SUMMARY RECORD OF THE SECOND MEEl'ING

WHO Conference Hall Wednesday. 2 October 1968 at 9.00 a.m.

(WPR/RC19/sR/2 )

CP.AlRMAN: Dr C.S. Gatmaitan (Philippines)

CONl'ENI'S

1 Address by incoming Chairman ...................................... 135

2 Adoption of the Agenda ........................................ 1.36

3 statement by the Chairman of the Technical Discussions ••• 136

4 statement by the Regional Director .................................... 137

5 Establishment of the Sub-Committee on Programme and Budget 138

6 Acknowledgement by the Chairman of brief reports received from governments on the progress of their health activities 138

7 Report of the Regional Director •••••••••••••••••••••••••• 138

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1:32 REGIONAL COMMITI'EE: NINETEENTH SESSION

SECOND MEmING

Wednesday, 2 October 1968 at 9.00. a.m.

PRESENT

I. £l.epresentatives of' ME"..!llber States ~

~

AUSTRALIA Dr H.M. Franklands Mr Tore Lokoloko Dr R.F.R. Scragg Mr P.A. Jackson Dr R.H. MacDonald •

CAMBODIA Dr Thor Peng Thong

CHINA. Dr C.K. Chang Dr Y.T. Wang Dr L.P. Chow

FRANCE Medecin-General J. Rondet

JAPAN Dr T. Muranaka Mr K. Watanabe Mr N. Maekawa Mr Y. Masuko

LAOS Dr Tiao Jaisvasd Visouthiphongs

MALAYSIA Tan Sri (Dr) Mohamed Din bin Ahmad Dr Chong Chun Hian Dr Fang Ung Seng

>.~

Dr K.S. Jap

NEW ZEALAND Dr C.N.D. Ta\y"lor

PHILIPPINES Dr C.S. Gatmaitan Dr J. Dizon -'

Dr J. Navarro Dr G. Balbin Dr E. Perez Dr F. Nepomuceno Dr J. Sumpaico Mr V. Flores Mr T. Carreon

POR'lUGAL Dr N.C. de Andrade

~

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SUMMARY RECORD OF THE SECOND MEETING

REPUBLIC OF KOREA Mr Sang Yung Soh Dr K. S •. Chang

SINGAPORE Mr Lye Thim Fatt

UNITED KINGDOM Dr P.H. Teng Dr C.H. Gurd

UNITED STATES OF AMERICA Dr R. K. C. Lee Dr J. K. Shafer Dr H. DeLien

VIET-NAM Dr LEl Nhan Thuan

WESTERN SAMOA Mr Luam.a.nuvae Eti

II. Representatives of the United Nations and Specialized Agencies

UNITED NATIONS DEVELOPMENT PROGRAMME

Mr G. Hamdy

III. Representatives of other intergovernmental organizations

rv .

INTERNATIOlfAL COMMl'I'orEE OF MILITARY MEDICINE AND PHARMACY

SOUTH PACIFIC COMMISSION

Colonel P.J. Barcelona, Me

Dr A. Guinea

Representatives O!~~B-~overnmental organizations

INTERNATIONAL UNION OF Mr J. E. Nifialga ARCHITECTS

INTERNATIONAL DENTAL Dr F. Rojas FEDERATION

INTERNATIONAL UNION :roR Miss C. del Rosario HEALTH EDUCATION

MEDICAL WOMEN'S INTERNATIONAL Dr Fe del Mundo ASSOCIATIOlf

INTERNATIONAL COMMITTEE OF Mrs M. Ordonez CATHOLIC NURSES

133

134 REGIONAL COMMITl'EE: NINEI'EENI'H SESSION

WORLD FEDERATION OF OCCUPAT:-()NAL THERAPISTS

INTERNATIONAL PLANNED PARENTHOOD FEDERATION

V. Observers

RYUKYU ISLANDS

VI. WHO Secretariat

DIRECTOR-GENERAL

SECRETARY

Mrs C. M. Abad

Professor D. Chun Dr H.M.C. Poortman

Captain D.A. Sebahar

Dr M.G. Candau

Dr Francisco J. Dy Regional Director

...

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SUMMARy RECORD OF lliE SECOND MEETING

The CHAIRMAN welcomed l-1edecin-General Rondet, Representative of

France.

Medecin-General RONDET (France) apologized for his delayed arrival

\m.ich was due to a sudden change in airline schedule. He thanked the

Commi ttee for having elected him as Vice-Chairman Hhich was an honour

both to him and the country he represented.

