised which, baited with tepa,achieves 90 per cent. sterility of the male C. fatigansthat pass through it, but its dependence on lineelectric power is a real handicap to its practical use.It is recommended that attention be paid in Delhi toautochemosterilization methods that are independentof line power, including the use of chemosterilant trapspowered by batteries.

ANNEX 9 75

Release of male flies sterilized by tepa on the LipariIslands off the Italian coast succeeded in reducing thefly population to a very low level. Chemosterilizedmales of tsetse -flies have also been investigated in theLake Kariba area.

3.2 Hybrid Sterility

When two related species hybridize, the maleoffspring are usually sterile. Opportunity for the useof these sterile hybrids has been offered within the fivespecies of the Anopheles gambiae complex. A fieldtrial recently completed at Pala, Upper Volta, utilizedthe hybrid males from a species B x melas cross, whichwere liberated to control a population of species A.Unfortunately, only a small degree of sterility wasachieved in the eggs appearing in the field, possiblydue to the use of species B rather than species A as theorigin of the hybrid males.

Research proposed

It is recommended that a field trial be undertakento determine the effectiveness of hybrid sterility as ameans of controlling An. gambiae. This experimentcould be undertaken by the WHO Anopheles ControlResearch Unit No. 1 located at Kaduna, Nigeria.

3.3 Translocations

Strains in which parts of chromosomes have beenreciprocally translocated on to others have beeninvestigated theoretically for tsetse -flies and in labora-tory experiments in the case of houseflies. A singleliberation of males of these translocated strains isexpected to result in a partial sterility which, if greaterthan 40 per cent., will continue to bring the survivingpopulation down in every succeeding generation.Strains of Culex fatigans in which the chromosome I(which determines maleness) has been translocatedon to an autosome produce a sterility inheritedthrough the males which, amounting to about 40 percent., has eliminated target populations in the labora-tory within eight generations. The advantage of theuse of translocated strains is that it does not matterif the occasional female is liberated along with themales. Great stress will be placed by the WHOResearch Unit in Delhi, India, on the field investigationof translocations to control C. fatigans. A trans -location which causes 80 per cent. sterility is knownin Aedes aegypti, and this or a similar strain shouldalso be tested in the field.

3.4 Cytoplasmic Incompatibility

Within the Culex pipiens complex, of which C. fati-gans is really a subspecies, there are populations which

show cytoplasmic incompatibility one with another.It is found that the egg cytoplasm of some strainscauses the male pronucleus of some other strains todisintegrate before the fusion with the female pro -nucleus, necessary for fertilization, takes place.

A strain was synthesized (the D2 strain, actually aFreetown -Fresno compound with Paris cytoplasm)with which the C. fatigans population of southernBurma was incompatible, and these Burma eggsinseminated by D2 sperm failed to hatch. The villageof Okpo near Rangoon therefore was treated with thedaily liberation of 5000 D2 males for a period of12 weeks. This treatment so overcame the nativemales that by the end of the period all the egg -raftslaid in the village were sterile, and thus the Culexpopulation was apparently eradicated.

It is proposed to perform a feasibility study of thismethod on a large scale in the Delhi area. Calculationsindicate that if a large city measuring 12 miles acrosswere first treated with insecticide to reduce the Culexpopulation down to 15 million, then a weekly liberationof 75 million cytoplasmically incompatible malesshould achieve eradication within three months at atotal production cost of $27 000. Exceptional caremust be taken to cull every last female from the maleliberation.

The many different populations of the filariasisvector Aedes scutellaris frequently show cytoplasmicincompatilibity between each other. Since this vectorbreeds in relatively inaccessible habitats difficult totreat with insecticides, it would be an excellentcandidate for genetical control.

3.5 Other Possibilities

Sex -ratio distorters are known in Aedes aegyptiwhereby a meiotic drive ensures that there is a greatpreponderance of male -producing gametes and thusvery few females are produced. Possibly certainrecessive lethal factors or sex -linked sterility factorscan be coupled with a meiotic drive, and would thus beable to sweep through a population after their initialintroduction.

It is anticipated that the WHO Research Unit inDelhi, India, will investigate any possible mechanismswhich may exist for genetical control of Anophelesstephensi. Such investigations are especially necessaryfor An. albimanus, which is now so frequently resistantto organochlorine insecticides and occasionally toorganophosphorus compounds. The possibility ofgenetic control of Ornithodoros tholozani, a vector ofrelapsing fever that usually occurs in small populations,should be tested on the sterile -male principle. Thegenetical control of Simulium would be very desirable,but cannot be investigated until the means of culturing


these blackflies in the laboratory have been furtherdeveloped.

It is therefore evident that research into the geneticmechanisms that might be useful in control should beencouraged and supported in a number of laboratories.Before these mechanisms can be exploited in the field,development research should be undertaken onpractical matters such as mass production of the insectconcerned, the method and dosage cf the sterilant tobe employed, and the topographical pattern of fieldrelease necessary to ensure maximum effectiveness.

As a general practice, wherever liberations are madefor genetical control it would be advantageous if the

strain employed was resistant to the insecticides beingused in the area. In cases where eradication of apopulation might be achieved, thought should be givento replacing it (if necessary) with a strain or species thatdiffers by not being a vector of the disease concerned.In this case, it is important that it shows incompatibilityin both directions (both the reciprocal crosses) withthe native species or population. An experiment toreplace one species with another is to be attempted onan island in the Tuamotu archipelago of the Pacificby replacing the filariasis vector Aedes polynesiensiswith the species Ae. albopictus, which is not a vectorof filariasis.

4. OTHER ALTERNATIVE METHODS OF CONTROL

4.1 Attractants and Traps

Attractants and traps have been widely used for thehousefly, which is attracted to a wide variety of odours.Liquid molasses -type baits and solid cornmeal -typebaits have been used to attract houseflies to be killedby malathion insecticide or sterilized by a chemo-sterilant.

Mosquitos however do not respond to odours fromlarge distances, and compounds attractive to themin the laboratory (i.e., lysine, lactic acid for females,dioxane derivatives for males) have negligible powerin the field. Some success has been obtained withultraviolet -light or wingbeat -sound traps for males,but they require a source of line electric power. Thesame difficulty applies to modified light traps in whichnewly- hatched chicks are used as an attractant abovethe intake fan, and which have proved quite highlyattractive to female Culex mosquitos and Simuliumblackflies. One trap requires no power and is effectiveto retain not the mosquitos but the eggs they lay; theseare the ovitraps of the United States Public HealthService -black wide -mouth jars containing water anda tongue- depressor as an oviposition substrate.Originally they were baited with methyl butyrate, butlater this was found to be redundant. It is proposed toinvestigate the effect of continuous removal of theeggs laid in a given area by means of exposing ovitrapsin a circumscribed and, if possible, somewhat isolatedarea. The procedure would be employed only afterthe existing population had been greatly reduced byinsecticidal or other source -reduction control. Aprotocol for this experiment has been drawn up bythe Director of the Entomology Research Division,United States Department of Agriculture, the acknow-ledged world expert on the quantitative prognosis ofthe results of control operations. This experimentcould be carried out against Aedes aegypti at the WHO

East Africa Aedes Research Unit, Dar es Salaam,and possibly against Culex fatigans at the WHOAedes Research Unit, Bangkok, in order to determinewhether this method could be of value in an integratedprogramme in which a preliminary breeding- sourcereduction by other or conventional means had reducedthe population to a low level.

An alternative control method is to use as death-traps selected natural breeding sites treated with larvi-cides, to which an attractant has been added. Capricacid has proved useful against northern Aedes species,the products of its natural bacterial decompositionbeing highly attractive. Certain proteinaceous ma-terials have proved very attractive to ovipositingfemales of several Culex species. The search forattractants, whether ovipositional or not, should becontinued and encouraged, especially with a view tocharacterizing the sex attractants of mosquitos,houseflies and tsetse -flies. Those with an adequaterange (distance) of action, while perhaps not beingeffective when used alone, could be very effective inconjunction with insecticides or chemosterilants, aswork with fruit -flies in the agricultural field has shown.

4.2 Hormones and Natural Products

One of the objectives of research is to find naturalproducts which may be substituted for the artificialsynthetic insecticides. Recently, great expectationshave been raised by the identification of the chemicalhormones which normally prevent insect larvae frommetamorphosing prematurely into adults. Thesejuvenile hormones prove to be close relatives of thesimple compound farnesol, and are now availablecommercially in reasonable quantities. At presenthowever they require to be applied in very much higherdosage than conventional insecticides if they are toact on the larval insect.

ANNEX 10 77

4.3 Environmental Sanitation

It is obvious that as much attention should be paidto reducing the vectors at their source by means ofsanitation measures as the economy allows. Propermanagement of waste disposal, dairy farms, seed lotsand poultry farms remains essential for houseflycontrol. Heavy infestations of Culex fatigans followinadequacies in surface water drainage in towns, whileC. tritaeniorhynchus and other encephalitis vectorsmultiply where irrigation and rice -field waters areallowed to accumulate for any length of time. Domesticinfestations of Aedes aegypti are frequently eliminatedupon the installation of a piped water supply.

