1

(WP/RC10/Mln/3 Rev.l)

MINUrES Of! THE THIRD MEETING

City Hall Monday, 2l September 1959 at 9.00 a.m.

CHAIRMAN: Dr. E. Valencia, Vice-Chairman

CONrENTS

Announcements ............................................ E.!L

126

2 Address by Dr. Valencia, Vice-Chairman •••••••••••••••••••• 126

3 Consideration of draft resolutions proposed by rapporteurs .••••••••••••••••••••••.••••.••••••••••••••• 128

4 Time, place and duration of the eleventh and t-welfth sessions ......................................... . 128

5 Malaria eradication •••••••••••••••••••••••.••••••••.•••••• 134

- 123 -

124 REGIONAL COMMITTEE: TENTH SESSION

Third Meeting

Monday, 21 September 1959 at 9.00 a.m.

PRESENT

I. Representatives of Member states

Dr. George M. Redshaw Dr. Roy F.R. Scragg

CAMBODIA Dr. Thor-Peng-Thong Dr. Kim-Vi en

CHINA Dr. T. Hsiang Wang Dr. C.H. Yen Dr. H.T. Lin

FEDERATION OF MALAYA Dr. Haji Mohamed Bin-Mohd.

FRANCE Medecin-Colonel M. Demange

JAPAN Dr. Mutsuma Kawakami Mr. H. Fukada Mr. Y. Saito

KOREA Dr. Yong Sung Kim Dr. Sang Tae Han

NErHERLANDS Dr. G. Hijsmuller

NEW ZEALAND Dr. G.O.L. Dempster

PHILIPPINES Dr. Elpidio Valencia Mr. Marcelo C. Angeles Dr. Jesus Azurin Dr. Fidel Nepomuceno

PORrUGAL Dr. Vi valdo Eurico Modesto

UNITED KINGDOM Dr. L. J. Clapham Dr. R. Dickie Dr. P.H. Teng

UNITED STATES OF AMERICA Dr. A.S. Osborne Dr. R.L. Cherry

VIEr NAM Dr. Le -Cuu Truong Dr. Le ... Van Ngon Dr. Truong-Dinh-Vy

Secretary: Dr. I.C. Fang Regional Director

Ibrahim

da Rosa

MrNUrES OF THE THIRD MEErING

n. Representati ves 0'£ the United Nations and Specialized Agencies

UNITED NATIONS

UNITED NATIONS CHILDREN'S FUND

UNITED NATIONS TECHNICAL ASSI~.ANCE BOARD

Sir Alexander MacFarquhar

Mr. Y.C. Chen

Sir Alexander MacFarquhar

III. R!presentatives of other inter-governmental organizations and of non-governmental organizations

INTERNATIONAL COMMITTEE OF MrUT.ARY MEDICINE AND PHARMACY

INrERNATIONAL DENI'AL FEDERATION

INTERNATIONAL SOOImy FOR THE WELFARE OF CRIPPIES

MEDICAL vlOMEN I S INrERNATIONAL ASSOCIATION

SOurR PACIFIC COMMISSION

WORLD VETERANS FEDERATION

Major General Yang vIen Tall

Dr. Yu Pei Chung

Mr. M.O. Ekern

Dr. Yung-chen Shih

Dr. Thos. C. Lonie

Dr. Toshihiro Uemura

126 REGIONAL COMMITTEE: TENTH SESSION

1 ANNOUNCEMENTS

Dr. VAIENCIA (Philippines) acted as Chairman during this meeting of

the COmmittee, and before proceeding to the Order of the Day made the

follOwing announcements:

At 10.15 a.m. the representatives of the Regional Committee would

depart for Yangminshan to meet His Excellency, the President of the

Republic of China. The plenary session would,therefore, continue in

the afternoon from 2.00 to 4.00 o'clock and the field trip would take

place at 4.00 o'clock.

He apologized to the representatives of the non-governmental

organizations for their not being able to make their statements in the

morning and invited them to do so in the afternoon.