1 ADDRESS BY INCOMING CHAIRMAN: Item 6 of the Provisional Agenda

The CHAIRMAN stated that health conditions in most countries had

improved during the last two decades. In the more developed and

advanced countries, communicable diseases and diseases related to poor

environmental sanitation \'lere in their final stages of control. This

health progress was attributed by people in the public health field to

several factors: the existence of well-functioning health departments

with adequate and well-equipped health and medical facilities; a suffi­

cient number of trained health, medical and paramedical personnel;

improved environmental sanitation and a health-minded and educated

citizenry.

In the Regional Director's Report, it Has mentioned that health

conditions in the developing and underdeveloped countries had changed

very little. Many governments were still faced with the problem of

combatting a high incidence of communicable diseases.

Improved communications had brought countries closer together.

This meant economic and educational progress for the peoples concerned.

However, epidemiologically speaking, this might also result in the

spread or introduction of communicable disease from one country to

another. He suggested that the various epidemiological methods for

the identification of the means of spread and. the control or eradica­

tion of communicable disease in the Region should be reviewed jointly

by countries, and that governments, leaders, health administrators,

and others should analyze whether they had done their share in

;p6 REGIONAL COMMITTEE: NINEl'EENTH SESSION

improving the state of health and sanitation in accordance with the

standards set by WHO. This would mean making an inventory of the nUlilber

of properly equipped health and medical facilities, such as rural health

units, dispensaries, health centres, hospitals and medical centres; of

the number of staff that medical, nursing, paramedical and post-graduate

schools could turn out yearly for preventive and curative work; of

determining whether sufficient funds had been allocated to sanitation,

nutrition and the various fields of health. All these and other questions

could be summed up in three words - national health planning, which was

the subject of this session's technical discussions.

The Chairman hoped that representatives would actively partiCipate

in the deliberations and share their experiences, knowledge and methods

so that the task of health building in the Region might be successfully

accomplished. The agenda of the meeting \~as \'1611 balanced and he hoped

that the discussions would be fruitful and successful.

2 ADOPTION OF THE AGENDA: Item 7 of the Provisional Agenda (Document WPR/RC19/1 Rev.l)

Dr F'RANKIJU"l])S (Australia) r:toved and Dr TAYLOR (New Zealand)

seconded the adoption of the agenda.

Decision: In the absence of any comments, the agenda was adopted.

3 STATEMENT BY THE CHAIRMAN OF THE TECHNICAL DISCUSSIONS: Item 8 of the Agenda

The CHAIRMAN announced that, in accordance with the resolution

adopted by the Regional Committee at its eleventh session, the

Chairman of the technical discussions was selected by the Regional

Director, in consultation with the Chairman of the Regional Committee.

Tan Sri (Dr) Mohamed Din bin Ahmad, Director of Medical Services (West

Malaysia) and Permanent Secretary, Ministry of Health. Malaysia. had

been selected to serve in this capacity.

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SUMMARY RECORD OF THE SECOND MEETING 137

The Chairman then invited Dr Din to speak.

Dr DIN (Malaysia) informed the Committee of the arrangements made

for the technical discussions, the topic of which was "Health Planning

as an Administrative Tooll!. The purpose of the discussion was outlined

in document WPR/RC19/TD5 entitled "Guidelines for the Technical Discus-

sions". Four working papers had been distributed.

To facilitate the discussions, the participants would be divided

into three groups, t\'IO of which would be English-speaking; the third

would be in French and English. The last group would be provided with

interpretation facilities.

There would be three sessions in all: the afternoon of Friday,

4 October, \'lhich would consist of a plenary meeting followed by group

meetings; Saturday morning, 5 October, continuation of the group

meetings; and Monday morning, 7 October, when the draft report of the

technical discussions would be discussed in a second plenary meeting.

Dr Arne Barkhuus, formerly Chief of the National Health Planning

Unit at 1.rffiO Headquarters and now a \'ffiO consultant, and Dr Hernan Duran,

Chief of the Training Division, Pan American Program for Health Planning,

Pan American Health Organization, would speak at the first plenary session.

(For consideration of the report of the technical discussions. see the

sixth meeting, section 3.)

4 STATEMENT BY THE REGIONAL DIRECTOR

The REGIONAL DIRECTOR thanked the Representatives for the kind

remarks they had made about him during the celebration of the Twentieth

Anniversary of WHO. He was fortunate to have a competent staff both

in the Regional Office and in the field, and they all worked as a team.

He was also fortunate to be associated with governments whose under­

standing made the work pleasant and rewarding. He looked forward to

continued co-operation with governments in their partnership to improve

the health of all peoples.