Environmental sanitation should be accompaniedby and proceed from a proper topographical know-ledge of the area, to the extent that all breeding sitesof vectors are mapped. In the case of mosquitos, notonly drainage but also shore -line clearance anddeepening represent continuing activities for perma-nent abatement, while elimination of aquatic vegetationis especially necessary where filariasis is transmittedby Mansonia mosquitos. On the other hand, theplanting of larvicidal aquatic plants such as Utriculariamay have a place in mosquito abatement. It is alsoimportant to note that the mucilaginous seeds ofcertain cruciferous plants can destroy larvae byentrapping their mouth- parts, and field trials willbe performed with them by the University of California,Riverside, USA, in the coming year.

4.4 Integrated Control

The replacement of chemical control by alternativemethods would involve the substitution of a single,comparatively simple, procedure by multiple pro-cedures each demanding considerable expertise.Among the alternative methods discussed, there are

very few which are likely to be effective on their own,and almost none which would be equally effectiveover the entire range of the vectors. Thus it is necessaryto contemplate using them in pairs or in sy §tems,where advantage is taken of the particular propertiesof each. For example, genetical control gives the bestresults only when the initial population is low, ascould obtain after an initial application of insecticide.At this point the genetical method has a chance ofachieving what insecticides cannot do, namely elimi-nating the last surviving insects. The use of ovipositiontraps is more suited to maintain a.fow infestation rateonce produced than to achieve it in the first place.Even fish sometimes need assistance from chemicalsto keep them at a favourable ratio to their prey.Therefore in contemplating alternative methods it isnecessary to think in terms of integrated control,wherein the 1),se of insecticides must certainly retaina place.

The objective is progressively to reduce the use ofpersistent insecticides, especially the organochlorinesthat can accumulate in the tissues of humans and wild-life. The substitution of the organophosphorus andcarbamate insecticides is a step in the right direction,but their purchase price is still comparatively high.Therefore these chemicals should be progressivelyreplaced whenever and wherever possible by thesealternative methods, based on biological, genetical,naturalistic and environmental procedures. Instead ofa simple recipe for chemical control, each vector -infested district must have an inclusive working planand a system for surveillance and maintenance ofrecords and maps, which in turn presuppose a perma-nent staff and headquarters. Vector control mustevolve from the simple and unskilled to the multipleand specialized; the present task is to accelerate thisprocess of evolution in the methods of c ombatinginsect vectors of human disease.

Annex 10

STUDY OF THE CAPACITY OF THE UNITED NATIONS DEVELOPMENT SYSTEM 1

[A23 /P &B /11 -2 May 1970]


Introduction

At its forty -fifth session the Executive Board decidedto place on the agenda of the Twenty -third WorldHealth Assembly the Study of the Capacity of theUnited Nations Development System. Since this

See resolution WHA23.44.

study was still being considered at the time of theBoard's session by the Governing Council of theUnited Nations Development Programme (UNDP),the Director -General was not in a position to commenton the substance of the report.

Since that date the Governing Council held its ninthsession in January 1970 and a special session in March


1970 at which certain aspects of the Study of theCapacity of the United Nations Development Systemwere considered. The Council will continue itsdeliberations at its next session in June 1970.

The Director -General believes that the Assemblywould wish to have a brief report on the progressbeing made in the examination of the Capacity Studyand the present document describes the various eventsand developments which led up to the issue of thereport on the Study and to its consideration by theInter -Agency Consultative Board (IACB) and theCouncil.

Developments leading to the Capacity Study

In 1967 the Administrator of UNDP presented tothe Governing Council an initial paper on the futureneeds for pre- investment activities in relation to theadministrative capacity of the United Nations systemto programme and implement such activities. Subse-quently, in a progress report to the Governing Councilat the sixth session in June 1968, the Administratordefined the scope of the proposed Study of the Capacityof the United Nations Development System. TheCouncil decided that the Study should proceed on thebasis of agreed terms of reference. Sir Robert Jacksonwas appointed as Commissioner for the CapacityStudy and the Director -General agreed to provide thenecessary accommodation in the WHO headquartersbuilding for the Commissioner and his staff.

The Governing Council also appointed a panel ofconsultants to advise the Commissioner; the Panelheld four meetings in the period 1969 -1970. At thesame time, the executive heads of the agencies, togetherwith UNDP, selected senior members of their res-pective secretariats to form a group, also to advise theCommissioner. It held five meetings in 1968 and afurther meeting in 1969.

In pursuance of the agreement by the agenciesrepresented on IACB to participate in and assistwith the Study, the Commissioner in July 1968and again in February 1969 invited agencies as wellas UNDP to reply to two series of questionnaireson UNDP assistance. The Director -General's replieswere submitted to the Commissioner on 30 September1968 and 20 April 1969 respectively. The Commis-sioner presented a progress report on his work toIACB at its sixth session in October 1968 and to theseventh session of the Governing Council which washeld in January 1969; and a further report on thestatus of the Capacity Study was made by the Com-missioner to the seventh session of IACB in March1969. The Council decided that the Capacity Studyshould be issued not later than the beginning ofDecember 1969 and that it should be submitted

simultaneously to governments, the Administrator ofUNDP and agencies.

At the eighth session of IACB in October 1969,immediately prior to the issue of the Capacity Study,the Administrator invited the heads of agencies topresent him with their views on the Study by15 January 1970.

On 17 November the Director -General received theStudy of the Capacity of the United Nations Develop-ment System from the Commissioner and the Studywas presented to the Administrator on 24 Novemberand released for general distribution on 1 December1969. One copy of the 500 -page document, A Studyof the Capacity of the United Nations DevelopmentSystem,1 has been distributed to each delegation.

After consultation with all parts of the Organi-zation, including the regional offices, the Director -General on 7 January 1970 provided the Administratorwith his preliminary observations on the CapacityStudy.

Consideration by the Governing Council and the Inter -Agency Consultative Board

At its ninth session, held in New York in January1970, the Governing Council undertook an initialreview of the Study and, during the debate, the Councilintimated that adequate time should be foreseen forfull discussion of the Study before taking any finaldecisions. It invited the Administrator, the Panel ofConsultants and IACB to present comments on theCapacity Study for the Council's consideration.

A special session of IACB was held from 3 to5 February 1970 with the specific task of consideringthe Capacity Study. The session was attended by theheads of agencies under the chairmanship of theAdministrator of UNDP and with the participation ofthe Commissioner for the Capacity Study. Statementswere made by UNDP and the agencies expressing theirrespective views in regard to the Capacity Study,following which the collective comments of themembers of IACB were issued for the considerationof the Governing Council scheduled to meet in specialsession from 16 to 26 March 1970. The documententitled " Comments of the Inter- Agency ConsultativeBoard on the Capacity Study," 2 issued on 6 Febru-ary 1970, and the " Report of the Administrator: aBasic Action Programme for the UNDP," 3 issued on20 February 1970, have been distributed together withthe volumes of the Capacity Study (one copy foreach delegation).

United Nations (1969) A study of the capacity of the UnitedNations development system, Geneva, 2 vols.

2 UNDP document DP /6.3 UNDP document DP /7.

ANNEX 11 79

At the special session of the Council, unanimousagreement emerged on the Capacity Study's keyproposals regarding the introduction of countryprogramming, and the Council reached a consensus ona set of provisional conclusions on general principles,indicative planning figures, co- ordination of UNDPand other inputs, and formulation, appraisal andapproval of projects, under the general subject ofcountry programming. The conclusions of the Councilare set out in its progress report which is annexedto the present document.' It should be noted thatspecific recommendations on the procedure to befollowed for the approval of projects should be madeby the Administrator to the Council's tenth session.The Administrator also agreed to submit to the Councilfor consideration at its tenth session additionaldocuments on a number of topics, as listed in para-graph 10 of the progress report.

The Governing Council also had a preliminaryexchange of views on the implications of implemen-tation of UNDP assistance under the new proposedsystem. In considering this the Council had beforeit a working paper submitted by the President of theGoverning Council which appears as an annex to the

progress report mentioned above. The Council,however, did not have sufficient time at its specialsession to arrive at any conclusions on this matter,which will be pursued at the Council's tenth sessionto be held in the WHO headquarters building from9 to 26 June 1970.

Future Consultations

As the Study of the Capacity of the United NationsDevelopment System is still under consideration bythe Governing Council and other bodies, the Director -General feels that the Assembly will wish to await theoutcome of the Governing Council's tenth session inJune 1970 in order to have a clearer view of therecommendations which are to be made to the Econo-mic and Social Council at its summer session. Mean-while, the Director -General will continue to hollowclosely all developments, and proposes to submit afurther progress report to the Executive Board at itsforty- seventh session in January 1971. Taking intoaccount the state of progress achieved, the Assemblymay wish to provide guidance to the Director -Generalin his further consultations on this subject.

