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wmj201602<\/a><\/p>\n

COUNTRY
\nvol. 62
\nMedicalWorld
\nJournal
\nOfficial Journal of The World Medical Association, Inc.
\nISSN 2256-0580
\nNr. 2, June 2016
\nContents
\nBioterrorism.The Question is \u2013 When? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t41
\n203rd
\nWMA Council Session, Buenos Aires, April 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t42
\nWMA Council Resolution on Refugees and Migrants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t51
\nWMA Council Resolution on Zika Virus Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t51
\nWorld Health Assembly Week . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t52
\nCouncil of Europe. Recommendation on Biobanks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t56
\nZika virus infection and pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t61
\nIstanbul Symposium on War, Migration and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t66
\nSoutheast European Medical Forum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t68
\nBulgarian Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t72
\nChinese Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t72
\nFinnish Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t73
\nMalaysian Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t74
\nMyanmar Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t75
\nRwanda Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t75
\nSlovak Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t77
\nSwedish Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t78
\nSwiss Medical Association (SMA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t78
\nMedical Association of Thailand (MAT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t79
\nZambia Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \t79
\nEditor in Chief
\nDr.\u00a0P\u0113teris Apinis, Latvian Medical Association, Skolas iela 3, Riga, Latvia
\nPhone +371 67 220 661
\npeteris@arstubiedriba.lv, editorin-chief@wma.net
\nCo-Editor
\nProf. Dr.\u00a0med. Elmar Doppelfeld, Deutscher \u00c4rzte-Verlag, Dieselstr. 2, D-50859 K\u00f6ln, Germany
\nAssistant Editor
\nMaira Sudraba, Velta Poz\u0146aka; lma@arstubiedriba.lv
\nJournal design and
\ncover design by
\nP\u0113teris Gricenko
\nLayout and Artwork
\nThe Latvian Medical Publisher, \u201cMedic\u012bnas apg\u0101ds\u201d, President Dr.\u00a0Maija \u0160etlere, Skolas street 3, Riga, Latvia
\nPublisher
\nThe Latvian Medical Association, \u201cLatvijas \u0100rstu biedr\u012bba\u201d,
\nSkolas street 3, Riga, Latvia.
\nISSN: 2256-0580
\nSir Michael MARMOT
\nWMA President
\nBritish Medical Association
\nBMA House,Tavistock Square
\nLondon WC1H 9JP
\nUnited Kingdom
\nDr.\u00a0Donchun SHIN
\nWMA Chairperson of the Finance
\nand Planning Committee
\nKorean Medical Association
\n46-gil Ichon-ro
\nYongsan-gu, Seoul 140-721
\nKorea
\nProf. Dr.\u00a0Frank Ulrich
\nMONTGOMERY
\nWMA Vice-Chairperson of Council
\nBundes\u00e4rztekammer
\nHerbert-Lewin-Platz 1 (Wegelystrasse)
\n10623 Berlin
\nGermany
\nDr.\u00a0Xavier DEAU
\nWMA Immediate Past-President
\nConseil National de l\u2019Ordre des
\nM\u00e9decins (CNOM)
\n180, Blvd. Haussmann
\n75389 Paris Cedex 08
\nFrance
\nDr.\u00a0Joseph HEYMAN
\nWMA Chairperson
\nof the Associate Members
\n163 Middle Street
\nWest Newbury, Massachusetts 01985
\nUnited States
\nDr.\u00a0Masami ISHII
\nWMA Treasurer
\nJapan Medical Assn
\n2-28-16 Honkomagome
\nBunkyo-ku
\nTokyo 113-8621
\nJapan
\nDr.\u00a0Heikki P\u00c4LVE
\nWMA Chairperson of the Medical
\nEthics Committee
\nFinnish Medical Association
\nP.O. Box 49
\n00501 Helsinki
\nFinland
\nDr.\u00a0Miguel Roberto JORGE
\nWMA Chairperson of the Socio-
\nMedical Affairs Committee
\nBrazilian Medical Association
\nRua-Sao Carlos do Pinhal 324,
\nCEP-01333-903 Sao Paulo-SP
\nBrazil
\nDr.\u00a0Ardis D. HOVEN
\nWMA Chairperson of Council
\nAmerican Medical Association
\nAMA Plaza, 330 N. Wabash,
\nSuite 39300
\n60611-5885 Chicago, Illinois
\nUnited States
\nDr.\u00a0Otmar KLOIBER
\nSecretary General
\nWorld Medical Association
\n13 chemin du Levant
\n01212 Ferney-Voltaire
\nFrance
\nWorld Medical Association Officers, Chairpersons and Officials
\nOfficial Journal of The World Medical Association
\nOpinions expressed in this journal \u2013 especially those in authored contributions \u2013 do not necessarily reflect WMA policy or positions
\nwww.wma.net
\n41
\nBACK TO CONTENTS
\nThere is no way to stop scientific progress.Modern biology is a dou-
\nble-edged sword. The key question is: whose are the hands holding
\nthe biological agent, for example, an instrument for manipulating
\nthe anthrax bacteria or the bird flu virus H5N1 genes? Typically,this
\ninstrument would be locked up in a safeguarded laboratory located
\nin a developed democratic country. It is not good any longer if it
\nhappens to be in the hands of avaricious researchers from a weak
\nand collapsing economy that are ready to sell it to a \u201ctrustworthy
\nand moneyed business partner from the East\u201d.
\nA large amount of antibiotics in the armoury of a greedy owner of a
\nfish breeding farm, a gigantic poultry or pig farm is a hazard when
\nthese people, ignoring international laws, start seeking for illegal
\nadditional profit of a million dollars. This could possibly happen in
\na country where labour is cheap and law is weak.
\nBioterrorism threat is rapidly increasing worldwide. This is fuelled
\nboth by political processes and scientific progress. The microorgan-
\nisms causing dangerous infectious diseases that can be used as bio-
\nlogical weapons have been thoroughly researched, and the informa-
\ntion often is broadly accessible, including for potential terrorists.To
\narrange a bioterrorism act is much less costly, less conspicuous and
\ntherefore more realistic than any other type of broad-based attack to
\na country or a group of countries.
\nCurrently there is no uniform definition of terrorism that would
\nbe correct from the legal aspect. As a matter of fact, terrorism is a
\nviolent combat method that one group of people exercises against
\nanother group of people having an alternative persuasion, with a
\npurpose to attain political, religious or other goals. Biological ter-
\nrorism or bioterrorism is a deliberate dissemination of a biological
\nagent, for example, a pathogenic microorganism, with the purpose
\nto cause a human disease and death, and to create confusion, panic
\nand fear in the society.
\nAccording to the experts, the use of biotechnology methods for ter-
\nroristic aims is an ever increasing reality; consequently, the risks of
\nbioterrorism are rapidly building up as well.The use of one or several
\nbiological agents with terroristic aims is unavoidable. Under certain
\ncircumstances, most of infectious diseases can be dangerous both
\nto an individual and to the society. However, some microbes are
\nespecially hazardous,because they are highly contagious,pathogenic
\nand virulent. Human infections and parasitic diseases are particu-
\nlarly dangerous. They have a capability of developing a malignant
\nclinical course, spreading rapidly, and in such situation an absence
\nof effective preventive measures and treatment will jeopardise the
\nhealth of each individual and the society in general.
\nAccording to the USA Department of Homeland Security, the
\nmost dangerous microorganisms are Variola major, Bacillus anthra\u2011
\ncis, multidrug resistant Bacillus anthracis, Yersinia pestis, Rickettsia
\nprowazekii, the Ebola virus, the Marburg virus, Clostridium botu\u2011
\nlinum toxine, Burkholderia mallei, Burkholderia pseudomallei, Fran\u2011
\ncisella tularensis.
\nTo a large extent, people themselves have made these causal agents
\nresistant and have created mutations.The idea of any living being is
\nsurvival, and this is true in respect of an individual in short-term as
\nwell as in respect of a group of similar individuals, such as species.
\nLife on the Earth is a struggle to survive, and it is on-going at mul-
\ntiple levels. As soon as man discovered antibiotics, bacteria started
\ntheir struggle to survive \u2013 they had an option to develop resistance
\nor to die.The strongest survived. From the physicians\u2019point of view,
\nthese robust and resistant bacteria are the bad ones, while from the
\npoint of view of other bacteria they are the heroes.
\nNow it is time that man and the human race start their struggle to
\nsurvive in the occasion of a bioterrorism act or a highly resistant
\npathogenic microbe or a modified virus stem spreads. Let me re-
\nmind you that in 2014 Yoshihiro Kawaoka from the University of
\nWisconsin-Madison in the USA modified the H1N1 bird flu virus
\nstem that it is no longer recognised by a human immune system.
\nSuch virus becomes exceedingly dangerous and is a potential causal
\nagent of a new pandemic!
\nThe World Medical Association is the sole global organisation that
\nhas the ability of creating a synthesis of medical, preventive, eco-
\nnomic and political aspects for preserving the continuity of man-
\nkind. We are facing serious challenges. Let us start with the \u201cOne
\nWorld, one Health\u201d approach, and this year let us start waging war
\nagainst unjustified use of antibiotics on a global scale.
\nP\u0113teris Apinis,\u00a0
\nEditor in Chief, WMA
\nBioterrorism.The Question is \u2013 When?
\n42
\nWMA News
\nCouncil
\nThe 203rd
\nCouncil meeting at the Sheraton
\nConvention Centre in Buenos Aires, Ar-
\ngentina was officially opened by Dr.\u00a0Ardis
\nHoven, Chair of Council. Her first task was
\nto welcome Dr.\u00a0 Jorge Lemus, Argentina\u2019s
\nMinister of Health, to officially open the
\nproceedings.
\nDr.\u00a0 Lemus spoke about the new health
\nchallenges facing the medical profession
\nand the importance of the social determi-
\nnants of health and issues such as poverty,
\nlack of health, housing and proper drink-
\ning water.This meant that health and well-
\nbeing was an inter-sectorial matter where
\nthey had to establish partnerships with
\nother sectors in order to meet their goals.
\nHe had been emphasising the importance
\nof the social determinants for many years.
\nThis was a key issue in tackling the prob-
\nlems of Argentina and the region, as well
\nas globally. At present the region was also
\nfaced with the Zika virus, which was an
\nenvironmental matter due to the tropi-
\ncalisation of the weather. These were is-
\nsues facing physicians and he hoped that
\nthe WMA meeting would reach important
\ndecisions.
\nDr.\u00a0Jorge Coronel, President of the Medi-
\ncal Confederation of the Republic of Ar-
\ngentina, welcomed more than 100 WMA
\ndelegates from 35 national medical as-
\nsociations. He spoke about the need for
\nthe active participation of physicians in
\nsolving the problems facing Argentina,
\nincluding violence which was seen in hos-
\npitals and clinics. There had been deaths
\nof physicians, which was a matter for
\nenormous sadness. It was also the fact that
\nphysicians\u2019 working conditions needed to
\nbe improved. Doctors lacked the neces-
\nsary means and materials to take care of
\npatients.
\nCouncil
\nThe WMA Secretary General Dr.\u00a0 Otmar
\nKloiber reported that there were two new
\nmembers of Council, Prof Brian. Owler
\nrepresenting the Australian Medical As-
\nsociation, who was present, and Dr.\u00a0Mark
\nPorter from the British Medical Associa-
\ntion, who was not able to be present, be-
\ncause of industrial action by the junior doc-
\ntors in England.
\nPresident\u2019s Report
\nIn his interim report, WMA President Sir
\nMichael Marmot reminded the meeting
\nthat his mission as President was to encour-
\nage doctors\u2019 involvement in the social de-
\nterminants of health and health equity. To
\nsupport this mission, he had set out three
\naims \u2013 that the WMA issue a statement on
\nsocial determinants of health and health eq-
\nuity and produce a supporting publication
\nthat would answer the question: \u201cwhat do
\nwe do?\u201d; to promote regional networking;
\nand to support post-graduate education and
\ntraining.
\nHe said the WMA statement had been is-
\nsued as the Declaration of Oslo and a docu-
\nment had been introduced answering the
\nquestion from physicians about what they
\ncould do. This emphasised five domains of
\nactivity \u2013 education and training, seeing the
\npatient in a broader perspective, the health
\nservice as employer and its impact on the
\nlocal community, working in partnership
\nand advocacy.
\nOn networking, he reported keen interest
\nfrom most regions of the world and gave ex-
\namples from the Americas, Africa, Europe,
\nAsia and Oceania.
\nSir Michael concluded by saying that he had
\nbeen enormously impressed by the enthusi-
\nasm he had encountered among physicians
\non the social determinants of health and he
\nended with the words: \u2018We are all working
\nin the cause of social justice and health\u2019.
\nSecretary General\u2019s Report
\nDr.\u00a0Kloiber submitted a lengthy written re-
\nport about the activities of the Association
\nover the past year. He spoke briefly about
\nnew translations of the WMA\u2019s Medical
\nEthics manual. He also reminded Coun-
\ncil about two forthcoming meetings, the
\nWorld Health Professions Alliance Con-
\nference on Regulation in Geneva (May 21
\nand 22) and the One Health Conference, in
\nFukuoka, Japan (Nov.\u00a010\u201311) together with
\nthe Japan Medical Association and the Ja-
\npan Veterinary Association.
\nChair\u2019s Report
\nDr.\u00a0 Hoven submitted her written report.
\nShe referred to the Governance Work
\nGroup and said that it was larger than
\nnormal work groups because it was impor-
\ntant to have as much diversity as possible
\nin the representation. In addition to those
\nthat had expressed an interest in participat-
\ning, representation from the Junior Doctors
\nNetwork, the Associate members, and Past
\nPresidents and Chairs group had been in-
\ncluded in the work group. She looked for-
\nward to their efforts on behalf of the WMA
\nand was optimistic that a more transparent
\nand representative organization would be
\naccomplished in order to maximize the As-
\nsociation\u2019s advocacy and impact throughout
\nthe world.
\nReferring to the WMA Expert Meeting on
\nHealth Databases in Seoul that had been
\nheld, Dr.\u00a0 Hoven said she had been im-
\npressed by the depth of knowledge of those
\ninvolved and the detailed examination of
\ninformation necessary to successfully com-
\nplete this work. She said it was imperative
\nthat they listened to all the voices speaking.
\nShe also looked forward to attending for
\nthe first time the WMA Caring Physicians
\nof the World Medical Leadership, Com-
\nmunication and Advocacy Course in Jack-
\n203rd
\nWMA Council Session,
\nBuenos Aires, April 2016
\n43
\nWMA News
\nBACK TO CONTENTS
\nsonville, Florida and said that this course
\nthrough the years had received great ratings
\nfrom those who have attended from nation-
\nal medical associations (NMAs).
\nEmergency Resolution
\nThe Turkish Medical Association submit-
\nted an emergency Resolution on Refugees
\nand Migrants, presented by Dr.\u00a0 Bayazit
\nIlhan. He said the Resolution was based
\non a communique following the sympo-
\nsium held in February in Istanbul on War,
\nMigration and Health. Large numbers of
\npeople were presenting at borders seeking
\nrefuge or asylum. Some were fleeing war
\nzones or other conflicts, others were fleeing
\nfrom desperate poverty, violence and other
\nappalling injustices and abuse. The global
\ncommunity was ill prepared for this mass
\nmovement of people and had responded
\nby closing borders, seeking to turn back the
\ninflux. What should physicians do in these
\ncircumstances? He said the emergency Res-
\nolution included a number of recommenda-
\ntions emerging from the symposium.
\nDelegates agreed that the Resolution
\nshould be considered by Council later in the
\nmeeting.
\nMedical Ethics Committee
\nDr.\u00a0 Heikki P\u00e4lve (Finnish Medical Asso-
\nciation) took the Chair.
\nThe Committee received the Secretary
\nGeneral\u2019s oral report. Dr.\u00a0Kloiber said sev-
\neral important issues had emerged since
\nthe Moscow Assembly. The first was the
\noccurrence of gene editing systems, which
\nhad raised some ethical concerns around
\nthe world. For the first time it gave the op-
\nportunity to do germ line changes in our
\ngenetic inheritance and this was something
\nthat had ethical implications and which the
\nWMA had to look into. The second item
\nreferred to research ethics according to the
\nDeclaration of Helsinki and the work of
\nethics committees. These were issues the
\nWMA needed to consider.
\nThe third item was the work being carried
\nout on medical ethics in times of armed
\nconflict, which had been referred to the Se-
\ncurity Council of the United Nations.
\nPerson Centered Medicine
\nThe Committee received an oral report
\nof the Person Centered Medicine Work
\nGroup, presented by Prof. Vivienne Na-
\nthanson (British Medical Association).
\nShe said work was proceeding on the basis
\nof definitions drawn up by the group. She
\nhoped that by the next meeting they would
\nbe able to present the committee with a
\ndraft policy paper.
\nHealth Databases and Biobanks
\nDr.\u00a0 Jon Snaedal (Iceland), Chair of the
\nWork Group on Health Databases and Bio-
\nbanks, gave an oral report about the work of
\nthe group considering a proposed Declara-
\ntion on Ethical Considerations regarding
\nHealth Databases and Biobanks. Over the
\npast four years there had been several open
\nexpert meetings and the document had
\ngone through almost a dozen revisions. He
\nproposed that the group\u2019s current briefing
\npaper be circulated to NMAs and that the
\nWork Group be allowed to include discus-
\nsion with partners outside the WMA. He
\nhoped that WMA policy would be adopted
\nby the next Assembly in October following
\nanother face to face meeting of the Work
\nGroup.
\nThe committee agreed to circulate the
\nproposed Declaration on Ethical Consid-
\nerations regarding Health Database and
\nBiobanks to NMAs, that comments be in-
\nvited from expert organisations outside the
\nWMA and that a further meeting of the
\nWork Group should take place in Septem-
\nber to finalise a document to be presented to
\nthe Council in Taipei.
\nDeclaration of Geneva
\nAn oral report was given by Dr.\u00a0 Ramin
\nParsa-Parsi (German Medical Association),
\nChair of the Work Group considering the
\nrevision of the Declaration of Geneva. He
\nsaid the group was planning a final draft for
\nconsideration at the October 2017 General
\nAssembly session in Chicago, because he
\ndid not want this work to be confused with
\nthe current debate on the high level data-
\nbase policy document. Further discussion
\nwould take place at the committee meeting
\nin Taipei in October this year when a draft
\ndocument would be submitted. Fruitful dis-
\ncussions had been continuing and he urged
\nNMAs to complete and return the survey
\nthat had been sent out on the use of the
\nDeclaration of Geneva.
\nParticipation of Physicians in
\nPre-Natal Gender Selection
\nThe Committee considered a Proposed
\nRevision of the WMA Statement on the
\nParticipation of Physicians in Pre-Natal
\nGender Selection submitted by the Swiss
\nMedical Association, which had been cir-
\nculated to all NMAs. This urges all NMAs
\nto recommend their national governments
\nto adopt laws and regulations that would
\nprohibit the use of prenatal sex-selection
\nfor reasons of gender-preference. The
\nStatement calls for the installation of pro-
\ntection mechanisms for those physicians
\nwho refuse to participate in pre-natal diag-
\nnostic tests and abortions performed solely
\nfor reasons of gender preference, excluding
\nsex selection of a fetus or pre-embryo for
\npurposes of avoiding a severe sex-linked
\ndisease.
\nAfter a brief debate it was agreed to send
\nthe document back to the rapporteur to
\nanalyze in relation to existing WMA policy
\non related topics. If the substance of the
\nStatement is not sufficiently covered in the
\nexisting policies, the Statement will be re-
\nconsidered by the committee.
\nEuthanasia and Physician
\nAssisted Dying
\nThe Royal Dutch Medical Association,
\ntogether with the Canadian Medical
\n44
\nWMA News
\n\u00adAssociation, presented a proposed State-
\nment on Euthanasia and Physician Assist-
\ned Dying. Speakers from the two NMAs
\nsaid they were aware these issues were
\nvery controversial. What was required was
\na fair, open and respectful debate on the
\ndiversity of views that existed on this issue
\nas well as scope and respect for diverging
\nviews.
\nFollowing a lengthy debate about whether
\nor not to circulate the document among
\nNMAs, it was decided that it should be cir-
\nculated.
\nQuality Assurance in
\nMedical Education
\nDr.\u00a0 Steven Stack (American Medical As-
\nsociation) proposed a new Declaration on
\nQuality Assurance in Medical Education,
\naddressing the issue of the quality of un-
\ndergraduate medical education and medical
\nschools.
\nDelegates welcomed the document and the
\ncommittee agreed it should be circulated to
\nNMAs for consideration.
\nClassification of 2006 Ppolicies
\nThe committee reviewed the recommenda-
\ntions received for revising medical ethics
\npolicies for which it had been 10 years since
\nadoption or last revision.
\nIt recommended the following actions:
\nCouncil Resolution on Organ Donation in
\nChina
\nThe committee agreed to reaffirm the Reso-
\nlution. Dr.\u00a0 Kloiber said he would contact
\nthe Chinese Medical Association to request
\ninformation on the current situation con-
\ncerning organ transplantation and whether
\nobtaining organs from prisoners was still
\npracticed in China.
\nDeclaration of Geneva
\nThe committee agreed that consideration of
\nthe Declaration be postponed pending the
\noutcome of the Work Group on this docu-
\nment.
\nInternational Code of Medical Ethics
\nThe committee agreed that the Code be
\npostponed pending the outcome of the
\nWork Group on this document.
\nDeclaration of Sydney
\nThe committee agreed that the Declaration
\non the Determination of Death and the Re-
\ncovery of Organs be reaffirmed with minor
\nrevisions.
\nDeclaration on Therapeutic Abortion
\nIt was decided to reaffirm the Declaration
\nwith minor revisions.
\nDeclaration of Tokyo with guidelines for
\nMedical Doctors concerning Torture and other
\nCruel, Inhuman or Degrading Treatment or
\nPunishment in relation to Determination and
\nImprisonment
\nIt was decided to reaffirm the Declaration
\nwith minor revisions.
\nDeclaration of Venice on Terminal Illness
\nThe committee agreed that this Declaration
\nundergo a major revision.
\nDeclaration of Malta on Hunger Strikers
\nIt was agreed that the Declaration should
\nundergo a major revision.
\nStatement on Combating HIV\/AIDS and the
\nMedical Profession Statement on HIV\/AIDS
\nand the Medical Profession
\nIt was agreed that this Statement be re-
\nscinded and archived.
\nStatement on Child Abuse and Neglect
\nThe committee agreed that this Statement
\nbe reaffirmed with minor revisions.
\nStatement on Animal Use in Biomedical Re\u2011
\nsearch
\nIt was agreed that this Statement be reaf-
\nfirmed.
\nStatement on Patient Advocacy and Confiden\u2011
\ntiality
\nThe committee agreed that this Statement
\nbe reaffirmed.
\nStatement on Medical Ethics in the Event of
\nDisaster
\nIt was agreed that this Statement be reaf-
\nfirmed with minor revisions.
\nStatement on Weapons of Warfare and Their
\nRelation to Life and Health
\nIt was agreed that this Statement be reaf-
\nfirmed with minor revisions.
\nStatement on Assisted Reproductive Technolo\u2011
\ngies
\nIt was agreed that this Statement undergo a
\nmajor revision.
\nStatement on HIV\/AIDS and the Medical
\nProfession
\nIt was agreed that this Statement undergo a
\nmajor revision.
\nHuman Rights
\nClarisse Delorme, the WMA\u2019s Advocacy
\nAdvisor, referred to the recent joint Turkish
\nMedical Association\/WMA Conference on
\nWar, Migration and Health held in Istan-
\nbul, and on related activities in Turkey and
\nEgypt.
\nSocio-Medical Affairs
\nCommittee
\nDr.\u00a0Miguel Roberto Jorge (Brazil) took the
\nChair.
\nDr.\u00a0Kloiber spoke about the global activity
\non the social determinants of health and he
\nurged NMAs to involve themselves in this
\narea.
\nHe also said they were still seeing a strong
\nreluctance to immunization around the
\nworld.This included poor countries that did
\nnot have enough resources to do immuniza-
\ntion, as well as a rejection in affluent coun-
\ntries sometimes based on weird arguments.
\nSometimes, even physicians were involved
\nin spreading this reluctance.
\nHe said that a number of NMAs had been
\nworking on the issue of illegal drugs and
\ndrug overdoses. There had been an increas-
\n45
\nWMA News
\nBACK TO CONTENTS
\ning number of fatalities from illegal drug-
\nrelated use and from prescription drugs.
\nThere was also a global tendency to legalise
\ndrugs, for instance in some states in US.
\nFinally, he said that tobacco control had
\nnot been properly addressed in many coun-
\ntries and there was still an agenda there for
\nNMAs to consider.