138 REGIONAL COMMI'l'l'EE: NINEl'EENTH SESSION

5 ESTABLISHMENT OF THE SUB-COMMI'l'l'EE ON PROGRAMME AND BUDGEI': Item 9.1 of the Agenda

In accordance with the principle of rotation, it was agreed that

the membership should be composed of the Representatives of Cambodia,

France, Laos, Malaysia. Philippines. Portugal. Singapore. the United

States of America and Western Samoa. It was also agreed that the Sub­

Committee would meet at 2.30 p.m. on Thursday. 3 October. and that a

further meeting would be held on the afternoon of Monday. 7 October.

to review the draft report of the Sub-Committee. (For consideration

of the report of the Sub-Committee. see the sixth meeting. section 5.)

6 ACKNCMLEDGEMENT BY THE CHAIRMAN OF BRIEF REPORTS RECEIVED FR0r<l GOVERNMENTS ON THE PROGRESS OF THEIR HEALTH ACTIVITIES: Item 10 of the Agenda

The CHAIRMAN acknowledged reports received from governments on

the progress of health activities in the following countries and

territories: Australia, Cambodia. China. Hong Kong. Japan, Laos,

~acao. Malaysia. New Caledonia and its Dependencies, New Zealand,

Philippines. Republic of Korea, Timor and Western Samoa. In addition.

the Government of Japan had submitted "A Brief Report on Public Health

Administration in Japan". covering the period from January 1967 to

August 1968. (For further reports acknowledged. see the fourth and

fifth meetings. section 1.)

7 REPORT OF THE REGIONAL DIRECTOR: Item 11 of the Agenda (Document WPR/RC19/3)

The REGIONAL DIRECTOR. in introducing the Report, stated that

in the field of communicable diseases control priority had been given

to the fight against malaria. The malaria eradication programmes in

Sabah and Sarawak had been strengthened as a result of the recommenda­

tions made by the WHO independent assessment teams which had visited

these countries. A malaria eradication programme had started in West

Malaysia. The administrative management and the operational practices

in the programme in the Philippines had been improved. In Korea. the

status and functions of the basic health services and their possible

,..

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SUMMARY RECORD OF THE SECOND MEETING 139

participation in the future malaria eradication programme were being

assessed. As pointed out in the Report, the global strategy of malaria

eradication was being re-examined. The Governments of Malaysia and the

Philippines had agreed to WHO's proposal that consultant teams might

carry out studies in their countries.

Although no cases of smallpox had been reported in the Region

during the period under review, Cambodia and Laos were undertaking

intensive smallpox vaccination campaigns. Freeze-dried vaccine was

being produced in a number of countries. WHO had provided consultants

to advise on the maintenance and operation of the production units and

fello\-lships to train the staff concerned.

Last year a fairly extensive focus of human schistosomiasis

had been discovered in Laos. Cases had now been found in Cambodia.

A WHO team, conSisting of a paraSitologist and a malacologist, would

carry out extensive surveys in C~~bodia and Laos later this year.

In the filariasis control pilot project in Western Samoa mass

drug distribution had resulted in a marked reduction in the micro­

filarial rate, in the average filarial count per infected person,

and in infection rates in mosquitoes.

BeG vaccination campaigns \~ere being steadily expanded. WHO

recommended that in countries where a BCG vaccination programme was

indicated, at least 75% of the eliGible popUlation should be protected.

This requirement had been met in the New Hebrides and Western Samoa.

The effectiveness of direct BeG vaccination of infants and young

children \~thout preliminary testing had been demonstrated by the

increasing proportion of children under five years of age now being

vaccinated.

A programme of training in health planning had been established

in collaboration with the University of the Philippines. The annual

three-month course would consist of an introduction to the required

basic disciplines (e.g., economics, public administration, demography,

sociology), a theoretical presentation of the various aspects of

planning (e.g., economic development, phYSical, social) with emphasis

140 REGIONAL COMMITI'EE: NINETEENTH SESSION

on national health and manpower planning, followed by field practice in

health planning.

As a consequence of the interest shown in national health planning,

renewed attention was being given to the integrated content and purpose

of the communi ty health service in the hierarchy of the general health

services. Various patterns for the organization of general health

services and their delivery to the community were being evolved.

Additional studies and operational research were being undertaken in

some countries so that the most rational use could be made of available

resources in the field of health.

The pattern for local health services development which had been

tried out in a demonstration project in Korea tms now being extended

to other provinces. In vlest Malaysia, 40% of the rural health units

originally scheduled for establishment had been completed. A WHO team

had just completed an evaluation of what had been done and operational

studies of local health services in districts were under consideration.

