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wmj14<\/a><\/p>\n

WorldMMeeddiiccaall JJoouurrnnaall
\nVol. No.2,June200753
\nOFFICIAL JOURNAL OF THE WORLD MEDICAL ASSOCIATION, INC.
\nG 20438
\nContents
\nEEddiittoorriiaall 29
\nNew Chair of WMA Council 29
\nDr. Andr\u00e9 Wynen 1924\u20132007 30
\nMMeeddiiccaall EEtthhiiccss aanndd HHuummaann RRiigghhttss
\nRelease of Palestinian Physician
\nand Bulgarian Nurses 31
\nWMA Declaration Concerning Support for
\nMedical Doctors Refusing to Participate in,
\nor to Condone, the Use of Torture or
\nOther Forms of Cruel, Inhuman or Degrading
\nTreatment 33
\nWWoorrlldd MMeeddiiccaall AAssssoocciiaattiioonn
\n176th
\nWMA Council meeting 31
\nSecretary General\u2019s report to the
\n176th
\nWMA Council Session 43
\nFFrroomm tthhee SSeeccrreettaarryy GGeenneerraall
\nAbout Changing the Scope of Practice,
\nTask Shifting and the Proper Use of Words 46
\nWWHHOO
\nPractical solutions to tackle
\nhealth worker migration 47
\nInternational Health Regulations
\nenter into force 48
\nWHO 15th
\nessential medicines list published 50
\nNew opportunity to respond to international
\npublic health threats 50
\nGlobal health partners mobilize
\nto counter yellow fever 51
\n2.5 million people in India living with HIV,
\naccording to new estimates 52
\nWHO publishes key world health statistics 53
\nNew WHO report marks First
\nUN Global Road Safety Week 54
\nWHO and UNAIDS issue new guidance on HIV
\ntesting and counselling in health facilities 55
\n176th
\nWMA Council Meeting
\n00_US_02_2007.qxd 02.08.2007 09:06 Seite 1
\nWebsite: https:\/\/www.wma.net
\nWMA Directory of National Member Medical Associations Officers and Council
\nAssociation and address\/Officers
\nWMA OFFICERS
\nOF NATIONAL MEMBER MEDICALASSOCIATIONS AND OFFICERS
\ni see page ii
\nPresident-Elect President Immediate Past-President
\nDr. J. Snaedal Dr. N. Arumagam Dr. Kgosi Letlape
\nIcelandic Medical Assn. Malaysian Medical Association The South African Medical Association
\nHlidasmari 8 4th Floor MMA House P.O Box 74789
\n200 Kopavogur 124 Jalan Pahang Lynnwood Ridge 0040
\nIceland 53000 Kuala Lumpur Pretoria 0153
\nMalaysia South Africa
\nTreasurer Chairman of Council Vice-Chairman of Council
\nProf. Dr. Dr. h.c. J. D. Hoppe Dr. J. E. Hill Dr. K. Iwasa
\nBundes\u00e4rztekammer American Medical Association Japan Medical Association
\nHerbert-Lewin-Platz 1 515 North State Street 2-28-16 Honkomagome
\n10623 Berlin Chicago, ILL 60610 Bunkyo-ku
\nGermany USA Tokyo 113-8621
\nJapan
\nSecretary General
\nDr. O. Kloiber
\nWorld Medical Association
\nBP 63
\n01212 Ferney-Voltaire Cedex
\nFrance
\nANDORRA S
\nCol\u2019legi Oficial de Metges
\nEdifici Plaza esc. B
\nVerge del Pilar 5,
\n4art. Despatx 11, Andorra La Vella
\nTel: (376) 823 525\/Fax: (376) 860 793
\nE-mail: coma@andorra.ad
\nWebsite: www.col-legidemetges.ad
\nARGENTINA S
\nConfederaci\u00f3n M\u00e9dica Argentina
\nAv. Belgrano 1235
\nBuenos Aires 1093
\nTel\/Fax: (54-11) 4381-1548\/4384-5036
\nE-mail:
\ncomra@confederacionmedica.com.ar
\nWebsite: www.comra.health.org.ar
\nAUSTRALIA E
\nAustralian Medical Association
\nP.O. Box 6090
\nKingston, ACT 2604
\nTel: (61-2) 6270-5460\/Fax: -5499
\nWebsite: www.ama.com.au
\nE-mail: ama@ama.com.au
\nAUSTRIA E
\n\u00d6sterreichische \u00c4rztekammer
\n(Austrian Medical Chamber)
\nWeihburggasse 10-12 – P.O. Box 213
\n1010 Wien
\nTel: (43-1) 51406-931\/Fax: -933
\nE-mail: international@aek.or.at
\nREPUBLIC OF ARMENIA E
\nArmenian Medical Association
\nP.O. Box 143, Yerevan 375 010
\nTel: (3741) 53 58-68
\nFax: (3741) 53 48 79
\nE-mail:info@armeda.am
\nWebsite: www.armeda.am
\nAZERBAIJAN E
\nAzerbaijan Medical Association
\n5 Sona Velikham Str.