2 ADDRESS BY DR. VAIENCIA, VICE-CHAIRMAN

Dr. VAIENCIA then stated that he would like to make a few remarks

before proceeding with the business of the day. He referred to the

honour conferred not only on him but the Filipino people by electing

him to the office of Vice-Chairman, and pledged his whole-hearted

support of the task given to him. He expressed the grateful appreciation

of his Government to the Member States for their splendid co-operation

during the past year and spoke of the assistance given to him by the

Regional Director Vhose understanding and sympathy of the problems of

the Filipino peo~le made it easier for him, during his first year of

incumbency in the Department of Health, and had helped in the carrying

out .of the reorganization of the Department, especially in its first

and most difficult initial stage. Through the hospitality of the

MINlJlIES OF THE THIRD MEmING 127

Government of Nationalist China the representatives of nations in the

Western Pacific were gathered to discuss matters for the protection and

improvement of the health of millions of people. This was a welcome

opportunity to strengthen further the ties of friendship. Dr. Valencia

referred to the activities in the world Which would seek to destroy life

and curtail the freedom of man. The men of science throughout the world

represented a powerful force for good and could serve to alleviate human

misery, prolong life and help build a happy world. The efforts of the

meeting should make manifest that men of science were engaged in

determined action to rid mankind of disease and the factors that make

for poverty and weakness. Dr. Valencia referred to the fact that th

present meeting was a ~ontaneous, sincere union of hearts and minds

spurred on to place service to humanity above all other material

considerations. WHO was among the most powerful instruments for good

because it worked for the enhancement of peace. Health was one of the

fundamental rights of every human being without distinction of race,

religion , political belief, economic or social condition. It was their

duty to promote the health of all peoples as fundamental to the attain­

ment of peace and security and seek the fullest co-operation of indivi­

duals and states. Health was not only the absence of disease or

infirmity but a state of complete physical, mental and social well-being.

If men of science were to apply themselves with a missionary zeal to

accentuating both the passive and active ~ects of those beliefs they

could not but contribute substantially to international efforts, to

preserve the peace and promote the welfare and happiness of all peoples.

128 REGIONAL COMMITTEE: TENTH SESSION

CONSIDEP.ATION OF DRAFT RESOLUl'IONS PROPOSED BY RAPPORrEURS

The CHAIRMAN invited Dr. CLAPHAM (United Kingdom) to present the

draft resolutions before the Committee which were as follows:

(1) Annual Report of the Regional Director (WP/RCIO/WP/l)

(2) Aqcommodation for the Regional Office (WP/RCIO/WP/2)

(3) Method of Appointing Regional Directors (WP/RCIO/v~/3)

(4) Convention on the Privileges and Immunities of the Specialized Agencies: Status of Accessions to the Convention and to Annex VII thereof (WP/RCIO/wp/4)

Decision: The proposed resolutions were adopted (see resolutions WP!RCIO.Rl"WP/RCIO.R2, WP/RCIO.R3, WP/RCIO.R4).

4 TIME, PLACE AND DURATION OF EIEVENrH AND TWELFTH SESSIONS: Item 22 of the Agenda (Documents WP /RCIO/13 and Add.l)

The SECREI'ARY stated that item 22 had been advanced in order that

one of the representatives who had to leave early might have the

opportunity of speaking.

The SECREI'ARY then stated that, in accordance with the policy that

every second year the meeting would be held at regional headquarters,

the site of the eleventh session of the Committee would be Manila. The

attention of the Committee was drawn to the situation which existed as

a result of the invitation of the Govermnent of India to the Iforld Health

Assembly to meet in New Delhi in 1961 and it was suggested that the date

of the meeting should be left to the discretion of the Regional Director

who would make a decision in consultation with the Director-General.

The Government of New Zealand had extended an invitation to the

Committee to hold its twelfth session in New Zealand in 1961 and this

)[[NtJ1'ES OF THE THIRD Mll::ErING

invltation was reproduced in addendum one to document WP/RC10/13.

The CHAIRMAN then asked Dr. Dempster if he wished to address the

meeting.

129

Dr. DEMPSI'ER (New Zealand) referred to the communication from the

Minister of External Affairs of New Zealand 'Who, on behalf of the New

Zealand Government, extended a hearty invitation to this committee to

hold its meeting in 1961 in vlellington, New Zealand. He stated that

Dr. Turbott had told him that many representatives would be pleased to

visit New Zealand to see something of the public health organization.

Should the Committee decide to accept the invitation, it would have

the opportunity to see some general public health work 'Which might be

of interest. He hoped therefore that the Committee would accept the

invitation extended by his Government.

Dr. YEN (China) seconded the motion of the representative from

New Zealand and said that he, personally, appreciated the inti tat ion of

the New Zealand Government. Furthermore, the Regional Committee meetings

so far had been held on this side of the Pacific and he considered it

very opportune and interesting for Member countries to visit the other

side of the Pacific Ocean. He, therefore, strongly supported the

proposal of the representative from New Zealand.

Dr. TENG (United Kingdom), Dr. DA ROSA (Portugal), Dr. HAJI MOHAMED

(Federa.tion of Malaya), Dr. AZURIN (Philippines) and Dr. KAllAKAMJ: (Japan),

all expressed their approval and support of the proposal made by the

representative from New Zealand.