\nHealth Care in Danger
\nDr.\u00a0Bruce Eshaya-Chauvin, from the Inter-
\nnational Committee of the Red Cross and
\ncoordinator of the Health Care in Danger
\nProject, reported on the recent activities of
\nthe project.This included a resolution on the
\nethical principles for health professionals in
\nconflict zones, which was to be discussed in
\nthe UN Security Council.Delegates heard a
\nreport on the activities of the WMA Work-
\ngroup on Health Care in Danger which had
\nmet the previous day, including discussion
\nabout further incidents of violence against
\nhealth care professionals.
\nRole of Physicians in Preventing
\nthe Trafficking with Minors
\nand Illegal Adoptions
\nThe Spanish Medical Association reported
\nthat the Work Group had met the previ-
\nous day. It had agreed on a proposal for a
\nWMA Statement on the Role of Physi-
\ncians in preventing Trafficking with Mi-
\nnors and Illegal Adoptions.This denounces
\nall forms of human trafficking, especially
\nthose that involve children, and puts for-
\nward proposals for action that physicians
\ncould take.
\nIt was agreed that the document should be
\ncirculated among members for comments.
\nArmed conflicts
\nDr.\u00a0Dongshun Shin (Korean Medical As-
\nsociation) reported on the activities of the
\nWork Group that had been asked to look at
\nthree proposals submitted to the Council in
\nMoscow \u2013 Territorial Disputes and Armed
\nConflicts, Children in Armed Conflicts and
\nTriggering Armed Conflicts \u2013 with the aim
\nof preparing a single proposal. A new pro-
\nposed WMA Statement on Armed Con-
\nflicts, drawing on all these documents, was
\nthe result.
\nThe committee considered the new docu-
\nment and agreed that it should be circulated
\namong NMAs for comments.
\nOccupational Health
\nDr.\u00a0 Mzukisi Grootboom (South African
\nMedical Association) reported on the ac-
\ntivities of the Work Group that had been
\ntasked with looking at three proposed poli-
\ncies submitted to the Council in Moscow\u00a0\u2013
\nOccupational Health, Workers Health
\n& Safety and Protection Reproductive
\nHealth\u00a0\u2013 with the aim of preparing a single
\nproposal. A new Resolution on Occupa-
\ntional and Environmental Safety as well
\nas Gender Aspects was submitted and the
\ncommittee agreed the document should be
\ncirculated to NMAs.
\nAgeing
\nDr.\u00a0Nivio Moreira (Brazilian Medical As-
\nsociation) reported on the activities of the
\nWork Group on Ageing. It put forward a
\nproposal for a Statement on Ageing with
\nrecommendations to improve the care of el-
\nderly people throughout the world. During
\na debate, delegates discussed the need to in-
\nclude the provision of secondary health care
\nfor the elderly, including the psychosocial
\naspects of managing care. The committee
\nagreed that the document, as amended, be
\napproved by the Council and be forwarded
\nto the General Assembly for adoption.
\nBoxing
\nA proposed revision to the WMA State-
\nment on Boxing was introduced by the
\nSouth African Medical Association. This
\nputs forward new recommendations for ad-
\nditional action to be taken until boxing is
\ncompletely abolished. In a brief debate, it
\nwas decided that the document was not yet
\nready for adoption and it was agreed to cir-
\nculate the document to NMAs.
\nTobacco
\nThe Committee considered a proposed
\nrevision from the Australian Medical As-
\nsociation of the WMA Resolution on the
\nImplementation of the WHO Framework
\nConvention on Tobacco Control.The docu-
\nment, which recognizes the importance of
\nthe Framework as a mechanism to protect
\npeople from exposure and addiction to to-
\nbacco, was approved and the committee
\nagreed to send it to the Council for for-
\nwarding to the General Assembly for adop-
\ntion.
\nObesity in Children
\nA proposed WMA Statement on Obesity
\nin Children was submitted by the Israel
\nMedical Association. There was a debate
\nabout whether this document should be
\ncombined with the WMA\u2019s more general
\nstatement on obesity. It was also suggested
\nthat the document should highlight more
\nprominently the social determinants of
\nhealth and the role of educating parents in
\npreventing child obesity.
\nThe committee agreed to recirculate the
\nStatement to NMAs for reconsideration
\nand that the Statement on the Physician\u2019s
\nRole in Obesity, currently under the 10
\nyears\u2019 review process, be examined at the
\nsame time, to ensure coherence between the
\ntwo policies.
\nPhysicians\u2019 Right to Information
\nThe committee considered the proposed
\nWMA Declaration on Physicians\u2019 Right
\nto Information about the World Medical
\nAssociation and its Policies, submitted to
\nthe Assembly in Moscow by the Russian
\nMedical Society. After considerable de-
\nbate, the committee recommended that
\nfurther consideration of the document be
\npostponed to the next meeting in Taipei in
\nOctober.
\n46
\nWMA News
\nProfessional Autonomy of Physicians
\nThe committee considered the proposed
\nWMA Declaration on Professional Auton-
\nomy of Physicians as the Main Condition
\nfor Implementation of the Human Right
\nto Health. The Russian Medical Society,
\nwhich originally submitted the document,
\nasked for the document to be withdrawn,
\nand this was agreed by the committee.
\nFossil Fuel Divestment
\nThe proposed Statement on Divestment in
\nFossil Fuels was considered. The Statement
\nurges national medical associations to raise
\nawareness of the negative health effects
\ncaused by fossil fuel pollution and climate
\nchange, and to shift their investment port-
\nfolios toward renewable clean energy gen-
\neration.
\nAfter several delegates said that there were
\nstill some issues to be resolved, the commit-
\ntee decided the Statement needed further
\nreconsideration and recommended that it
\nshould be recirculated to NMAs for com-
\nments.
\nGlobal Medical Electives
\nA proposed WMA Statement on Ethi-
\ncal Considerations in Global Medical
\nElectives was considered by the commit-
\ntee. The document from the Junior Doc-
\ntors Network proposes ethical guidelines
\nconcerning medical trainees participating
\nin global educational experiences. After a
\nbrief debate the committee recommended
\nthe Statement be approved by the Council
\nand forwarded to the General Assembly
\nfor adoption.
\nHealth and Environment
\nDr.\u00a0Dongshun Shin, Chair of the Environ-
\nmental Caucus, reported on the activities of
\nthe Caucus that had met earlier that day.
\nThe meeting had focused on the outcome
\nand follow-up of the Inter-Governmental
\nClimate Change Conference in Paris in
\nDecember 2015 and on air pollution. He
\nsaid it was important to activate national
\nand regional action to raise concern on
\nthese issues.
\nFriday April 29
\nThe second day of the meeting
\ncontinued with the Socio-
\nMedical Affairs Committee
\nFemale Genital Mutilation
\nThe committee considered a proposed re-
\nvision of the WMA Statement on Female
\nGenital Mutilation Physicians. This en-
\ncourages national medical associations to
\nbecome more active in campaigning to end
\nthe practice of female genital mutilation.
\nProf. Nathanson explained the changes of
\nwording to clarify the document\u2019s advice to
\nphysicians.
\nAfter a debate, the committee recommend-
\ned that the document as amended be ap-
\nproved by the Council and forwarded to the
\nGeneral Assembly for adoption.
\nBody Searches of Prisoners
\nThe committee considered a proposed re-
\nvision of the WMA Statement on Body
\nSearches of Prisoners. This led to a debate
\non clarifying the guidance for physicians
\nwho are directed to conduct body searches
\nand the issue of consent. There was also a
\ndiscussion on the document\u2019s reference to
\nsearches involving transgender people.
\nFollowing the debates, the committee rec-
\nommended that the document, as amended,
\nbe approved by the Council and forwarded
\nto the General Assembly for adoption.
\nCyber Attacks on Health and
\nother critical infrastructures
\nThe German Medical Association submit-
\nted a proposed Statement on Cyber-Attacks
\non health and other critical infrastructures
\narguing that the WMA and NMAs should
\nbe urging governments to take all neces-
\nsary measures to guard against this threat.
\nDelegates were told that attacks on critical
\ninfrastructure, including hospitals, were on
\nthe rise, posing a threat to patients\u2019 funda-
\nmental right to data privacy and safety. As a
\nresult, it was essential to raise awareness of
\nthis problem by anticipating and defending
\nagainst such cyber intrusions. It was argued
\nthat physicians were simply not aware of the
\nextent of this problem, which included the
\nrisk of records being manipulated.
\nThe committee agreed to circulate the paper
\nto NMAs for consideration.
\nZika virus
\nThe Committee considered a proposed
\nWMA Statement on the Zika virus infec-
\ntion calling on the World Health Organ-
\nisation to work with disease control organ-
\nisations to better understand the natural
\nhistory and current epidemiology of the
\ninfection. It was argued that this was an in-
\nternational health emergency and was go-
\ning to affect people throughout the world.It
\nwas causing a great deal of distress and what
\nphysicians needed was consistent advice to
\nuse with their patients or for people think-
\ning of travelling to affected areas. Delegates
\ndebated whether there should be one state-
\nment on pandemics as well as resolutions
\non specific viruses. The committee agreed
\nthat the Statement should be changed into
\na Resolution.
\nDuring the debate that followed, various
\namendments were agreed, and delegates
\nheard reports from Latin American NMAs
\nabout the current situation in their coun-
\ntries, including the lack of information be-
\ning received by physicians.
\nAt the conclusion of the debate, the com-
\nmittee agreed that the document,as amend-
\ned, should be forwarded to the Council for
\napproval.
\nMedical Tourism
\nThe Israeli Medical Association submitted
\na proposed Statement on Medical Tourism
\n47
\nWMA News
\nBACK TO CONTENTS
\nsetting out protocols to protect the right of
\nforeign patients who receive medical treat-
\nment abroad. The aim of the guidelines for
\nphysicians is to protect patients receiving
\ntreatment abroad from any attempt at harm,
\nfraud or unprofessionalism and to preserve
\nthe principles of medical ethics for medical
\ntourists and local patients alike.
\nDelegates were told that there was an
\nemerging industry with health systems
\naround the world competing for foreign
\npatients. There was a need for some ethical
\nobligations to protect foreign patients from
\nbeing taken advantage of.
\nThe committee agreed to circulate the doc-
\nument to NMAs.
\nMedical Cannabis
\nThe South African Medical Association
\nsubmitted a proposed new Statement on
\nMedical Cannabis. This declares that in the
\nabsence of convincing scientific evidence on
\nthe therapeutic effectiveness of cannabis,
\nthere should be more rigorous research car-
\nried out before governments decide to legal-
\nise medical cannabis.
\nThe committee agreed that the document
\nshould be circulated to NMAs for com-
\nment.
\nClassification of 2006 Policies
\nThe committee considered the recommen-
\ndations received on the potential revision of
\nthe SMAC policies for which it has been
\n10\u00a0years since adoption or last revision
\nIt agreed that the following policies should
\nbe rescinded and archived:
\n\u2022\t the Council Resolution in support of the
\nBolivian Medical Association
\n\u2022\t the Statement on Professional Responsi-
\nbility for standards of Medical Care
\nIt agreed that the following policies under-
\ngo a major revision:
\n\u2022\t the Resolution on Medical Assistance in
\nAir Travel
\n\u2022\t the Resolution on Tuberculosis
\n\u2022\t the Statement on Access to Health Care
\n\u2022\t the Statement on Medical Education
\nIt agreed that the following policies be reaf-
\nfirmed:
\n\u2022\t the Resolution on Child Safety in Airline
\nTravel
\n\u2022\t the Resolution on North Korean Nuclear
\nTesting
\n\u2022\t the Statement on the Role of Physicians
\nin Environmental Issues
\nIt agreed that the following policies under-
\ngo minor revision
\n\u2022\t the Statement on Injury Control
\n\u2022\t the Statement on Traffic Injury
\n\u2022\t the Statement on Adolescent Suicide
\n\u2022\t the Statement on Alcohol and Road
\nSafety
\n\u2022\t the Statement on Physicians and Public
\nHealth
\n\u2022\t the Statement on Avian and Pandemic
\nInfluenza
\n\u2022\t the Statement on the Physician\u2019s Role in
\nObesity
\n\u2022\t the Statement on the Responsibilities of
\nPhysicians in Preventing and Treating
\nOpiate and Psychotropic Drug Abuse
\nThe committee also agreed that a rappor-
\nteur be appointed to undertake a review
\nof the WMA\u2019s general policies on alco-
\nhol.
\nAdvocacy
\nDr.\u00a0 Andr\u00e9 Bernard (Canadian Medical
\nAssociation), Chair of the Advocacy Ad-
\nvisory Group, reported on the activities of
\nthe group, including a suggestion from the
\nTurkish Medical Association for holding a
\nWorld Day to recognize the issue of vio-
\nlence against health professionals. He said
\nthat the group had considered how to take
\nthis idea forward and recommended that
\nfurther work be carried out on the pro-
\nposal.
\nHe also said the group was discussing the
\nmore general issue of progressing advocacy
\nwithin the Association.
\nFinance and Planning
\nCommittee
\nDr.\u00a0Dongshun Shin (Korean Medical As-
\nsociation) took the chair.
\nMembership Dues Payments
\nThe Committee received a report from Mr.
\nAddy H\u00e4llmayr, the WMA\u2019s Financial Ad-
\nvisor, on Membership Dues Payments for
\n2015.
\nFinancial Statement
\nMr H\u00e4llmayr provided a detailed explana-
\ntion of the pre-audited Financial Statement
\nfor 2015 and the committee received the
\ndocument as an interim financial statement
\nas it will be audited in June 2016. It agreed
\nthat the interim Financial Statement for
\n2015 be approved.
\nWMA Strategic Plan
\nAn oral report was given by the Secre-
\ntary General. He said that plans for a new
\nWMA strategic plan would be developed
\nfrom the input from three workgroups, the
\nAdvocacy Advisory Group,Business Devel-
\nopment Group and Work Group on Gover-
\nnance Review.
\nBusiness Development
\nThe Committee considered a report from
\nthe Business Development Group, includ-
\ning possible ways of expanding additional
\nresources through sponsorship within the
\nAssociation\u2019s ethical guidelines and by es-
\ntablishing a foundation trust as a starting
\npoint of discussion.
\nIt was agreed that the group should contin-
\nue to study this plan and report back to the
\ncouncil in Taipei.
\nWMA Statutory Meetings
\nPlans were discussed for changing the
\nagenda for the 2018 General Assembly
\n48
\nWMA News
\nin Reykjavik, Iceland. Dr.\u00a0 Jon Sn\u00e6dal
\nsuggested shortening the Assembly by
\none day by changing the Scientific Ses-
\nsion to combine it with the international
\nconference, 13th
\nWorld conference on
\nBioethics and Medical ethics before or
\nafter the Assembly. This would be in
\ncollaboration with UNESCO Chair of
\nBioethics, WPA, WAML and local col-
\nlaborators.
\nThe committee agreed that the secretariat
\ntogether with the Icelandic Medical Asso-
\nciation start to prepare for a medical ethics
\nconference in conjunction with 2018 Gen-
\neral Assembly in Reykjavik and to report
\nback to the next meeting.
\nIt was agreed that the 2018 Spring Coun-
\ncil meeting (Apr 26\u201328) be held in Riga,
\nLatvia and the 2018 General Assembly be
\nheld in Reykjavik, Iceland (Oct 3\u20136) and
\nthat Istanbul be the venue for the General
\nAssembly in 2019 and Tbilisi, Georgia be
\nthe venue for the General Assembly in
\n2020.
\nIt was agreed that the topic of the scientific
\nsession at the General Assembly in Chicago
\n2017 be Assuring Quality in Undergradu-
\nate Medical Education.
\nWMA Special Meetings
\nThe Committee received an oral report from
\nDr.\u00a0Kloiber about two side events just be-
\nfore and during the World Health Assem-
\nbly in Geneva in May \u2013 the first a World
\nHealth Professional Alliance conference on
\nRegulation on May 21 and 22, and on May
\n23 a joint conference with the ICRC on
\nSocial Determinants of Health and Health
\nCare in Danger. He also said there would
\nbe a One Health Conference, in Fukuoka,
\nJapan (Nov.10-11) together with the Japan
\nMedical Association and the Japan Veteri-
\nnary Association.
\nAssociate Membership
\nDr.\u00a0 Joe Heyman, Chair of the Associate
\nMembers Group, reported on the activi-
\nties of the group. He said there had been
\ngrowth during the year and he spoke about
\nthe new Google group which had been es-
\ntablished and had discussed many issues,
\nincluding death and dying, responsibili-
\nties of ethics panels in clinical trials, fu-
\nture governance and processes of the As-
\nsociated Members. He said these activities
\nprovided a good platform which led the
\nAssociate Members being part of WMA
\nmembership as individuals. He encouraged
\nall members to become Associate Mem-
\nbers.
\nJunior Doctors Network
\nThe Committee received the report of the
\nJunior Doctors Network. In his written
\nreport, the JDN Chair, Dr.\u00a0Ahmet Murt,
\nhighlighted the JDN\u2019s activities since
\nOctober 2015 and its future plans. He
\nsaid the priority of the JDN in the past
\nyear had been to expand the member-
\nship, both in quantity and its reach. Its
\nprojects, initiatives and the meetings at-
\ntended all served this purpose. The JDN
\nmailing list now included more junior
\ndoctors with a balanced representation
\nacross all continents. Communications
\nwith regional junior doctors\u2019 organisa-
\ntions had been active. The JDN sought to
\nbe one of the central organisations in the
\nfield of postgraduate medical education.
\nThe JDN had played an instrumental role
\nrepresenting the WMA at several meet-
\nings.
\nThere had been a consensus among the
\nJDN Management Team since last year that
\na Strategic Plan should be developed in or-
\nder to better prepare the JDN for the future.
\nA task force had been formed for this pur-
\npose and its work was ongoing.
\nDr.\u00a0Murt concluded by saying that the JDN
\nwas very concerned about the imposition
\nof contracts on junior doctors in England
\nwhich would have a negative effect on phy-
\nsicians\u2019 welfare and also on patient safety.
\nHe said he would like to express the JDN\u2019s
\nsupport for the British Medical Associa-
\ntion\u2019s actions in not accepting this imposi-
\ntion.
\nPast Presidents and Chair
\nof Council Network
\nThe Committee received a report of the Past
\nPresidents and Chairs of Council Network.
\nGovernance Review
\nThe Committee received a report of the
\nGovernance Review Work Group. Prof. van
\nder Gaag, Chair of the Work Group, said
\nfive topics had been defined for workgroups
\nto focus on \u2013 involvement,inclusiveness and
\nrepresentation; transparency and openness;
\nconsistency, efficiency and quality of WMA
\nwork; the status of Associate Members; and
\naffordability. He also referred to plans for a
\nsurvey to be carried out.
\nRevision of Rules Applicable to
\nWMA Associate Membership
\nThe Committee considered a proposal to
\nconsider Revision of Rules Applicable to
\nWMA Associate Membership and agreed
\nthat this matter be referred to the Work
\nGroup on Governance Review.
\nWorld Medical Journal
\nThe Committee received the report of
\nWMJ Editor, Dr.\u00a0Peteris Apinis. He said
\nthat over the past year four journals had
\nbeen published, 35 articles, four interviews
\nand documents from the Council session
\nand the General Assembly. The length of
\nthe Journal remained unchanged at 40
\npages plus a cover page. The Journal was in
\ndigital format and was also sent to libraries
\nin printed format. Demand for the paper
\nversion was increasing. He said they were
\nnow working to make the WMJ accessible
\nto a larger audience and to raise interest in
\nreading it. He hoped to be able to report
\nsome progress at the General Assembly in
\nthe autumn.
\nPublic Relations
\nThe Committee received the Public Rela-
\ntions Report for 2015\/16.
\n49
\nWMA News
\nBACK TO CONTENTS
\nSecondments\/Internships
\nThe Committee received an oral report
\nfrom the Secretary General. He reported
\nthat the WMA continued with its intern-
\nship programmes with the IFMSA which
\nhad started in 2013, and with the Univer-
\nsity of Pennsylvania since 2014. A medical
\nstudent from Indonesia was now doing an
\ninternship and further interns were expect-
\ned to join during the year. Three bioethics
\nstudents from Pennsylvania would conduct
\ninternships at the WMA office in the sum-
\nmer.
\nSaturday
\nReconvened Council
\nMohammad Wassim Maaz
\nThe reconvened Council meeting began
\nwith delegates standing for a minute\u2019s si-
\nlence in memory of Mohammad Wassim
\nMaaz, the Syrian paediatrician, who had
\nbeen killed in an air strike at the al-Quds
\nhospital in Aleppo three days earlier.
\nMedical Ethics Committee
\nRefugees and Migrants
\nThe Council considered the Resolution on
\nRefugees and Migrants introduced by the
\nSwedish Medical Association. This led to
\na debate in which delegates heard reports
\nfrom the Turkish and Australian Medical
\nAssociations about the refugee situation in
\ntheir countries. Having amended the word-
\ning of the document,the Council agreed the
\nResolution for immediate publication and
\nfor forwarding to the Assembly for formal
\nadoption.
\nPhysician Assisted Suicide
\nThe Royal Dutch and Canadian Medical
\nAssociations proposed postponing circu-
\nlation of their draft Statement on Eutha-
\nnasia and Physician Assisted Dying to al-
\nlow workshops to be set up to debate what
\nwas a very controversial issue. This led to a
\nlengthy debate about how such workshops
\nmight operate. Following this, the Royal
\nDutch and Canadian Medical Associa-
\ntions proposed that their draft document be
\nwithdrawn to allow the debate to continue.
\nIt was argued that this would allow time for
\nan open debate.
\nThe Council agreed that the proposed
\nStatement should be withdrawn and that
\nthe issue of how to progress the debate
\nshould be considered by the Council Ex-
\necutive Committee.
\nHealth Databases and Biobanks
\nThe Council agreed that the proposed
\nWMA Declaration on Ethical Consid-
\nerations regarding Health Database and
\nBiobanks be circulated to NMAs, that
\ncomments be invited from expert organ-
\nisations outside the WMA and that a fur-
\nther meeting of the Work Group should
\ntake place in September to finalise a docu-
\nment to be presented to the Council in
\nTaipei.
\nParticipation of Physicians
\nin Pre-Natal Gender
\nSelection
\nThe Council agreed to send back the pro-
\nposed Revision of the WMA Statement on
\nthe Participation of Physicians in Pre-Natal
\nGender Selection to the rapporteur to ana-
\nlyze in relation to existing WMA policy on
\nrelated topics. If the substance of the State-
\nment is not sufficiently covered in the exist-
\ning policies, the Statement will be reconsid-
\nered by the committee.
\nQuality Assurance in
\nMedical Education
\nThe Council agreed that the proposed Dec-
\nlaration on Quality Assurance in Medical
\nEducation should be circulated to NMAs
\nfor consideration.
\nClassification of 2006 Policies
\nThe Council agreed to the Committee\u2019s rec-
\nommendations on classifying policies that
\nwere 10 years old
\nFinance and planning committee
\nMembership Dues Payments
\nThe Council approved the document on
\nMembership Dues Payments for 2015 and
\nthe interim Financial Statement for 2015.
\nWMA Statutory Meetings
\nThe Council agreed the recommended ven-
\nues and dates for future meetings.
\nSocio-medical affairs committee
\nDoctors for Health Equity
\nThe President referred to the draft report
\n\u2018Working for Health Equity: The Role
\nof Health Professionals\u2019 on what doctors
\ncould do on the issue of health equity and
\nthe social determinants of health. The re-
\nport looked at the areas of education and
\ntraining, the health service as employer
\nand working in partnership and advocacy.
\nSir Michael said that what he was seeking
\nfrom NMAs were examples of case stud-
\nies of what had been happening in differ-
\nent countries. A final version would then be
\npublished.
\nAgeing
\nThe Council considered the proposed
\nStatement on Ageing and approved the
\ndocument as amended.
\nZika virus
\nThe Council considered the proposed Reso-
\nlution on the Zika Virus Infection. A fur-
\nther debate took place about the need to
\ninclude men as well as women among those
\n50
\nWMA News
\nwho need to be advised on this issue. This
\nwas supported and the Council agreed that
\nthe document,as amended,be approved and
\nforwarded to the General Assembly for for-
\nmal adoption.
\nIt was also agreed that a separate general
\ndocument should be prepared on pandemic
\nmanagement.
\nRole of Physicians in Preventing
\nthe Trafficking with Minors
\nand Illegal Adoptions
\nThe Council agreed that the proposed
\nStatement be circulated among members
\nfor comments.
\nArmed conflicts
\nThe Council agreed that the proposed new
\nStatement on Armed Conflicts should be
\ncirculated among NMAs for comments.
\nOccupational Health
\nThe Council agreed that the new Resolu-
\ntion on Occupational and Environmental
\nSafety as well as Gender Aspects be circu-
\nlated to NMAs.
\nAgeing
\nThe Council agreed that the Statement on
\nAgeing be forwarded to the General As-
\nsembly for adoption.