Annex 11

SUMMARY OF BUDGET ESTIMATES FOR THE FINANCIAL YEAR 1 JANUARY - 31 DECEMBER 1971

As approved by the Twenty-third World Health Assembly 2

1971Estimatedobligations

US $Chapter 30 Space and Equipment Services

1971Estimated

obligationsUS $

PART I : ORGANIZATIONAL MEETINGS 31 Rental and maintenance of premises 12 92932 Rental and maintenance of equipment 4 495

SECTION 1: WORLD HEALTH ASSEMBLY17 424Chapter 00 Personal Services Total - Chapter 30

01 Salaries and wages (temporary staff) 109 170

02 Short-term consultants' fees . . . . 1 800 Chapter 40 Other Services

Total - Chapter 00 110 970 41 Communications 60043 Other contractual services 40044 Freight and transportation

Chapter 20 Travel and Transportation charges 3 400

21 Duty travel 12 50022 Travel of short-term consultants 1 800 Total - Chapter 40 4 400

25 Travel of delegates 126 00026 Travel of temporary staff 18 000 Chapter 50 Supplies and Materials

Total - Chapter 20 158 300 51 Printing 202 00052 Visual materials 2 00053 Supplies 12 580

1 UNDP document DP /L.128 (not reproduced in this volume). Total - Chapter 50 216 580



1971 1971Estimated Estimatedobligations obligations

US$ US$Chapter. 60 Fixed Charges and Claims Chapter 20 Travel and Transportation

62 Insurance 60 21 Duty travel 36 88026 Travel of temporary staff 25 740

Total - Chapter 60 6062 620Total - Chapter 20

Chapter 80 Acquisition of Capital Assets Chapter 30 Space and Equipment Services82 Equipment 34 250 31 Rental and maintenance of premises 125

32 Rental and maintenance of equipment 125Total - Chapter 80 34 250Total - Chapter 30 250

TOTAL - SECTION 1 541 984Chapter 40 Other Services

41 Communications 1 800SECTION 2: EXECUTIVE BOARD AND ITS COMMITTEES 43 Other contractual services 13 550

44 Freight and other transportationChapter 00 Personal Services charges 4 650

01 Salaries and wages (temporary staff) 96 42020 000Total - Chapter 40

Total - Chapter 00 96 420 Chapter 50 Supplies and Materials

Chapter 20 Travel and Transportation 53 Supplies 15 310

21 Duty travel 12 700 Total - Chapter 50 15 31025 Travel and subsistence of members 64 300

126 90026 Travel of temporary staff 15 000 TOTAL - SECTION 3

Total - Chapter 20 92 000 TOTAL - PART I 904 834

Chapter 30 Space and Equipment Services

31

32Rental and maintenance of premises 3 180Rental and maintenance of equipment 1 650

PART II : OPERATING PROGRAMME

Total - Chapter 30 4 830 SECTION 4: PROGRAMME ACTIVITIES

Chapter 40 Other ServicesChapter 00 Personal Services

4143

Communications 100Other contractual services 1 000

01 Salaries and wagesLess: Staff assessment

30 446 5647 047 192

44 Freight and other transportation Net salaries and wages 23 399 372charges 900 02 Short -term consultants' fees 2 117 700

Total - Chapter 40 2 000 Total - Chapter. 00 25 517 072

Chapter 50 Supplies and Materials Chapter 10 Personal Allowances

51 Printing 34 000 11 Terminal payments 1 909 259

53 Supplies 6 000 12 Pension fund 4 320 22713 Staff insurance 293 910

Total - Chapter 50 40 000 14 Representation allowance 10 40015 Other allowances 5 566 843

Chapter 60 Fixed Charges and Claims Total - Chapter 10 12 100 63962 Insurance 700

Travel and TransportationChapter 20Total - Chapter 60 700 21 Duty travel 1 402 866

22 Travel of short-term consultants 2 117 700TOTAL - SECTION 2 235 950 23 Travel on initial recruitment and

rapatriation 199 32524 Travel on home leave 1 147 015

SECTION 3: REGIONAL COMMITTEES 25 Travel of temporary advisers . . 508 100

Chapter 00 Personal Services 2627

Travel of temporary staffTransportation of personal effects

89 24078 754

01 Salaries and wages (temporary staff) 28 720 28 Installation per diem 105 491

Total - Chapter 00 28 720 Total - Chapter 20 5 648 491

ANNEX 11 81

Chapter 30 Space and Equipment Services

1971Estimated

obligationsUS $

Chapter 10 Personal Allowances

1971Estimated

obligationáUS $

31 Rental and maintenance of premises 507 543 11 Terminal payments 255 78932 Rental and maintenance of equipment 99 355 12 Pension fund 579 016

13 Staff insurance 39 383606 898Total - Chapter 30 14 Representation allowance 15 600

15 Other allowances 563 415

Chapter 40 Other Services Total - Chapter 10 1 453 203

41 Communications 449 36742 Hospitality 11 100

43 Other contractual services 1 614 198 Chapter 20 Travel and Transportation

44 Freight and other transportation 21 Duty travel 118 000charges 106 317 23 Travel on initial recruitment and

repatriation 14 290Total - Chapter 40 2 180 982 24 Travel on home leave 125 735

27 Transportation of personal effects 4 580

Chapter 50 Supplies and Materials 28 Installation per diem 6 670

51 Printing 641 510 Total - Chapter 20 269 27553 Supplies 2 121 645

Total - Chapter 50 Chapter 30 Space and Equipment Services2 763 155

31 Rental and maintenance of premises 206 730Chapter 60 Fixed Charges and Claims 32 Rental and maintenance of equipment 41 075

62 Insurance 40 237 Total - Chapter 30 247 805

Total - Chapter 60 40 237Chapter 40 Other Services

Chapter 70 Grants, Contractual Technical Services 41 Communications 224 390and Training Activities 42 Hospitality 9 000

43 Other contractual services 111 41071 Fellowships 5 550 700 44 Freight and other transportation72 Grants and contractual technical ser- charges 39 495

vices 3 773 10073 Participants in seminars and other Total - Chapter 40 384 295

educational meetings 1 215 01674 Staff training 100 000

Chapter 50 Supplies and Materials10 638 816Total - Chapter 70

51 Printing 5 74052 Visual materials 60 500

Chapter 80 Acquisition of Capital Assets 53 Supplies 139 780

81

82Library booksEquipment 1

48311

130857

Total - Chapter 50 206 020

Total - Chapter 80 Chapter 60 Fixed Charges and Claims1 359 987

TOTAL - SECTION 4 60 856 277 62 Insurance 19 930

Total - Chapter 60 19 930SECTION 5: REGIONAL OFFICES

Chapter 00 Personal Services Chapter 80 Acquisition of Capital Assets

01 Salaries and wages 4 344 055 81 Library books 11 420Less: Staff assessment 766 192 82 Equipment 125 165

Net salaries and wages 3 577 863 Total - Chapter 80 136 585

Total - Chapter 00 3 577 863 TOTAL - SECTION 5 6 294 976


SECTION 6: EXPERT COMMITTEES

Chapter 00 Personal Services

1971Estimated

obligationsUS$

Chapter 20 Travel and Transportation

obligations

1971Estimated

US$

21 Duty travel 79 00001 Salaries and wages (temporary staff) 29 260 22 Travel of short -term consultants . . 9 000

23 Travel on initial recruitment andTotal - Chapter 00 29 260 repatriation 14 283

24 Travel on home leave 74 90827 Transportation of personal effects 15 386

Chapter 20 Travel and Transportation 28 Installation per diem 7 507

25 Travel and subsistence of members . 127 200Total - Chapter 20 200 084


Chapter 40 Other Services Chapter 30 Space and Equipment Services

43 Other contractual services 12 600 31 Rental and maintenance of premises 139 35732 Rental and maintenance of equipment 25 220Total - Chapter 40 12 600


Chapter 50 Supplies and Materials

51 Printing 46 340Chapter 40 Other Services

Total - Chapter 50 46 34041 Communications 97 26842 Hospitality 3 900

Chapter 60 Fixed Charges and Claims 43 Other contractual services 80 662

62 Insurance 1 40044 Freight and other transportation

charges 20 508

Total - Chapter 60 1 400 Total - Chapter 40 202 338

TOTAL - SECTION 6 216 800

TOTAL - PART II 67 368 053 Chapter 50 Supplies and Materials

51 Printing 350

PART III: ADMINISTRATIVE SERVICES 5253

Visual materialsSupplies

8670

000414

SECTION 7: ADMINISTRATIVE SERVICES Total - Chapter 50 156 764

Chapter 00 Personal Services

01 Salaries and wages 3 321 690Less: Staff assessment 731 081 Chapter 60 Fixed Charges and Claims

Net salaries and wages 2 590 609 62 Insurance 6 838

02 Short -term consultants' fees 9 000 Total - Chapter 60 6 838

Total - Chapter 00 2 599 609

Chapter 80 Acquisition of Capital AssetsChapter 10 Personal Allowances

11 Terminal payments 210 545 82 Equipment 16 68212 Pension fund 476 14113 Staff insurance 32 378 Total - Chapter 80 16 68214 Representation allowance 15 60015 Other allowances 366 857 TOTAL - SECTION 7 4 448 413

Total - Chapter 10 1 101 521 TOTAL - PART III 4 448 413

ANNEX 12 83

SECTION 8:

PART IV: OTHER PURPOSES

HEADQUARTERS BUILDING:

1971Estimated

obligationsUS S

PART VI: RESERVE

1971Estimatedobligations

US S

REPAYMENT OF LOANS SECTION 10: UNDISTRIBUTED RESERVE 4 738 833

Chapter 80 Acquisition of Capital AssetsTOTAL - SECTION 10 4 738 833

83 Land and buildings 508 700

TOTAL - PART VI 4 738 833Total - Chapter 80 508 700

TOTAL - ALL PARTS 86 857 764TOTAL - SECTION 8 508 700

TOTAL - PART IV 508 700

Less:SUB -TOTAL - PARTS I, II, III AND IV 73 230 000

Reimbursement from the Technical Assistancecomponent of the United Nations Development

PART V: STAFF ASSESSMENT Programme 1 268 624

SECTION 9: TRANSFER TO TAX EQUALIZATION FUND

Chapter 00 Personal Services Less: Casual Income01 Salaries and wages 8 544 465

Adjustment to amount appropriated Assessments on new Members from previous years 21 565for 1970 344 466 Miscellaneous income 978 435

Total -- Chapter 00 8 888 931 TOTAL - CASUAL INCOME 1 000 000

TOTAL - SECTION 9 8 888 931 TOTAL - DEDUCTIONS 2 268 624

TOTAL - PART V 8 888 931 TOTAL - ASSESSMENTS ON MEMBERS 84 589 140

Annex

CONSIDERATION OF RESERVATIONS TO THE

REPORT OF THE WORKING GROUP

I. The Working Group established by Committee Bon 15 May 1970 to consider the reservations to theInternational Health Regulations was composed ofthe following delegations: Ceylon, France, Ghana,Mexico, New Zealand, Poland, United Kingdom ofGreat Britain and Northern Ireland, and UnitedStates of America.