130 REGIONAL COMMIT'.rEE: TENrH SESSION

Dr. TRUONG (Viet Nam) stated that the delegaticn cf the Republic

cf Viet Nam "ivould be very glad to. visit New Zealand in 1961. He said

that they had heard a great deal abcut New Zealand, especially as far

as their public health activities were ccncerned but had no. precise

idea abcut the ccuntry, and they would be extremely glad to. suppcrt

the prcpcsal cf the representative frcm New' Zealand.

Dr. OSBORNE (United states cf America) remarked that he would like

to. put himself in line with thcse who. had spoken befcre and suggested

that apprcval cf the prcpcsal cf the New Zealand Gcvernment ·be done by

acclamaticn, there being no. opinicn to. the contrary frcm the cther

members cf the CcrMaittee.

Decisicn: The prcpcsal cf the Government cf New Zealand to. hcld the twelfth sessicn o.f the Regicnal Ccmmittee in ,'lellingtcn in 1961 was approved unanimcusly.

The CHAIRMAN then referred to the invitaticn from the Commcnwealth

cf Australia with regard to. the place cf the fourteenth sessicn cf the

Regicnal Ccr~uttee fcr the western Pacific (document WP/RCIO/13 Add.2),

and invited Dr. Redshaw to. speak.

Dr. REDSHA'H (Australia) stated that the Government of the Ccmmcn-

wealth cf Australia was very appreciative and aware of its respcnsibility

in requesting the Regicnal Ccmmittee to. hcld its fcurteenth sessicn in

its territcry. In making the request, the Government had full ccnfidence

that it cculd readily carry cut the duties ccmmitted to. it should the

cccasicn arcse.

In line with what the representative frcm China had stated earlier,

Dr. REDSHAW said that many cf the Regicnal Ccmmittee meetings, in fact

MImms OF THE THIRD ~ING 121

most of them, had been held in the northern area of the Region and 1961

woul.d be the first time that the Committee 'Vrould meet in the southern I

part. This arrangement would give the New Zealand Government an

opportunity not only to act as host to the Committee but also to present

its problems and progress to the members of the Committee.

Dr. REDSHAW therefore considered it appropriate for the Regional

Committee to go to Australia in 1963 Where again the local conditions,

problems and progress, quite distinct from New Zealand, could be seen.

He thought that it might be too early definitely to fix the site of the

meeting so far in advance, but would like the Committee to consider the

proposal to hold the meeting in Port Moresby in 1963 and decide on the

ma.tter next year.

He then requested Dr. Scragg to add to his remarks.

Dr. SCRAGG (Australia) informed the Committee that during the visit

of Dr. F.J. Dy the possibility of the 1961 session of the Regional

Commi ttee being held in Port Moresby in the Territory of Papua and New

Guinea had been discussed. However, information had come later that

the New Zealand Government's proposal was firm and definite, and,

although the Australian Government had agreed to 1961 it was sim,ple

to have the arrangement transferred to 1963.

Dr. SCRAGG supported the points raised by Dr. Redshaw. Without

doubt, Melanesia, the Territory of Papua and New Guinea, Netherlands

New Guinea, the British Solomons and New Hebrides were the most primi-

tive countries in the Region. To date there had been no meeting held

in this area and his Government felt that there were therefore many

132 REGIONAL COMMITTEE: TENI'H SESSION

good reasons why representatives from other countries should be made

aware of the particular problems and realize what it was dOing and how,

particularly in the fields of tuberculosis control, malaria control,

health education and medical research. The control of these diseases

was difficult particularly because, as opposed to the situation existing

in countries north of the equator, the people in that area were without

a language and were only now being taught to put their thoughts down on

paper. Therefore, problems of communication and health education were

very great. Tuberculosis and maJ..aria "Tere the main medical problems,

but the real problem was ignorance.

As far as the proposed site for the Regional Committee meeting was

concerned, Dr. SCRAGG explained that Port Moresby was a town of only

twenty thousand people but was quite a developed community. From the

point of view of climate, the month of September was one of the best

months and the temperature was below that which now prevailed in

Taipei. The place of the meeting would be the Legislative Chamber

and the representatives were assured of an interesting and profitable

time in New Guinea, which would benefit not only the Territory but

also the deliberations of the group. Finally, the Government of

Australia and the people of the Territory of Papua and New' Guinea

would be greatly honoured if the decision was eventually made to hold

the fourteenth session of the Regional Committee in Port Moresby.