\nBoxing
\nThe Council agreed that the proposed
\nStatement on Boxing be circulated the
\nNMAs for consideration.
\nTobacco
\nThe Council agreed that the proposed
\nrevision of the WMA Resolution on the
\nImplementation of the WHO Framework
\nConvention on Tobacco Control be for-
\nwarded to the General Assembly for adop-
\ntion.
\nObesity in Children
\nThe Council agreed that the proposed
\nStatement on Obesity in Children should
\nbe recirculated to NMAs for reconsidera-
\ntion.
\nPhysicians\u2019 Right to Information
\nThe Council agreed that consideration of
\nthe proposed Declaration on Physicians\u2019
\nRight to Information about the World
\nMedical Association and its Policies be
\npostponed to the next meeting in Taipei in
\nOctober.
\nProfessional Autonomy of
\nPhysicians
\nThe Council agreed to the request that the
\nproposed Declaration on Professional Au-
\ntonomy of Physicians as the Main Condi-
\ntion for Implementation of the Human
\nRight to Health be withdrawn.
\nFossil Fuel Divestment
\nThe Council agreed that the proposed
\nStatement on Divestment in Fossil Fuels be
\nrecirculated to NMAs for comments.
\nGlobal Medical Electives
\nThe Council agreed that the proposed
\nStatement on Ethical Considerations in
\nGlobal Medical Electives be forwarded to
\nthe General Assembly for adoption.
\nFemale Genital Mutilation
\nThe Council agreed that the Statement on
\nFemale Genital Mutilation be approved
\nand forwarded to the General Assembly for
\nadoption.
\nBody Searches of Prisoners
\nThe Council agreed that the Statement on
\nBody Searches of Prisoners be approved
\nand forwarded to the General Assembly for
\nadoption.
\nCyber Attacks on Health and
\nother critical infrastructures
\nThe Council agreed that the proposed
\nStatement on Cyber-Attacks on Health
\nand Other Critical Infrastructures be circu-
\nlated to NMAs for consideration.
\nMedical Tourism
\nThe Council agreed that the proposed
\nStatement on Medical Tourism be circu-
\nlated to NMAs for consideration.
\nMedical Cannabis
\nThe Council agreed that the proposed new
\nStatement on Medical Cannabis be circu-
\nlated to NMAs for comment.
\nClassification of 2006 Policies
\nThe Council agreed the recommendations
\nfor reclassifying policies that were 10 years
\nold.
\nWorld Health Assembly
\nClarisse Delorme reported on the work
\nbeing done to prepare documents for the
\nWorld Health Assembly the following
\nmonth.
\nDr.\u00a0Kloiber said that one issue that would
\nbe raised at the WHA was that of the
\nhealth work force.The United Nations Sec-
\nretary General had set up a high level com-
\nmission to discuss this issue and in its evi-
\ndence to the panel, the WMA had stressed
\nthe importance of the health work force as
\nan investment not a cost.The WMA looked
\nforward to the recommendations from the
\nCommission in order to help take this mat-
\nter forward.
\nThe Chair then brought the meeting to a
\nclose.
\n51
\nWMA News
\nBACK TO CONTENTS
\nRecognizing that the WHO has designat-
\ned the Zika virus infection a global health
\nemergency, the WMA provides the follow-
\ning recommendations.
\n1.\t WHO should work with ECDC, CDC
\nand other disease control organisations
\nto better understand the natural history
\nand current epidemiology of Zika virus
\ninfection.
\n2.\t Information should be disseminated
\nwidely to advise and protect all women
\nand men who live in or must travel to
\nZika-affected areas and who are con-
\nsidering becoming parents. Advice
\nshould also include recommendations
\nfor women who are already pregnant
\nwho may have been directly exposed to
\nthe Zika virus or whose partners live
\nPreamble
\nCurrently, a very large number of people
\nare seeking refuge and\/or asylum; some are
\nfleeing war zones or other conflicts, others
\nare fleeing from desperate poverty, violence,
\nand other injustices and abuses with po-
\ntentially very harmful effects to mental and
\nphysical health.
\nThe global community has been ill prepared
\nfor handling the refugee crisis, including
\naddressing the health needs of those seek-
\ning refuge.
\nThe WMA recognizes that mass migration
\nwill continue unless people are content to
\nstay in their birth countries because they see
\nopportunities to live their lives in relative
\npeace and security and to offer themselves
\nand their families the ability to live lives
\nwith opportunities for fulfilment of various
\nsorts, including economic improvement.
\nThe global community has a responsibility
\nto seek to improve the lot of all popula-
\ntions, including those in countries currently
\nwith the poorest economies and other key
\nfactors. Sustainable development will give
\nall populations improved security, and eco-
\nnomic options.
\nThe WMA recognizes that warfare and
\nother armed conflict, including continuous
\ncivil strife, unrest and violence, will inevi-
\ntably lead to people movement. The worse
\nthe conflict the higher the percentage of
\npeople who will want to leave the conflict
\nzone. There is a responsibility for the global
\ncommunity,especially its political leaders,to
\nseek to support peace making and conflict
\nresolution.
\nThe WMA recognizes and condemns the
\nphenomenon of forced migration, which is
\ninhumane and must be stopped. Such cases
\nshould be considered for referral to the In-
\nternational Criminal Court.
\nPrinciples
\nThe WMA reiterates the WMA Statement
\non Medical Care for Refugees originally
\nadopted in Ottawa, Canada in 1998 which
\nstates:
\n\u2022\t Physicians have a duty to provide ap-
\npropriate medical care regardless of the
\ncivil or political status of the patient, and
\ngovernments should not deny patients
\nthe right to receive such care, nor should
\nthey interfere with physicians\u2019 obligation
\nto administer treatment on the basis of
\nclinical need alone
\n\u2022\t Physicians cannot be compelled to par-
\nticipate in any punitive or judicial ac-
\ntion involving refugees, including asylum
\nseekers, refused asylum seekers and un-
\ndocumented migrants, or Internally Dis-
\nplaced Persons or to administer any non-
\nmedically justified diagnostic measure or
\ntreatment, such as sedatives to facilitate
\neasy deportation from the country or re-
\nlocation.
\n\u2022\t Physicians must be allowed adequate
\ntime and sufficient resources to assess
\nthe physical and psychological condi-
\ntion of refugees who are seeking asy-
\nlum.
\n\u2022\t National Medical Associations and phy-
\nsicians should actively support and pro-
\nmote the right of all people to receive
\nmedical care on the basis of clinical need
\nalone and speak out against legislation
\nand practices that are in opposition to
\nthis fundamental right.
\nWMA urges governments and local au-
\nthorities to ensure access to adequate
\nhealthcare as well as safe and adequate
\nliving conditions for all regardless of their
\nlegal status.
\nWMA Council Resolution on Refugees and Migrants
\nAdopted by the 203rd
\nWMA Council Session, Buenos Aires, April 2016
\nWMA Council Resolution on Zika Virus Infection
\nAdopted by the 203rd
\nWMA Council Session, Buenos Aires, Argentina, April 2016
\n52
\nWMA News
\nin or have travelled to Zika-affected
\nareas.
\n3.\t Relevant agencies, including WHO,
\nshould gather data on the efficacy of
\ndifferent mosquito control methodolo-
\ngies, including the potentially harmful
\nor teratogenic effects of the use of vari-
\nous insecticides.
\n4.\t Work on diagnostic tests, antivirals,
\nand vaccines should continue with an
\nemphasis on producing a product that
\nis safe for use in pregnant women and
\npublic funding should be assured for
\nthis research. When such products are
\ndeveloped states should ensure that they
\nare available to, and affordable by, those
\nmost at risk.
\n5.\t States which have witnessed the deliv-
\nery of a number of babies with micro-
\ncephaly and other fetal brain abnormal-
\nities must ensure that these infants are
\nproperly followed up by health and oth-
\ner services, and provide support to fami-
\nlies seeking to cope with a child with
\ndevelopmental abnormalities. Wherever
\npossible research on the consequences
\nof microcephaly should be published, to
\nbetter inform future parents, and to al-
\nlow the development of optimal service
\nprovision.
\nMr. Nigel Duncan,
\nPublic Relations Consultant,
\nWMA
\nThe Sixty-ninth session of theWorld Health
\nAssembly, the supreme decision-making
\nbody of the World Health Organisation,
\nwas held in Geneva from May 23\u201328. Dur-
\ning the week, delegates agreed resolutions
\nand decisions on air pollution, chemicals,
\nthe health workforce, childhood obesity,
\nviolence, non-communicable diseases, and
\nthe election of the next Director-General.
\nAs usual the meeting attracted to the Swiss
\ncity a galaxy of world leaders, health min-
\nisters, chief medical officers, global leaders
\nfrom the health professions and countless
\nlobbyists. Thousands of delegates from the
\nWHO\u2019s Member States attended the As-
\nsembly, including many WMA leaders.
\nOnce again an enthusiastic group from the
\nJunior Doctors Network (JDN) were active
\nin presenting WMA policy on a wide range
\nof topics.
\nWHPA Regulation
\nConference May 21\u201322
\nFor the WMA, the week began with the
\nfourth World Health Professions Alliance
\nRegulation Conference, held at the Crowne
\nPlaza Hotel in Geneva. The two-day con-
\nference, which attracted an audience of 260
\npeople from 47 countries, focused on three
\nmajor areas \u2013 balancing regulation of in-
\ndividual health professionals and of health
\nservices, health professional regulation and
\ntrade agreements, and the Sustainable De-
\nvelopment Goals.
\nThe first speaker, Me Andr\u00e9 Gari\u00e9py, Com-
\nmissioner for the Recognition of Profes-
\nsional Competence at the Government of
\nQuebec, Canada, delivered a talk entitled
\n\u2018International regulation rather than na-
\ntional regulation\u2019. He said that globalization
\nand labour mobility were putting pressure
\non the services sectors and said that calls for
\nsimplification of regulation, aiming at in-
\nternationalization of professions, were often
\nmade. He discussed the different drivers for
\ninternationalization of professions and said
\nthat the universal good was a driver for the
\nprofession.
\nMrs H\u00e9l\u00e8ne Leblanc, Head of Public and
\nInternational Affairs at the French Cham-
\nber of Pharmacists, spoke about the Euro-
\npean Union regulation of healthcare and
\nthe implications for health care and health
\nprofessionals. She talked in particular about
\nqualification recognition and the need to
\nstrike the right balance between the mobil-
\nity of health professionals and allowing free
\nmovement while protecting patients. She
\nsaid that health workers in the EU under
\ninvestigation in their own country could
\nsimply move to another country and prac-
\ntice.This was a challenge for regulators.The
\nkey was that competent authorities must
\nexchange information.
\nDr.\u00a0Elizabeth Wiley, Deputy Chair of the
\nWMA\u2019s Junior Doctors Network, talked
\nexpertly about the new generation of trade
\nagreements and warned they might un-
\ndermine efforts to achieve universal health
\ncare and social accountability. She spoke
\nin particular about the Transatlantic Trade
\nand Investment Partnership and its impli-
\ncations for health care and health profes-
\nsionals.This new generation of agreements
\nwere unprecedented in their size,scope and
\nsecrecy. One of the most formidable chal-
\nWorld Health Assembly Week
\nGeneva May 23\u201328 2016
\nNigel Duncan
\n53
\nWMA News
\nBACK TO CONTENTS
\nlenges in analyzing the agreements and
\ntheir implications for health professionals
\nand health systems, as well as engaging in
\nadvocacy, was the lack of transparency. Ac-
\ncess to negotiating texts was limited \u2013 the
\ntexts were generally not publicly available.
\nCivil society had to rely on leaked texts.
\nOpportunities for engagement were of-
\nten quite limited as well and stakeholder
\nsessions were often poorly attended and
\nseemed to have limited impact.
\nShe said the TTIP agreement might have
\nbroad potential effects on public health
\nand national health and healthcare regula-
\ntion, including the supply, distribution and
\nmovement of health care workers. Its con-
\nsequences needed to be weighed against the
\nrelatively modest economic benefits. She
\nsaid that TTIP would put corporate inter-
\nests above those of health.
\nDr.\u00a0 Wiley said that this new generation
\nof negotiations had occurred largely out-
\nside of existing World Trade Organisa-
\ntion structures. The purported goal of the
\nnegotiations was to establish a new model
\nfor all future agreements \u2013 and, de facto,
\na new global trade governance frame-
\nwork. The focus of the negotiations had
\ngenerally been reductions in non-tariff
\nbarriers to trade, regulatory harmoniza-
\ntion with the goal of further liberalization
\nand ultimately economic growth. But a
\nkey question for the health sector was at
\nwhat cost? She spoke about the Investor
\nState Dispute Settlement (ISDS) mecha-
\nnism providing a mechanism for inves-
\ntors to bring claims against governments
\nand seek compensation. It provided new
\nand novel opportunities for multinational
\ncorporations to challenge domestic laws
\nthat threatened their interests. There was
\nconcern and some evidence that the mere
\navailability of ISDS might deter govern-
\nments from adopting laws and regulations
\nthat might be targeted for challenge by in-
\nvestors \u2013 and this included policies to ad-
\nvance universal coverage including access
\nto medicines.
\nWith respect to health professions\u2019 educa-
\ntion, she said there was speculation that
\nsome provisions, including potentially
\nstate-owned enterprise provisions, could
\nbe used to incite privatization of higher
\neducation.
\nDr.\u00a0Wiley concluded by saying that these
\ntrade agreement negotiations might help
\nor hinder efforts to realize universal health
\ncoverage and social accountability. There
\nwere clearly risks. The health and health
\ncare consequences of these agreements must
\nbe weighed against potential economic ben-
\nefits.The implications for health and health
\ncare needed to be considered in negotia-
\ntions and the health sector needed to en-
\ngage in these negotiations.
\nDr.\u00a0Carmen Catizone, Executive Director
\nof the National Association of Boards of
\nPharmacy, talked about the effect of tech-
\nnology on health care regulation. Internet
\nweb sites and the products and services
\nbeing offered by them were reshaping the
\ntraditional delivery of care. There were
\nproblems to be solved about the lack of
\nconnectivity of devices. Less than one per
\ncent of all the world\u2019s devises were actually
\ninterconnected. There was also the wide-
\nspread availability on the web of illegal and
\nfraudulent drug sites. He spoke about the
\nDot Pharmacy project that was accessible
\nto accredited organisations to fight coun-
\nterfeit drugs on the web. It was established
\nto regulate pharmacists online because 96
\nper cent of internet drug outlets were il-
\nlegal.
\nDay Two of the conference looked at
\nbalancing regulation of individual health
\nprofessions and of health services, and it
\nopened with a speech from David Ben-
\nton, CEO of the National Council of
\nState Boards of Nursing. He set the
\ncontext of the changes facing regulators
\nand health systems and talked about the
\nemerging trends that regulatory bodies
\nneeded to address. These trends could not
\nbe addressed in isolation, but needed to
\nbe considered as part of a comprehen-
\nsive approach to dealing with the reality
\nof a complex adaptive system. He spoke
\nabout improvements in joint collabora-
\ntion and said that protecting the public
\nwas not uniquely the responsibility of the
\nindividual practitioner, nor was it the re-
\nsponsibility of the regulator, the educator
\nor even the employer. It was a shared re-
\nsponsibility in which they all had to play a
\npart. They were simply instruments in an
\norchestra that collectively could achieve a
\nmiracle.
\nMartin Fletcher, CEO of the Australian
\nHealth Practitioner Regulation Agency,
\nspoke about regulatory principles in Aus-
\ntralia that helped the health system regu-
\nlators work together. The goal of protect-
\ning the public from harm was shared with
\nmany players, including governments,
\nservice providers, professional associations
\nand health care consumers themselves.
\nWorking together was not an optional
\nactivity. It was a core activity. Dr.\u00a0Marga-
\nret Grant, former CEO of the Australian
\nPhysiotherapy Council, talked about risk-
\nbased approaches to regulation, which she
\nsaid had the potential to deliver a range of
\nbenefits. But for health, it was relatively
\nnew. She referred to moving from a light
\ntouch to a right touch approach to regula-
\ntion and said that risk-based regulation of
\nhealth workers must seek and address the
\nroot cause of the risk.
\nKatya Maznyk, CEO of the Canadian
\nAlliance of Physiotherapy Regulators,
\nstressed the need to focus on patients, pa-
\ntient outcomes and quality of care. She dis-
\ncussed collaborative initiatives that focused
\non competencies, shared roles and respon-
\nsibilities and patient engagement to im-
\nprove the delivery of health services. She
\nexplained how the physiotherapy profes-
\nsion used national accepted competencies,
\nshared standards of practice and a code of
\nethics to promote quality and consistency
\nin regulatory practices. However, she ar-
\ngued that a barrier in inter-professional
\n54
\nWMA News
\ncollaboration could be differential pay
\nstructures for different professions.
\nThe final session of the conference was on
\nthe WHO\u2019s draft global strategy on hu-
\nman resources for health. It began with
\nJim Campbell, Director of the Health
\nWorkforce Department at the WHO, ex-
\nplaining the background to the strategy.
\nHe was followed by the last speaker, Sir
\nMichael Marmot, President of the World
\nMedical Association, whose well-received
\ntalk was entitled \u2018Sustainable Develop-
\nment Goals: What is the impact on Hu-
\nman Resources for Health\u2019. He spoke
\nabout the goal to achieve healthy lives
\nand wellbeing for all at all ages. This was
\nnot only a matter for the health sector but
\nwas inter-sectorial. What was needed was
\ncoherent action across sectors and society
\non the social, economic, environmental
\nand political determinants of health. He
\nwas absolutely sure that an educated and
\ndedicated health work force was vital to a
\ncivilized society.
\nHe said a key question he always asked was
\n\u2019Why treat people and send them back to
\nthe conditions that made them sick\u2019. He
\nargued the need for social justice and the
\ncreation of conditions for people to have
\ncontrol over their lives. Health equity and
\nthe social determinants of health were in-
\nextricably linked with sustainable develop-
\nment. He wanted everyone to be concerned
\nabout the inequalities of health between
\nand within countries. He illustrated his ar-
\nguments with statistics about differing life
\nexpectancy throughout the world, mortality
\nstatistics among under-fives and the impor-
\ntance of improving mothers\u2019 education. He
\nsaid they should all be standing up for all
\npolicies that were likely to have a positive
\nimpact on health and a fairer distribution.
\nThey needed to be advocates for policies
\nthat would improve the health of popula-
\ntions and patients they served. And he
\nended with his familiar mantra \u2018Health is a
\nhuman right: Do something, do more, do
\nbetter\u2019.
\nFollowing a panel discussion, the confer-
\nence ended with a spirited summing up of
\nthe two days of debate by Dr.\u00a0Ardis Hoven,
\nChair of the WMA. She said the discus-
\nsion had demonstrated that they must have
\nregulatory models that were flexible and
\nadaptable. They must keep the patient-cen-
\ntred focus and they must all collaborate and
\nremove barriers. A shared responsibility was
\na core issue for all of them.
\n\u2018Insecurity and Social
\nDeterminants of Health\u2019
\nThe following day, Monday May 23, a side
\nevent was organised by the WMA and the
\nJunior Doctors Network, jointly with the
\nInternational Committee of the Red Cross,
\nheld at the ICRC\u2019s headquarters. The pur-
\npose of the well-attended event was to iden-
\ntify social determinants of health as poten-
\ntial drivers of violence, to explore strategies
\nto address health challenges through SDH
\nin terms of prevention, ensuring safety of
\npatients and health professionals, and to
\nraise awareness of the relevance of SDH as
\na way forward to protect health and prevent
\ninsecurity.
\nThe keynote speech was given by Sir Mi-
\nchael Marmot. He said that the different
\naspects of insecurity were linked \u2013 social
\ninsecurity, economic insecurity, political
\ninsecurity and insecurity in terms of safe-
\nty and peace. The social determinants of
\nhealth were the drivers of conflict as well as
\nthe consequences of conflict and the driv-
\ners of health inequalities. Insecurity came
\nfrom the detrimental effects on the health
\nof whole populations,on the social determi-
\nnants of health and on the effects of other
\ncountries through refugees seeking asylum
\nand insecure borders.
\nSir Michael argued that the direct effects
\nof conflict of death, physical and mental
\nmorbidity and disability had to be added to
\nthe considerable indirect effects due to the
\nbreakdown of social life and infrastructure.
\nThese included the destruction of educa-
\ntion and health systems, macroeconomic
\nand household economic losses, popula-
\ntion relocation and the destruction of social
\nnetworks and detrimental environmental
\naspects.
\nHe said that the main countries where the
\nworld\u2019s refugees came from were Syria, Af-
\nghanistan, Somalia, South Sudan and the
\nCongo, all areas of great conflict. This mass
\nmigration would continue unless and until
\npeople were content to stay in their birth
\ncountries because they saw the opportuni-
\nties to live their lives in relative peace and
\nsecurity.
\nHe went on: \u2018We need urgent action to pre-
\nvent the consequences on the health of a
\nwhole population, the resulting problem of
\nrefugees, insecure borders and the violation
\nof human rights. We need action to prevent
\nthe random sexual violence that women
\nface, the great mortality and morbidity that
\nchildren suffer, the widespread loss of jobs
\nadults face and the collapse of health ser-
\nvice systems. The unrelenting poverty and
\noppression that flow from conflict are inde-
\nfensible.\u2019
\nAction was required across all sectors to
\ngive every child the best start in life, to en-
\nable all children, young people and adults to
\nmaximise their capabilities and have control
\nover their lives, to create fair employment
\nand good work for all, to create and develop
\nhealthy and sustainable places and commu-
\nnities and to strengthen the role and impact
\nof ill health prevention.This, he argued, was
\nwhy it was important to tackle the social
\ndeterminants of health around the globe. In
\nshort, a world where social justice was taken
\nseriously.
\nAlso speaking was Dr.\u00a0Elizabeth Wiley, on
\nbehalf of the Junior Doctors Network. She
\nspoke about insecurity and health profes-
\nsional safety from a junior doctor perspec-
\ntive. As a network and community of junior
\ndoctors, one of the areas of focus over the
\n55
\nWMA News
\nBACK TO CONTENTS
\nlast few years had been the safety and well-
\nbeing of junior doctors around the world.
\nFrom colleagues across continents, regions,
\ncountries and cultures, they had heard sto-
\nries of physical and even sexual violence
\nand harassment in health care settings, and
\nthese risks were amplified by conflict. Junior
\ndoctors in rural areas were particularly sus-
\nceptible to these threats
\nShe said the relationship between the social
\ndeterminants of health and insecurity and
\nconflict was both undeniable and multi-
\nfaceted and bidirectional, and created cre-
\nates conditions under which the safety of
\npatients and health care workers might be
\nat risk. But there were no easy solutions to
\nprotecting the safety of health care workers.
\nHowever, what seemed to be clear from a
\njunior doctor perspective was the imperative
\nto address the social determinants of health
\nas a preventive strategy to protect health
\nprofessionals.
\nDr.\u00a0Wiley highlighted two particular op-
\nportunities. First was the pending adop-
\ntion of the Global Strategy on Human
\nResources for Health that week. It was
\ncritical that member states and civil soci-
\nety alike recognized the urgent need to en-
\nsure the safety of health professionals, for
\nthe recruitment and retention of a robust,
\nfit-for-purpose global health workforce.
\nSecond, another important opportunity
\nfor prevention was in medical education.
\nSpecifically, key concepts needed to be
\nfully integrated into medical education
\naround the social determinants of health,
\ninsecurity and safety, violence prevention
\nand most importantly advocacy, because it
\nwas their responsibility as health profes-
\nsionals to address health inequities and be
\nadvocates for and with the patients they
\nserved.
\nWorld Health Assembly
\nThroughout the week, delegates from the
\nJunior Doctors Network attended the main
\nAssembly sessions and presented a series
\nof interventions, setting out WMA policy.
\nThey delivered speeches on topics includ-
\ning air pollution, antimicrobial resistance,
\npromoting the health of migrants, health
\nworkforce and violence against women.This
\nwas accompanied by a mass of activity on
\nthe WMA twitter site.
\nAssembly Resolutions
\nDuring the week the Assembly approved
\nnew resolutions on WHO\u2019s Framework
\nfor Engagement with Non-State Actors,
\nthe Sustainable Development Goals, the
\nInternational Health Regulations, tobac-
\nco control, road traffic deaths and inju-
\nries, nutrition, HIV, hepatitis and STIs,
\nmycetoma, research and development, ac-
\ncess to medicines and integrated health
\nservices.
\nThe WHO Framework of Engagement
\nwith Non-State Actors, adopted after
\nmore than two years of intergovernmental
\nnegotiations, provides the Organization
\nwith comprehensive policies and proce-
\ndures on engaging with nongovernmen-
\ntal organizations, private sector entities,
\nphilanthropic foundations and academic
\ninstitutions.