The Working Group met on 18 and 19 May 1970.A number of other delegates, including representa-

tives of most of the countries that had submittedreservations, attended and participated in the dis-cussions.

Dr L. E. Buley, representative of ICAO, waspresent.


12

INTERNATIONAL HEALTH REGULATIONS 1

[A23/B/WP/2 - 19 May 1970]

APPOINTED BY COMMITTEE B

Dr G. Wynne Griffith (United Kingdom) waselected Chairman, and Dr F. C. Grant (Ghana)Rapporteur.

II. The Working Group considered the reservations tothe International Health Regulations submitted byStates under the terms of Article 100, paragraph 1,of these Regulations.

The Working Group adopted as its terms ofreference:

1. To consider the effect of the reservations sub-mitted by Member States on the general purposesof the Regulations and whether the reservationssubstantially detract from the character and pur-pose of the International Health Regulations. On


the basis of these considerations, to make recom-mendations on the reservations as to their accepta-bility or otherwise.

2. To identify those items included in the com-munications received from Member States whichare in effect comments on or proposed amendmentsto the Regulations and to recommend their sub-mission to the Committee on International Surveil-lance of Communicable Diseases.

With regard to the question of reciprocity in theapplication of reservations which might be acceptedby the World Health Assembly, the Working Grouprecommends that the principles outlined in OfficialRecords No. 42, page 360, should continue to applyto the International Health Regulations.

III. The Working Group noted that several of thereservations entered by Member States were based onthe difficulties anticipated by them in implementingimmediately some of the new provisions of theInternational Health Regulations. The WorkingGroup, while accepting that this was the presentposition, nevertheless recommends that the Director -General be requested to draw the attention of allMember States to the importance of complying withthese new provisions as soon as the necessary servicescan be developed.

IV. The Working Group accepted that the conceptof " infected area ", as provided in Article 3 anddefined in Article 1, was central to the whole approachof the International Health Regulations. It noted thatthe Governments of Cuba, India, Pakistan, SouthAfrica and United Arab Republic had reservationsregarding this interpretation of " infected area " inso far as it concerned yellow fever. The WorkingGroup recognized the potentially serious nature ofthe threat in the case of this disease so far as thesecountries were concerned. The Working Group,therefore, recommends that certain of these reser-vations be accepted but only for a limited period ofthree years from the date of entry- into -force of theRegulations. This recommendation would allow timefor experience to be gained in the operation of the newdefinition of " infected area " and for surveillanceactivities to be further developed in the countrieswhere the disease occurs.

V. While making this special exception in the caseof yellow fever, the Working Group does not, however,agree that the same considerations apply to the otherdiseases subject to the Regulations. In particular theWorking Group considers that those reservationswhose effect would be to permit the imposition ofmeasures in excess of the Regulations as regards

cholera cannot be justified in the light of presentknowledge of the clinical and epidemiological charac-teristics of that disease.'

VI. In view of the terms of Article 102, according towhich the procedure for withdrawing a reservation inwhole or in part is by notifying at any time theDirector -General, the Working Group decided tomake recommendations to the World Health Assemblyon the reservations submitted by governments, eventhough a delegate might express to the WorkingGroup the intention of his government to withdrawthe whole or any part of a reservation.

VII. The Working Group recommends that itsfindings on the reservations, if adopted by the As-sembly, be submitted to governments in compliancewith the terms of Article 105, in order that governmentsmay notify the Director -General, unless they havealready done so, of the withdrawal of their reservationor reservations in so far as they have not beenaccepted by the World Health Assembly.

VIII. The attention of the Working Group was drawnto a cable of 18 May 1970 from the Government ofIran, received by the Director -General on 18 May1970, reading as follows: " 173 Iranian health authori-ties reserve chapter two part five covering Articlessixty -two to seventy -one and Article ninety -five parttwo of International Health Regulations July 1969 ".

As the nine -month period provided in Article 100,paragraph 1, of the Regulations expired on 8 May 1970,this notification fell, in the view of the Working Group,within the terms of paragraph 3 of the same Article.2

IX. The communications received from governmentsare reproduced below; they are followed by therecommendations of the Working Group.

AUSTRALIA

Letter from the Director -General of Health, received14 April 1970

I refer to your letter of 8 August 1969, referenceC.L.17.1969, concerning the International HealthRegulations. A certified copy of the InternationalHealth Regulations was received with your letter.

As noted in your letter the Regulations wereadopted by the Twenty- second World Health Assemblyand will enter into force on 1 January 1971.

' Expert Committee on Cholera, second report (Wld HlthOrg. techn. Rep. Ser., 1967, 352).

2 This paragraph reads " Any rejection or reservation receivedby the Director -General after the expiry of the periods referredto in paragraph 1 or 2 of this Article shall have no effect ".

ANNEX 12 85

I have to advise you that Australia wishes to makereservations to the following Articles of the Inter-national Health Regulations: 1, 24, 26, 29, 35, 36, 39,47, 48, 49, 59, 67, 70, 74, 84, 86, 87, 90, 94, 96.

The Articles are listed below with the reservationfollowing:

Article 1

The definitions in this Article of "disinsecting "and " free pratique " are not acceptable. In regardto disinsecting, although it is realized that the Regu-lations apply to human diseases, the right must beretained to employ disinsecting which would preventthe entry of insect agents and vectors of plant andanimal diseases. The definition of " free pratique " isnot acceptable under Australian quarantine practice.Australia employs two kinds of pratique, " limited "and " full " pratique, and in addition may allow avessel to proceed around the Australian coastline inquarantine. It is considered that the definition of" free pratique " would not allow this practice to becontinued.

Article 24

Under certain circumstances Australia may wish totake action in excess of those measures prescribed bythe Regulations and this right must be retained.

Article 26

The right must be retained to also employ measuresto prevent the entry of exotic animal and plant diseases.

Article 29

This Article is not acceptable on account of theconcept of " free pratique " being unacceptable (seethe notes on " free pratique " under Article 1).

Article 35

Part (b) of this Article would permit passengers and,crew from a healthy aircraft to transfer from oneairport to another even though some of these passen-gers and crew may be unvaccinated. This practicewould be unacceptable to Australia.

Article 36

Two reservations are held to this Article. (1) Theconcept of " free pratique " is not acceptable (seenotes on " free pratique " under Article 1). (2) Infor-mation concerning the health situation on board aship is accepted for the purposes of radio pratiqueonly when the ship carries a surgeon and the surgeonhas carried out an inspection of all persons on boardwithin 24 hours of the time of arrival at the first portof entry into Australia. It has not been found practi-cable to apply a similar procedure to aircraft.

Article 39

This Article is unacceptable because it compels ahealth authority to remove an infected person from avessel if so required by the person in charge of thevessel. In view of the extended coastline of Australiathe implementation of this practice would not bepracticable.

Article 47

This Article is unacceptable as the right must beretained to disinfect cargo and goods to prevent theentry of agents or vectors of animal and plant diseases.This Article limits health measures to cargo and goodscoming from infected areas and which are believed tobe contaminated by an agent of a disease subject tothe Regulations or may serve as a vehicle for thespread of any such disease.

Article 48The right must be retained to disinfect or disinsect

baggage to prevent the introduction of agents orvectors of diseases of animals and plants.

Article 49The right must be retained to disinfect or take other

appropriate measures in regard to postal parcels asconsidered necessary. In addition, the right must beretained to prevent the entry of agents and vectorsof animal and plant diseases which may be carried bypostal parcels.

Article 59The term " free pratique " is not acceptable (see

note on " free pratique " under Article 1).

Article 67The term " free pratique " is not acceptable (see

note on " free pratique " under Article 1).

Article 70Paragraph 1 of this Article is not acceptable. It

is considered that the testing of samples by exami-nation of cultures is an insufficient safeguard to excludeinfected food or beverages.

Article 74The right must be retained to disinsect aircraft on

arrival to prevent the introduction of insect agents andvectors of human, animal and plant disease. Para-graph 2 of this Article would not allow this.

Article 84The right must be retained to detain in quarantine

a person who does not fulfil the Australian require-ments for vaccination against smallpox. In view ofAustralia's extensive area, surveillance is not alwayspracticable.


Article 86

The term " free pratique " is not acceptable (seenotes on " free pratique " under Article 1).

Article 87

Under Article 87 the term " free pratique " is notacceptable (see notes on " free pratique " underArticle 1).