In Laos, it had been decided to redefine and expand the coverage

of assistance previously provided by WHO under the rural health

development project. The new project had as its long-term objectives

the strengthening of facilities for the training of health personnel

and the development of health services at all levels, including the

establishment of better co-ordination between special and general

health programmes. In keeping with the Government's five-year

development plan, the project's activities would be concentrated in

the Vientiane Plain and in the area where the first large dam tms

being built.

In the New Hebrides, where the tuberculosis control programme

had been so successful, a broadening of the project to cover the

development of the basic health services was under study so that

the achievements of this mass campaign would be maintained.

In Western Samoa, the WHO public health team had already

assessed the rural health services with particular attention to

their actual activities. A reorganization of the Health Department

was under way.

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SUMMARY RECORD OF THE SECOND MEETING 141

The health survey in the four riparian countries of the Lower

Mekong Basin had been completed at the end of 1967. One of the recom­

mendations made by the team was the creation of a public health desk

in the Mekong Committee Secretariat. A vlHO public health administrator

and a sanitary engineer "(Quld, therefore, be appointed to ensure that

health reqUirements were given adequate attention throughout the plan­

ning and execution of all Mekong Committee projects, which would result

in important movements of population. This team would operate in close

co-operation \'lith the WHO representative in each country and through

them with the national Mekong Committees and the health authorities.

One of the concerns of the nursing and allied health professions

in most countries of the Region had continued to be how to provide

enough nursing and midwifery personnel to meet the needs of rapidly

growing popUlations. In some countries, nursing skills were still

being Nasted as a result of the poor utilization of nursing time, the

rate of turnover of employed staff and the emigration of the best

qualified nurses to other countries. This situation would have to be

improved if the nursing requirements of the expanding health services

were to be met.

Nutritional problems in the Region mainly affected mothers and

young children. Frank malnutrition was sometimes seen. A degree of

gro,,~h retardation was common, especially from six months to two

years of age. The Regional Office's general approach to these problems

was by nutrition education, through maternal and child health programmes

and applied nutrition programmes which involved other agencies (FAO

and UNICEF) and diSCiplines (education, agriculture and community

development). There had been increasing contact with the World Food

Programme, whose resources had recently been greatly increased. New

policies in favour of supplementary feeding for vulnerable groups were

being developed.

The number of countries in the Region where family planning had

been adopted as an official policy was increaSing. The importance

of integrating family planning as well as maternal and child health

142 REGIONAL COMMI'!'l'EE: NINE1'EENTH SESSION

services into the basic health services was understood, but in some

countries this procedure was not being followed. This was an area to

which more attention \'lould have to be given.

Activities in the field of environmental health had continued to

expand. Important strides had been made in planning for sewerage and

the disposal of other wastes, in the control of environmental pollution

and in establishing environmental health standards. The United Nations

Development Programme had approved Special Fund assistance to China

(Taiwan) in connexion with a sewerage planning project for Taipei.

This was the second major project in the Region which had qualified

for this type of assistance.

Despite all the efforts of governments there still existed a

widespread shortage of medical and paramedical personnel. The

strengthening of national training centres continued, therefore, to

be one of the priorities in the regional programme. A major develop­

ment during the period under review was the decision of the Government

of Viet-Nam to set up a national institute of public health to train

various categories of health workers. The United States of America

had pledged a contribution of one million US dollars and the Kingdom

of the Netherlands had pledged 500 000 US dollars, which ~lould be

paid in five yearly installments of 100 000 US dollars each, the first

of which had already been received. He understood that some other

countries were also considering making contributions to support this

project.

Increased emphasis had been placed by the Regional Office on

the need for evaluation of its programmes of assistance. A new

outline had been prepared for plans of operation. This included

built-in methods of evaluation which would permit the Organization

to assess, in consultation with governments, the progress that was

being made yearly and to determine whether the assistance being given

should be continued, redefined or withdrawn.

In closing, the Regional Director stated that he was fully

aware that the work done by vntO in the Region represented only a

small part of the efforts being made by all governments to improve the

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SUMMARY RECORD OF THE SECOND MEETING

health of their peoples. The problems facing the developing countries

were enormous but governments were showing an increasing capacity to

absorb WHO assistance effectively.

On the suggestion of the CHAIRMAN, the Report was discussed

section by section.

Introduction (pages vii-xv)

Dr DIZON (Philippines) stated that he was particularly appreciative

of the skill with which priorities had been established to meet the needs

of Member countries. The problem of communicable disease control was

important and he was pleased to note that emphasis was being given to this

aspect of the programme. The Philippine delegation noted with pleasure

that increased attention \~s being b~ven to evaluation. Assistance must

be evaluated in terms of the problems and needs of a particular situation.