\nOn Sustainable Development Goals del-
\negates agreed a comprehensive set of steps
\nthat lay the groundwork for pursuing the
\nhealth-related Goals. They agreed to pri-
\noritize universal health coverage, and to
\nwork with actors outside the health sector
\nto address the social,economic and environ-
\nmental causes of health problems, including
\nantimicrobial resistance.
\nOn road traffic deaths and injuries delegates
\nadopted a resolution requesting Member
\nStates to accelerate implementation of the
\noutcome document of the Second Global
\nHigh-Level Conference on Road Safety
\n2011\u20132020 held in November 2015, and on
\nnutrition they adopted two resolutions urg-
\ning countries to make concrete policy and
\nfinancial commitments to improve people\u2019s
\ndiets, and calling on UN bodies to imple-
\nment national nutrition programmes and
\nsupport monitoring and reporting mecha-
\nnisms.
\nIhsan Do\u011framac\u0131
\nFamily Health
\nFoundation Award
\nThe week ended when Sir Michael Marmot
\nwas awarded the Ihsan Do\u011framac\u0131 Family
\nHealth Foundation prize for his work in
\nfamily health. Accepting the award, he said
\nthat the WHO need not dictate to Member
\nStates what they should do. But instead, it
\ncould play a key function simply by bring-
\ning the evidence he had amassed into the
\npolicymaking process.
\n\u2018Nobody has to listen to me,\u2019 said Sir Mi-
\nchael. \u2018But I can speak passionately about
\nthe evidence. So, that is not telling people
\nwhat to do, but it is leading them to the
\nconclusions of what the evidence suggests
\nwe should be doing.\u2019
\nMr. Nigel Duncan,
\nPublic Relations Consultant,
\nWMA
\n56
\nBiobanks
\nVery recently, on 11 May 2016, the Com-
\nmittee of Minsters of the Council of
\nEurope (see box) adopted a revised rec-
\nommendation on research on biological
\nmaterials of human origin1
\n.This new docu-
\nment replaces a similar recommendation2
\nof the year 2006. Important provisions are
\nkept like \u201cbroad consent\u201d or access to and
\nuse of stored human biological material
\nwithout the free informed consent of the
\ndonor only exceptionally under specific
\nconditions.
\nSuch a research needed and will need in
\nthe future a favourable opinion of an en-
\n1
\n\u2002\u0007Recommendation CM\/Rec(2016)6\u2028of the Com-
\nmittee of Ministers to member States\u2028on rese-
\narch on biological materials of human origin
\n(Adopted by the Committee of Ministers on 11 May
\n2016\u2028at the 1256th meeting of the Ministers\u2019 Depu\u2011
\nties)
\n2
\n\u2002\u0007Recommendation Rec(2006)4 of the Commit-
\ntee of Ministers to member states on research on
\nbiological materials of human origin (Adopted by
\nthe Committee of Ministers on 15 March 2006 at the
\n958th meeting of the Ministers\u2019 Deputies)
\ntitled ethics committee and, if required by
\nnational law, the approval of a competent
\nauthority. There have been, during the
\nyears of the elaboration of the new docu-
\nment, several attempts to weaken specifi-
\ncally this latter provision, which has been,
\nhowever, confirmed as it stands since
\n2006.
\nAs the previous one the revised recom-
\nmendation is based in the framework
\nof the Council of Europe given by the
\nOviedo Convention3
\nand by the Addi-
\ntional4
\nprotocol on biomedical research.
\nThe recommendation is aimed to give a
\nsynergy between the protection of the
\nhuman rights of the donor of the mate-
\nrial and the need of research based on
\nhuman tissues becoming more and more
\nimportant. It addresses all researchers in-
\ncluding researching physicians. It is up to
\nnational legislators how and in which way
\nproposals of professional or other groups
\n\u2013 NGOs \u2013 are respected or followed dur-
\ning the procedure of the implementation
\nof the recommendation into the legal sys-
\ntem.
\nThis overview follows the structure of the
\nrecommendation and is formulated narrow
\nto its wording, which is sometimes quoted,
\nto prevent any misunderstanding of the
\nlegal instrument which covers research on
\nstored biological materials as defined by its
\nscope.
\n3
\n\u2002\u0007Convention for the protection of Human Rights
\nand Dignity of the Human Being with regard to
\nthe Application of Biology and Medicine: Con-
\nvention on Human Rights and Biomedicine,
\nCETS No. 164
\n4
\n\u2002\u0007Additional Protocol to the Convention on Hu-
\nman Rights and Biomedicine, concerning Bio-
\nmedical Research, CETS No.195
\nScope
\nThe recommendation applies to the ob-
\ntaining of biological materials of human
\norigin for storage for future research pur-
\nposes, to the storage of such materials for
\nfuture research purposes and to the use in
\na research project of those materials that
\nare stored or were previously obtained
\nfor another purpose, including a previous
\nresearch project. It does not apply to em-
\nbryonic and foetal biological materials and
\nnot to the use in a specific research project
\nof human materials removed for the sole
\npurpose of that project. (Covered by the
\nResearch protocol, see footnote 4). As-
\nsociated personal data are included in the
\nscope. A definition of identifiable and non
\nidentifiable biological material is given in
\nthe text.
\nGeneral provisions
\nGeneral provisions address different as-
\npects of the research in view. The physical
\nrisks arising from removal of biological
\nmaterials for storage for future research
\nshould be minimised. Other risks for the
\ndonor and, where appropriate, for the
\nfamily or for persons in the same group
\nas the donor, related to research activi-
\nties, in particular the risks to private life,
\nshould be minimised also. Risks should not
\nbe disproportionate to the potential ben-
\nefit of the research activities. Appropriate
\nmeasures should be taken to prevent dis-
\ncrimination against, and to minimise the
\nlikelihood of stigmatisation of, any person,
\nfamily or group. Refusal to give consent to
\nor authorisation for the removal, storage
\nor research use of biological materials or
\nthe withdrawal or alteration of the scope
\nof the consent or authorisation should not
\nlead to any form of discrimination against
\nthe person concerned, in particular regard-
\ning the right to medical care. Biological
\nmaterials of human origin should not, as
\nsuch, give rise to financial gain. Confiden-
\ntiality on any information of personal na-
\nElmar Doppelfeld
\nCouncil of Europe
\nRecommendation on Biobanks
\nGERMANY
\n57
\nBACK TO CONTENTS
\nBiobanks
\nture collected in removing, storing or using
\nbiological material or in obtaining by the
\nresearch must be safeguarded according to
\nthe rules for the protection of private life.
\nThis provision applies also in transfer of
\nbiological materials. Member States are in-
\nvited to improve the interest of the public
\non research on biological materials by ap-
\npropriate information. Member States are
\nfree to introduce wider protection than is
\nstipulated in the recommendation.
\nObtaining and storage
\nfor future research
\nIntroductory remarks. Obtaining human
\nbiological material for future research
\ncan in a specific manner violate human
\nrights. Therefore this recommendation en-
\ntails rather strong and detailed provisions.
\nThese provisions address different central
\nfields. Valuable information is the appro-
\npriate basis for a free informed consent
\nof the donor of the biological material. If
\nthis person is not able to consent accord-
\ning to law, e.g. because of age or disease,
\n\u201cfree informed consent\u201d is substituted by
\n\u201cauthorisation\u201d. The manner and the pro-
\nvisions for that authorisation differ from
\nState to State. Therefore the recommen-
\ndation as a legal instrument uses a rather
\nspecific wording to cover these different
\nregulations: \u201cauthorisation of his or her
\nrepresentative or an authority, person or
\nbody provided for by law\u201d. To facilitate
\nthe understanding of this article the ex-
\npression \u201clegal representative\u201d is used ad-
\ndressing the various regulations. However
\nindependent from any internal regulation,
\nthe legal representative receives the same
\ninformation and exercises the same rights
\nas the represented person if being able to
\nconsent. Usually consent or authorisation
\nare given for specific research projects. In
\ncontrast specific research projects are not
\nyet identified in the moment of storage of
\nmaterial for future research. It is accepted
\nmore and more that an autonomous person
\nor the legal representative can consent also
\nto this situation on the basis of appropriate
\ninformation (see below). The person may
\ndefine restrictions of the scope of the re-
\nsearch and may ask to be contacted before
\nany other use of the material. To safeguard
\nhuman rights the donors are insured that
\nthe material is only used for research proj-
\nects reviewed by an ethics committee and,
\nif required by law, approved by a compe-
\ntent body. These two basic conditions for
\nbroad consent are taken over from the for-
\nmer recommendation. Finally: consent or
\nauthorisation is needed for the use of dif-
\nferent materials: those removed specifically
\nfor future research, materials already used
\nfor research and afterwards stored and ma-
\nterials removed for other purposes than re-
\nsearch, e.g. for diagnosis or treatment, of-
\nten known as \u201cleft overs.\u201d For person from
\nwhom this material has been removed the
\nterm \u201cdonor\u201d is used in this text.
\nInformation
\nPrior to consent to or to authorisation for
\nthe storage of biological materials for fu-
\nture research, the person concerned or, in
\ncase of a donor not able to consent, the
\nlegal representative should be provided
\nwith comprehensible information that is
\nas precise as possible in view of the na-
\nture of any envisaged research use and
\nthe possible choices that he or she could
\nexercise, the conditions applicable to the
\nstorage of the materials, including access
\nand possible transfer policies and any rel-
\nevant conditions governing the use of the
\nmaterials, including re-contact and feed-
\nback .The donor or the legal representative
\nshould also be informed of the rights and
\nsafeguards provided for by law, and specif-
\nically of his or her right to refuse consent
\nor authorisation and to withdraw consent
\nor authorisation at any time. This infor-
\nmation should also include any possible
\nlimitation on withdrawal of the consent
\nor authorisation. Prior to the removal of
\nbiological materials the donor or the le-
\ngal representative should be provided with
\nadditional information specific to the in-
\ntervention carried out to remove the ma-
\nterials.
\nBiological materials from
\npersons able to consent
\nBiological materials should only be re-
\nmoved for storage for future research with
\nCouncil of Europe
\nThe Council of Europe, established in 1951, should not be confused with the European
\nUnion. Both maybe considered as \u201cintergovernmental bodies\u201d with different intentions.
\nThe Council with its 47 Member States, representing around 830 Millions of citizens,
\nhas the main mission to promote and to harmonise human rights and fundamental
\nfreedoms. To this aim the Council uses Conventions and Additional protocols to these
\nConventions. This treaties enter only into legal force by signature and ratification of
\na Member State to safeguard the democratic procedure and basis. In contrast to the
\nEU the Council has no right to issue regulations with binding force for its Member
\nStates. Recommendations may be considered as a proposal to the Member States how
\nto regulate specific fields. They are however, in structure and content imbedded in the
\nlegal framework.
\nWhen implementing legal provisions of the Council of Europe the national legislator
\ndecides how and to which extent proposals from NGOs will be accepted.
\nGERMANY
\n58
\nthe prior, free, express and documented
\nconsent of the donor given the informa-
\ntion as outlined above. Biological materials
\npreviously removed for another purpose
\n\u2013 sometimes addressed as \u201cleft overs in
\nclinical routine\u201d\u00a0 \u2013 should only be stored
\nfor future research with the consent of the
\nperson concerned as provided for by law.
\nWhenever possible, consent should be re-
\nquested before any removal of biological
\nmaterials. Biological materials previously
\nremoved for another purpose and already
\nnon-identifiable may be stored for future
\nresearch subject to authorisation provided
\nfor by law.
\nBiological materials from
\npersons not able to consent
\nResearch on biological materials from per-
\nsons not able to consent, e.g. minors or
\nadults with specific diseases, may be justi-
\nfied. However the obtaining and the use of
\nthese materials require specific protective
\nprovisions. Biological materials from these
\npersons who, according to law, are not able
\nto consent \u201cshould only be obtained or
\nstored for future research having the po-
\ntential to produce, in the absence of direct
\nbenefit to the person concerned, benefit to
\nother persons in the same age category or
\nafflicted with the same disease or disorder
\nor having the same condition, and if the
\naims of the research could not reasonably
\nbe achieved using biological materials
\nfrom persons able to consent.\u201d Under this
\nprecondition, quoted from the recommen-
\ndation, biological materials should only be
\nremoved from a person not able to consent
\nif the removal only entails minimal risk
\nand minimal burden and with the written
\nauthorisation for such removal given by
\nthe legal representative. The necessary au-
\nthorisation should be specific to the inter-
\nvention carried out to remove the materials
\nand as precise as possible with regard to the
\nenvisaged research use. Biological materi-
\nals previously removed for another purpose
\nfrom a person not able to consent should
\nonly be stored for future research with the
\nauthorisation given in the same procedure
\nas mentioned above. Whenever possible,
\nauthorisation should be requested before
\nany removal of biological materials. There
\nare specific provisions for the authorisa-
\ntion procedure. If the person not able to
\nconsent is an adult, he or she should, as far
\nas possible, take part in the authorisation
\nprocedure. If the person not able to con-
\nsent is a minor, his or her opinion should
\nbe taken into consideration as an increas-
\ningly determining factor in proportion to
\nage and degree of maturity. Any objection
\nby the person not able to consent should be
\nrespected. Any wishes previously expressed
\nby such a person should be taken into ac-
\ncount. Where a donor, not able to consent
\nin the moment of removal of biological
\nmaterial, attains or regains the capacity to
\nconsent, reasonable efforts should be made
\nto seek his or her consent for continued
\nstorage and research use of his or her bio-
\nlogical materials. Biological materials pre-
\nviously removed for another purpose from
\na person not able to consent and which are
\nalready non-identifiable may be stored for
\nfuture research subject to authorisation
\nprovided for by law.
\nRight to withdraw consent
\nor authorisation
\nThe donor of identifiable biological ma-
\nterials stored for future research should,
\nwithout being subject to any form of dis-
\ncrimination, in particular regarding the
\nright to medical care, retain the right to
\nwithdraw consent at any time or to alter
\nthe scope of that consent. When identifi-
\nable biological materials are stored only,
\nthe person who has withdrawn consent
\nshould have the right to have, in confor-
\nmity with national law, the materials and
\nassociated data either destroyed or ren-
\ndered non-identifiable. The donor consid-
\nering withdrawing consent should be made
\naware of any limitations on withdrawal of
\nhis or her biological materials.
\nThe legal representative having authorised
\nthe storage for future research of identifi-
\nable biological materials removed from a
\nperson who is not able to consent, should
\nhave the same rights as listed above. There
\nshould be no form of discrimination for
\nthe donor, in particular regarding the right
\nto medical care. Where a donor attains or
\nregains the capacity to give consent, he or
\nshe should have the rights to withdraw the
\nauthorisation under the conditions as out-
\nlined.
\nRemoval of biological
\nmaterial from a deceased
\nperson
\nBiological materials should only be re-
\nmoved from the body of a deceased per-
\nson for storage for future research with
\nthe consent given during life or with au-
\nthorisation provided for by law. Biological
\nmaterials should not be removed if the de-
\nceased person is known to have objected
\nto it.
\nGovernance of collections
\nGeneral conditions
\nThe storage of biological materials to be
\nused for future research should only be
\ndone in a structured manner and in ac-
\ncordance with principles of governance
\nas laid down in the recommendation. The
\nperson and\/or institution responsible for
\nthe collection should be publicly known.
\nTransparency and accountability should
\nbe the leading principles of the manage-
\nment. To this end information on speci-
\nfication, access to, use and transfer of the
\nstored material should be publicly avail-
\nable. Before any change of the purpose of
\na collection an independent examination
\nof its compliance with the provisions of
\nthe recommendation should be carried
\nout. As consequence of this examination
\nmay result the requirement of renewed
\nBiobanks GERMANY
\n59
\nBACK TO CONTENTS
\nconsent or a renewed authorisation in re-
\nlation to the change of the purpose. Each
\nsample in the collection should be appro-
\npriately documented and traceable. For
\nan appropriate documentation informa-
\ntion on the scope of any consent or au-
\nthorisation is necessary. Quality assurance
\nmeasures should be in place concerning
\nan appropriate security and confidential-
\nity during establishment of the collection,
\nstorage, use and for the case of transfer of
\nbiological materials.Transfer of the whole
\nor of part of the collection as well a its
\nclosure may only be performed following
\nestablished procedures in accordance with
\nthe original consent or authorisation. The
\nexercise of the right to withdraw consent
\nor authorisation needs updated informa-
\ntion on management and use of a collec-
\ntion. This information should be available
\ntherefore for the persons concerned, the
\ndonor or the legal representative. For
\nmore public acceptance of a collection are
\nadvisable regular reports on past or en-
\nvisaged activities, information on access
\ngranted to materials and on progress in
\nresearch projects using the stored samples.
\nThe publication of a summary of findings
\non completion of each research projects
\nwill contribute to the public acceptance of
\ncollections.
\nIndividual feedback
\nArticle 10 of the Oviedo Convention un-
\nderlines for the health field the right of a
\nperson \u201cto know or not to know\u201d, which is
\ntaken up by the recommendation. In line
\nwith this provision clear policies are re-
\nquired to inform on findings relevant for
\nthe health of the persons detected in the
\nuse of their biological materials. The same
\ninformation should be given when persons,
\nwho are not able to consent, are the source
\nof the material. This feedback should take
\nplace within a framework of appropriate
\nhealth care or counselling. The wishes not
\nto be in formed on these findings should be
\nobserved.
\nAccess
\nFor safeguarding an appropriate access to
\nand use of stored biological materials by re-
\nsearchers clear conditions should be set up
\nand documented. These conditions should
\ninclude the respect for any restrictions de-
\nfined by the donor or during the procedure
\nof authorisation.Transparent policies of ac-
\ncess and oversight of a collection should be
\npublished. Appropriate access mechanisms
\nmay contribute to maximise the value of
\ncollections. Traceability of the use of the
\nstored materials can have an additional
\nbenefit.
\nTransborder flows
\nResearch on human biological materials
\nas all research is carried out in an inter-
\nnational context, exchange of samples
\nbetween researchers working in differ-
\nent States with often different levels of
\nprotection is common. In relation to this
\nfact the recommendation requires that in
\ncase of any transfer of materials to an-
\nother State an appropriate level of pro-
\ntection is ensured. This can be achieved
\nby the law of the accepting State. As a
\nsolution are also considered legally bind-
\ning and enforceable instruments adopted
\nand implemented by the parties involved
\nin the transfer for future research activi-
\nties. To this end may serve a documented
\nand signed agreement between the sender
\nof the materials and the recipient. The
\nagreement should include statements on
\nconsent or authorisation and on relevant
\nrestrictions as defined by the donor or by
\nthe legal representative.
\nOversight
\nA collection may be established only after an
\nindependent examination of its compliance
\nwith the provisions of the recommendation.
\nOnce established a collection should be
\nsubject to an oversight proportionate to the
\nrisks for the donors of the materials stored
\nin that collection. The specific aim of this
\noversight is safeguarding the rights and in-
\nterests of the donors in view of the research
\nactivities of the collection. The recom-
\nmendation entails oversight mechanisms,
\nunderstood as minimum items. Object of
\nsuch an oversight is the implementation of
\nsecurity measures and of procedures on ac-
\ncess to, and use of, biological materials. The
\nabove mentioned system of annually reports
\nis another object. The oversight includes
\nany changes in the risks to the donors of the
\ncollected material. As a result the revision
\nof policies may be requested. The provision
\nof appropriate information to the donor or
\nto the legal representative responsible for
\na given authorisation on changes in the
\nmanagement of the collection is part of the
\noversight. This is a condition for exercising
\nthe right to withdraw. Another important
\nissue for the oversight are development and
\nimplementation of feedback policies in-
\ncluding a regular review. Oversight mecha-
\nnisms may be adapted to evolutions of the
\ncollection and of its management.
\nUse of biological materials
\nin a research project
\nGeneral provisions
\nThis chapter of the recommendation can
\nbe considered as meeting point of require-
\nments of research and of protective provi-
\nsions. As a basic principle is accepted that
\nbiological materials can only be used if the
\nenvisaged research project is within the
\nscope of a given consent or authorisation.
\nIf this condition is not fulfilled consent or
\nauthorisation to use the material for that
\nspecific research project should be sought.
\nTo this end reasonable efforts are required
\nto contact the donor or the person or in-
\nstitution entitled to give an authorisation.
\nIt may happen that a person, in the mo-
\nment of removal of biological material
\nor later on , expresses the wish to be no
\nmore contacted. This wish should be ob-
\nBiobanksGERMANY
\n60
\nserved. In case of unsuccessful attempts
\nof these contacts the biological materials
\nmay be used if an independent evaluation
\nstates the fulfilment of the following con-
\nditions as a whole. Evidence is provided
\nthat reasonable efforts have been made to
\nestablish the above mentioned contacts \u2013
\na sole declaration of the researcher is not
\nconsidered as sufficient. The research proj-
\nect addresses an important scientific inter-
\nest and is in accordance with the principle
\nof proportionality. The aim of the research
\ncan only be achieved using these materials
\nwhich can not be substituted by materials
\nfor which consent or authorisation can be
\nobtained. Finally it is not known that the
\ndonor or the legal representative has ex-
\npressly opposed such research use. These
\nare of course rather strong conditions for
\nscientific use of materials without consent
\nor authorisation. The recommendation
\ntries to open the way in a distinct frame
\nto bind a decision on specific conditions to
\nenable a synergy of the needs of research
\nand of the protection of individuals. Iden-
\ntifiability and non-identifiability play a
\nmajor role in research. The use of material
\nin an identifiable form should be justified
\nin advance in the research protocol to be
\nsubmitted for examination. Rendering ma-
\nterials non-identifiable may be considered
\nas an easier way for their use. However the
\nrecommendation requires that rendering
\nmaterials non-identifiable is depending
\non the consent of the donor or of the legal
\nrepresentative . Both of them may define
\nrestrictions which must not be violated
\nusing these materials when rendered non-
\nidentifiable. The recommendation address-
\nes specifically the attention to any authori-
\nsation by law.The research use of biological
\nmaterials removed of persons not able to
\nconsent is object of a controversial discus-
\nsion. The recommendation entails the fol-
\nlowing provision, elaborated in line with
\nthe Oviedo Convention and the Addi-
\ntional protocol concerning biomedical re-
\nsearch: \u201cBiological materials from persons
\nwho, according to law, are not able to con-
\nsent should only be used for research hav-
\ning the potential to produce, in the absence
\nof direct benefit to the person concerned,
\nbenefit to other persons in the same age
\ncategory or afflicted with the same disease
\nor disorder or having the same condition,
\nand if the aims of the research could not
\nreasonably be achieved using biological
\nmaterials from persons able to consent.\u201d
\nIndependent review
\nThe recommendation requires an indepen-
\ndent review of research proposals using
\nbiological materials. This review follows
\nthe system established in the research field.
\nBy an independent examination scientific
\nmerit, importance of the aim and the ethi-
\ncal acceptability of the research have to be
\nproved. No research should be undertaken
\nwithout this examination. This examination
\nis usually carried out by an ethics commit-
\ntee according to national law. The recom-
\nmendation states explicitly that national
\nlaw may in addition require approval by a
\ncompetent body. Principles concerning eth-
\nics committees are contained in Chapter
\nIII of the Additional Protocol concerning
\nbiomedical Research (see footnote 4). The
\nrecommendation proposes Member States
\nto apply these principles to the review of
\nthe research project within its scope. Re-
\nview procedures should be flexible and may
\ntherefore be adapted to the nature of the re-
\nsearch and to the possible identification of
\nthe donors.
\nAvailability of results
\nThe recommendation tries to prevent the
\nwell known \u201csilent death or silent disap-
\npearance\u201d from research projects. Therefore
\non completion of a project a report or sum-
\nmary should be sent to the ethics committee
\nor the competent body and to the collection
\ngranting the materials. Another well prob-
\nlem is the scientific publication of results.
\nIt seems that researchers legally cannot be
\nforced to publish results of their research.
\nThe same difficulty was met during the
\nelaboration of the Protocol concerning bio-
\nmedical research (see footnote 4). The rec-
\nommendation uses a nearly identical word-
\ning: \u201cThe researcher should take appropriate
\nmeasures to make public the results of re-
\nsearch in reasonable time.\u201d
\nClosing remarks
\nResearch on human biological materials
\naddresses two fields of problems: the re-
\nmoval of the donor and the scientific use.
\nWhereas it is unanimously accepted that
\nthe removal needs consent or authorisation
\nthe conditions for use are still in discus-
\nsion. It is argued, that there is no physical
\nharm to a person if his or her materials,
\nseparated from the body, are used. How-
\never the idea is since decades adopted also
\nthat the donor should have the right to de-
\nfine this use \u2013 treatment and\/or research.
\nThe way for the protection of this right
\nis object of controversial discussions. The
\nrecommendation agreed by 47 European
\ngovernments shows a solution respecting
\nas far as possible the different positions
\nand national legislations.
