European Forum of Medical Associations and WHO

(Berlin, 7-9 February 2003)
Report on the WMA General Assembly - Washington, D.C., October 2002 by Dr Delon Human, Secretary General, World Medical Association

Mr Chairman,
Distinguished Participants in the Forum,
Ladies and Gentlemen,

It is a pleasure for me to be here this afternoon and to address you on the subject of the General Assembly of the WMA held last October in Washington, D.C.

I should like to start by congratulating the organizers on preparing an excellent programme for this meeting. All of our constituent National Medical Associations and the WMA itself have a profound interest in the topics discussed so far as well as those on the programme for tomorrow. We have met here in this great Capital City of Berlin, where so many notable advances were made in the medical field, in the presence of genuine and profoundly committed leaders of the medical profession in Europe, as well as senior WHO staff members.

I have been asked to present a report on our recent Assembly, including the Scientific Session. This Session was devoted to the theme "Responding to the Growing Threat of Terrorism and Biological Weapons".

Let me begin with the Assembly proper. This was indeed a historic Assembly in many ways, and I hope to demonstrate this in my presentation.

We began with a Ceremonial Session. We heard a fine welcome address by the President of the AMA, Dr Yank Coble. He expressed his confidence that the traditions of medicine, based on ethics, science and service, would prevail over future obstacles to health care delivery. He emphasized the importance of unity in the medical profession. This Forum is, I am convinced, an expression of that unity within Europe.

We were then privileged to hear Dr Richard Carmona, the US Surgeon General. He noted some of the challenges that lay ahead of him and his staff. Amongst others, he mentioned the following areas:

• Education of children to lead a healthy lifestyle in terms of diet and regular exercise;
• The reduction of health disparities amongst minority groups in the USA;
• Strengthening of the national health care networks, by increasing the number of health care centres and personnel serving in the public health system;
• Preparedness for any major threats to public health, whether they be caused by terrorists or natural disasters. In this regard he called for the need of the national offices to link up with their international counterparts.

Dr Carmona emphasized the need for all physicians to keep themselves educated, especially concerning new threats, such as deliberately spread communicable diseases like smallpox.

According to Dr. Carmona, there was unfortunately a disproportion in the amount of time and resources spent on bioterrorism as opposed to natural disasters. In both instances the value and role of the "first responders" could not be overemphasized. All countries should make sure that these teams are adequately trained and equipped to do their job. He remarked "this is not a cheap endeavour, neither is it an endeavour to be done on the cheap" - but that this was the price to be paid for preparedness.

If he could single out one theme for his term as Surgeon General, it would be prevention. It was his intention to ensure that in the USA diseases such as obesity, asthma and diabetes are prevented, while the same principle of prevention would be employed to areas such as bioterrorism. He ended by saying that although prevention would be a focus, this would in no way dilute the time, resources and energy his department would devote to other public health issues. He was looking forward to a fruitful collaboration and relationship with the WMA to make the world a healthier and safer place.

We then heard an excellent valedictory address by the outgoing Presidents of the WMA. I refer to Dr Eitaka Tsuboi of Japan, who had served with distinction as President of the WMA for 2000-2001, and Dr Enrique Accorsi of Chile, who had served with no less distinction for 2001-2002.

Dr Tsuboi mentioned that he had been invited to the World Economic Forum in Davos, where he had been able to share his views on medical ethics, advances in medical technology and the role of globalization in these processes. Let me quote from a summary of Dr Accorsi's address. I quote:

"As a united profession, physicians could become a role model and a point of reference to all the other groups in society. This was also applicable to other aspects such as equity in health care. It was an ethical imperative that all people have access to health care services, and to achieve this there needed to be a balance between market forces and access to health care. Creative and open dialogue could prevent any kind of economic injustice or inequity, and physicians should be responsible and accountable partners in this process."

He concluded his address by urging all WMA members to strive to have ethics and quality as the seal of the medical profession. With this as a basis, and with the confidence that physicians can also contribute to freedom, justice and peace in the world, he had confidence in a better world during the 21st century.