Dr THOR PENG THONG (Cambodia) was happy to note the progress being

made and the fact that the activities being carried out by the Regional

Office had become more numerous. His country had received a tremendous

amount of assistance from WHO and, as a result, it had been possible to

solve many health problems.

Dr LEE (United States of America) recalled that last year the

Regional Director had discussed bankable projects for the funding of

community water supplies. Reference was made in the Introduction to

assistance being given to governments in preparing bankable projects

of this type and he would like to have furthe~ information. He also

r- asked if Western Samoa had been able to get support for its community

water supply project from the Asian Development Bank.

The REGIONAL DIRECTOR said that there were two projects in the Region

financed under the Special Fund component of the United Nations Develop­

ment Programme, the Development of a Master Plan for the Sewerage of

Greater Manila Area (Philippines) and the Development of a Plan for

~ Sewerage in Taipei City. He hoped that when these plans were developed,

further assistance could be given to the governments concerned in making

i44 REGIONAL COMMITl'EE: NINETEENTH SESSION

the projects bankable so that funds could be borrowed from external sources

to carry them out. Assistance was being given to Western Samoa in develop:ing

feasibility studies for a water supply programme.

Dr FRANKLANDS (Australia) stated that he was particularly interested

in the quarantinable diseases. He was pleased to note, therefore, that

the attention of governments cont:inued to be drawn to this problem. Any·

measures to prevent the spread of disease from countries in which they

were endemic to countries free of them deserved support.

Dr DIN (Malaysia) said that the Regional Office had continued to

weigh and balance with great care the needs of countries in the Region,

and at the same time had given full attention to those subjects of regional

interest. He had noted that the Regional Director had made no reference

to health laboratory services in his introductory remarks and asked what

priority would be given to this aspect of the programme in the future.

The REGIONAL DIREaI'OR stated that for some time now it had been

realized that communicable disease control programmes were very weak

on the laboratory side. For this reason, a post of regional adviser in

health laboratory services had been included in the 1969 budget. The

assistance which WHO could provide in this field would be strengthened

when the new adviser assumed his post.

Dr TENG (United Kingdom) was particularly pleased to see that the

Regional Office had appointed an adviser in the organization of medical

care. This was one area which should always be kept under constant

review in view of the changing pattern of diseases - the long-term cases

and the aging population. The other problem which had been emphasized

was the health manpower requirement. The Regional Director should be

congratulated for having pin-pointed the problem of shortage of qualified

teaching staff and also the "brain drain".

Dr LEE (United States of America) asked about the qualifications

of the regional adviser in health laboratory services, because public

health laboratory services in the Region must vary considerably.

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SUMMARY RECORD OF THE SECOND MEETING

The REGIONAL DIRECTOR said that he had asked the Director-General

to permit the Chief of Health Laboratory Services at WHO Headquarters

to Join the regional office staff. He hoped that the Director-General

would agree to this proposal.

Dr CHOW (China) referred to the remarks made by the Regional

Director in connexion with family planning. He felt this ''las an

important area which was a growing health need in many countries in

the Region. He hoped that with the assistance, guidance and encourage­

ment of WHO, activities in this area could be strengthened and integrated

with the general health services.

Part I, section 1: Malaria (pages 3-11)

Dr CHONG (Malaysia) stated that progress ,,~as being made in the

malaria eradication programme in Sarawak and, depending on the avail­

ability of funds, it was hoped to reach a version of the consolidation

phase by 1972 or 1974. He stressed "version of the consolidation phase"

because it would be a consolidation phase with a high maintenance cost

as the country shared a long border with Indonesian Borneo, which had

not yet started an eradication project. Recently, WHO had been

assisting in two specific respects: by supporting the inter-country

co-ordination conference in Borneo, dUring which good relationships

had been established with the Indonesian representative; and by the

visit of the independent malaria assessment team. Follovang this visit,

the Government had worked out a new strategy for eradication. It had

been hoped that if this could be followed, the consolidation phase

would be reached by 1971. It had been discovered, however, that the

plans made were not practical, firstly because of shortage of funds,

and secondly, because it would involve the hiring of short-term workers.

This was not politically acceptable to the State. New plans had been

made confirming the recommendations of the independent malaria assess­

ment team but adapting them to the particular needs of the country.

It was now hoped that a smaller number of people could be hired,

146 REGIONAL COMMITrEE: N:INErE£mrH SESSI~,!.-_____ _

trained and kept. The budget would thus be smaller and there would be

greater state partioipation, so that the people in Sarawak would regard

malaria eradication as their own work.