\nProf. Elmar Doppelfeld MD
\nFormer Chairman of the \u201cSteering Committee
\non Bioethics (CDBI)\u201d of the Council of Europe
\nMember of the German delegation
\nto the DH\u2011BIO (Former CDBI)
\nof the Council of Europe
\nChairman of EUREC (European
\nNetwork of Research Ethics Committees
\nE-mail: elmar-doppelfeld@t-online.de
\nBiobanks GERMANY
\n61
\nBACK TO CONTENTS
\nZika VirusFEDERATIVE REPUBLIC OF BRAZIL
\nDescription of the Evidence Colection
\nMethod:
\nThe literature review of manuscripts was held
\nin the databases Medline, Embase and Co-
\nchrane, using the terms (MeSH terms) indi-
\nvidually or grouped structured according to
\nP.I.C.O. (\u201cPatient\u201d,\u201cIntervention\u201d,\u201cControl\u201d
\nand \u201cOutcome\u201d) methodology. After carefully
\nreading the titles and abstracts, only articles
\ncontaining relevant information to the com-
\nponents of P.I.C.O.were included.The stud-
\nies were analyzed for relevance and level of
\nevidence according to the Oxford Centre for
\nEvidence Based Medicine [1] (D) table.
\nGrade of recommendation
\nand strength of evidence
\nA.\u0007Experimental or observational studies
\nof higher consistency.
\nB. \u0007Experimental or observational studies
\nof lower consistency.
\nC. \u0007Case reports\/non-controlled studies.
\nD. \u0007Opinions without critical evaluation,
\nbased on consensus, physiological stud-
\nies,or animal models.
\nObjective:
\nThis guideline is intended for physicians,
\nnurses,public health officials and patients at
\nrisk of infection with Zika virus, with the
\npurpose of assessing the effects on the pe-
\nriod of pregnancy and postpartum.
\nConflict of interest:
\nNo conflict of interest was declared by the par-
\nticipants in the development of this guideline.
\nIntroduction
\nZikavirus,firstisolatedin1947inrhesusmon-
\nkeys, is an arbovirus, member of the Flaviviri-
\ndae family. First found in humans in Nigeria
\nin 1954, for 50 years was described as a cause
\nof sporadic human infections in Africa and
\nAsia, until in 2007 an epidemic took place in
\nMicronesia [2,3] (C). More recently in Brazil,
\nThe Ministry of Health,as verified by the data
\nprovided by the Live Births Information Sys-
\ntem \u2013 SINASC, has recorded substantial in-
\ncrease in the number of cases of microcephaly
\nafter a high incidence of infection.The clinical
\nfeatures and natural history of Zika infection
\nare based on a limited number of case reports;
\nhowever, it is clear that vertical transmission
\nof the virus can occur during pregnancy, as
\nseen in a series of reports of cases of micro-
\ncephaly among children whose mothers were
\ninfected with Zika virus [4,5] (C) [6] (D).
\nIn view of these aspects, the development of
\nclinical guidelines regarding the knowledge
\nacquired to date on an association between
\ninfection with Zika virus and its effects on
\npregnancy and childbirth is imperative in
\norder to delimit and advise on panoramas
\nrelated to preconception counseling, pre-
\nnatal, labor, postpartum and newborn care.
\nObjectives
\nPrepare a clinical guideline that includes, in
\nlight of current scientific evidence available,
\nanswers to clinical questions structured
\naccording to the components of P.I.C.O.
\n(P\u00a0[Patient]; I [Intervention]; C [Compari-
\nson]; O [Outcome]).
\nMaterial and Methods
\nThe evidence used to evaluate the occurrence
\nof infection with Zika virus during pregnancy
\nwas obtained according to the following steps:
\npreparation of the clinical question, structur-
\ning of the question, search for evidence, criti-
\ncal evaluation and selection of evidence.
\nStructured questions
\n1.\t During pregnancy,what is the association
\nbetween Zika virus and microcephaly?
\n2.\t What is the association between Zika
\nvirus and Guillain-Barr\u00e9 syndrome? Is
\nit different during pregnancy? Can it af-
\nfect the fetus?
\n3.\t What are the symptoms in pregnant
\nwomen with suspected Zika virus in-
\nfection? Are they different than in the
\ngeneral population?
\n4.\t How to make a definitive diagnosis of
\nZika virus infection during pregnancy?
\n5.\t What is the treatment for Zika virus in-
\nfection during pregnancy?
\n6.\t How is the follow-up of pregnant wom-
\nen infected with Zika virus done?
\n7.\t What are the precautions to be taken
\nwith babies born from pregnant women
\nwith a history of Zika virus infection?
\n8.\t What care is required for newborns diag-
\nnosedwithmicrocephalyduringpregnancy?
\nZika virus infection and pregnancy
\nFlorentino Cardoso Giovanni Cerri Antonio Salom\u00e3o Wanderley Bernardo Ricardo Sim\u00f5es Renata Buzzini
\n62
\nFEDERATIVE REPUBLIC OF BRAZILZika Virus
\nDatabases consulted
\nPrimary scientific databases consulted were
\nMedline, Embase and Cochrane using the
\nterms \u201cZika Virus\u201d and \u201cPregnancy\u201d individu-
\nally or grouped. A manual search from the ref-
\nerences of narrative reviews was also performed.
\nChart1 displays the number of studies retrieved
\nfrom each scientific database until 2\/23\/16.
\nChart 1. Number of studies retrieved by pri-
\nmary database
\nDatabase Number of studies
\nPubMed-Medline 173
\nEmbase 171
\nCochrane 0
\nInclusion criteria for
\nstudies retrieved
\nSelection of studies, assessment of titles and
\nabstracts was conducted by two researchers
\n(R.S.S. and W.M.B.) both independent and
\nblinded. Whenever the title and the summary
\nwere not enlightening, researchers sought the
\nfull article. Case reports, case series and guide\u2011
\nlines were included in the evaluation.Narrative
\nreviews were included in the reading with the
\npurpose of retrieving reference that could have
\nbeen lost in the initial search strategy. Physio-
\nlogical reports or studies based on animal mod-
\nels,as well as those unrelated with our P.I.C.O.
\ncomponents, were not included. Only articles
\nwhose full text was available were included in
\nthe guideline. We included studies available in
\nPortuguese,English,French or Spanish.
\nStudies retrieved
\nAfter entering the search strategy in the pri-
\nmary databases the assessment of titles and
\nabstracts led to the selection of 288 studies.
\nEvidence selected
\nThe studies considered for full text read-
\ning were assessed according with the set
\ninclusion and exclusion criteria, P.I.C.O.,
\nlanguage and availability of the full text
\n(Figure 1).
\n1. During pregnancy, what is
\nthe association between Zika
\nvirus and microcephaly?
\nIn Brazil, a possible association between
\nZika virus infection during pregnancy and
\nmicrocephaly has been under investigation
\nsince October 2015 when the Ministry of
\nHealth reported an increase in the number
\nof cases of microcephaly close to 20 times of
\nthat previously reported (approximately 0.5
\ncases for each 10,000 live births) after an
\noutbreak of this virus [10,11] (D). This re-
\nport made the Pan American Health Orga-
\nnization (PAHO) publish a warning about
\nthe increased occurrence of microcephaly in
\nBrazil [12] (D).In the same year,the PAHO
\nreported viral genome identification using
\nreverse transcriptase technique followed by
\npolymerase chain reaction in real time (RT-
\nPCR) in amniotic fluid samples from two
\npregnant women whose fetuses had micro-
\ncephaly identified during ultrasonography
\nperformed during prenatal monitoring. In
\naddition, the Zika virus RNA was identi-
\nfied in various tissues, including the brain,
\nof a child with microcephaly who died in
\nthe immediate neonatal period [13] (D).
\nThese events led to new alerts issued by the
\nMinistry of Health of Brazil, the European
\nCentre for Disease Prevention and Control
\n(ECDC), and the US Center for Disease
\nControl and Prevention (CDC) on a pos-
\nsible association between microcephaly and
\nthe recent outbreak of Zika virus infection
\n[14,15] (D). The first case of congenital
\nmalformations (microcephaly) found in the
\nEuropean Union and which is associated
\nwith infection by Zika virus during preg-
\nnancy, was published in February 2016 [4]
\n(C). The report was that of a case of fetus
\nwith microcephaly, whose mother had Zika
\nvirus infection in the first trimester of preg-
\nnancy after a trip to Brazil [4] (C).
\nThe sudden increase in the number of chil-
\ndren born with microcephaly associated
\nwith brain damage typically seen in congen-
\nital infections in regions where newly circu-
\nlating virus outbreak occurred, as well as the
\nidentification of viral genome in amniotic
\nfluid, are suggestive of a possible causal re-
\nlationship. Also, neurotropism of this virus
\nis known since 1952, found in studies using
\nguinea pigs [16] (C) [17] (D). However,
\nsome questions are necessary to understand
\nand validate the relationship of cause and
\nPubmed\/Medline
\nn=173
\nEmbase
\nn=171
\nCochrane
\nn=0
\nDuplicate articles
\nn=56
\nArticles selected for detailed reading of
\nthe full text n=288
\nArticles selected to be included
\nin the guideline n=30
\nStudies excluded
\nbecause they were
\nnot related to the
\ncomponents of
\nP.I.C.O. (n=171);
\nphysiological
\nstudies or animal
\nmodels (n=46); lack
\nof full text (n=41)
\nIncludedEligibilitySearchSearch
\nFigure 1. Flowchart for study selection
\n63
\nBACK TO CONTENTS
\neffect. The first point refers to the preva-
\nlence of the historical birth of infants with
\nmalformations of the central nervous sys-
\ntem in Brazil, which is about five cases per
\n100,000 live births, less than the estimates
\nrecently made of 10 to 20 cases per 100,000
\nlive births.This may indicate the occurrence
\nof underreporting of microcephaly in the
\ncountry [18] (D).Thus, any active search for
\nthis congenital malformation would be able
\nto increase its prevalence, with a clear excess
\nin the number of cases. Another point re-
\nlated to the increase in the number of cases
\nwould be the change in diagnostic criteria,
\naccepting as microcephaly cases of head
\ncircumference measuring less than 33 cm,
\nand possibly explaining a situation of over-
\ndiagnosis. Since the infection with Zika vi-
\nrus in newborns and pregnant women was
\nnot confirmed by laboratory tests at first,
\nanother relevant question is that the history
\nof nonspecific rash referred to during preg-
\nnancy is subject to recall bias and may have
\nincurred potential misclassification regard-
\ning exposure to Zika virus.Regardless of any
\ncontroversies to confirm, or not, the role of
\nZika virus in the genesis of cases of micro-
\ncephaly, measures to prevent infection with
\nthis virus are necessary and unquestionable.
\n2. What is the Association Between
\nZika Virus and Guillain-Barr\u00e9
\nSyndrome? Is it Different During
\nPregnancy? Can it Affect the Fetus?
\nGuillain-Barr\u00e9 syndrome (GBS) is a neu-
\nrological disease that consists of an acute
\nautoimmune inflammatory demyelinat-
\ning polyneuropathy. This is the leading
\ncause of widespread flaccid paralysis in the
\nworld with an annual incidence of 1 to 4
\ncases per 100,000 inhabitants [19] (D). It
\ntypically appears in two to three weeks after
\nnonspecific viral infection. The occurrence
\nof neurological syndromes after infectious
\nprocesses by dengue virus and chikungunya
\nhas been described since the late 1960s, and
\nwith Zika virus infection since 2007, espe-
\ncially after the outbreaks in Micronesia and
\nin French Polynesia [2] (C).
\nIn the primary databases consulted, there is
\nonly one case report on French Polynesia in
\nwhich GBS was diagnosed in a patient in-
\nfected with Zika virus.The report showed the
\nfirst case of GBS manifested seven days after
\nfebrile illness characterized as Zika virus in-
\nfection based on serological results [20] (C).
\nThe association between Zika virus infec-
\ntion and Guillain-Barr\u00e9 syndrome still
\nneeds confirmation through analytical stud-
\nies. One factor that hinders greater under-
\nstanding about this association in Brazil is
\nthe lack of epidemiological data specific to
\nthis syndrome.
\n3. What are the symptoms in pregnant
\nwomen with suspected Zika virus
\n\u00adINFECTION? Are they different
\nthan in the general population?
\nIt is estimated that 80% of people infect-
\ned with Zika virus do not develop clinical
\nmanifestations as seen from epidemiologi-
\ncal studies,however,when they appear,signs
\nand symptoms usually are fever, pruritic
\nmaculopapular rashes, non-purulent con-
\njunctivitis, fatigue and myalgia, and joint
\npain in the extremities (wrist\/ankle), often
\nassociated with edema. Other unspecific
\nmanifestations that may be reported are
\nheadache, retro-orbital and abdominal pain,
\ndiarrhea, vomiting, constipation and cough
\n[3,4,21-24] (C). No sign is pathognomonic
\nof infection with Zika virus.
\nStudies specifically evaluating the population
\nof pregnant women infected with Zika virus
\nare rare in the literature. However, a case se-
\nries conducted in Brazil revealed that 72.4%
\n(n = 21) of the women experienced rash;
\n44.8% (n = 13) had fever; 37.9% (n =\u00a011) had
\narthralgia; with headache in 17.2%, and pru-
\nritus in 13.8%. All pregnant women denied
\nophthalmologic manifestations [23] (C). In
\nthis study, other causes for the symptoms
\nwere excluded such as infection with cyto-
\nmegalovirus, rubella, herpes virus, syphilis,
\ntoxoplasmosis and HIV. Nevertheless, the
\nmajor problem in this assessment would be
\nthe sample which was made for the con-
\nvenience of women who showed signs and
\nsymptoms suggestive of infection with Zika
\nvirus. Another point of great limitation for
\nthe interpretation of these results is the lack
\nof statistical analysis which would make it
\nimpossible to claim that the percentages or
\nfindings are exclusive to this population or
\nif they can be extrapolated to all presumed
\ninfections with Zika virus [23] (C).
\n4. How to make a definitive diagnosis
\nof Zika virus INFECTION
\nduring pregnancy?
\nInformation about laboratory abnormalities
\nduring Zika virus infection are scarce in the
\nliterature, but leukopenia, thrombocytope-
\nnia, elevation of serum lactate dehydroge-
\nnase, and elevated markers of inflammatory
\nactivity such as C-reactive protein are re-
\nported [25,26] (C).
\nA limiting factor that hinders a direct bio-
\nlogical diagnosis, especially using molecular
\nbiology techniques, and may be related to
\nfalse-negative results is that the Zika virus
\ngenome is made of ribonucleic acid (RNA)
\nwhich is very fragile. The Zika virus can be
\nisolated in cell cultures such asVero cells,and
\nits identification is done by indirect immu-
\nnofluorescence. However, this technique is
\nreservedforspecializedlaboratories[24](C).
\nImmunoenzymatic test (ELISA) for detec-
\ntion of immunoglobulins (IgG and IgM) and
\nplaque-reduction neutralization test (PRNT)
\ncan be used. But there is a problem related to
\nserological testing which is the possibility of
\ncross-reactivity as a result of previous infec-
\ntion by other flavivirus [4] (C) [27] (D).
\nThe identification of viral genome by re-
\nverse transcriptase followed by real-time
\npolymerase chain reaction (RT-PCR) from
\nRNA directly extracted from the patient\u2019s
\nserum and preferably collected up to the
\nsixth day of the disease is the most sensi-
\ntive and specific method for diagnosis of
\nZika virus infection [4,29] (C) [28] (D).
\nOne must be aware of the possibility of
\nfalse-negative results since,contrary to what
\nis observed for other viruses, the restricted
\ncirculation of Zika virus has limited the
\nknowledge about its actual genetic diversity.
\nZika VirusFEDERATIVE REPUBLIC OF BRAZIL
\n64
\n5. What is the treatment for Zika virus
\nINFECTION during pregnancy?
\nThere are no vaccines, preventive drugs, or
\nspecific antiviral treatments for Zika virus
\ninfection. Treatment is generally support-
\nive and may include rest, hydration, non-
\nsteroidal anti-inflammatory drugs or non-
\nsalicylic analgesics used on an individual
\nbasis after careful clinical evaluation. Given
\nthat clinical diagnosis is not conclusive, and
\neven serological analysis may fail, the use of
\nsalicylates as analgesics should be discour-
\naged because of the increased risk of hem-
\norrhagic events described in hemorrhagic
\nsyndromes, as in other flavivirus infections.
\nThe pathophysiology of cutaneous mani-
\nfestations remains unknown, but antihista-
\nmines may be of benefit to patients, acting
\nas a sedative and not as an agent to treat the
\ncause of the itching [30] (D).
\n6. How is THE follow-up of
\npregnant women INFECTED
\nWITH Zika virus done?
\nPregnant women tested positive for Zika
\nvirus infection (identified by RT-PCR or
\ndetection of IgM\/IgG immunoglobulins)
\nshould be referred for high-risk prenatal
\ncare. There are no studies with an appro-
\npriate design plan for the monitoring of
\npregnant women diagnosed with Zika virus
\naiming to assess the prognosis or quality of
\nlife. However, if the fetal ultrasound exami-
\nnation is normal in women tested positive
\nfor Zika virus infection, both physician and
\npatient should considerer scheduling ultra-
\nsounds serially every 3 to 4 weeks to moni-
\ntor fetal anatomy and growth [31] (D).
\n7. What are the precautions to
\nbe taken with babies born from
\npregnant women with a history
\nof Zika virus INFECTION?
\nTargeted diagnostic tests to identify Zika
\nvirus infection should be recommended for
\ninfants with microcephaly or intracranial
\ncalcifications born to women who traveled
\nto or lived during pregnancy in areas where
\nthe virus circulates; or children born to
\nmothers with positive or inconclusive results
\nfor Zika virus infection. A newborn is con-
\nsidered congenitally infected if viral RNA
\nor antigen is identified in any samples pre-
\nsented for analysis, including testing of am-
\nniotic fluid or placental cord blood analysis.
\nFor newborns with laboratory evidence of
\npossible congenital infection with Zika vi-
\nrus, further clinical evaluation and monitor-
\ning are recommended. In these cases, clini-
\ncal history, physical examination including
\nmeasurement of head circumference,length,
\nweight and assessment of gestational age,
\nare needed.Neurological abnormalities,skin
\nrashes, dysmorphic features, splenomegaly
\nand hepatomegaly should be evaluated.
\nOphthalmologic evaluation and otoacoustic
\nemission examination should be conducted
\nbefore hospital discharge or within a month
\nafter birth [32] (C).
\nFor children with microcephaly or intra-
\ncranial calcifications, additional evaluation
\nshould include consultation with a pediatric
\nneurologist.Test for other congenital infec-
\ntions such as syphilis, toxoplasmosis, rubel-
\nla, cytomegalovirus and herpes simplex vi-
\nrus infections should be requested. Genetic
\ncauses should also be investigated, as well
\nas maternal substance abuse, exposure to
\nionizing radiation, use of teratogenic agents
\nand infections in general [33] (D).
\n8. What care is required for
\nnewborns diagnosed with
\nmicrocephaly during pregnancy?
\nBecause of the wide variety of differential
\ndiagnosis ranging from other congenital
\ninfections, genetic abnormalities, familial
\nmicrocephaly, and more, it is imperative
\nto confirm the diagnosis of Zika virus in-
\nfection in microcephalic newborns. Thus,
\ncareful history should answer the following
\nquestions: maternal history (intrauterine in-
\nfections, placental insufficiency, pre-existing
\nmaternal diseases); maternal exposure to
\nionizing radiation or potentially terato-
\ngenic agents (drugs, alcohol, smoking, etc.);
\ndrugs used during pregnancy; presence of
\nskin rash and other signs and symptoms
\nof infection during pregnancy; and family
\nhistory. Complete physical examination of
\nthe newborn should be performed, with the
\nmeasurement of head circumference,length,
\nweight and gestational age assessment, also
\nincluding a detailed neurological examina-
\ntion. Ophthalmologic evaluation within
\n1 month after birth is recommended, in-
\ncluding retinal assessment, since abnormal
\nophthalmologic findings such as macular
\nabnormalities and optic nerve disorders are
\nreported in microcephalic children with
\npossible congenital infection with Zika vi-
\nrus [23,24] (C). The mother must also be
\ntested for Zika virus infection, in case this
\nwas not done during pregnancy.
\nReferences
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\nFEDERATIVE REPUBLIC OF BRAZILZika Virus
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\nBACK TO CONTENTS
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\nprevalencetables.
\n19.\t Yoshikawa H. [Epidemiology of Guillain-Barr\u00e9
\nsyndrome]. Brain Nerve. 2015; 67(11):1305-11.
\n20.\tOehler E, Watrin L, Larre P, Leparc-Goffart I,
\nLastere S, Valour F, et al. Zika virus infection
\ncomplicated by Guillain-Barr\u00e9 syndrome \u2013 case
\nreport, French Polynesia, December 2013. Euro
\nSurveill. 2014; 19(9). pii: 20720.
\n21.\tHeang V, Yasuda CY, Sovann L, Haddow AD,
\nTravassos da Rosa AP, Tesh RB, et al. Zika vi-
\nrus infection, Cambodia, 2010. Emerg Infect Dis.
\n2012; 18(2):349-51.
\n22.\tOlson JG, Ksiazek TG, Suhandiman, Tri-
\nwibowo. Zika virus, a cause of fever in Central
\nJava,Indonesia.Trans R SocTrop Med Hyg.1981;
\n75(3):389-93.
\n23.\tde Paula Freitas B, de Oliveira Dias JR, Prazeres
\nJ, Sacramento GA, Ko AI, Maia M, et al. Ocular
\nfindings in infants with microcephaly associated
\nwith presumed Zika virus congenital infection in
\nSalvador, Brazil. JAMA Ophthalmol. 2016. [Epub
\nahead of print]
\n24.\tHeang V, Yasuda CY, Sovann L, Haddow AD,
\nTravassos da Rosa AP, Tesh RB, et al. Zika vi-
\nrus infection, Cambodia, 2010. Emerg Infect Dis.
\n2012; 18(2):349-51.
\n25.\tZammarchi L, Stella G, Mantella A, Bartolozzi
\nD, Tappe D, G\u00fcnther S, et al. Zika virus infec-
\ntions imported to Italy: clinical, immunological
\nand virological findings,and public health impli-
\ncations. J Clin Virol. 2015; 63:32-5.
\n26.\tCao-Lormeau VM, Roche C, Teissier A, Robin
\nE,Berry AL,Mallet HP,et al.Zika virus,French
\npolynesia, South pacific, 2013. Emerg Infect Dis.
\n2014; 20(6):1085-6.
\n27.\tMansfield KL, Horton DL, Johnson N, Li L,
\nBarrett AD, Smith DJ, et al. Flavivirus-induced
\nantibody cross-reactivity. J Gen Virol. 2011;
\n92(Pt 12):2821-9.
\n28.\tScaramozzino N, Crance JM, Jouan A, DeBriel
\nDA, Stoll F, Garin D. Comparison of flavivirus
\nuniversal primer pairs and development of a
\nrapid, highly sensitive heminested reverse tran-
\nscription-PCR assay for detection of flaviviruses
\ntargeted to a conserved region of the NS5 gene
\nsequences. J Clin Microbiol. 2001; 39(5):1922-7.
\n29.\tBalm MN, Lee CK, Lee HK, Chiu L, Koay
\nES, Tang JW. A diagnostic polymerase chain
\nreaction assay for Zika virus. J Med Virol. 2012;
\n84(9):1501-5.
\n30.\tEuropean center for disease prevention and con-
\ntrol. [cited 2016 Feb 19]. Available from: http:\/\/
\necdc.europa.eu\/en\/healthtopics\/zika_virus_in-
\nfection\/factsheet-health-professionals\/
\nPages\/factsheet_health_professionals.aspx
\n31.\tOduyebo T, Petersen EE, Rasmussen SA, Mead
\nPS, Meaney-Delman D, Renquist CM, et al.
\nUpdate: Interim Guidelines for Health Care
\nProviders Caring for Pregnant Women and
\nWomen of Reproductive Age with Possible Zika
\nVirus Exposure \u2013 United States, 2016. MMWR
\nMorb Mortal Wkly Rep. 2016; 65(5):122-7.
\n32.\tVentura CV, Maia M, Bravo-Filho V, G\u00f3is AL,
\nBelfort R Jr. Zika virus in Brazil and macular at-
\nrophy in a child with microcephaly.Lancet.2016;
\n387(10015):228.
\n33.\tStaples JE, Dziuban EJ, Fischer M, Cragan
\nJD, Rasmussen SA, Cannon MJ, et al. Interim
\nGuidelines for the Evaluation and Testing of
\nInfants with Possible Congenital Zika Virus
\nInfection \u2013 United States, 2016. MMWR Morb
\nMortal Wkly Rep. 2016; 65(3):63-7.