Article 90

Paragraph 3 of this Article is not acceptable. InAustralia a quarantine officer has to advise the ChiefBoarding Officer (Immigration) of any persons onboard the ship who on landing may become a chargeon the State because of a chronic disability. TheMaritime Declaration of Health in the Regulations isnot sufficiently comprehensive to cover cases of thisnature.

Article 94

Under Australian quarantine procedures a Supple-mentary Health Report is used when infectiousdisease is present on a sea vessel or when a secondinspection of a vessel is considered necessary. ThisArticle would prohibit the use of this document andaccordingly is not acceptable.

Article 96

The right must be retained to disinsect aircraft onarrival. Paragraph 1 of this Article would not allowthis.

These reservations ace submitted in conformitywith Article 22 of the Constitution of the Organizationand Article 100 of the Regulations.

It would be appreciated if you would acknowledgereceipt of this letter.

Observations and Recommendations of the WorkingGroup

The Working Group considered that the reservationsentered by the Government of Australia, and inparticular the reservations regarding Articles 24, 26,

47, 74, 84, 90 and 96, would permit the reserving Stateto disregard those provisions limiting the measurespermitted under the Regulations and would accord-ingly be incompatible with their character and purpose.Under these circumstances the reservations are tanta-mount to a rejection of the Regulations and theWorking Group therefore recommends that thesereservations be not accepted.

The communication of the Government of Australiafrequently makes mention of measures taken foragricultural purposes. These are not acceptable sincethe International Health Regulations refer to diseases

subject to the Regulations and vectors of humandisease. However, in the interests of facilitation ofinternational traffic, the Working Group recommendsthat health administrations work closely with agri-cultural and veterinary authorities where problemsmay arise from the importation of pathological agentsor vectors of plant and animal diseases.

The Working Group recommends that the commentsof the Government of Australia relating to " freepratique " be drawn to the attention of the Committeeon International Surveillance of CommunicableDiseases.

CUBA

Letter, dated 28 April 1970, from the Director ofRelations with International Organizations andConferences, received 8 May 1970 (translation fromthe Spanish)

With regard to the International Health Regulationsadopted by the Twenty -second World Health Assemblyon 25 July 1969 in the city of Boston, Massachusetts,United States of America, I have the honour to informyou that the Government of Cuba has decided tomake the following reservations to the aforesaidRegulations:

Article 63 (Chapter 11- Cholera)

" The Revolutionary Government of the Republicof Cuba reserves the right to extend measures for thecontrol of cholera from international travellers arrivingfrom an infected area to all persons coming from anypart of the territory of a country in which a case ofsickness has been notified."

Article 73 (Chapter Ill-Yellow Fever)

" With regard to measures for protection againstyellow fever, the Revolutionary Government of theRepublic of Cuba will require international certificatesof vaccination against yellow fever to be produced byall international travellers coming from territoriesincluded in the endemic zones delineated by the WorldHealth Organization, until such time as evidence isforthcoming that the virus is not active. In the caseof travellers unable to produce such a certificate, themeasures specified in Article 75 of these Regulationsmay be applied to them."

I think I should add that the reservation to Article 63

is based on the fact that the passports of travellersarriving from abroad do not specify the exact part ofthe country from which they have come, so that theymay have come directly from or passed through aninfected area.

ANNEX 12 87

With regard to the reservation applicable toArticle 73, the reason why it has been made is, asyou can see, self -explanatory.

In notifying you of the above reservations, inaccordance with the provisions of Article 22 of theConstitution of the Organization, I should like to takethis opportunity of once again assuring you of myhighest regard.


Article 63

The reservation to this Article, if accepted, would ineffect allow the reserving State to decide what areas inanother country were infected areas so far as cholerais concerned. For the reasons advanced in paragraph Vof this report, the Working Group considers such adeparture from the Regulations to be unjustified.

The Working Group therefore recommends that thisreservation be not accepted as it substantially detractsfrom the character and purpose of the Regulations.

Article 73

The Working Group considered that the problemreferred to would be more appropriately dealt with bya reservation under Article 3, paragraph 1, andArticle 4, paragraph 1, to the effect that the Govern-ment of Cuba reserves the right to consider the wholeterritory of a country as infected with yellow feverwhenever yellow fever has been notified under Article 3,paragraph 1, or Article 4, paragraph 1.

The Working Group recommends that, in view ofthe considerations mentioned under paragraph IVabove, the World Health Assembly accept a reser-vation in these terms for a period of three years fromthe date of entry- into -force of the Regulations.

INDIA

Letter, dated 2 May 1970, from the Deputy Secretary,Ministry of Health, Family Planning and Works,Housing and Urban Development (Department ofHealth), received 4 May 1970

1. With reference to your letter No. C.L.17.1969,dated the 8th August, 1969, on the subject mentionedabove, I am directed to notify the Director -General,World Health Organization, the reservations inrespect of Articles 1, 7(2)(b), 43, 44 and 94 to theInternational Health Regulations adopted by theWorld Health Assembly at its meeting held at Bostonin July, 1969, as shown in the annexure to this letter.

2. It is requested that the reservations referred toabove may kindly be placed for consideration beforethe World Health Assembly at its next meeting.

3. The receipt of this letter may kindly be acknow-ledged.

Reservations to the International Health Regulations

Article 1 of the International Health Regulations

" The Government of India reserves the right toconsider the whole territory of a country as infectedwith yellow fever whenever a case of yellow fever isreported from that country in terms of the definitionof ' infected area ' in the International Health Regu-lations."

Article 7(2) (b) of the International Health Regulations

" The Government of India reserves the right tocontinue to regard an area as infected with yellowfever until there is definite evidence that yellow -feverinfection has been completely eradicated from thatarea."


" The Government of India reserves the rightimmediately to disinsect on arrival an aircraft which,on its voyage over infected territory, has landed at asanitary airport which is not itself an infected area, ifan unprotected person from the surrounding infectedarea has boarded the aircraft and if the aircraftreaches India within a period during which such aperson is likely to spread yellow -fever infection.

The above reservation will not apply to the aircraftwhich are fitted with sound DDVP system and thesame is compulsorily operated. The aircraft notfitted with the said system shall be subject to the abovereservation."


" The Government of India reserves the right toapply the terms of Article 75 to the passengers andcrew on board an aircraft landing in the territory ofIndia who have come in transit through an airportsituated in yellow -fever infected area, not equippedwith the direct transit area."


" The Government of India shall have the right torequire of persons on an international voyage arrivingby air in its territory or landing there in transit, butfalling under the terms of paragraph 1 of Article 76,information on their movements during the last sixdays prior to disembarkation."



Article 1

The Working Group considered that the problemsreferred to would be more appropriately dealt with bya reservation to Article 3, paragraph 1, and Article 4,

paragraph 1, as in the case of Cuba, and recommendsthat a reservation in the same terms be accepted fora period of three years from the date of entry-into-force of the Regulations.

Article 7, paragraph 2 (b)The Working Group recommends that this reser-

vation be accepted for a period of three years from thedate of entry- into -force of the Regulations and thatthe technical problems involved be referred to theCommittee on International Surveillance of Communi-cable Diseases.

Article 43

The Working Group recommends that this reser-vation be accepted for a period of three years fromthe date of entry- into -force of the Regulations andthat the technical problems involved be referred tothe Committee on International Surveillance ofCommunicable Diseases.

Article 44

The Working Group recommends that this reser-vation be accepted.

Article 94


INDONESIA

Letter, dated 18 April 1970, from the Director -Generalfor Communicable Disease Control, received4 May 1970

Re:

1. The adoption of the International Health Regu-lations by the Twenty- second World HealthAssembly in July 1969 in Boston;

2. The fact that these Health Regulations shall comeinto force on the 1st January 1971;

3. The responsibility of Indonesia as a Member Stateof WHO and, on the other hand, its ability toexecute the International Health Regulations;

Having taken note of Articles 100 and 106 of theInternational Health Regulations, I have the honourto draw your attention to the following:

A. Indonesia has reservations about :

(1) Article 1: (a) Concerning the definition of" infected person ". For Indonesia the old definitionof ISR-1951 remains, i.e., " infected person means aperson who is suffering from a quarantinable disease,or who is believed to be infected with such a disease ".

Note: This definition will be handled in the firstplace by the Port Medical Officer in charge and itwill be very difficult for him to find out what isstated in the new definition, namely: who is sub-sequently shown to have been incubating such adisease.

(b) Concerning the definition of " in quarantine ".For Indonesia, at the end of the new definition, shouldbe added: "... or to which by the health authorityconcerned has not yet been given free pratique ".

(2) Article 39: For Indonesia at the end of theArticle should be added the following sentence:

" Such removal, if required by the person in chargeof the means of transport, should not be insistedupon in ports and airports where adequate facilitiesfor the reception of such a person cannot be expectedto be available ".

Note: Not yet all ports with international traffichave these facilities.

(3) Article 58, paragraph 4: After the word" infected " should be added the words " or sus-pected of being infected " so that for Indonesiaparagraph 4 reads: " if a rodent infected or suspectedof being infected with plague is found on board anaircraft, the aircraft shall be disinsected and deratted ".

Note: It is very difficult for the Port MedicalOfficer in charge to make a diagnosis at the airportthat a rodent is infected with plague without alaboratory examination, and to wait for the resultof the laboratory examination lasts in Indonesia arelatively long time.