Referring to the Regional Director's statement that the work of

WHO represented only a portion of the many other health activities

being carried out, Dr Chong said that his country had received generous

aid from Great Brita.:!.n, Canaca, Australia, New Zealand and the United

States of America. He wished to single out Canada since it had no

representative at the meeting. There were presently twenty medical

students from Sarawak undertaking various types of training in Canada.

five of them had already returned home and six of the trainees were

natives of Sarawak.

Speaking of WHO assistance in general. Dr Chong said that although

Sarawak needed more aid, the amount it was presently receiving was about

all that could be usefully absorbed. Counterparts were now available

for all WHO personnel assigned to his country. He hoped that WHO would

make more use of the economic approach as this was particularly essential

when obtaining the approval of his Government for the various projects

that the health authorities in Sarawak hoped to undertake. Another maj or

need in Sarawak was the local training of multi-skilled health workers

who could be absorbed into the permanent service.

The REGIONAL DIRECTOR referred to the national health planning

course which had recently been started in Manila and which would be

an annual event. The Organization fully appreciated the importance

of health workers being able to speak the language of the economists

and this aspect was \11e11 covered in the course.

Dr ANDRADE (Portugal) stated that his Government was deeply

concerned with the problem of malaria in Portuguese Timor and that

it would do its best not only to improve the basic health services

so as to provide a suitable infrastructure for the implementation

of a malaria eradication programme but also to hasten the necessary

epidemiological enquiry already begun.

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SUMMARY RECORD OF THE SECOND MEETING 147

Section 2.3.4: Japanese encephalitis (page 15)

Mr WATANABE (Japan) referred to section 2.3.4 (page 15) and stated

that the figures provided in connexion with cases and deaths of Japanese

encephalitis in Japan should be corrected as follows: 1967 - 1028 cases

and 659 deaths; 1966 - 2301 cases and l4JJ.2 deaths. Between 1 January

and 16 September 1968, there had only been 462 cases· and 156 deaths.

These figures were considerably lower than those reported in the corres­

ponding period in 1967. The reasons for the considerable decrease were

not kno\'m although it was presumed that this was due, first, to the

completion of the encephalitis vaccination campaign, which had covered

almost thirty million people, and second, to the decrease in the

mosquito population and the general improvement of environmental sanita­

tion, as a result of the very extensive activities of the community

health organizations in which the people themselves had participated.

In 1967, a field research project had been started with a view to finding

out other ways of preventing the disease. In Nagasaki prefecture

of Kyushu Island, where the outbreak usually occurred first,

twenty thousand young pigs had been immunized with attenuated live

vaccines. This had also been done in Osaka in 1968. The idea was that

the vector mosquito ~lould not be infected with the virus if it bit the

vaccinated pigs. This study would be continued for another two or three

years.

Mr SOH (Republic of Korea) stated that there ~lere many cases of

Japanese encephalitis in Korea every year. In 1967, 2688 cases and

789 deaths had been reported: 1200 cases had already been reported

this year. He understood that WHO was not yet in a pOSition to state

that the vaccine available in some countries was effective against

Japanese encephalitis. He asked WHO to undertake studies, not only

on vector biology research, but vaccine trial and vector control

studies in the hope of finding a solution to the problem.

148 , ____ ..;;.RE"" • .;;;GI:;;.,;O;,;;:.N;;.c;A.::,.LCOMMITI'EE! NINErEENTII::.....::;SES=S;:=I;::.;DN:.:.-______ _

Dr CHOW (China) said that the health authorities and the public in

Taiwan had become more aware of the need to do something to control

Japanese encephalitis. In 1965, a study using mouse brain encephalitis

vaccine with diphtheria toxoid as placebo had been undertaken. The

results had indicated that the efficacy of mouse brain vaccine was

about 80%. His Government was now producing mouse brain vaccine and

was very grateful to WHO for providing a short-term consultant to help

in the production aspects and to undertake other epidemiological studies.

Studies had also been undertaken on the conversion rate of peak titres

and the bionomics of the vector.

Dr Chow requested WHO to assign a research team to assist his

Government to study the epidemiology and other features of tp~s

disease, in particular, the biological control of the vector mosquito.

There were a few entomologists and epidemiologists ~lho could serve as

counterparts of the WHO experts who would undertake the. studies, and

other resourcE'S, such as NAMRU II, which could provide technical

assistance in co-operation with the WHO team.

The REGIONAL DIRECTOR pointed out that the interest of WHO in

this disease was not confined to the control of the vector. WHO had

sent an epidemiologist to Korea to discuss the question of the production

of Japanese encephalitis vaccine. The question of a field trial had been

discussed by the Representative of Korea to the World Health Assembly

last May wi th the Chief of the Virus Diseases Unit at WHO Headquarters,

and he (the Regional Director) had been present during this discussion.