During the Assembly, Dr Kati Myllymäki of Finland was installed as the 54th President of the WMA, for the period 2002-2003. Time does not permit me to attempt to summarize her eloquent Inaugural Address, but I would like to mention that she quoted a great German theologian, Dietrich Bonhoeffer. She referred to a short poem he wrote before his death, which, she said, could act as an inspiration to physicians. I quote:

"When the power of evil around us seems to be growing, we should not lose our faith in good. We should not give in. We should not become desperate or pessimistic."

Dr Myllymäki urged physicians to work even harder for these ideals. She stated that her motto for her term of office was "pro humanitate", to serve humanity.

I should mention at this juncture that Dr Jim Appleyard from the UK was elected President for the term 2003-2004. He will, I am sure, be known to many of us.

Let me turn now to the resolutions, statements and declarations adopted by the Washington Assembly. I refer to these in their order of adoption and not of course in any order of priority.

The Assembly adopted a Note of Clarification on paragraph 29 of the Declaration of Helsinki, in the revised form that had been endorsed by the General Assembly in Edinburgh in October 2000. You will, I am sure, be aware that this paragraph, which deals with the use of placebo in clinical trials, had aroused a substantial degree of controversy in the medical and bioethical literature.

The Assembly also adopted the following:

• a Statement on Female Foeticide
• a Declaration on Medical Ethics and Advanced Technology
• a Resolution on Political Abuse of Psychiatry
• a Resolution on Euthanasia
• a Declaration on Biological Weapons. This was given the name of "The Declaration of Washington". I shall return to this Declaration at the end of my presentation
• a Declaration on Patient Safety
• a Resolution on the Woman's Right to Health Care and How that Relates to the Prevention of Mother-to-Child HIV Infection
• a Statement on Safe Injections
• a Statement on Self-Medication
• a Declaration on Ethical Considerations Regarding Health Databases
• a Resolution on the Pan American Health Organization; and
• a Resolution on the Provision of Health Care Services in Afghanistan.

The Assembly also dealt with a whole range of administrative, technical and financial matters and I do not propose to bore you by dealing with these. Of most interest to this Forum, I believe, is the fact that we admitted the Medical Associations of three EURO Member States, Russia, Georgia and Azerbaijan, to membership of the WMA.

Let me turn now to the Scientific Session, which was held on 3-4 October. I can of course in the brief time available deal only with highlights.

We began with an address by Dr D. A. Henderson, now based in the White House. Many of you from WHO will recall the brilliant campaign waged by D.A. while at WHO to eradicate smallpox, a campaign which was of course ultimately crowned with success. He addressed the session on "Bioterrorism: Present Realities and Future Prospects".

Dr George Poste, Chairman of Orchid BioSciences, based in Princeton, New Jersey, then spoke on "The Promise and Peril of the Biotechnology Revolution."

We were then privileged to hear a presentation entitled "World-Wide Perspective of Infectious Diseases" by Dr David Heymann. He is, as most of us here will know, the Executive Director of the Communicable Diseases Cluster at WHO Headquarters. Dr Heymann was previously a key member of the brilliant HIV/AIDS group at WHO originally led by the late Jonathan Mann. In September 2001, he had the formidable task of testifying before the Committee on Foreign Relations of the United States Senate on "Strengthening Global Preparedness for Defense Against Infectious Disease Threats".

This was followed by a Panel Session on "Epidemic Response to Bioweapons and Infectious Diseases", moderated by Dr James Hughes; the Director of the Centers for Disease Control and Prevention in Atlanta, Dr Julie Gelberding, gave us an excellent presentation entitled "Detection and Response to Deliberately Caused Anthrax in the US". This was followed by a talk on "Accidental Exposure to Anthrax in Russia, 1979", by Dr David Walker.

I cannot go over the entire programme of the Panel Sessions, but I would like to mention that devoted to smallpox. It was moderated by Dr Henderson and included a presentation by him on "Smallpox as a Bioweapon."

The Second Day of the Scientific Session included a Panel Session on "Working Together Internationally: Bioweapons Prevention", moderated by Ambassador Tibor Toth, the Hungarian diplomat who has played a major role in matters relating to the implementation of the BWC, the Biological and Toxin Weapons Convention.

The final Panel Session was devoted to a topic that will be of particular interest to all of the NMAs represented here, namely "How Can the WMA Participate in International Partnerships Against Bioterrorism?" In addition to Dr Enrique Accorsi and myself from the WMA, we had Dr Henderson, Dr John Tam from Hong Kong, and Dr Gelberding as panelists. Let me sum up some of the points made by this Panel.