(4) Article 77, paragraph 2: For Indonesia thesecond sentence should read as follows:

" It shall be regarded as suspected if the healthauthority is not satisfied with a disinsecting carriedout or it finds live mosquitos on board even if adisinsecting is carried out in accordance withparagraph 2 of Article 74."

Note: The original wording does not mention otherdisinsecting methods and the wording is not clear.

(5) Article 92, paragraph 5: For Indonesia thesewords should be deleted: " and no photograph shallbe included "; they should be replaced by the words:" but a recent photograph may be included ".

ANNEX 12 89

Note: In Indonesia it is very difficult to depend onlyon a man's name, since it is allowed to change hisname in important circumstances for the personconcerned.

B. Indonesia makes the following remarks concerning:

(1) Article 1: Concerning the definition " diseasessubject to the Regulations (quarantinable diseases) ".For Indonesia the quarantinable diseases remain asis mentioned in the International Sanitary Regulations1951, namely six diseases until such time as theIndonesian law of quarantinable diseases is changed(is passed by Parliament).

(2) Article 20, paragraph 1 and paragraph 2: Atpresent Indonesia is not yet in a position to carry theseparagraphs out, especially as Indonesia now has41 ports, where international traffic is allowed andwhile also no specifications are available concerning:

(a) how much of the port -area should be kept freeof Aedes aegypti and of mosquito vectors of malariaand other diseases of epidemiological significancein international traffic,(b) effective methods to be used.

(3) Article 74, paragraph 3 and paragraph 4.Note: At present Indonesia has not got sufficientfacilities for carrying them out.

(4) Article 96, paragraph 1 and paragraph 2.Note: See note for Article 74.

(5) Article 97, paragraph 1: This Article could bein contradiction with Article 24 and gives possibilitiesof excessive measures (as in a certain State concerningpilgrims). It is suggested that this Article should beread:

" Migrants, nomads, seasonal workers or personstaking part in periodic mass congregations, and anyship, in particular small boats for internationalcoastal traffic, aircraft, train, road vehicle or othermeans of transport carrying them, may be subjectedto additional health measures conforming to anyagreement concluded between the importing andthe exporting States."Notes: Indonesia experienced many difficulties tofulfil the requirements of a certain country, whichwere in excess of the International Sanitary Regu-lations, during the pilgrimage season.


The delegate of Indonesia made a statement on thegeneral intent of her Government and on the scope

and content of the points made in the communicationof 18 April 1970 from the Director -General forCommunicable Disease Control. From the exchangeof views it was evident that the points made were notto be regarded as formal reservations but as commentson the interpretation and application of the Regu-lations.

The Working Group therefore recommends that,subject to formal confirmation of the position, thecommunication from the Director -General for Com-municable Disease Control be referred to the Com-mittee on International Surveillance of CommunicableDiseases for detailed consideration.

NETHERLANDS

Letter, dated 24 April 1970, from the Director -Generalfor International Affairs, received 29 April 1970

I inform you herewith that the Government ofSurinam has informed me that the Government is inagreement with the text of the International HealthRegulations, but that it has to make a reservationregarding Article 17, paragraph 2, and Article 58.


The Working Group recommends that the reser-vations entered on behalf of the Government ofSurinam with respect to Articles 17, paragraph 2, and58 be accepted in the same terms as those previouslyaccepted by the World Health Assembly to thecorresponding Articles of the 1951 InternationalSanitary Regulations.

PAKISTAN

Letter, dated 30 April 1970, from the Assistant Director -General of Health, received 7 May 1970

I am directed to refer to your letter No. C.L.17.1969dated the 8th August 1969, on the above subject, andto say that the Government of Pakistan have givencareful consideration to the provisions of the proposednew International Health Regulations and to informthe Organization that these Regulations it is felt exposePakistan, a receptive country, to a serious risk of im-portation of yellow fever. However, the Governmentof Pakistan accept these Regulations subject to thefollowing reservations as detailed in its reservations tothe unamended International Sanitary Regulations,1951:


1. Article 1 (definition " infected area")The Government of Pakistan reserves the right to

consider the whole territory of a country as infectedwith yellow fever, where conditions in terms of thedefinition of yellow fever infected area are fulfilled inany part of its territory. Further the Governmentof Pakistan reserves the right in special circumstancesafter giving fullest possible consideration to thepopulation characteristics, density and mobility,vector and animal reservoir potential to delineate azone as a yellow fever endemic zone in terms of thedefinition as contained in Article 1 of the unamendedInternational Sanitary Regulations, 1951 and alsoreserves the right to apply measures against arrivalsin its territory from infected area or group of infectedareas where the conditions of the definition of " yel-low fever endemic zone " are fulfilled, but which areoutside the delineated zone, as if they were part of thedelineated zone.

In declaring to the Organization the infected area,or group of infected areas, to which the reservationwould apply, the Government of Pakistan shall givemotives underlying such a declaration and the reasonsfor urgency, in order to permit the Organization tonotify all States accordingly.

In regard to persons who embark on a ship or air-craft in a port or an airport which has been removedfrom a yellow fever endemic zone, in compliance withthe terms of paragraph 2 of Article 70 (of the Inter-national Sanitary Regulations 1951 unamended) andwho are unable to prove that they have not been in ayellow fever endemic zone within nine days prior todisembarkation, the Government of Pakistan reservesthe right to treat such persons as if they had come froma yellow fever endemic zone.

The Government of Pakistan shall declare to theOrganization, without delay, the ports or airports towhich this reservation will apply.

2. Article 43

The Government of Pakistan reserves the right todisinsect immediately on arrival an aircraft which, onits voyage over infected territory, has landed at asanitary airport which is not itself an infected area.

3. Article 44The terms of Article 75 may be applied to the

passengers and crew on board an aircraft landing inthe territory or territories of the Government ofPakistan who have come in transit through any airportsituated in a yellow fever endemic zone, not equippedwith a direct transit area.

4. Article 75The words " six days " shall be replaced by the

words " nine days ".

5. Article 94

The Government of Pakistan shall have the rightto require of persons on an international voyagearriving by air in its territory or landing there intransit but falling under the terms of paragraph 1 ofArticle 76, information on their movements during thelast nine days prior to disembarkation.


Article 1

The Working Group considered that the problemreferred to would be more appropriately dealt with bya reservation to Article 3, paragraph 1, and Article 4,paragraph 1, as in the case of Cuba, and recommendsthat a reservation in the same terms be accepted fora period of three years from the date of entry -into-force of the Regulations.

Article 43

The Working Group recommends that this reser-vation be accepted for a period of three years fromthe date of entry- into -force of the Regulations andthat the technical problems involved be referred tothe Committee on International Surveillance of Com-municable Diseases.

Article 44

The Working Group recommends that this reser-vation be accepted with the substitution of " infectedarea " for the words " endemic zone ".

Article 75

The Working Group recommends that this reser-vation be accepted for a period of three years and thatthe technical problems involved be referred for furtherconsideration to the Committee on InternationalSurveillance of Communicable Diseases.

Article 94


SINGAPORE

Letter, dated 12 September 1969, from the Director ofMedical Services, received 15 September 1969

1. I refer to your circular letter of 8 August 1969Ref: C.L.17.1969, advising us of resolution WHA22.46of 25 July 1969 with regard to the International HealthRegulations which are to replace the existing Inter-national Sanitary Regulations.

ANNEX 12 91

2. As you are aware, the Republic of Singapore hasnot in the past been bound by the InternationalSanitary Regulations which the International HealthRegulations will replace.

3. It is the view of the Ministry of Health that thereservations which have previously been communicatedto the Director -General in respect of the InternationalSanitary Regulations are still applicable; Singaporewould wish to maintain the necessary flexibility it hashad in respect of the application of its quarantineprocedures and is therefore not in a position to acceptthe International Health Regulations.

4. Our major reservations cover the following points :

(i) " infected area " -The concept and definitionof " infected area " is too broad and general to beeffective and meaningful for the application ofcontrol against introduction of external disease.(ii) It is the view of this Ministry that isolationexpenses should be chargeable to carriers and thisis currently being done in respect of quarantine ofdeck passengers. Provision also exists in respect ofother passengers should the need arise.(iii) It is necessary to take additional quarantinemeasures against deck passengers, barter tradersand other travellers who, having regard to theepidemiological situation prevailing in South -EastAsia, still pose a high risk in the transmission ofdangerous infectious disease.(iv) A certification of sanitary ports and airportsby external agencies imposes powers beyond thescope of national health administrations.(v) It is felt that the period of infectivity in the caseof yellow fever should be nine days. It is also ourview that any person leaving a yellow fever endemicarea should be in possession of a valid yellow fevercertificate.

5. For these reasons, it is our view that the Republicof Singapore will continue to remain in the positionas heretofore, i.e., in not being bound either by thepresent International Sanitary Regulations or theproposed new International Health Regulations.


The Working Group noted that, in his letter of12 September 1969, the Director of Medical Servicesstated that Singapore is " not in a position to accept "the International Health Regulations and does notconsider itself bound by them. The Working Group,therefore, is obliged to construe this communicationas a rejection.

The Working Group recommends that the commentsof Singapore be referred for consideration to the Com-mittee on International Surveillance of CommunicableDiseases.