\nAZE 370001, Baku
\nTel: (994 50) 328 1888
\nFax: (994 12) 315 136
\nE-mail: Mahirs@lycos.com \/
\nazerma@hotmail.com
\nBAHAMAS E
\nMedical Association of the Bahamas
\nJavon Medical Center
\nP.O. Box N999
\nNassau
\nTel: (1-242) 328 1857\/Fax: 323 2980
\nE-mail: mabnassau@yahoo.com
\nBANGLADESH E
\nBangladesh Medical Association
\nBMA Bhaban 5\/2 Topkhana Road
\nDhaka 1000
\nTel: (880) 2-9568714\/9562527
\nFax: (880) 2-9566060\/9568714
\nE-mail: bma@aitlbd.net
\nBELGIUM F
\nAssociation Belge des Syndicats
\nM\u00e9dicaux
\nChauss\u00e9e de Boondael 6, bte 4
\n1050 Bruxelles
\nTel: (32-2) 644-12 88\/Fax: -1527
\nE-mail: absym.bras@euronet.be
\nWebsite: www.absym-bras.be
\nBOLIVIA S
\nColegio M\u00e9dico de Bolivia
\nCalle Ayacucho 630
\nTarija
\nFax: (591) 4663569
\nE-mail: colmed_tjo@hotmail.com
\nWebsite: colegiomedicodebolivia.org.bo
\nBRAZIL E
\nAssocia\u00e7ao M\u00e9dica Brasileira
\nR. Sao Carlos do Pinhal 324 \u2013 Bela Vista
\nSao Paulo SP \u2013 CEP 01333-903
\nTel: (55-11) 317868-00\/Fax: -31
\nE-mail: presidente@amb.org.br
\nWebsite: www.amb.org.br
\nBULGARIA E
\nBulgarian Medical Association
\n15, Acad. Ivan Geshov Blvd.
\n1431 Sofia
\nTel: (359-2) 954 -11 26\/Fax:-1186
\nE-mail: usbls@inagency.com
\nWebsite: www.blsbg.com
\nCANADA E
\nCanadian Medical Association
\nP.O. Box 8650
\n1867 Alta Vista Drive
\nOttawa, Ontario K1G 3Y6
\nTel: (1-613) 731 8610\/Fax: -1779
\nE-mail: monique.laframboise@cma.ca
\nWebsite: www.cma.ca
\nCHILE S
\nColegio M\u00e9dico de Chile
\nEsmeralda 678 – Casilla 639
\nSantiago
\nTel: (56-2) 4277800
\nFax: (56-2) 6330940 \/ 6336732
\nE-mail: rdelcastillo@colegiomedico.cl
\nWebsite: www.colegiomedico.cl
\nTitle page: The historic Meistersaal (1910\u20131913), Potzdammer Platz, Berlin, site of the 176th
\nWMA Council meeting (lower photo)
\nwas built as a Guild House by architectural students. Later noted for its nearness to the Berlin Wall (\u201cThe Hall by the Wall\u201d),
\nit was to become famous especially for its superb recording acoustics. It was damaged in WW II
\nand after restoration was used for concerts in the 50s and 60\u2019s.
\nFurther restored in 2003, the Hall continues to be used for concerts, lectures and meetings etc.
\nU2–4_WMJ_02_07.qxd 02.08.2007 09:02 Seite U2
\nCHINA E
\nChinese Medical Association
\n42 Dongsi Xidajie
\nBeijing 100710
\nTel: (86-10) 6524 9989
\nFax: (86-10) 6512 3754
\nE-mail: suyumu@cma.org.cn
\nWebsite: www.chinamed.com.cn
\nCOLOMBIA S
\nFederaci\u00f3n M\u00e9dica Colombiana
\nCarrera 7 N\u00b0 82-66, Oficinas 218\/219
\nSantaf\u00e9 de Bogot\u00e1, D.E.