\n34.\tVentura CV, Maia M, Ventura BV, Linden VV,
\nAra\u00fajo EB, Ramos RC, et al. Ophthalmological
\nfindings in infants with microcephaly and pre-
\nsumable intra-uterus Zika virus infection. Arq
\nBras Oftalmol. 2016; 79(1):1-3.
\nBrazilian Medical Association
\nFlorentino Cardoso,
\nPresident of the Brazilian Medical Association
\nE-mail: presidente@amb.org.br
\nGiovanni Cerri,
\nScientifc Director of the Brazilian
\nMedical Association
\nE-mail: giovanni_cerri@uol.com.br
\nAntonio Salom\u00e3o,
\nProfessor of Gynecology,
\nUniversity of S\u00e3o Paulo
\nE-mail: antoniosalomao@uol.com.br
\nWanderley Bernardo,
\nGuideline Scientific Editor of the
\nBrazilian Medical Association
\nE-mail: wmbernardo@usp.br
\nRicardo Sim\u00f5es,
\nMember of the Guideline Program,
\nBrazilian Medical Association
\nE-mail: ricardo.simoes@amb.org.br
\nRenata Buzzini,
\nMember of the Guideline Program,
\nBrazilian Medical Association
\nE-mail: renata@cardapioterapia.com.br
\nZika VirusFEDERATIVE REPUBLIC OF BRAZIL
\n66
\nREPUBLIC OF TURKEYNMA News
\nThe Turkish Medical Association and its lo-
\ncal body the Istanbul Chamber of Medicine
\nin collaboration with the World Medical
\nAssociation hosted a very important event
\non 26\u201327 February 2016 in Istanbul on the
\nrecent global migration crisis. The \u201cWar,
\nMigration and Health: What Should Phy-
\nsicians Do?\u201d symposium agenda included
\nmany aspects of the crisis, offering solutions
\nas well. See Flyer of the Symposium.
\nThe Symposium started with key speeches
\nframing the burden as a global issue. Prof.
\nSir Michael Marmot, President of the
\nWorld Medical Association, opened the
\nSymposium with his marvelous key speech
\nhighlighting the inequalities in the world.
\nFrom beginning to end, excellent speeches
\nfrom distinguished guests were presented.
\nHumanity, health, ethics, economic and
\nother aspects were discussed during the
\nSymposium.
\nAbout 200 participants from 17 countries
\nparticipated in the Symposium. Medical
\nAssociations from Germany, Greece, Bel-
\ngium, France, the United Kingdom, Israel,
\nSweden, Switzerland, the Turkish Republic
\nof Northern Cyprus, Lithuania, Norway,
\nPoland, Ukraine, representatives of medi-
\ncal organizations from the US, Albania and
\nUganda, representatives of international
\norganizations (United Nations Population
\nFund (UNFPA), M\u00e9decins Sans Fron-
\nti\u00e8res (MSF), Physicians for Human Rights
\n(PHR), Junior Doctors Network (JDN),
\nWorld Health Organization (WHO)-Tur-
\nkey, Presidency of Migration Management,\u00a0
\nDisaster and Emergency Management
\nAuthority (AFAD), Peoples\u2019 Bridge Asso-
\nciation, Peace Association,Turkish Medical
\nStudents International Committee\u00a0 (Turk-
\nish MSIC),Turkish Psychiatry Association,
\nTurkish Thorax Association, Association of
\nPublic Health Specialists (HASUDER),
\nTurkish Nurses Association, and Associa-
\ntion of Social Workers Migration) [2] dis-
\ncussed migration as a result of the war with
\nall its effects.
\nMain messages given in the Symposium are
\nlisted below:
\n1.\t About the current situation:
\na.\t Global inequality is a very significant
\nchallenge and creates health gap.
\nb.\tMigration, very closely linked with
\nwar, has been occurring and is deter-
\nmined by inequalities, the economic
\ncrisis, and other unlisted determinants
\nof health.
\nc.\t Millions of people have to move from
\nhome countries to other places because
\nof war and other compelling life threat-
\nening conditions.
\nd.\tThreats are occurring for migrants
\nwhile leaving their homelands on their
\nmigration path, and while adapting to
\ntheir \u201cnew\u201d lands.
\ne.\tChildren, women, disabled people,
\naged people have double burden in
\ntheir struggle aiming to survive.
\nf.\t The problem is not local. Global agen-
\nda is needed for solution.
\n2.\t About the major goal(s):
\na.\t Ending the underlying conditions re-
\nsponsible for the migration of people.
\nb.\t Guarantee of life and travel conditions
\nfor migrants.
\nc.\tHuman dignity should be protected for
\nall affected people.
\nd.\tHuman rights should be guaranteed to
\nall individuals.
\n3.\t About the responsible bodies:
\na.\t State-level public authorities have the
\nmajor responsibility to provide human-
\nitarian conditions for everyone.
\nb.\tMunicipalities should support state-
\nbased services.
\nc.\tRecommendations,guidelines and dec-
\nlarations of international organizations,
\ne.g. the United Nations and the World
\nMedical Association, should be used in
\nfull without any exception.
\nd.\tCollaboration with public authorities
\nand civil society should be created.
\n4.\t About the physicians\u2019 role(s):
\na.\t Physicians have role(s) in facing the
\ndifficulties of armed conflict(s).
\nb.\tPhysicians have significant role(s) in
\norganizing and providing healthcare
\nservices to individuals and communi-
\nties in dire conditions.
\nIstanbul Symposium on War, Migration and
\nHealth
\nBayazit Ilhan Dilek Aslan
\n67
\nBACK TO CONTENTS
\nREPUBLIC OF TURKEY NMA News
\nc.\tPhysicians providing services should
\nnot be hampered due to any reason. All
\nprecautions should be taken in this re-
\ngard.
\nd.\tPhysicians should struggle for human
\ndignity.
\ne.\tPhysicians should advocate for peace at
\nthe global level as they are the voice of
\nhumanity.
\nIn conclusion, the Symposium gave the orga-
\nnizers and participants a chance to discuss
\nthe \u201cwar\u201d and \u201cmigration\u201d issues in a very
\nbroad perspective. In this sense, solutions
\nwere discussed realistically and sincerely.
\nThe Symposium was full of hope that the
\nrecommendations will be implemented in
\nreal life.
\nThe Symposium ended with accepting a
\ncommuniqu\u00e9 including all the discussed
\nproblems and solutions [3]. The Sympo-
\nsium website (warmigrationhealth.com) is
\nstill active including all the details and vid-
\neo records of the speeches in English and
\nTurkish.
\nThe Turkish Medical Association and its
\nlocal body the Istanbul Chamber of Medi-
\ncine were honored to collaborate with the
\nWorld Medical Association in organizing
\nsuch a symposium on a very hot topic for
\nthe Global Health Agenda.
\nHopefully, outputs of the Symposium
\nwould contribute to solving the problem(s)
\nin the very near future.
\nDoctors as the voices of solidarity and peace
\nwill work continuously in this regard\u2026
\nReferences
\n1.\t [Cited 2016 June 07] Available from http:\/\/
\nwww.wma.net\/en\/50events\/20otherevents\/99p
\nastotherevents\/92Istanbul2016021\/index.html.
\n2.\t [Cited 2016 June 07] Available from http:\/\/war-
\nmigrationhealth.com\/?lis=en
\n3.\t [Cited 2016 June 07] Available from http:\/\/
\nwarmigrationhealth.com\/kategori\/commu-
\nnique-287.html
\nBayazit Ilhan, MD,
\nPresident, Turkish Medical Association
\nE-mail: ilhanbayo@yahoo.com
\nDilek Aslan, MD,
\nTurkish Medical Association, Bureau
\nof International Affairs, member of the
\nSymposium organizing committee
\nE-mail: diaslan.dr@gmail.com
\nSYMPOSIUM
\n26-27 February 2016
\nIstanbul \/ Turkey
\nwarmigrationhealth.com
\n\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014
\n\u2022 War,\tmigration\tand\tsocial\tdeterminants
\nof\thealth
\n\u2022 Medical\tproblems\trelated\tto\tmigration
\n\u2022 Experience\tof\tTurkey\tand\tTMA\u2019s
\nactivities
\n\u2022 Policies\tof\tcountries\tand\tinstitutions
\nrelated\tto\tmigration
\n\u2022 Women\tand\tWar
\n\u2022 Presentations\tof\tphysician
\norganisations
\nBACKGROUND
\nThe World Medical Association
\ntogether with the Turkish Medical
\nAssociation and the Istanbul Chamber
\nof Medicine will hold a Symposium on
\nWar, Migration and Health, following an
\nemergency resolution adopted by the
\nWMA General Assembly in October
\n2015 on this critical issue.
\nMany countries face signi\ufb01cant
\nproblems maintaining effective health
\nand social care systems and are
\nunable to respond to the basic needs
\nof refugees and migrants. War and
\ninternal con\ufb02icts in countries of origin,
\nextreme poverty in transit countries,
\nand limited resources and political
\npressure in rich destination countries
\nare just some of the obstacles
\ninhibiting action. The resultant impact
\nis that refugees and migrants face
\nsevere dif\ufb01culties in securing food,
\nshelter and access to healthcare.
\nPARTICIPATION
\nthe WMA wishes to address these
\nproblems in an international
\nsymposium, and therefore urgently
\nrequests your participation in order to
\nlearn from your experience including.
\nthe health problems of refugees and
\nmigrants, access to healthcare,
\ngovernment reactions and responsive
\npolicies, experiences of healthcare
\nworkers, NMAs and NGOs,
\nobservations and recommendations.
\nPlease see the website for details.
\nwarmigrationhealth.com
\nWar
\nMigration
\nand
\nHealth
\n68
\nSoutheast European Medical Forum
\nSEEMF is a legal non-for-profit entity. It
\nis registered under Bulgarian legislation.
\nSEEMF President is Dr.\u00a0Andrey Kehayov \u2013
\nPresident of Bulgarian Physician Association,
\nvice-presidents are Prof. Pavel Poredos \u2013 Pres\u2011
\nident of the Slovenian Medical Association and
\nDr.\u00a0 Oleg Musii \u2013 Member of Parliament of
\nUkraine and President of the Ukrainian Med\u2011
\nical Association, Secretary General \u2013 Dr.\u00a0Styli\u2011
\nanos Antypas, Athens, Greece.
\nSEEMF Board
\nPresident: Dr.\u00a0Andrey Kehayov, Bulgaria
\nVice-Presidents:
\nProf. Pavel Poredos, Slovenia; Dr.\u00a0 Oleg
\nMusii, Ukraine
\nSecretary General: Dr.\u00a0Stylianos Antypas,
\nHellas
\nMembers:
\nDr.\u00a0Din Abazaj, Albania
\nDr.\u00a0Fatmir Brahimaj, Albania
\nProf. Veselin Borisov, Bulgaria
\nDr.\u00a0Valiantsina Hancharova, Belarus
\nProf. Gia Lobzhanidze, Georgia
\nProf. Slobodan Tomic, Montenegro
\nProf. Dusko Vasic, Republic Of Srpska
\nProf. Sinisa Miljkovic, Republic Of Srpska
\nDr.\u00a0Aizhan Sadykova, Kazakhstan
\nDr.\u00a0Zokhid Abdurakhimov, Uzbekistan
\nProf. Abdullah Khudaybergenov, Uzbekistan
\nDr.\u00a0Nariman Safarli, Azerbaijan
\nDr.\u00a0Romeo Scerbina \u2013 Moldova
\nProf. Jaroslav Blahos, Czech Republic
\nDr.\u00a0Gligor Tofoski, Macedonia
\nDr.\u00a0Goran Dimitrov, Macedonia
\nDr.\u00a0Athanasios Exadaktylos, Hellas
\nProf. Milan Milanov, Bulgaria
\nMember-countries: Bulgaria, Slovenia,
\nHellas, Albania, Belarus Georgia, Monte-
\nnegro, Republic Of Srpska, Kazakhstan,
\nUzbekistan, Azerbaijan, Moldova, Czech
\nRepublic, Macedonia
\nThe Southeast European Medical Forum
\n(SEEMF) was founded at a meeting in So-
\nfia in 2005 by medical organizations of Al-
\nbania, Bulgaria,Greece,and Macedonia as a
\nsociety of organizations of physicians from
\nSoutheast European countries \u2013 neighbor-
\ning countries with similar problems. The
\nmeeting adopted Statutes. Decision was
\ntaken to invite other organizations from the
\nregion to join.The name of the organization
\nwas agreed upon.
\nSEEMF was later joined by the medical as-
\nsociations of Slovenia, Republic of Srpska,
\nMontenegro, Ukraine, Georgia, Kazakh-
\nstan, Belarus, Uzbekistan, Azerbaijan, Mol-
\ndova, Czech Republic.
\nIts purpose is to promote the partnership
\nof the medical profession in the member-
\ncountries, to discuss common problems
\nand to find solutions; to enable exchange
\nof experience, strengthen the relations and
\nelaborate common approaches in all fields
\nof activity of the medical organizations;
\nto develop continuous medical educa-
\ntion through medical congresses and other
\nforms of mutual activity; to assist its mem-
\nbers for improvement of their medical and
\nmanagement-related qualification; to es-
\ntablish contacts and partnership with other
\ninternational organizations.
\nMain Goals
\n1.\t To unite and assist its members for
\nachievement of their common aims;
\n2.\t To enable exchange of experience and
\ndevelop common approaches in all fields
\nof activity of the medical organizations;
\n3.\t To promote in the Southeast European
\ncountries the best possible medical edu-
\ncation, medical practice and healthcare;
\n4.\t To strengthen the relations between the
\nmedical organizations of the Southeast
\nEuropean countries;
\n5.\t To strengthen the relations between the
\nphysicians from the Southeast Euro-
\npean countries and the exchange of ex-
\nperience with their colleagues from the
\nEU member-countries;
\n6.\t To assists its members for improvement
\nof their medical and managerial quali-
\nfication;
\n7.\t To establish contacts with similar orga-
\nnizations;
\n8.\t To defend the rights and interests of
\nphysicians, healthcare establishments,
\nand medical professionals before the
\nlegislative, executive and legal authori-
\nties by submission of drafts and stands
\non regulations, legal proceedings, etc.
\nAs of 2010 SEEMF intensified its activities
\nand is holding at least two Board Meetings
\nand a Congress each year.
\nThe First SEEMF Congress took place in
\nVarna, Bulgaria in 2010.
\nIt focused on different specialized topics
\nas well as on Patient Safety and Health Is-
\nsues and Health Policies under Conditions
\nSoutheast European Medical Forum
\nAndrey Kehayov
\n69
\nBACK TO CONTENTS
\nSoutheast European Medical Forum
\nof Economic Crisis. Participants from 14
\ncountries attended the event and presenta-
\ntions were made by outstanding physicians
\nand representatives of medical science, in-
\ncluding Prof. Enis Ozyar from Turkey and
\nProf. Peter Schwarz from Germany. The
\nmeeting adopted the following
\nThe Second international medical congress of
\nSEEMF was held in the period 7\u201311 Sep-
\ntember 2011 in Nesebar, Bulgaria.
\nThe main Congress topics were:
\n\u2022\t Diabetes and Complications
\n\u2022\t Cardiovascular Diseases
\n\u2022\t Infectious Diseases
\n\u2022\t Oncologic Diseases
\nA Round Table was held on \u201cHealth Re-
\nforms and Funding\u201d
\nDr.\u00a0 Wonchat Subhachaturas, President of
\nthe World Medical Association welcomed
\nthe Congress participants and presented the
\nWorld Medical Association.
\nThe first awards Outstanding Physician of
\nSoutheast Europe were granted to Prof.
\nGencho Nachev, Bulgaria and Prof. Jovan
\nTofoski, Macedonia
\nThe Third international medical congress of
\nSEEMF took place in Belgrade, Serbia in
\nthe period 12\u201315 September 2012.
\nReports on major topics, namely cardiology,
\ndiabetes, oncology and Immunization in the
\n21st century aroused great interest among the
\nparticipants.The agenda included discussions
\non \u201cHealth and health systems in Southeast
\nEurope in the 21st Century\u201d and \u201cNational
\nmedical associations and chambers in South-
\neastern Europe \u2013 the role of professional self-
\nregulation.\u201d A significant number of partici-
\npants shared their views on these issues.
\nDuring the Congress a Board Meeting was
\nheld at which changes to the SEEMF Stat-
\nutes were adopted and elections were held
\nfor Board leaders.\t SEEMF President, two
\nVice-Presidents and Secretary General
\nwere elected.
\nThe Fourth international medical congress
\nof SEEMF took place in Portoroz, Slovenia
\nin the period 11\u201315 September 2013 with
\nparticipants from over 20 countries and fac-
\nulty of about 60 outstanding professors in
\ndifferent medical fields.
\nThe Congress was organized in partnership
\nwith the Slovenian Medical Association,
\nand was attended by guests from Albania,
\nAzerbaijan, Belarus, Bosnia and Herze-
\ngovina, Bulgaria, Croatia, Germany, Greece,
\nKazakhstan, Latvia, Macedonia, Serbia,
\nSlovenia,Turkey, Ukraine and Montenegro.
\nSelf-evident of the reputation that the
\nSEEMF has, as well as of the need of medi-
\ncal professionals to share their thoughts and
\nexperience was the fact that the medical as-
\nsociations of Azerbaijan and Moldova were
\naccepted as members of the organization.
\nThe multidisciplinary scientific agenda of
\nthe Congress was focused mainly on the
\nfields of cardiology, diabetes treatment, or-
\ngan transplantations and oncology. Many
\ninteresting topics were debated at a round
\ntable discussion on the issues of healthcare
\nfunding and the role of professional orga-
\nnizations. The high value of reports, lectur-
\ners and topics was the fact that participants
\nwere granted European certificates with the
\nscore of 15 credits.
\nThe Fifth international medical congress of
\nSEEMF was held in the period 10\u201314 Sep-
\ntember 2014,in Ohrid,Macedonia.The main
\nscientific topics were: Oncology, Diabetes
\nmellitus, Cardiology,Calamity Medicine
\nThe Public Health Impact of immunization
\nand vaccine prophylaxis \u2013 challenges and
\npriorities
\nThe Round Table was dedicated to e-health;
\nrealities, problems and financing of health
\nsystems in SE Europe.
\n2014 created a new opportunity for
\nthe Southeast European Medical Fo-
\nrum (SEEMF) to expand its reach and
\nstrengthen its recognition. The Forum ac-
\ncepted a new member \u2013 the Czech Medi-
\ncal Association, which has 34 000 doctors
\nas its members. At the opening of the
\nCongress, which was hosted by the city
\nof Ohrid, Macedonia, the president of the
\nSEEMF Dr.\u00a0Andrey Kehayov said a sig-
\nnificant scientific forum was about to take
\nplace. \u201cRegardless of the political situation
\nwe provided the idea that doctors have
\nto stand united because they all have one
\nmission in every country \u2013 treat their pa-
\ntients. Communication among doctors is
\nof vital importance to help them improve
\ntheir experience,\u201d Kehayov said. The Fifth
\nCongress of SEEMF honoured the most
\nworthy doctors of Southeast Europe, as
\nwell as organisations and structures that
\nsupported the Forum.
\nThe Fifth SEEMF Congress also issued a
\nresolution, based on all the reports present-
\ned at the Congress, in the fields of oncol-
\nogy, cardiology, infectious diseases, disaster
\nmedicine, and immunisation. Because of
\nthe vital significance of preventive measures
\nthe Congress issued an appeal for the na-
\ntional immunisation calendars in Southeast
\nEurope to be adapted to the best immuni-
\nsation practices of the European Union, in
\norder to achieve quality protection of chil-
\ndren health. Doctors recommended that a
\ncertain number of vaccines be introduced
\nto the universal mass vaccination: pneu-
\nmococcus vaccines, human papillomavirus
\nvaccines, rotavirus vaccines and vaccines
\nagainst meningococcal meningitis. The
\nunderfunded health systems of the coun-
\ntries in Southeast Europe would not secure
\nequal access to quality healthcare.Therefore,
\nall the states in the region should turn the
\nimprovement of their health sectors into a
\ntopmost priority.
\n70
\nAccording to the President of the SEEMF
\nDr.\u00a0 Andrey Kehayov, the resolution re-
\nflected all that had been shared with the
\nparticipants in the numerous lectures and
\nreports, as well as the experience the col-
\nleagues had shown to each other. Important
\nproblems were defined and addressed to the
\nmedical associations in respective countries
\nand the institutions responsible for solving
\nsuch issues. The participation of Standing
\nCommittee of European Doctors President
\nDr.\u00a0Katr\u00edn Fjeldsted allowed for the reso-
\nlution to be reviewed by all European and
\ninternational medical associations.
\nSEEMF also passed a declaration of in-
\nternational significance, in which doctors
\nof Southeast Europe declared themselves
\nagainst the decision to drop toxic chemicals
\nin the Mediterranean Sea after the destruc-
\ntion of Syria\u2019s chemical weapons\u2019caches.\u201cAs
\nprofessionals we have the fundamental goal
\nof protecting people\u2019s health. Recognising
\nall possible dangers of such a decision we
\ndeclare that we are categorically opposed to
\nan action that could jeopardize the life of all
\npeople inhabiting the area,\u201d the declaration
\nsaid.
\nSixth international medical congress of
\nSEEMF was held in the period 9\u201313 Sep-
\ntember 2015, Odessa, Ukraine
\nSoutheast European Medical Forum
\n(SEEMF) held its regular Sixth Interna-
\ntional Congress in Odessa Ukraine from
\n9.09 to 12.09.2015. The event was orga-
\nnized jointly with the Ukrainian Medical
\nAssociation, which celebrated its 25th an-
\nniversary.
\nThe Forum was attended by over 750 rep-
\nresentatives from more than 15 countries.
\nPresident of the World Medical Association
\nDr.\u00a0Xavier Deu welcomed the participants.
\nScientific reports in the field of cardiovas-
\ncular diseases, oncological diseases, repro-
\nductive health and other socially significant
\ndiseases were presented by distinguished
\nexperts from Bulgaria, Ukraine, Georgia,
\nBelarus,Latvia,Poland,Macedonia,Greece
\nand Slovenia. Military medicine and ca-
\nlamity medicine were among the topics
\ndiscussed. The participants in the round-
\ntable discussed the aspects of doctors\u2019 pro-
\nfessional autonomy. Dr.\u00a0Xavier Deu shared
\nthe experience of the French Medical As-
\nsociation.
\nDr.\u00a0Andrey Kehayov- President of SEEMF
\npresented the activities of SEEMF and ex-
\npressed his expectation about the effect of
\nthe Congress significant scientific contribu-
\ntions.
\nDr.\u00a0Maciej Hamankevich, president of the
\nSupreme Medical Council presented the
\nprofessional autonomy of the Polish doctors
\nand dentists.
\nDuring the event a meeting of the Board
\nof SEEMF was held. Dr.\u00a0 Stylianos Anti-
\npas from the Hellenic Republic was elected
\nSecretary General of the Forum, with a
\nmandate until 2017.
\nFour new members were elected in the
\nBoard of the organization \u2013 Prof.Milan Mi-
\nlanov, president of Sofia Branch of the Bul-
\ngarian Medical Association, Dr.\u00a0Anastasios
\nEksadaktilos \u2013 Chairman of Thessaloniki
\nMedical Association and two representa-
\ntives of the Macedonian Medical Organi-
\nzation- Dr.\u00a0 Goran Dimitrov, chairman of
\nthe Macedonian Medical Association and
\nDr.\u00a0Gligor Tofoski. The board resolved that
\nnext year the organization will hold two
\ncongresses \u2013 one in Georgia and one in the
\nHellenic Republic.
\nThe Board approved the traditional award
\nnominations in the field of medicine, such
\nas outstanding physician of Southeastern
\nEurope, for contribution to public health
\ndevelopment, etc.
\nDr.\u00a0 Oleg Musii Chairman of the Ukrai-
\nnian Medical Association and member
\nof the Verkhovna Rada was awarded for
\ncontribution to the development of Public
\nHealth. The President of the World Medi-
\ncal Association Xavier Due was awarded
\nfor his outstanding contribution to the
\ndevelopment of international medical co-
\noperation. Prof.Krasimir Gigov, Secretary
\nGeneral of the Bulgarian Red Cross was
\nawarded for contribution to the develop-
\nment of public health. University Hospital
\n\u201cSaint Catherine\u201d by CEO Prof. Gencho
\nNachev and Prof. Milan Milanov, presi-
\ndent of the Metropolitan Medical College
\nwere honored for contribution to the de-
\nvelopment of SEEMF. Dr.\u00a0Nikolai Tish-
\nchuk of Ukrainian Medical Association
\nwas honored with the award for many years
\nof work in the interest of the medical pro-
\nfession. Dr.\u00a0Stylianos Antipas \u2013 SEEMF
\nBoard member was honored for his ac-
\ntive position on environmental protection
\nand public health issues. Acd. Prof. Lu-
\nbomir Pyrgi from Ukraine, Prof. Svetoslav
\nSchnittke, from Belarus and Prof. Ketevan
\nNemsadze, corresponding member of the
\nGeorgian National Academy of Sciences
\nwere honored for contribution to medical
\nscience development.