Dr. YEN, on behalf of his delegation, thanked the Government of

Australia for its very kind invitation and appreCiated the reason for

making the offer far in advance as against the usual procedure. The

site was well chosen and would show a developing type of health work

MINUrES OF THE THIRD MEmING 133

in a remote area, where difficult problems such as tuberculosis and

malaria control, health education and rural sanitation were being faced.

In Taiwan there were also rural districts and aboriginal tribes living

in the high mountain ranges. The Regional Committee representatives

would have the opportunity of learning how these many problems were being

solved. Dr. Yen suggested that, although the date set was far advanced

the Committee should accept the invitation that its fourteenth session

be held in Port MPresby in 1963.

Dr. KIM (Korea) supported the proposal made by the representative

from China.

Dr. vlIJSMULIER (Netherlands) expressed his Government I s endorse-

ment of the suggestion made by the Government of Australia to hold

the 1963 session of the Regional Committee in Port Moresby. It "Tas

his Government's opinion that these meetings were very often held in

urban communities and the invitation, if accepted, would give a very •

good opportunity for the Committee members to see some of the health

work in more rural societies and to travel through the Territory of

Netherlands New Guinea, getting a better understanding of the conditions

prevailing in both territories.

Dr. OSBORNE stated that his delegation would very much like to see

the fourteenth session held in Port Moresby in the Territory of Papua

and New Guinea. He said that he had been a guest of the Australian

Government in the early spring and had attended the meeting held in

Rabaul, Territory of Papua and New Guinea, preparatioris for which

had taken about a year or less. If the Government of Australia and the

Government of the Territory of Papua and New Guinea had three years

REGIONAL CCMaTTEE: TENTH SESSION

during which to prepare for the meeting of the Regional Committee,

Dr. Osborne was certain that the representatives would be happily

received and they could see a great deal of activities which they had

never seen before.

Dr. TRUONG, Dr. HAJI MOHAMED and Dr. THOR-PENG-THONG (Cambodia)

shared the feelings expressed by the other representatives.

Decision: The invitation extended by the Government of Australia and the Government of the Territory of Papua and New Guinea to hold the fourteenth session of the Regional Committee in Port Moresby in 1963 was unanimously accepted.

Dr. REDSHAll remarked that he and his colleague, Dr. Scragg were

overwhelmed by the Committee's very kind acceptance of their invitation.

He thanked and assured the Committee that the Government of Australia

would be very appreciative of the attitude shown towards the proposal.

MALARIA ERADICATION: Item 14 of the Agenda (Documents WP /RC10/7 and Add.l)

The SECRETARY stated that although considerable progress had been

made in all the projects receiVing WHO assistance, a number of problems

had arisen which he felt should be brought to the attention of the

Committee. These were set out in addendum one to document HP/RC10/7

but for the convenience of the Committee he would summarize them: the

main vector in the Philippines had developed resistance to dieldrin;

assessment had revealed that malaria transmission was actually

recurring in several areas from which it was thought to be cleared;

the disappointing response to the Director-General's appeal for

contributions to the Special Account meant that unless these contributions

MrNtJrES OF THE THIRD ME:E.TING 135

were increased very greatly the assistance from this source would have

to be very much curtailed.

Dr. YEN said that his Government was very interested in and concern d

by the report of the Regional Director. Some of the health workers in

the Region had become a little optimistic in thinking that the surveil­

lance programmes in their countries were reaching the end-stage.

Although in his country there had as yet been no case of resistance

to insecticide~ such as that found in the Philippines, it did not mean

that his Goverrunent would not meet this problem at any time in the

future. The Regional Director I s calling the attention of the Committee

to this particular point was very important and served as an alert to

his Government to adopt measures to prevent this occurrence. Dr. Yen

said that he had no doubt that all other governments would also take

heed of this warning and hoped that measures not only in connexion with

insecticides but also in envirorunental sanitation would be carried out

simultaneously with the malaria eradication activities. He further

hoped that the Regional Director would circulate to all countries any

information received regarding similar cases, with the approval, of

course, of the goverrunents concerned.

As regards financial. support to the Malaria Eradication Special

Account, Dr. YEN expressed his Government I s wish that the Cornmi ttee

at this stage should consider increased contributions to the Special

Account.

Dr. TRUONG drew the attention of the Committee to the importance

of malaria eradication programmes in the Region as a whole, and asked

that allllossible steps be taken by governments to carry out these

136 REGIONAL COMMITTEE: TENrH SESSION

programmes throughout this region. In Viet Nam the programme was

proceeding satisfactorily. The millionth house would have been sprayed

by the end of the year and epidemiological studies were beins undertaken

in an area south of Saigon, which would enable the Government to protect

a population of nearly six million inhabitants in this area. Spraying

operations in hyper-endemic areas were in progress and drug distribution

would be made once or twice a year.