SOUTH AFRICA

Communication, dated 6 May 1970, from the SouthAfrican Permanent Mission, received 6 May 1970

The South African Permanent Mission presents itscompliments to the Director -General of the WorldHealth Organization and has the honour to refer tothe latter's letter No. C.L.17.1969 of 8 August 1969,to the Secretary for Health in South Africa, in con-nexion with the International Health Regulationswhich were adopted by the Twenty- second WorldHealth Assembly to replace the existing InternationalSanitary Regulations.

The South African Permanent Mission wishes toinform the Director -General that the South Africanauthorities are substantially in agreement with theprovisions of the new International Health Regulations.They wish, however, to retain their reservation inregard to yellow fever. Since South Africa is a yellowfever receptive area and is, therefore, vulnerable tothat disease, the limited scope of the new definitionof " infected area " cannot be accepted as adequate.

With regard to the term " International voyage " inArticle 1 of the new International Health Regulations,the South African authorities wish to state that theyare experiencing difficulties with international fishingvessels visiting ports under the jurisdiction of theRepublic of South Africa and which come into regularcontact with foreign ships on the open sea and fromwhich source they may convey infection to the abovementioned ports and so to the Republic and to portsunder its jurisdiction. For these reasons, they wouldprefer that the words " including a ship " be addedafter the words " has relations with the territory ofany other State ... "

In the view of the South African authorities, the newdefinition of the term " Medical examination " inArticle 1 of the new Regulations is broader than theexisting one. " The scrutiny of vaccination certi-ficates " is a function which at present devolves onnon -medical personnel at ports of South Africa orports under its jurisdiction and the existing arrange-ment has been found satisfactory.

The South African Mission wishes to state furtherthat plague is endemic in wild rodents in South Africa.Although their activity has, as a result of intensivecontrol measures, been reduced to two foci of relativelylimited extent, the plague bacillus is present in theserodents " within the Republic of South Africa "


and is likely to remain there for the foreseeable future,although in terms of Article 7(2)(c)(ii), South Africais free of plague. The South African authoritiesconsider that the reference to the plague bacillus inArticle 4(1) should have been limited to bacilli isolatedin human cases.

In view of the above, the South African authoritieswish to reserve the right:

(i) to take any steps necessary to prevent theintroduction of yellow fever into South Africa andareas under its jurisdiction;

(ii) to take whatever steps are necessary to preventforeign ships visiting the ports of South Africa orports under its jurisdiction that could have been incontact with ships on the high seas, from conveyinginfective conditions from the latter to such ports;

(iii) to continue using non -medical staff at portsunder South African jurisdiction for the scrutiny ofvaccination certificates; and

(iv) to report to the World Health Organizationonly such cases of human plague found to beinfected with Pasteurella pestis.


In the communication dated 6 May 1970 from theSouth African Permanent Mission, specific referenceis made to four points:

1. Yellow fever. The Working Group considered thatthe problems referred to would be more appropriatelydealt with, as far as South Africa is concerned, if theGovernment was prepared to enter a reservation toArticle 3, paragraph 1, and Article 4, paragraph 1,as in the case of Cuba, and recommends that a reser-vation in the same terms be accepted for a period ofthree years from the date of entry- into -force of theRegulations.

2. Foreign ships visiting South African ports havingbeen in contact with other ships on the high seas. Whilerecognizing that the problem raised by the PermanentMission exists and may become increasingly importantin future, the Working Group is unable to recommendacceptance of this reservation. It recommends,however, that the problem involved be referred to theCommittee on International Surveillance of Communi-cable Diseases.

3. The use of non -medical staff in port health activities.The Working Group accepts that this is the practicein many countries and, therefore, a reservation is notnecessary.

4. Reporting of rodent plague. The Working Groupconsidered that to confine the notification of plagueto human cases and to fail to report plague in rodents,distinguishing between wild and domestic rodents asrequired under Article 4, paragraph 2, would seriouslyimpair the ability of the Organization to exercisesurveillance over that disease.

The Working Group therefore recommends thatthis reservation be rejected.

TURKEY

Letter, dated 29 April 1970, from the Minister of Healthand Social Welfare, received 4 May 1970 (translationfrom the French)

I have the honour to refer to your letter of 8 August1969 informing us of the adoption by the Twenty -second World Health Assembly of the new Inter-national Health Regulations.

I have pleasure in informing you that Turkey isprepared to accept these new Regulations subject tothe provisions and declarations of the Lausanne PeaceTreaty, signed on 24 July 1923, and the provisions andAnnexes of the Montreux Convention, signed on20 July 1936.

I am confident that the World Health Assemblywill understand Turkey's position and accept thisreservation. Needless to say, at the Assembly theTurkish delegation will be ready to provide informationon this subject to any delegation that may desire it.


The Working Group finds itself unable to pronounceon the communication from the Government of Turkeybecause the precise Articles to which the Governmentof Turkey wishes to enter reservations are not specifiedtherein.

The Working Group therefore recommends thatthe Government of Turkey be invited, if it so wishes,to restate its request in terms which would allow theWorld Health Assembly to decide whether or not theproposed reservations would substantially detract fromthe character and purpose of the International HealthRegulations.

UNITED ARAB REPUBLIC

Letter, dated 20 April 1970, from the Under -Secretaryof State for Health, received 4 May 1970

I wish to refer to WHO circular letter No. 17 of8 August 1969 regarding the new International Health

ANNEX 12 93

Regulations, and the reservations of this Ministry inthis respect.

We wish to inform you that the Ministry agrees toaccede to the new International Health Regulations,to which the attached reservations are made.

Article 1- Infected Area

The Government of the UAR taking in considerationhealth measures being only applied to infected areas asdefined in Article 1 of the Regulations and as notifiedby the health administration concerned, reserves theright in special circumstances to treat passengersarriving from territories outside the delineated areanotified as infected with cholera or yellow fever, as ifthey were coming from the infected area. The reser-vation is based upon the following facts:

(1) Free mobility of the population, vectors, meansof transport and water channels within a country.

(2) The impossibility of verification whether apassenger arriving from a non -infected area in acertain country had been to any of the infected areasin that country within the incubation period of thedisease prior to his departure.

Article 22

This new Article cannot be accepted because theprinciple of inspection of airports of a country bymembers from other countries is in contradiction withthe sovereignty of the State on its territory.

We suggest regulations to include necessary stand-ards for sanitary airports and transit areas, and healthadministrations being responsible of notification oftheir airports and transit areas fulfilling the standardsrequired by the Regulations. Consequently theGovernment of the UAR rejects this Article.

Article 70

The Government of the UAR finds the amendmentof Article 68 impracticable for the following reasons:

(1) Taking samples for laboratory examinationfrom food to be unloaded in a port, an airport or afrontier post will cause delay to the means of transport.The ship, aircraft or other means of transport has tobe detained until the health authority makes sure bylaboratory examination that there is no risk of infectionbeing carried to the population in this way.

(2) Negative laboratory results of random samplesof food cannot be a sure evidence that the wholequantity of food is free of pathogenic vibrios.

The Government of the UAR suggests the amend-ment to give power to the health authority owing toits own discretion to apply one of the following twomeasures:

(1) Either to take samples of food to be unloadedfor laboratory examination to exclude any possibilityof infection being carried to the population. Themaster of the means of transport has to accept waitingfor the results of the procedure;

(2) or to prohibit the unloading of the food withinthe territory of the country.

Article 71, paragraph 2

Owing to the new epidemiological findings in thefield of cholera, especially the carrier state, the Govern-ment of the UAR finds it absolutely necessary to stickto its present reservation on paragraph 2 of Article 69of the present Regulations.

The reservation in the new Health Regulations willread as follows:

Persons on an international voyage arriving froman infected area, within the incubation period ofthe disease, may be required to submit to stoolexamination, subject to the conditions:

(a) that the reservation constitutes no derogationfrom the provisions of Articles 35 and 63 orany other Articles of the Regulations;

(b) that the period within which a person may besubmitted to stool examination does not exceedfive days, reckoned from the date of the depar-ture of the person from the infected area;

(c) that the measure be used with discretion andonly in the case of absolute necessity.

Article 73

(1) The Government of the United Arab Republicreserves the right to consider an area as infected withyellow fever in case that area forms a part of the areaprovisionally delineated under Article 70 of the 1951Regulations as potential reservoir of the yellow fevervirus in mosquitos or vertebrates other than man.

Any new delineation of that area after definitiveevidence, adopted by the World Health Organization,that infection has been completely eradicated, will begiven full consideration in respect of the measures tobe applied upon arrivals from that area.

(2) The Government of the UAR reserves the rightto treat a person arriving from a country with one ormore yellow fever infected areas, and embarking froma free port or airport in that country, as if he had comefrom an infected area, unless he is able to prove thathe has not been to an infected area within six daysprior to disembarkation.


Articles 90 and 91

The Government of the UAR reserves the right toask for Maritime and Aircraft Declarations of Healthfrom all arriving ships and aircraft at the first portor airport of call in its territory.


The Government of the UAR reserves the right toisolate, for the incubation period of the disease, anypassenger arriving from an infected area and providedwith a certificate notifying that this vaccination iscontra -indicated on medical grounds.


The Government of the UAR reserves the right torequire that the standards of hygiene on ships andaircraft carrying persons taking part in periodic masscongregations shall not be inferior to those containedin Annex B, International Sanitary Regulations 1951.


Article 1

With regard to cholera, the Working Group re-commends, for the reasons stated in paragraph V ofthis report, that this reservation be rejected as itsubstantially detracts from the character and purposeof the Regulations.