\nInternational Cooperation
\nSEEMF leaders have taken part in a num-
\nber of international meetings, the most
\nimportant of which being the European
\nForum of Medical Associations and WHO
\nand the WMA General Assembly.
\nSEEMF Awards
\nOutstanding Physicians Of Southeastern
\nEurope
\nProf. Jovan Tofoski \u2013 2011
\nProf. Gencho Nachev \u2013 2011
\nProf. Pavel Poredos \u2013 2013
\nProf. Katica Zafirovska \u2013 2014
\nAcad. Wladimir Ovtscharoff \u2013 2014
\nProf. Dimitri Kordzaya \u2013 2014
\nAcad. Prof. Lubomyr Pyrih \u2013 2015
\nSoutheast European Medical Forum
\n71
\nBACK TO CONTENTS
\n2011
\n1.\t Dr.\u00a0 Stylianos Antypas \u2013 Award For
\nContribution To Healthcare Improve-
\nment In Southeastern Europe
\n2.\t Dr.\u00a0 Oleg Musii \u2013 \u2013 Award For Con-
\ntribution In The Field Of Healthcare
\nManagement And Policy
\n3.\t Dr.\u00a0 Vladimir Lazarevic \u2013 Award For
\nContribution To The Development Of
\nSeemf
\n4.\t Dr.\u00a0Wonchat Subhachaturas \u2013 Award
\nFor Contribution For The Develop-
\nment Of International Medical Col-
\nlaboration
\n2012
\n1.\t Prof. Wladimir Ovtscharoff \u2013 Award
\nFor Contribution To Healthcare Im-
\nprovement In Southeastern Europe
\n2.\t Dr.\u00a0Din Abazaj \u2013 Award For Contribu-
\ntion To The Development Of Seemf
\n3.\t Prof Dusko Vasic \u2013 Award For Contri-
\nbution To The Development Of Seemf
\n2013
\n1.\t Prof. Goce Spasovski \u2013 Award For
\nContribution To Medical Science And
\nEducation In Southeastern Europe
\n2.\t Dr.\u00a0 Aizhan Sadykova \u2013 Award For
\nContribution To The Development Of
\nSeemf
\n3.\t Prof Gia Lobzhanidze \u2013 Award For
\nContribution To The Development Of
\nSeemf
\n4.\t Assoc. Prof. Dr.\u00a0Mateja Kaja Je\u017eovnik,
\nMd, Phd, Department Of Vascular Dis-
\nease, University Medical Centre Lju-
\nbljana, Ljubljana, Slovenia
\n2014
\n1.\t Prof. Dr.\u00a0Tzekomir Vodenicharov, Md,
\nPhd, Dsci, Dean Of The Public Health
\nFaculty, Sofia Medical University, Bul-
\ngaria \u2013 Award For His Contribution To
\nPublic Health Development In South-
\neastern Europe
\n2.\t Dr.\u00a0Katrin Fjeldsted, Cpme President\u00a0\u2013
\nAward For Her Distinguished Contri-
\nbution To The Development Of Euro-
\npean Medical Organizations
\n3.\t Prof. Jaroslav Blahos, Md, President Of
\nThe Czech Medical Association, Em.
\nPresident Of The World Medical Asso-
\nciation \u2013 Award For His Contribution
\nTo Public Health Development
\n4.\t Prof. Dr.\u00a0Milan Milanov, President Of
\nThe Sofia Branch Of The Bulgarian
\nMedical Association \u2013 Award For His
\nDistinguished Contribution For The
\nDevelopment Of Seemf
\n5.\t Dr.\u00a0 Todor Cherkezov, Md, Ceo Of
\nMphat \u201cDr.\u00a0 At. Dafovski\u201d Hospital,
\nBulgaria \u2013 Award For His Distin-
\nguished Contribution For The Devel-
\nopment Of Seemf
\n6.\t Prof. Dr.\u00a0Aleksej Duma, Shtip Medical
\nFaculty, Macedonia \u2013 Award For His
\nActive Work To The Interest Of The
\nMedical Profession
\n7.\t Dr.\u00a0 Zokhid Abdurakhimov, Phd, Ex-
\necutive Director Of The Medical Asso-
\nciation Of Uzbekistan \u2013 Award For His
\nContribution For Seemf Enlargement
\n8.\t Bulgarian Red Cross \u2013 Award For The
\nSupport Ad Distinguished Contribu-
\ntion For The Development Of Seemf
\n9.\t Actavis Company \u2013 Award For Their
\nRepeated Support Of Seemf Con-
\ngresses
\n10.\tNovartis Company \u2013 Award For Their
\nRepeated Support Of Seemf Con-
\ngresses
\n2015
\n1.\t Dr.\u00a0 Oleg Musii, President Of The
\nUkrainian Medical Association \u2013 Award
\nFor Contribution To Public Health De-
\nvelopment
\n2.\t Dr.\u00a0 Xavier Deau, Wma President \u2013
\nAward For His Distinguished Contri-
\nbution For The Development Of Inter-
\nnational Medical Collaboration
\n3.\t Dr.\u00a0Mykola Tyshchuk, Ukrainian Med-
\nical Association \u2013 Award For His Active
\nWork To The Interest Of The Medical
\nProfession
\n4.\t Dr.\u00a0 Stylianos Antypas, Seemf Board
\nMember \u2013 Award For His Active Posi-
\ntion On Environmental Protection And
\nPublic Health Issues
\n5.\t Prof. Sviataslau Shnitko, Belarus \u2013
\nAward For His Contribution To Medi-
\ncal Science Development
\n6.\t Prof. Ketevan Nemsadze, Correspond-
\ning Member Of The Georgian National
\nAcademy Of Sciences \u2013 Award For Her
\nContribution To Medical Science De-
\nvelopment
\n7.\t Assoc. Prof. Krasimir Gigov, Bulgarian
\nRed Cross Secretary General \u2013 Award
\nFor His Contribution To Public Health
\nDevelopment
\n8.\t Prof. Milan Milanov, Bulgarian Medi-
\ncal Association \u2013 Award For His Con-
\ntribution To The Development Of The
\nSoutheast European Medical Forum
\n9.\t Uh Sveta Ekaterina, Sofia, With Ceo
\nProf. Gencho Nachev \u2013 Award For
\nContribution To The Development Of
\nThe Southeast European Medical Fo-
\nrum
\nBulgaria, Sofia, 102 Bulgaria Blvd.,
\ntel.\/fax: +359 2 854 87 82
\nE-mail: bulgmed@gmail.com
\nWebsite: www.zdravenews.net
\nSoutheast European Medical Forum
\n72
\nBulgarian Medical Association
\nOffice Bearers
\nPresident: Dr.\u00a0Ventsislav Grozev
\nVice Presidents: Prof. Dr.\u00a0Ognyan
\nHadzhiy\u00adski, Dr.\u00a0Galinka Pavlova
\nSecretary General: Dr.\u00a0Stoyan Borisov
\nHistory in brief: Bulgarian Medical Asso-
\nciation was established in 1901 which made
\nit the second professional medical associa-
\ntion in the world after the British one. At
\nfirst, its objectives were to protect the in-
\nterests of the medical profession, determine their fees, but later on
\nit began to organize the medical care across the country and deter-
\nmine the health policy of the state. During the communist regime
\nthe Bulgarian Medical Association was put under a ban. It has been
\nrestored after the democratic changes in 1990.
\nMembership: Adopted in 1999, the Act on the Professional Or-
\nganizations of Physicians and Dentists legitimized the Bulgarian
\nMedical Association and the Bulgarian Dental Association as au-
\ntonomous statutory organizations. This law regulates the structure,
\norganization and activities of the professional organisations of phy-
\nsicians and dentists, the conditions for practising the medical and
\ndental professions and the liability for breaching of professional
\nethics. The law stipulates that all practising physicians and dentists
\nshall be members of the Bulgarian Medical Association,respectively
\nthe Bulgarian Dental Association.
\nStructure and major commitments: Bulgarian MA consists of 28
\nRegional Colleges. All the physicians with their full name, specialty,
\nwork address, unique identity number and qualification degrees are
\nlisted in the register of the respective Regional Medical College.
\nEvery physician holds an electronic professional card.
\nThe Association is committed to implementation of the following
\nmajor commitments (as stipulated in the Act on the Professional
\nOrganizations of Physicians and Dentists):
\n1.\t to represent its members and protect their professional rights
\nand interests;
\n2.\t to represent its members as a party to the National Framework
\nAgreement under compulsory health insurance law;
\n3.\t to work out a Code of Professional Ethics of physicians and to
\nsupervise the compliance therewith;
\n4.\t to adopt Rules of Good Medical Practice, to propose them for
\napproval to the Minister of Healthcare and to supervise the
\ncompliance therewith;
\n5.\t to impose the penalties provided in the Act on the professional
\norganizations where necessary;
\n6.\t to establish and keep a national electronic register and regional
\nregisters of its members;
\n7.\t to participate in the organization and delivery of continuing
\nprofessional development for physicians through the Accredita-
\ntion Council established at the Bulgarian Medical Association
\nand the Expert Medical Boards in all specialties;
\n8.\t to participate through representatives in the Supreme Medical
\nCouncil at the Ministry of Healthcare;
\n9.\t to give opinions on draft legislation in the field of health-
\ncare;
\n10.\tto cooperate with other national and international organiza-
\ntions and institutions;
\n15, Akademik Ivan Geshov Blvd.,
\n1431 Sofia, Bulgaria
\nPh.: +359-2-9541126;
\nFax: +359-2-9541186
\nE-mail: blsus@mail.bg;
\nforeign.bls@gmail.com
\nWebsite: www.blsbg.com
\nChinese Medical Association
\nOffice Bearers:
\nPresident: Xiao-wei Ma
\nVice President: Yu-pei Zhao, Ya-sen
\nMaimaiti, Ying-kang Shi, Yan-fei Liu,
\nZhi Su, Qing-jie Li, Bao-feng Yang, Bo-li
\nZhang, Sai-juan Chen, Da-peng Jin, Shu-
\nsen Zheng, Yang Ke, Ke-qin Rao, Fu-chu
\nHe, Jian-guang Xu, Fu Gao
\nSecretary General: Keqin Rao
\nMembership: 506,000
\nMission: The missions of the Association shall be to unite and or-
\nganize professionals of medical science and technology, to abide by
\nthe national Constitution, laws and regulations, and to implement
\nnational policies for science and technology and healthcare. The
\nAssociation shall uphold medical ethics and advocate social integ-
\nrity. It shall operate with democratic principles, support freedom of
\nscholarship, and seek to raise the technical skills of the professionals
\nof medical science and technology. It shall promote the prosper-
\nity and development of medical science and technology, and the
\npopularization of medical science and technology knowledge. It
\nshall promote the growth of work forces in medical science and
\ntechnology and the integration of medical science and technology
\nwith China\u2019s economic development. The Association shall provide
\nservices for its members and for professionals of medical science and
\nVentsislav Grozev
\nXiao-wei Ma
\nNMA news
\n73
\nBACK TO CONTENTS
\ntechnology, for the health of the Chinese people, and for socialist
\nmodernization in China.
\nServices provided:
\n1.\t To carry out medical exchange programs, to organize activities
\nfor research priorities and investigations, and to promote rela-
\ntions and collaborations among scientific disciplines and learned
\ngroups.
\n2.\t To edit and publish journals, books and materials and pro-
\nduce electronic audiovisual products of medical sciences, tech-
\nniques, information, and popularization of medical science
\nknowledge.
\n3.\t To provide continuing medical education and to organize its
\nmembers and professionals of medical science and technology
\nto upgrade their knowledge and raise their professional levels in
\nmedical science and technology.
\n4.\t To organize medical and health knowledge popularization and
\nhealth promotion activities through various channels and in dif-
\nferent forms to improve public health knowledge and increase
\nthe ability of the public to care for their own health.
\n5.\t Tobeinvolvedinthetrainingandexaminationofmedicalspecialists.
\n6.\t To organize technical assessments of medical malpractices.
\n7.\t To organize assessment and appraisal of projects of medical sci-
\nence and technology, evaluations of new clinical technologies,
\nand reviews and evaluations of decisions concerning medical
\nscience and technology, and to put forward medical, pharma-
\nceutical and technological suggestions for evidence-based deci-
\nsion-making for the government.
\n8.\t To develop relations with foreign groups and professionals of
\nmedical science and technology and carry out international and
\nTaiwan, Hong Kong, and Macao regional exchange and coop-
\nerative programs.
\n9.\t To provide consulting services on medical, pharmaceutical and
\nhealth science and technology and organize exhibitions to facili-
\ntate transfer and application of medical research results.
\n10.\tTo select and award outstanding achievements in medical sci-
\nence and technology including scientific papers and popular sci-
\nence writings, etc. and organize the assessment and award of the
\nChina Medical Award.
\n11.\tTo find, recommend and train outstanding talents of medical
\nscience and technology;
\n12.\tTo promote and award medical professionals for their medi-
\ncal ethics and skills, and to commend and award Association
\nmembers who make outstanding contributions to the activi-
\nties of medical science and technology and Association staff
\nmembers who make remarkable achievements for the Asso-
\nciation.
\n13.\tTo serve its members by keeping the Party and the government
\ninformed of the views and aspirations of the professionals of
\nmedical science and technology and by protecting their legal
\nrights and interests. And to organize programs and activities for
\nits members.
\n14.\tTo undertake tasks entrusted by relevant governmental depart-
\nments.
\n42 Dongsi Xidajie, Beijing, China, 100710
\nE-mail: intl@cma.org.cn
\nWebsite: www.cma.org.cn
\nFinnish Medical Association
\nOffice Bearers:
\nPresident: Dr.\u00a0Marjo Parkkila-Harju
\nVice-presidents: Dr.\u00a0Antti Tamminen,
\nDr.\u00a0Arto Virtanen
\nChief Executive Officer: Dr.\u00a0Heikki P\u00e4lve
\nVice-CEO: Dr.\u00a0Hannu Halila
\nHealth Policy Adviser, International Af-
\nfairs: Mervi Kattelus
\nOffice and Membership:
\nThe Finnish Medical Association, estab-
\nlished in 1910, is a professional organization of which almost all
\n(94 %) doctors practicing in Finland are members. Membership is
\nvoluntary and available for all physicians practicing in Finland. In
\nthe beginning of 2016 the number of members was around 25 000.
\nThe FMA binds its members together to support common values
\n(advancement of medical expertise, humanity, ethics, and collegial-
\nity), and represents their common professional, social and economic
\ninterests. The FMA employs approximately 65 people (including
\nFinnish Medical Journal).
\nServices provided:
\nMember services include a patient injury and liability insurance,
\nlegal advice, membership in unemployment fund, CPD\/CME-
\ntraining, network of trusted physicians, Finnish Medical Network
\n(Fimnet) Internet portal, and grants for training, research and for
\ninternational co-operation. Members are also offered certain prod-
\nucts, discounts and social activities. In addition they receive Finnish
\nMedical Journal that is published in paper form weekly, and can
\nread the electronic version as well.
\nActivities:
\n\u2022\t We involve our members at regional and local level to participate
\npolicy-making of the association.
\n\u2022\t We negotiate the salaries of the physicians working in the public
\nsector.
\n\u2022\t We foster medical ethics in several ways: Medical Ethics Com-
\nmittee that involves representatives also from other physician\u00b4s
\nMarjo Parkkila-Harju
\nNMA news
\n74
\norganizations, Medical Ethics book (available also online), Medi-
\ncal Ethics Day once a year, seminars on timely ethical topics with
\nother professional organizations etc.
\n\u2022\t We follow actively health policy issues in the society and do ad-
\nvocacy work towards and together with the ministries in order to
\ndevelop health and health care system and patient\u00b4s rights in the
\ncountry.
\n\u2022\t We provide official and reliable data concerning physician work
\nforce both to the governmental agencies as well as to the media.
\n\u2022\t The views of the FMA are frequently quoted in the media.
\n\u2022\t The FMA is a member of the Confederation of Unions for Pro-
\nfessional and Managerial Staff in Finland (AKAVA).
\nVision:
\nFinnish Medical Association is a professional organization and a
\ntrade union of a unified medical profession. It benefits its members
\nas well as key stakeholders.
\nInternational cooperation:
\nFMA is a member of several international physician\u00b4s organizations
\ni.e. globally the WMA and in Europe Standing Committee of Eu-
\nropean Doctors (CPME), European Union of Medical Specialists
\n(UEMS), European Union of General Practitioners\/Family Physi-
\ncians (UEMO), and European Junior Doctors (EJD). We have also
\nactive cooperation with other Nordic countries. In addition, we are
\ninvolved with some development cooperation projects.
\nP.O. Box 49 (M\u00e4kel\u00e4nkatu 2 A)
\nFI-00510 Helsinki, Finland
\nE-mail: international@laakariliitto.fi
\nWebsite: www.laakariliitto.fi
\nMalaysian Medical Association
\nMMA Executive committee (2015\u20132016)
\nPresident: Dr.\u00a0Ashok Zachariah Phillip
\nImmediate Past president: Dr.\u00a0H Krishna
\nKumar
\nPresident Elect: Dr.\u00a0John Chew Chee Ming
\nHonorary General Secretary: Dr.\u00a0Ravin-
\ndran Naidu
\nHonorary General Treasurer: Dr.\u00a0Guna-
\nsagaran Ramanathan
\nHonorary Deputy Secretary: Dr.\u00a0Rajan
\nJohn
\nHonorary Deputy Secretary: Dr.\u00a0Ganabaskaran Nadason
\nChairman Schomos: Dr.\u00a0Vasu Pillai
\nChairman PPS: Dr.\u00a0Muruga Raj
\nMembership:
\n\u2022\t Currently there are over 41,715 registered medical practitioners
\nin Malaysia.
\n\u2022\t Almost 20 percent of them are MMA members.
\n\u2022\t MMA also has a separate wing for the student members.
\nObjectives:
\n\u2022\t To promote and maintain the honour and interest of the profes-
\nsion of medicine in all its branches and in every one of its seg-
\nments and help to sustain the professional standards of medical
\nethics.
\n\u2022\t To serve as the vehicle of the integrated voice of the whole pro-
\nfession and all or each of its segments both in relation to its own
\nspecial problems and in relation to educating and directing public
\nopinion on the problems of public health as affecting the com-
\nmunity at large.
\n\u2022\t To participate in the conduct of medical education, as may be
\nappropriate.
\n\u2022\t To promote social, cultural and charitable activities in building a
\nunited Malaysian nation.
\n\u2022\t To carry on any business, trade, joint venture, commercial ar-
\nrangement, transaction or any enterprise whatsoever which may
\nin the option of the Association be advantageous to the Associa-
\ntion or calculated directly or indirectly to enhance any of the As-
\nsociation\u2019s assets, properties or rights.
\nSections, Societies and Committees Of Mma
\n\u2022\t Sections
\n— Section Concerning House Officers, Medical Officers & Spe-
\ncialists (SCHOMOS)
\n— Private Practitioners Section (PPS)
\n\u2022\t Societies
\n— Society of Occupational & Environmental Medicine (SOEM)
\n— Society of Medical Students (SMMAMS)
\n— Society of Public Health
\n— Society of Sports Medicine
\n— 20 MMA Committees
\n— 29 MMA Representatives for External Organization, GOVT
\n& NGO committees
\nSection Concerning House Officers, Medical Officers & Spe-
\ncialists (Schomos)
\n\u2022\t Its objective is to identify, address and seek the cooperation of
\nthe government to resolve issues relating to the welfare, pay, and
\nallowances and working conditions of all grades of doctors in gov-
\nernment service.
\n\u2022\t SCHOMOS over the years has evolved into a powerful Section
\nof the MMA which conducts periodic meetings with the Direc-
\ntor General and other top Ministry of Health officers and has
\nachieved many notable successes in its ventures.
\nAshok Philip
\nNMA news
\n75
\nBACK TO CONTENTS
\n\u2022\t The issues discussed periodically includes: clinical allowance for
\nmedical officers, review of specialist allowance, overtime pay,
\n\u00adpromotion prospects for medical officers and specialists, house-
\nmen issues, etc.
\nThe Private Practitioners Section (PPS)
\nPrivate Practitioners Section of MMA was established to look after
\nthe needs of the private practitioners
\nPPS continues to be the negotiating arm of the Association in all
\nmatters relating to private practitioners. Currently, the PPS is con-
\ncerned on issues related to:
\n\u2022\t Pharmacy Bill-
\n\u2022\t FOMEMA
\n\u2022\t Third Party Administrator (TPA)\/Managed Care Organization
\n(MCO)
\n\u2022\t National Health Financing Scheme
\n4th Floor MMA House, No. 124 Jalan Pahang,
\n53000 Kuala Lumpur, Malaysia
\nE-mail: info@mma.org.my
\nWebsite: www.mma.org.my
\nMyanmar Medical Association
\nOffice Bearers
\nPresident: Prof. Rai Mra
\nHon. Secretary: Prof. Saw Win
\nMembership: Myanmar Medical As-
\nsociation (NMA) is the biggest asso-
\nciation of medical doctors in Myanmar.
\nIt was established in 1949, a year after
\nMyanmar (formerly known as Burma)
\ngot her independence from British colo-
\nnial rule. It is a non-governmental, non-
\npolitical professional association with permanent members of
\nmore than 12000 and more than 1000 pro-members. There are
\n15 branches in 15 States and Divisions of Myanmar and 37 spe-
\ncialist societies and 3 special interest groups under it\u2019s umbrella.
\nMMA is governed by 20 members elected Executive Committee.
\nMMA is an active member of World Medical Association
\n(WMA), Confederation of Medical Association of Asia and Oce-
\nania (CMAAO) and Medical Associations of ASEAN countries
\n(MASEAN).
\nServices provided: The main mission of MMA is to improve the
\nprofessional and ethical standards of medical doctors so as to have
\nbetter health care of the people. MMA also plays advisory role
\nin various health issues to Ministry of Health of Myanmar. MMA
\nprovide heath education and advocacy in various health problems
\nof the country.
\nActivities: We are conducting regular CME courses for Family
\nPhysicians, ad-hoc CME activities and regular Annual meeting and
\nConference, which will be 63rd
\ntime in coming 2017. We are pub-
\nlishing Myanmar Medical Journal ( MMJ) quarterly,which was first
\npublished in 1953 We also publish monthly newsletter.
\nAs social activities we have Support Group for Elderly Doctors
\n(SGED) and Health Care Volunteers groups. We had conducted
\nrapid disasters rescue and help in various disasters of Myanmar and
\nneighbouring countries.
\nThere are 10 public health projects conducting in collaboration with
\nUN organizations and other NGOs in areas of Malaria,Tuberculo-
\nsis, Reproductive Health and Youth Development.
\n249, Theinbyu Road,
\nMingalar taungnyunt township, Yangon.
\nPhone: +951 394141
\nE-mails: mmacorg@gmail.com;
\ndrsawwin@gmail.com; drkyawlynn@gmail.com
\nOfficial facebook page: MMA CME
\nWebsite: www.mmacentral.org
\nRwanda Medical Association
\nOffice bearers
\nPresident: Dr.\u00a0Kayitesi Kayitenkore
\nVice-President: Dr.\u00a0Joseph Ryarasa
\nNkurunziza
\nTreasurer: Dr.\u00a0Louise Kalisa
\nHead of Scientific& Research Committee:
\nDr.\u00a0Brenda Asiimwe-Kateera
\nHead of Ethics Committee:
\nDr.\u00a0Emmanuel Nkeramihigo
\nSecretary General: Dr.\u00a0Felix Cyamatare
\nRwabukwisi
\nExecutive Secretary: Mr. Rwabukwisi A.\u00a0Eddy
\nDescription and History:
\nFounded in 1997; the Rwanda Medical Association (RMA) is reg-
\nistered as a non-profit, a Non-Government-Organization (NGO)
\nthat advocates on behalf of its members and the public for access to
\nhigh quality healthcare, and provides leadership, guidance to physi-
\ncians for Continuous Professional Development. RMA also strives
\nfor the welfare; professional protection as well as medical ethics and
\nconduct among its members.
\nRai Mra
\nKayitesi Kayitenkore
\nNMA news
\n76
\nRMA is committed to being at the fore front of healthcare man-
\nagement by enhancing and integrating professionalism among its
\nmembers; integrating members into policy negotiation, formulation
\nand implementation and building alliances with other health pro-
\nfessional association and regulatory bodies to meet the health needs
\nand expectations of Rwandans.