He recalled that WHO had agreed to provide a consultant should the

Government decide to undertake this trial. The Regional Director , emphasized that the results of a field trial in China (Taiwan) might

not be applicable to Korea and vice versa.

1he DIRECTOR-GENERAL stated that the request made by the

Representat,ive of China for a team to carry out insect biology

stUdies and epidemiology on Japanese encephalitis came under the

SUMMARY RECORD OF THE SECOND MEEl'ING 149

Headquarters Research Progranme. He had been requested to put into

the 1970 budget some three posts: an epidemiologist. an entomologist

and an ecologist. to undertake this work in China (Taiwan). He could

not state today if he would be able to do this in view of the limitation

imposed on the total of the budget.

Section 2.3.5: Dengue-haemorrhagic fever (page 16)

Mr LYE (Singapore) referred to the subject of haemorrhagic fever.

In Singapore, it was considered that mosquito-borne diseases of this

nature were best tackled in an urban environment by sanitation improve­

ment rather than chemical therapy. Control had not been adequate and

a health education campaign had been organized to induce the population

to co-operate; the reaction had been very poor. With the rising number

of cases of haemorrhagic fever in the last few years, it was felt that

it was time to tackle the problem of mosquito control generally "Ii th

legal backing. Legislation had been passed Whereby mass partiCipation

was induced, especially in the eradication of water-bearing receptacles

and the breeding places of ~ mosquitoes. It was too early to say

what effect this would have but the preliminary results that had been

obtained by the Vector Control Unit were encouraging and this might

be a solution to the problem under urban conditions.

Section 2.4.2: Filariasis (pages 17-18)

Mr ETr (Western Samoa) stated that the control project in Western

Samoa had been established in 1965. The first mass campaign was

completed in October 1966. WHO had assigned an epidemiologist to

assess the results of the campaign and, as pointed out in the Regional

Director's Annual Report, encouraging results had been achieved. A

follow-up programme was in progress. A trial study on vector control

methods was now being carried out by a WHO consultant in entomology.

\-lestern Samoa was fortunate to have been host to the World Health

Organization/South Pacific Commission joint seminar on filariasis

150 REGIONAL COMMI'I'I'EE: NINEl'EE:::.:~=. :!-:::S:::::ES~S;:;:I::;::O!.:.N ________ _

which had been held in Apia from 6 to 12 August. The seminar had beert

well attended and the participants had sho\'m a keen interest in the

filariasis control project. It had been reported that following drug

therapy. the residual infection rate had a tendency to rise again after

the initial fall. and a second round of mass drug administration and a

vector control programme were. therefore. recommended.

It was hoped to carry out the second round of mass treatment in

the early part of 1969. It was also hoped that WHO and UNICEF would

continue to assist ~~e project. Substantial progress had been made

and he did not wish to see this progress deteriorate. The continuing

support of WHO and UNICEF was essential to prevent this happening.

The REGIONAL DIRECTOR stated that provision had been included in

the proposed programme and budget estimates for 1970 for the continuation

of the filariasis project in Western Samoa. In view of the many requests

received for advice in connexion with arthropod-borne infections such

as haemorrhagic fever. Japanese encephalitis, filariasis and plague.

provision had also been made in 1970 for an inter-country vector

control advisory services project.

Section 2.8.1: Cholera (page 25)

Dr DIN (Malaysia) referred to the Joint cholera study being carried

out by the Governments of the Philippines and Japan in co-operation

with WHO. Be noted that the findings of the team would be published

shortly and asked if the Committee could be given a preview of the

report. particularly on the bacteriological aspects of the use of

clasSical vaccines or their alternatives.

Dr DIZON (Philippines) stated that this programme was an example

of collaboration in the study of diseases. The study consisted of

three aspects: field cholera vaccine trials, which were being carried

out in Negros Occidental, carrier studies. and laboratory studies on

the viability and other characteristics of the vibrio. An issue of

.,

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- SUMMARY RECORD OF THE SECOND MEETING 151

the WHO Bulletin had been devoted to a preliminary report on the findings

and this was the only published report so far.

Dr YEN, Regional Adviser in Communicable Diseases, said that the

team was now in Bacolod and was carrying out studies on the treatment

of contacts and carriers. Information on the most recent findings was

not yet available in the Regional Office.

Section 2.4.1: Schistosomiasis (pages 16-17)

Dr VISOUTHIPHONGS (Laos) stated that last year a survey team had

detected some cases of schistosomiasis in Khong Island in the southern

part of Laos. The parasite had spread to other parts of the country,

but specific figures could not be given. It was hoped that the WHO

survey team would be able to collect detailed information and establish

a programme for the control of the disease. This could possibly be

included in the project for the development of the Lower Mekong River

Basin.