With regard to yellow fever, the Working Groupconsidered that the reservation under this Article andunder Article 73 would be more appropriately dealtwith by a reservation to Article 3, paragraph 1, andArticle 4, paragraph 1, as in the case of Cuba, andrecommends that a reservation in the same terms beaccepted for a period of three years from the date ofentry- into -force of the Regulations.

Article 22

In view of the provision of Article 22 that certifi-cation by the Organization would only be undertaken

at the request of the health administration concerned,the Working Group considers a reservation under thisArticle to be unnecessary.

Article 70

Since the terms of this Article are permissive, theWorking Group recommends that this reservationbe rejected but that the comments of the Governmentof the United Arab Republic be drawn to theattention of the Committee on International Sur-veillance of Communicable Diseases.


The Working Group recommends that this reser-vation be rejected as substantially detracting from thecharacter and purpose of the Regulations.

Articles 90 and 91

Since the terms of these Articles are permissive, theWorking Group does not consider these reservationsto be necessary.


In view of the provisions of Articles 75 and 84,paragraph 2, the Working Group recommends thatthis reservation be rejected.

The Working Group recommends that the Com-mittee on International Surveillance of CommunicableDiseases be invited to consider the problems of contra-indication to vaccination.


The Working Group noted that the standards ofhygiene on ships and aircraft carrying persons takingpart in periodic mass congregations, formerly containedin Annex B to the 1951 International Sanitary Regul-ations, are to be incorporated into the WHO re-commended standards on this subject. Consequentlythe Government of the United Arab Republic mayrequire that these standards of hygiene be applied tothe ships and aircraft concerned and a reservation toArticle 97 of the Regulations is unnecessary.

INDEX TO RESOLUTIONS AND DECISIONS

Accommodation, headquarters, future require-ments and acquisition of additional land, 4, 9

report on financing, 10Ad Hoc Committee of Experts to examine the

Finances of the United Nations and theSpecialized Agencies, implementation ofrecommendations, 15

Africa, Regional Office, extension of building andhousing of staff, 9

Agenda, adoption, 38Aircraft, disinsection, 32Annual Report of the Director -General for 1969, 5Appropriation Resolution, 1971, 27Assessments, scale, for 1971, 10

See also Contributions

Bacteriological (biological) weapons, 29Budget, level for 1971, and effective working

budget, 19order of magnitude, for 1972, 36

Cancer, International Agency for Research on,amendments to Statute, 12

Capacity of United Nations Development System,Study of, 23

Chemical and bacteriological (biological) wea-pons, 29

Committee on Credentials, composition, 37Committee on Nominations, composition, 37Community health services, research on organiza-

tion of, 25Community water supply, 18Constitution, amendments, 14Contributions, Members in arrears, 20

status of collection, 4Co- ordination with the United Nations, specialized

agencies and the International Atomic EnergyAgency, administrative, budgetary and financialmatters, 14, 15

programme matters, 21chemical and bacteriological (biological)

weapons, prohibition of, 29drug dependence, 22human rights, 21Second United Nations Development Decade,22study of capacity of United Nations develop-

ment system, 23See also Organizational study

Credentials, Committee on, composition, 37verification, 37

Resolution No.

WHA23.7WHA23.17WHA23.18

WHA23.31

WHA23.16(vii)WHA23.58WHA23.9WHA23.51WHA23.20

WHA23.53

WHA23.37WHA23.62

WHA23.23

WHA23.44

WHA23.53(i)(ii)

WHA23.49WHA23.36WHA23.29WHA23.39WHA23.6

WHA23.27WHA23.31WHA23.40

WHA23.53WHA23.42WHA23.41WHA23.43

WHA23.44

(i)(iii)

Director- General, Annual Report for 1969, 5 WHA23.9Disinsection of aircraft, 32 WHA23.58Displaced persons in the Middle East, health

assistance to, 28 WHA23.52

Resolution No.

Dr A. T. Shousha Foundation Medal and Prize,award, 6 WHA23.10

Drug dependence, 22 WHA23.42Drugs, efficacy, 25 WHA23.48

international monitoring of adverse reactions, 7 WHA23.13quality control, 23 WHA23.45

Emergency supplies, provision, 10 WHA23.19Environmental health, 34 WHA23.60Executive Board, election of Members entitled to

designate a person to serve on, 3 WHA23.3forty- fourth and forty -fifth sessions, reports on, 30 WHA23.54organizational study, co- ordination with the

United Nations and the specialized agencies,review, 13 WHA23.25

future, 13 WHA23.26External Auditor, reports, 3 WHA23.5

FAO, see Food and Agriculture Organization of theUnited Nations

Financial and administrative procedures of WHO,consideration of establishment of group ofrepresentatives of Member States to consultwith External Auditor, 20

Financial report on accounts of WHO for 1969, 3Food additives, health hazards, 26Food and Agriculture Organization of the United

Nations (FAO), 16, 26

General Committee, establishment, 38General programme of work covering a specific

period, 32German Democratic Republic, 6

WHA23.38WHA23.5WHA23.50

WHA23.32WHA23.50

(vi)

WHA23.59WHA23.11

Headquarters accommodation, future requirementsand acquisition of additional land, 4, 9 WHA23.7

WHA23.17report on financing, 10 WHA23.18

Health services, community, research on organi-zation, 25 WHA23.49

national, basic principles for development, 34 WHA23.61Human environment, 34 WHA23.60Human rights, 21 WHA23.41

ILO, see International Labour OrganisationInternational Agency for Research on Cancer,

amendments to Statute, 12 WHA23.23International Civil Aviation Organization, 32 WHA23.58International Health Regulations, reservations to, 31 WI-1A23.57International Labour Organisation (ILO), 24 WHA23.47

Léon Bernard Foundation Medal and Prize, award, 3 WHA23.4

Malaria eradication, revised global strategy, 6 WHA23.12Members and Associate Members, admission, 6 WHA23.11Miners, occupational health, 24 WHA23.47

- 95 -


Resolution No.

National health services, basic principles fordevelopment, 34 WHA23.61

Nominations, Committee on, composition, 37 (ii)

Occupational health, miners, 24 WHA23.47Officers, of Health Assembly, 38 (iv)

of main committees, 38 (v)Organizational study, co- ordination with the United

Nations and the specialized agencies, review, 13 WHA23.25future, 13 WHA23.26

Pension Board, United Nations Joint Staff, annualreport for 1968, 11 WHA23.21

Pension Committee, WHO Staff, appointment ofrepresentatives, 12 WHA23.22

Personnel, professional and auxiliary, training, 18 WHA23.35Pharmaceutical substances. see DrugsPlanning, long -term, in the field of health, 32 WHA23.59Programme of work covering a specific period, 32 WHA23.59Public health services, see Health services

Real Estate Fund, 8appropriation to, 9

Refugees and displaced persons in the MiddleEast, health assistance to, 28

Regional Office for Africa, extension of buildingand housing of staff, 9

Resolution WHA7.33, implementation, 14Revolving Fund for Real Estate Operations,

disestablishment, 8Revolving Fund for Teaching and Laboratory

Equipment for Medical Education andTraining, 7

Rules of Procedure of the World Health Assembly,amendments, 2

Shousha, Dr A. T., Foundation, award of Medaland Prize, 6

Smallpox eradication programme, 24Smoking, health consequences, 15Special Account for Servicing Costs, 31

WHA23.14WHA23.15

WHA23.52

WHA23.16WHA23.30

WHA23.14

WHA23.13

WHA23.2

WHA23.10WHA23.46WHA23.32WHA23.56

Resolution No.

Staff Pension Committee, WHO, appointment ofrepresentatives, 12 WHA23.22

Technical discussions, 1

Training of national health personnel, 18

United Nations, co- ordination with, administrative,budgetary and financial matters, 14, 15

programme matters, 21chemical and bacteriological (biological)

weapons, prohibition of, 29drug dependence, 22human rights, 21Second United Nations DevelopmentDecade,22Study of Capacity of United Nations Develop-

ment System, 23See also Organizational study

United Nations Development Decade, Second, 22United Nations Joint Staff Pension Board, annual

report for 1968, 11United Nations Relief and Works Agency for

Palestine Refugees in the Near East(UNRWA), 28

Vector control, research, 16Voluntary Fund for Health Promotion, 30

Water supplies, 18Working Capital Fund, advances from, for the

provision of emergency supplies to MemberStates, 10

review, 4status of advances to, 4use of, regarding international monitoring of

adverse reactions to drugs, 7World Health Assembly, method of work, 1

Rules of Procedure, amendments, 2Twenty- fourth, place of meeting, 14

World health situation, fourth and fifth reports, 12

Yellow fever, in Africa, 16

WHA23.1WHA23.35

WHA23.27WHA23.31WHA23.40

WHA23.53WHA23.42WHA23.41WHA23.43

WHA23.44

WHA23.43

WHA23.21

WHA23.52

WHA23.33WHA23.55

WHA23.36

WHA23.19WHA23.8WHA23.6

WHA23.13WHA23.1WHA23.2WHA23.28WHA23.24

WHA23.34

WORLD HEALTH ASSEMBLYapps.who.int/iris/bitstream/10665/85824/1/Official...WORLD HEALTH ASSEMBLY...

Documents

Transcript of WORLD HEALTH ASSEMBLYapps.who.int/iris/bitstream/10665/85824/1/Official...WORLD HEALTH ASSEMBLY...