\nVision: \u201cTo be a world class community of motivated medical doctors
\nwith the highest ethical and professional standards\u201d
\nMission: \u201cThe trusted and unified voice of medical doctors in promoting
\nboth professional excellence and welfare of medical doctors in Rwanda
\nObjectives:
\n\u2022\t To represent medical doctors with authority and credibility.
\n\u2022\t To advise the Government, other medical bodies and the general
\npublic on matters related to health.
\n\u2022\t To promote the integrity and collegiality in medical profession.
\n\u2022\t To contribute to the capacity building of doctors for providing
\nexcellent health care.
\n\u2022\t To contribute to the research and development in the Rwandan
\nhealth system.
\n\u2022\t To develop partnerships with other national and foreign associa-
\ntions\/organizations for opening opportunities to RMA.
\n\u2022\t To promote the welfare of medical doctors through RMA UMU-
\nGANGA (MD) Saving And Credit Cooperative Society Ltd.
\nGuiding principles:
\n\u2022\t Our members are our number one priority in all the work we do.
\nWe seek to build and maintain an association that is inclusive,
\ncollaborative, and accountable to physicians. We have an uncom-
\npromising commitment to serve them well, protect their interests,
\nand contribute to their overall health and well-being.
\n\u2022\t We are committed to be in the forefront of building a stronger,
\nhigher quality health-care system for our patients, and ensuring
\nvalued and effective roles for physicians in that system.
\nCore values: \u201cIntegrity, Professionalism, Collegiality and Empathy.\u201d
\nCollaborations:
\n1.National collaborations
\nWithin Rwanda, the association seeks to harmonize efforts with
\nsimilar organization in order to efficiently advocate for its members.
\nThe collaboration covers technical support from specialized orga-
\nnization and financial and policy support with public system. We
\ncollaborate with:
\n— Rwanda Ministry of Health
\n— Rwanda Medical and Dental Professionals
\n— Rwanda Health Care Federation
\n— Professional associations of specialist doctors in Rwanda
\n2.International Collaboration
\nThe RMA is a member of different International Medical Organi-
\nzation or Association such as:
\n— World Medical Association (WMA) www.wma.net
\n— Confederation of African Medical Associations and Societies
\n(CAMAS)
\n— East African Medical Association (EAMA).
\nCore and Routine activities
\nWith its members: RMA organizes Continuous Professional De-
\nvelopment (CPD) workshops for its members across the country, in
\ndifferent regions every quarter.The aim is to ensure RMA members
\nhave up to date medical information on relevant topics and targeted
\nknowledge gaps in order to improve the quality of service provided
\nby our members. Particular attention has been made to medical eth-
\nics which has been included in all our CPD activities. These ac-
\ntivities are supported by the contribution paid by our members and
\nlocal partner organizations.
\nRMA organizes an annual scientific conference each year which
\naims to bring together scientific innovation; political leaders and
\nimplementers to discuss key topics according to the context of med-
\nical practice in Rwanda. This has been an opportunity to keep the
\ndebate alive especially on issues that affect on one hand our mem-
\nbers\u2019 daily work and efficiency, on the other hand the healthcare
\nsystem as a whole.
\nRMA has started advocating for the professional indemnity insur-
\nance, professional consulting fees etc. for its members.
\nWith Partners: RMA actively participates in debates and work-
\nshops organized in the country in order to keep the voice of our
\nmembers represented in all circles that are impacting our work and
\nwelfare. We represent our members to the Ministry of Health; re-
\ngional discussion affecting the practice of medicine; legal and trade
\npolicy discussion.We also reach out to seek for financial and techni-
\ncal collaboration in order to increase the capacity of the association
\nto serve its members.
\nKG5 Avenue, Kigali-City,
\nGasabo District, Kacyiru Sector,
\nB.O.P: 458 Kigali-Rwanda,
\nCell: +250 788381486 or +250 788561597
\nE-mail: rmasecretariat@gmail.com
\nWebsite: www.rma.rw
\nNMA news
\n77
\nBACK TO CONTENTS
\nSlovak Medical Association
\nPresident: Prof. MUDr.\u00a0J\u00e1n Breza,
\nGeneral provisions
\nSlovak Medical Association (SkMA) is a
\nvoluntary, non-governmental, politically in-
\ndependent non-profit association compris-
\ning professional associations and societies
\nacting in the sphere of medicine, the mem-
\nbers of which participate in development of
\nmedical branches and health care.
\nSkMA is a legal person and civil association
\nin accordance with the Act No. 83\/1990, Collection, on Association
\nof Citizens as amended. It was registered in 1969. SkMA has the
\norganisational units comprising professional societies, physicians\u2019
\nguilds and pharmacists\u2019 guilds and societies of intermediate health
\ncare workers.
\nAs of December 31, 2015 it registers 98 professional asso-
\nciations, 16\u00a0of these are collective members. Altogether it unites
\n16\u00a0457\u00a0members: 14\u00a0622 physicians, pharmacists and 1795 other
\nhealth care workers. SkMA publishes a journal entitled Monitor
\nmedic\u00edny SLS\/ Medicine Monitor by SkMA.
\nPresidium of SkMA is a statutory body and has 15 members.SkMA
\nand its professional societies and guilds can be the members of the
\nother national and international non-governmental organisations
\n(associations, guilds) having a similar scope of interest (EFMA,
\nWMA, WHO, UEMS, CIOMS, CPME).
\nMission and objectives of SkMA
\nSkMA shall:
\n\u2022\t initiate and mediate transfer of the latest scientific professional
\nmedical, diagnostic and therapeutic information into practice in
\nthe form of continuous \u2013 further systematic education,
\n\u2022\t assert a decisive role of the professional societies mainly as expert
\nguarantors in continuous \u2013 further systematic medical education
\nof physicians, pharmacists and other medical workers,
\n\u2022\t initiate, submit, enforce and publish the opinions on
\na)\tthe issues connected with expertise and scientifically based
\nknowledge of medical sciences within individual medical
\nbranches;
\nb)\tthe issues connected with possibilities to apply top, diagnostic
\nand therapeutic methods in medical practice;
\nc)\tthe issues of ethic of physicians and medical workers;
\nd)\tthe issues of existing and being prepared legislative standards in
\nhealth care;
\ne)\tthe issues of specialised scopes of a further education system;
\nf)\tnomination of the experts as members of various commit-
\ntees,
\n— represent its professional societies and guilds outwards with the
\naim to protect their justified requests and interests in relation
\nto other subjects.
\nScope of SkMA activities (the Tasks)
\n15.\tWithin the scope of further education of medical workers it
\nshall organise, ensure and guarantee the expertise of intrastate
\nand international professional and scientific educational events
\n(congresses, meetings, symposiums, conferences, lectures, semi-
\nnars, courses, training courses etc), accompanying exhibitions
\nand symposiums of medical and pharmaceutical societies.
\n16.\tIt shall support participation of its members in professional and
\nscientific events at home and abroad.
\n17.\tIt shall issue and support issuing of professional medical jour-
\nnals, collections, bulletins, publications and other information
\nmaterials.
\n18.\tIt shall annually draw up and edit the Calendar of Professional
\nand Scientific Events.
\n19.\tFor the members of SkMA, it shall ensure methodical guid-
\nance connected with meeting the objectives, mission and scope
\nof activities of SkMA.
\n20.\tIt shall inform members and other medical workers about the
\nlatest medical and pharmaceutical products.
\n21.\tIt shall establish contacts and cooperate with international non-
\ngovernmental, scientific and professional organisations acting
\nwithin the health care sphere at home and abroad.
\n22.\tIt shall conclude agreements on cooperation and reciprocal ex-
\nchange of experts (members of SkMA) and employees of SkMA
\nwith partner international organisations.
\n23.\tIt shall organise competitions and award prizes and honours.
\n24.\tThrough delegated representatives it shall participate in selec-
\ntion, competition, attestation, accreditation and similar actions.
\n25.\tThrough delegated representatives it shall participate in the ac-
\ntivities of consultative bodies of parliament of the Slovak Re-
\npublic, Ministry of Health Care of the Slovak Republic, Slovak
\nMedical Chamber, Slovak Pharmacists\u2019 Chamber and other
\nchambers and professional institutions dealing with issues of
\nhealth care and public health.
\n26.\tTo secure the mission, objectives and scope of activities it shall
\npursue additional economic activities (e. g. publishing and edi-
\ntorial activities, advertising, lease, mailing services etc.).
\n27.\tTo pursue additional economic activities and provision of pub-
\nlicly useful services, it may establish the non-profit organisa-
\ntions, foundations, funds, business and other companies, or be
\ntheir associate.
\nCukrova 3, 813 22 Bratislava 1
\nSlovak Republic
\nTel: +421 903 650 978
\nE-mail: irina.sebova@pe.unb.sk
\nWebsite: www.sls.sk
\nJ\u00e1n Breza
\nNMA news
\n78
\nSwedish Medical Association
\nOffice Bearers:
\nPresident: Dr.\u00a0Heidi Stensmyren
\nCEO: Hans Dahlgren
\nMembership: I am not sure I understand
\nmembership but it is voluntary and you pay
\na monthly fee, high number of members as
\nwe are the only union for doctors in Sweden
\n8 out of 10 doctors are members.
\nServices provided: We provide Advice
\nand support in matters relating to your salary, contract, and general
\nworking conditions, insurance and pensions as well as support on
\nhow to get your foreign licence to practice recognised.
\nHelp with salary negotiations, and up-to-date salary statistics.
\nLegal assistance on disciplinary matters, such as negligence claims
\nor probation, and on general matters of healthcare.
\nHowever we also work with political issues and have a key role to
\nplay in influencing the development of healthcare in Sweden. The
\nSwedish Medical Association enters into collective agreements on
\nbehalf of its members in areas such as general employment con-
\nditions, which includes salaries, working hours, holidays, sick and
\nparental leave and pensions.
\nVision one association for all doctors through their whole career.
\nActivities, do you mean current activates besides our union work
\nwith helping members , doing collective bargaining. We also moni-
\ntor and work with healthcare politics on national, European and
\nInternational level.
\nInternational collaboration,
\nThe Swedish Medical Association is an Active member of the
\nUEMS, CPME on a European level as well as an active member
\nof the WMA.
\nBox 5610, Villagatan 5
\n114 86 Stockholm
\nPhone: 00468 \u2013 790 3303
\nmob: 004670 \u2013 790 3303
\nE-mail: info@slf.se
\nWebsite: www.lakarforbundet.se
\nhttp:\/\/www.slf.se\/Info-in-English
\nSwiss Medical Association (SMA)
\nOffice Bearers:
\nPresident: Dr.\u00a0med. Jacques de Haller
\nGeneral Secretary: Anne-Genevi\u00e8ve
\nB\u00fctikofer
\nThe Foederatio Medicorum Helvetico-
\nrum (FMH) or Swiss Medical Association
\n(SMA) is the politically and economically
\nindependent umbrella organisation for
\nmore than 70 core and specialised medical
\norganisations. The main objectives of the
\nSMA are:
\n\u2022\t to ensure the high quality of medical care in Switzerland
\n\u2022\t to promote further training and continued education for doctors
\n\u2022\t to play an active role in shaping the health policy framework so that
\ndoctors can work efficiently and in the full interests of patient welfare
\nThe SMA consists of the medical associations which bring together
\nthe 200 delegates of their member societies to create the \u201cphysicians\u2019
\nparliament\u201d,and of the 7-strong Central Committee which acts as a
\n\u201cgovernment\u201d, representing the interests and implementing the de-
\ncisions of the medical associations. The Central Committee acts in
\nan advisory capacity to the 33-member Delegates General Meeting.
\nThe SMA offers its members services such as the personal Health
\nProfessional Card (HPC) and provides support and assistance in
\nissues relating to the law, tariffs and business matters. External part-
\nners, media and the general public also benefit from SMA services
\nsuch as statistics on physicians, media releases or the popular ad-
\nvance directive (living will).
\nMajor challenges facing the SMA are
\n\u2022\t the rising volume of administrative demands made on the medi-
\ncal profession
\n\u2022\t the substitution of medical services by other healthcare profes-
\nsions and the resultant risk of healthcare fragmentation
\n\u2022\t the insufficient number of places for medical students and the
\nresultant scarcity of doctors
\nThe SMA is able to pursue its objectives vigorously thanks to its
\nmembers, whose interests it is committed to advocating. As such, it
\nis regarded by partners in the healthcare sector, politicians and the
\ncommunity as a highly effective mouthpiece for doctors in Swit-
\nzerland.
\nFMH Swiss Medical Association
\nElfenstrasse 18, Postfach 300, 3000 Bern 15
\nE-mail:info@fmh.ch
\nWebsite: www.fmh.ch
\nHeidi Stensmyren Jacques de Haller
\nNMA news
\n79
\nBACK TO CONTENTS
\nMedical Association of Thailand
\n(MAT)
\nOffice Bearers (2016\u20132017)
\nPresident: Prof. Dr.\u00a0Saranatra Waikakul
\nPresident Elect: Prof.Dr.\u00a0Ronnachai Kong-
\nsakon
\nVice-President: Group Captain Dr.\u00a0Paisal
\nChantarapitak
\nSecretary General: Dr.\u00a0Sawat Takerngdej
\nDeputy Secretary: Prof.Dr.\u00a0 Prakitpunthu
\nTomtitchong
\nTreasurer: Assoc. Prof. Dr.\u00a0Juvady Leopairut
\nHouse Master: Major Dr.\u00a0Chanrit Lawthaweesawat
\nScientific: Prof. Dr.\u00a0Wachira Kochakarn
\nPublication: Prof. Dr.\u00a0Amorn Leelarasamee
\nInternational Relations: Major. Gen. Assist. Prof. Dr.\u00a0 Kidaphol
\nWadhanakul
\nMedical Education: Assoc. Prof. Dr.\u00a0Yothin Benjawung
\nEthics: Assoc.Prof. Dr.Orawan Kiriwat
\nPublic Relations: Dr.\u00a0Sakda Arj-ong Vallipakorn
\nRegistration: Dr.\u00a0Komgrib Pukrittayakamee
\nWelfare: Dr.\u00a0Nithiwat Gijsriurai
\nSpecial Affairs: Prof.Dr.Apichat Asavamongkolkul
\nChief Executive Officer: Prof. Dr.\u00a0Somsri Pausawasdi
\nMembersof Committee: Pol.Gen. Dr.\u00a0Chumsak Pruksapong
\nDr.\u00a0Pinit Hirunyachote
\nAssoc.Prof.Dr.Thanya Subhadrabandhu
\nDr.Rungsima Saenghirunvattana
\nDr.\u00a0Somchai Thepcharoennirund (Regional Rept.)
\nDr.\u00a0Varaphan Unachak (Regional Rept.)
\nDr.\u00a0Suraphan Loiha (Regional Rept.)
\nDr.\u00a0Banjerd Sukapipatpanont (Regional Rept.)
\nMembership: Any Thai medical doctor can join the MAT as a
\nregular member.
\nServices provided: The main services provided by the MAT to their
\nmembership are activities for our members\u2019 safety and wellbeing, the
\nAnnual Academic Meeting as well as news and scientific publica-
\ntions, representation of their interests in national and international
\nforums and participating as a member of World Medical Association.
\nActivities (some examples)
\n\u2022\t With Members: Receiving lifelong access to Journals of the Med-
\nical Association of Thailand
\n\u2022\t With the Public: Through Medical Knowledge program for Thai
\nPeople as FAQs decease problem TNN TV Channel monthly by
\nthe Famous MAT speakers
\n\u2022\t With the Governments: As a Medical Counselor to support the
\nMinistry of Health for adoption of a medical career in the public
\nservices. NMA news
\n\u2022\t With the Media: Press releases related to health issues of public
\ninterest,promotion of debates related to health policies,education
\non health related issues.
\n\u2022\t With international organization: WMA, MASEAN, CMAAO
\nand oversea medical organizations
\n\u2022\t WithStrategic Partners: special research aiming to promote
\nhealth information to the public as well as to provide happiness
\nworking and safety to Thai physicians.
\n4th
\nFloor, Royal Golden Jubilee Building 2, soi Soonvijai
\nNewpetchbri Rd. Huay Kwang Bangkapi Bangkok 10310
\nE-mail: math@loxinfo.co.th
\nWebsite: www.mat-thailand.org
\nZambia Medical Association
\nOffice Bearers (2015\u2013 2017)
\nPresident: Dr.\u00a0Aaron Mujajati
\nVice President: Dr.\u00a0Abidan Chansa
\nSecretary General: Dr.\u00a0Jonathan Sitali
\nTreasurer: Dr.\u00a0Matthe w Manoj
\nChairman of Medical Education Board:
\nDr.\u00a0Mutinta Muyuni
\nChairman of Public Health Board:
\nDr.\u00a0Wilbroad Mutale
\nRepresentative to Health Professions Coun-
\ncil: Dr.\u00a0Kaunda Mwansa
\nPresident of Resident Doctors Association: Dr.\u00a0Francis Mupeta
\nBackground
\nThe Zambia Medical Association (ZMA) is a membership orga-
\nnization of Doctors in Zambia. Founded in 1964, the association
\nhas been providing support services to its members by represent-
\ning their professional interests in the public domain, speaking on
\nbehalf of the Zambian people on issues of health that affect them,
\nand influencing health policy in Zambia. ZMA began as a small
\nassociation for doctors based in Lusaka, the capital city of Zambia,
\nwith only a handful of members.ZMA now boasts of a membership
\nof just under 1000 doctors with representatives in all 10 provinces
\nof the country. ZMA therefore has undergone significant growth
\nsince its inception. It now has a secretariat in Lusaka from which its
\nactivities are coordinated and has been decentralized to provincial
\nlevel with a representative in each of the 10 provinces of Zambia.
\nIn 2014, ZMA established its international relations by becoming a
\nmember of the World Medical Association. It also has a represen-
\nSaranatra Waikakul
\nAaron Mujajati
\nNMA news
\n80
\ntative of Zambian doctors in the diaspora with a chairman based
\nin Geneva, Switzerland. ZMA also has regional representatives in
\nChina coordinating the Asia region, in the USA for the Americas
\nand in New Zealand for Oceania.
\nActivities of ZMA
\nContinuous Medical Education
\nOne of the key objectives of ZMA is to further the development
\nof the medical profession as an instrument of social development
\nand as an essential element for growth of society. In this regard we
\nseek to maintain a high standard of medical practice by providing
\ncontinuous medical education activities (CMEs) to our members.
\nWith an executive committee member in-charge of CME\u2019s in place,
\nZMA holds CMEs across the country throughout the year.
\nReports\/Presentations to Parliament
\nZMA is an important stakeholder in the country in the area of
\nhealth. The Zambian parliament has recognized this and has in the
\nlast year invited ZMA to make presentations to the select com-
\nmittee on health on key health issues affecting the country. In this
\nregard presentations on the HIV national response, maternal mor-
\ntality and on social health insurance and the healthcare system in
\ngeneral were made during the last year.
\nRepresentation on Various Boards and Committees
\nStill in keeping with the ZMA\u2019s mandate of remaining relevant to
\nthe public and aiming to influence national policy in the arena of
\nhealth, ZMA is represented on various boards and committees in
\nthe country. In particular, we have an executive committee member
\nwho sits on the board for the health professions council and another
\non the Zambia Medicines Regulatory Authority board. We also
\nhave representation on committees at the National AIDS Council
\nand at the Ministry of Health. These are important links to ZMA
\nbecause it is through these links that we get to influence national
\npolicies.
\nZMA Work with the First Lady of Zambia
\nZMA has recognized the unique role that the First Lady of the
\nRepublic Mrs.Esther Lungu,plays in the area of health through her
\ncharity work. She has had a lot of impact on various health issues
\nespecially relating to women and children. In recognition of this
\nwork and the impact her work has on those that are disadvantaged,
\nshe was a joint recipient of the prestigious 2015 ZMA President\u2019s
\naward. Since the award, ZMA has worked closely with her office to
\nsupport her work. In line with this, an executive committee member
\nhas since been appointed as ZMA liaison to the First Lady\u2019s office.
\nWorkshops with Religious, Traditional and Civic Leaders
\nIn our quest to impact the nation, ZMA has engaged national lead-
\ners at various levels on several issues of interest to the association in
\npublic interest. One area has been the issue of maternal mortality
\nand the significant contribution made by unsafe abortions. In this
\nregard,a series of separate workshops were organized in the last year
\nwith religious leaders, traditional leaders and members of parlia-
\nment to raise awareness about this problem and to highlight how
\nworkshop participants could use their positions to make a change in
\ntheir communities.
\nPublic Health Media Work
\nAs a way of engaging the public and ensuring our goals receive media
\ncoverage, ZMA supports public health programs on national radio
\nand television. These are weekly programs meant to highlight key
\npublic health issues.These programs serve as a conduit through which
\nZMA can reach the public.In line with this,we have a weekly column
\nin one of the national dailies dubbed the \u201cPublic Health corner.\u201dAr-
\nticles from this weekly column are also placed on our website.
\nUpcoming Events
\nThe 2016 ZMA Annual Scientific Conference and AGM will be held
\nfrom 28th to the 30th of July 2016 at Chrismar Hotel in Living-
\nstone.The theme for this year\u2019s meeting is \u201cPublic Health Solutions
\nfor Sustainable Development Goals.\u201d
\nMonitoring of the Zambia Presidential and General Elections and Ref\u2011
\nerendum by ZMA: On 11th August, 2016, Zambia goes to the polls
\nin a Presidential and General election and Referendum. ZMA will
\nbe involved as elections monitors.This is in keeping with the ZMA
\ngoal to ensure we remain relevant to our time and influence national
\npolicy. ZMA is nonpartisan and we are engaged in these elections
\nin an advisory capacity to the various stakeholders to ensure elec-
\ntions are held in a free and fair manner.We are especially alive to the
\nvarious public health concerns that may arise during an election and
\nthat may negatively affect the voting. It is to these that we want to
\nespecially address and ensure the relevant authorities address these
\nissues amicably.
\nThe 2016 ZMA Annual Ball and Awards Gala will be held on 10th
\nDecember, 2016 in Lusaka. The venue is yet to be confirmed. Last
\nyear\u2019s event was held at Hotel intercontinental and the Republican
\nPresident, His Excellency Edgar Lungu was the guest of honor.
\nThe 2017 World Medical Association Council meeting will be held in
\nLivingstone, Zambia in April of 2017. The meeting will be hosted
\nby ZMA at a pleasure resort on the banks of the Zambezi River just
\nnext to the Mighty Victoria falls. This is an area in a Game Park.
\nGuests to this meeting can plan for a holiday and experience a true
\nsafari in one of the most beautiful places in the world. Special pack-
\nages in this regard will be advertised in due course.
\nUnit 2, Brentwood court. Stand Number 6458,
\nLos Angeles Boulevard, Longacres, P.O. Box 50693, Lusaka.
\nE-mail: zambiamedicalassociation@gmail.com
\nWebsite: www.zambiamedicalassociation.org.zm
\nNMA news
\nIII
\nBACK TO CONTENTS
\nSave the date
\n2nd
\nGLOBAL CONFERENCE ON ONE HEALTH
\n10th
\n– 11th
\nNovember 2016
\nKitakyushu City, Fukuoka Prefecture, Japan
\nMoving forward from One Health Concept to
\nOne Health Approach
\nFollowing the successful Global Conference on One Health (GCOH) that was held in Madrid in May 2015, the WVA and
\nWMA in close collaboration with the Japan Medical Association (JMA) and the Japan Veterinary Medical Association
\n(JVMA) are preparing the 2nd
\nGCOH to be held on 10t-11th
\nNovember in Kitakyushu City, Fukuoka Prefecture,
\nJapan.
\nThe 2nd
\nGCOH aims to bring together Veterinarians, Physicians, Students, Public Health Officers, Animal Health Officers,
\nNGOs and other interested parties from the different world regions to learn, discuss and to address critical aspects of
\nthe ‘One Health’ Concept.
\nThe main objectives of the conference are to strengthen the links and communications and to achieve closer
\ncollaboration between Physicians, Veterinarians and all appropriate stakeholders to improve the different aspects of
\nhealth and welfare of humans, animals and the environment.
\nThe main conference sessions will focus on the issues of:
\n\u2022 Zoonotic diseases
\n\u2022 Foodborne diseases
\n\u2022 Antimicrobial resistance
\n\u2022 Environmental hazards exposure to humans and animals
\nMore details regarding the conference and registrations will be
\npublished soon on WVA and WMA websites
\nwww.worldvet.org www.wma.net
\nIV<\/p>\n"},"caption":{"rendered":"

wmj201602 COUNTRY vol. 62 MedicalWorld Journal Official Journal of The World Medical Association, Inc. ISSN 2256-0580 Nr. 2, June 2016 Contents Bioterrorism.The Question is \u2013 When? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":null,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2017\/03\/wmj201602.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media\/7488"}],"collection":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/comments?post=7488"}]}}