The REGIONAL DIRECTOR informed the Comrni ttee that some years ago,

WHO had suggested to the Mekong Committee that surveys should be made

in Laos and Cambodia to determine whether schistosomiasis existed. It

was felt this would be useful in view of the extensive development

projects being planned in the Lower Mekong River Basin. '!he earlier

surveys conducted by the WHO team had not revealed any snails or foci

of infection. As pointed out in the Report, a fairly extensive focus

of human schistosomiasis had been found last year in Laos, and in

Cambodia schistosomiasis eggs had been found during an operation of

a patient. A search had been made for the intermediate host but this

had been unsuccessful. It was hoped that the team which would be sent

to Cambodia and Laos would provide further information on these rather

interesting parasitological findings.

152 REGIONAL COMMI'lTEE: NINEI'EENTH SESSION

Section 2.7: Leprosy (page 25)

Medecin-Colonel RONDET (France) suggested that more attention

should be given to leprosy. This disease was highly endemic in New

Caledonia '(mere there was a high percentage of lepromatous cases.

The REGIONAL DIRECTOR informed the Committee that in 1970

provision had been made under inter-countr,rprojects for an adviser

to provide assistance in this field.

Dr THOR PENG THONG (Cambodia) referred to the schistosomiasis

problem in Cambodia. Pending the arrival of the WHO team, the Ministry·

of Health had decided to send communicable disease teams to conduct

a systematic preliminary survey. They had been able to find a rather

disquieting percentage of positive cases in a group of population

around Kratie.

Section 2.6: Tuberculosis (pages 18-25)

Dr THOR PENG THONG (Cambodia) agreed with the statement in the

Regional Director's report that the use of photofluorography in the

control of tuberculosis was costly and that it was difficult to use

this method in countries with limited resources. He noted that WHO

recommended the adoption of sputum microscopy as the primary means of

case detection in the developing countries. It was recognized that

sputum examination did not always reveal the bacilli, even in very

infectious cases. If the presence of bacilli \-las chosen as the

criterion for treatment, many infectious cases would not be treated.

The patients who came to the tuberculosis control service were usually

those who knew that they were sick. If they were not treated owing

to the absence of bacilli, the population might obtain an unfavourable

impression of the tuberculosis control programme.

Dr TAO, Regional Adviser in Tuberculosis, explained that every

patient was entitled to treatment but before diagnosis was made it

SUMMARY RECORD OF THE SECOND MEEl'ING 153

was impossible to initiate treatment. In many developing countries,

the number of available X-ray units was limited and it was not possible

to extend the X-ray service to many areas. In Cambodia, for instance,

there were only four photofluorographic units, two in Phnom-Penh and

two in Battambang. In all the other provinces, the only diagnostic

facility that could be expected within the next few years would be

microscopy. This was a question of priority. If there were microscopic

facilities for the diagnosis of tuberculosis in every province and ample

treatment facilities, the provision of X-ray facilities could be discussed.

It was not intended that patients with X-ray shadows without bacterio­

logical proof should not be treated. The matter was only a question

of the availability of diagnostic facilities.

Dr SCRAGG (Australia) referred to the remarks made on leprosy

by the Representative of France. Leprosy in the South Pacific area

~~s quite an important problem and considerable assistance in this

field had already been received from WHO. The proposed appointment of

a leprologist waS welcome. He then drew the Committee's attention to

the study which had been undertaken on BeG vaccination and which was

now under evaluation by WHO. It appeared from the work done in an

isolated area in New Guinea that this vaccination was about 50% effective in the prevention of the development of leprosy. This was

still ~ judice and the results might not be as good but it appeared

that BeG vaccination gave some measurable protection against leprosy.

This work had started in New Caledonia some ten or more years ago.

A new preparation of sulfone drugs, a 75-day injection, was also being

used in New Guinea. This had been most effective and had caused the

disappearance of lepra bacillus. It appeared that tremendous advances

were being made in the control of this infection.

Dr LEE (United States of America) referred to the statement on

page 25 that "emphasis has been placed on the importance of releasing

the arrested and non-infectious patients from sanitaria ••• " and asked

154

what the criteria were today for the eValuation of the laboratory diagnosis

of the acid-fast organism. He understood from the authorities in Hawaii

that Dr Robert Worth had been doing some work of this kind in Hong Kong

and that the findings of acid-fast organism did not mean that the patient

was infectious.

It was agreed that discussion on this point would be continued

in the afternoon. (For continuation of discussion. see the third

meeting, section 1.)

The meeting rose at 12.00 noon.