Dr. OSBORNE expressed his delegation's concurrence with the report.

He was particularly gratified to see that the resolution adopted ~G the

ninth session of the Regional Committee calling attention to the dangers

of the development of undue optimism of the administrative aspects of

malaria eradication programmes had been taken into consideration as

regards this type of programme in the Region. He believed, hOvTever,

that the Committee should go further than this. Training in malaria

eradication techniques was still a paramount need - the strengthening

of the school in the Philippines and the setting up of a course in

Viet Nam for French-speaking technicians were important. Dr. Osborne

pOinted out, however, that in the programme and budget document no

provision had been made for the implementation of such a training course.

The addendum to the document now under consideration by the Committee

had given an instance where the vector had developed resistance to the

normally used insecticide. In Latin America there had been reports of

the resistance to DDT of mosquitoes already resistant in dieldrin. In

some areas, this resistance was very high. For this reason, it would

be very helpful to have, as early as possible, information on the use

of medicated salt. It was understood that there were tvro such studies

going on the Region at the present time - one in Cambodia and the other

MINurES OF TEE THIRD MEEI'ING 137

in Netherlands New Guinea. Dr. Osborne em;phasized that it was not only

for the benefit of this region but also for the im;portance of malaria

eradication as a whole that these studies be supported and accelerated

as muCh as possible. He then drew the attention of the Committee to

the fact that the theme of the next Vlorld Health Day was nHorld

Malaria Eradication Effort'. He urged that Member countries should

take cognizance of the malaria eradication effort and contribute as much

as they could to the Malaria Eradication Special Account which, as both

the Director-General and the Regional Director had said, was not as muCh

as could be desired.

Dr. OSBORNE added that at present very little data were available

on the economic benefits of the malaria eradication programme, and

wondered if it would be possible to collect information on this aspect

to point out to the legislative and executive branches of governments

that it would be "rise to contribute to the malaria eradication effort,

even though the cost was seemingly high.

Dr. AZURIN informed the Committee that despite the resistance

problem and the recurrence of malaria in certain areas of the Philippines,

his Government had not relaxed its malaria eradication programme. The

National Economic Council had appropriated half a million pesos towards

the intensification of the malaria eradication activities in his country.

Dr. THOR-PENG-THONG stated that his Government was also concerned

with the resistance problem and proposed that the Committee pass a

resolution on the lines suggested by the representatives from the United

states of America. As far as the medicated salt programme was concerned,

the Government of Cambodia was undertaking studies in certain areas to

138 REGIONAL COMMI:TrEE: TENTH SESSI ON

determine the value of medicated salt in malaria control. As soon as

results had been obtained from these studies, his Government would inform

the Regional Office accordingly.

Dr. RAJI MOHAMED informed the Committee that in his country a

malaria eradication pilot project was being planned to start in January

1960. Plans had almost been completed, the site had been chosen and

the area to be covered comprised a population of about seventy-five

thousand. In the Federation of Malaya the big problem was that the

malaria vector was not the only one. The report on the resistance to

dieldrin was therefore very interesting, because the main vector in

the Federation of Malaya was DDT-resistant and, although dieldrin was

being used in the country no case of dieldrin-resistance had been met.

Dr. Haji Mohamed said that the project in the Federation would start

as soon as the necessary personnel, an entomologist, a malariologist,

and a sanitary engineer had been recruited.

Dr. DA ROSA reported that the health services in Macau considered

malaria as having been practically eradicated from the country. Last

year there had been only six cases as compared with the figures of the

previous years when malaria was endemic in Macau.

Dr. WIJSMULIER stated that malaria was of concern to the Govern­

ment of the Netherlands because the problem was of a malignant type

and the work was undertaken in a country vThere access was very difficult.

His Government had received assistance from UNICEF in starting a pilot

project in 1954. On the advice of the Regional Office the use of

antimalaria drugs was combined with residual spraying - this combined

action had, however, not stopped transmission completely.

MINurES OF THE THIRD MEEI'ING 1';

Chemoprophylaxis was a laborious procedure; however , it had had. some

effects. Dr. vlijsmuller believed that the use of medicated salt was

not providing a solution to the problem due to the costs involved - it

was very expensive and should perhaps only be applied on a very limited

scale in a particular area. His Government was aware that research in

malaria control was very important and would therefore like to stress

the need for further research in malaria control, particularly in view

of the development of resistance of mosquitoes to the residual action

of drugs.

The meeting adjourned at 10.20 a.m.