My time is running out but before dealing briefly with the new Washington Declaration on Biological Weapons, let me quote Dr Randy Smoak, the Chairperson of the WMA Council. I quote:

"It is time for physicians worldwide to take a more aggressive stance in tackling the threats from bioterrorism.
These issues are no longer distant threats. They're here and they're real and the medical community has a central role to play to do all it can to protect citizens around the world."

Let me turn now to the Declaration. I shall confine myself, because of time constraints, to carefully selected quotations from what is a fairly lengthy text. But first let me touch on the structure of the Declaration. It is subdivided as follows: A. Introduction; B. Strengthening Public Health and Disease Surveillance Systems; C. Enhancement of Medical Preparedness and Response Capacity; D. Bioweapons Research; and E. Recommendations.

I shall begin by quoting the final sentence of the first paragraph of the Introduction. I quote:

"The World Medical Association believes that medical associations and all who are concerned with health care bear a special responsibility to lead in educating the public and policy makers about the implications of biological weapons and to mobilize universal support for condemning research, development, or use of such weapons as morally and ethically unacceptable."

Let me now quote paragraph 4 of the Introduction. I quote:

"Actions can be taken to diminish the risk of biological weapons as well as the potentially harmful consequences of serious epidemics whatever their origin. International collaboration is needed to build a universal consensus that condemns the development, production, or use of biological weapons. Programs of surveillance are needed in all countries for the early detection, identification, and response to serious epidemic disease; health education and training is needed for professionals, civic leaders, and the public alike; and collaborative programs of research are needed to improve disease diagnosis, prevention, and treatment."

Time permits me to quote only one paragraph of Section B. I quote:

"Public health officials, dealing with an epidemic, will require the cooperation of emergency management agencies, law enforcement officials, healthcare facilities, and a variety of community service organizations. For these different groups to work together effectively, advance planning will be important. In addition to developing surveillance activities for early detection and reporting, public health efforts should be directed toward educating primary caregivers and public health staff about potential agents that might be used, building laboratory capacity for rapid identification of biological agents, providing medical and hospital services as well as vaccines and drugs to control the epidemic."

I propose to conclude by quoting each and every one of the five Recommendations because I think it would be invidious to single out some as being more important than others. I quote:

1. That the World Medical Association and National Medical Associations worldwide take an active role in promoting an international ethos condemning the development, production, or use of toxins and biological agents that have no justification for prophylactic, protective, or other peaceful purposes.
   
   
2. That the World Medical Association, National Medical Associations and healthcare workers worldwide promote, with the World Health Organization, the United Nations, and other appropriate entities, the establishment of an international consortium of medical and public health leaders to monitor the threat of biological weapons, to identify actions likely to prevent bioweapons proliferation, and to develop a coordinated plan for monitoring the worldwide emergence of infectious diseases. This plan should address:
   1. international monitoring and reporting systems so as to enhance the surveillance and control of infectious disease outbreaks throughout the world;
   2. the development of an effective verification protocol under the UN Biological and Toxin Weapons Convention;
   3. education of physicians and public health workers about emerging infectious diseases and potential biological weapons;
   4. laboratory capacity to identify biological pathogens;
   5. availability of appropriate vaccines and pharmaceuticals; and
   6. financial, technical, and research needs to reduce the risk of use of biological weapons and other major infectious disease threats.
      
      
3. That the World Medical Association urge physicians to be alert to the occurrence of unexplained illnesses and deaths in the community and knowledgeable of disease surveillance and control capabilities for responding to unusual clusters of diseases, symptoms, or presentations.
   
   
4. That the World Medical Association encourage physicians, National Medical Associations and other medical societies to participate with local, national, and international health authorities in developing and implementing disaster preparedness and response protocols for acts of bioterrorism and natural infectious disease outbreaks. These protocols should be used as the basis for physician and public education.
   
   
5. That the World Medical Association urge all physicians who participate in biomedical research to consider the implications and possible applications of their work and to weigh carefully in the balance the pursuit of scientific knowledge with their ethical responsibilities to society."

Thank you, Mr Chairman, for having very kindly given me enough time to do justice to what was, I think, a very important Assembly. And for allowing me to present some of the highlights of the Declaration of Washington.