\nTel\/Fax: (57-1) 256 8050\/256 8010
\nE-mail: federacionmedicacol@
\nsky.net.co
\nDEMOCRATIC REP. OF CONGO F
\nOrdre des M\u00e9decins du Zaire
\nB.P. 4922
\nKinshasa \u2013 Gombe
\nTel: (243-12) 24589
\nFax (Pr\u00e9sidente): (242) 8846574
\nCOSTA RICA S
\nUni\u00f3n M\u00e9dica Nacional
\nApartado 5920-1000
\nSan Jos\u00e9
\nTel: (506) 290-5490
\nFax: (506) 231 7373
\nE-mail: unmedica@sol.racsa.co.cr
\nCROATIA E
\nCroatian Medical Association
\nSubiceva 9
\n10000 Zagreb
\nTel: (385-1) 46 93 300
\nFax: (385-1) 46 55 066
\nE-mail: hlz@email.htnet.hr
\nWebsite: www.hlk.hr\/default.asp
\nCZECH REPUBLIC E
\nCzech Medical Association
\nJ.E. Purkyne
\nSokolsk\u00e1 31 – P.O. Box 88
\n120 26 Prague 2
\nTel: (420-2) 242 66 201-4
\nFax: (420-2) 242 66 212 \/ 96 18 18 69
\nE-mail: czma@cls.cz
\nWebsite: www.cls.cz
\nCUBA S
\nColegio M\u00e9dico Cubano Libre
\nP.O. Box 141016
\n717 Ponce de Leon Boulevard
\nCoral Gables, FL 33114-1016
\nUnited States
\nTel: (1-305) 446 9902\/445 1429
\nFax: (1-305) 4459310
\nDENMARK E
\nDanish Medical Association
\n9 Trondhjemsgade
\n2100 Copenhagen 0
\nTel: (45) 35 44 -82 29\/Fax:-8505
\nE-mail: er@dadl.dk
\nWebsite: www.laegeforeningen.dk
\nDOMINICAN REPUBLIC S
\nAsociaci\u00f3n M\u00e9dica Dominicana
\nCalle Paseo de los Medicos
\nEsquina Modesto Diaz Zona
\nUniversitaria
\nSanto Domingo
\nTel: (1809) 533-4602\/533-4686\/
\n533-8700
\nFax: (1809) 535 7337
\nE-mail: asoc.medica@codetel.net.do
\nECUADOR S
\nFederaci\u00f3n M\u00e9dica Ecuatoriana
\nV.M. Rend\u00f3n 923 \u2013 2 do.Piso Of. 201
\nP.O. Box 09-01-9848
\nGuayaquil
\nTel\/Fax: (593) 4 562569
\nE-mail: fdmedec@andinanet.net
\nEGYPT E
\nEgyptian Medical Association
\n\u201eDar El Hekmah\u201c
\n42, Kasr El-Eini Street
\nCairo
\nTel: (20-2) 3543406
\nEL SALVADOR, C.A S
\nColegio M\u00e9dico de El Salvador
\nFinal Pasaje N\u00b0 10
\nColonia Miramonte
\nSan Salvador
\nTel: (503) 260-1111, 260-1112
\nFax: -0324
\nE-mail: comcolmed@telesal.net
\nmarnuca@hotmail.com
\nESTONIA E
\nEstonian Medical Association
\n(EsMA)Pepleri 32
\n51010 Tartu
\nTel\/Fax (372) 7420429
\nE-mail: eal@arstideliit.ee
\nWebsite: www.arstideliit.ee
\nETHIOPIA E
\nEthiopian Medical Association
\nP.O. Box 2179
\nAddis Ababa
\nTel: (251-1) 158174
\nFax: (251-1) 533742
\nE-mail: ema.emj@telecom.net.et \/
\nema@eth.healthnet.org
\nFIJI ISLANDS E
\nFiji Medical Association
\n2nd Fl. Narsey\u2019s Bldg, Renwick Road
\nG.P.O. Box 1116
\nSuva
\nTel: (679) 315388\/Fax: (679) 387671
\nE-mail: fijimedassoc@connect.com.fj
\nFINLAND E
\nFinnish Medical Association
\nP.O. Box 49
\n00501 Helsinki
\nTel: (358-9) 3930 91\/Fax-794
\nE-mail: fma@fimnet.fi
\nWebsite: www.medassoc.fi
\nFRANCE F
\nAssociation M\u00e9dicale Fran\u00e7aise
\n180, Blvd. Haussmann
\n75389 Paris Cedex 08
\nTel\/Fax: (33) 1 45 25 22 68
\nGEORGIA E
\nGeorgian Medical Association
\n7 Asatiani Street
\n380077 Tbilisi
\nTel: (995 32) 398686 \/ Fax: -398083
\nE-mail: Gma@posta.ge
\nGERMANY E
\nBundes\u00e4rztekammer
\n(German Medical Association)
\nHerbert-Lewin-Platz 1
\n10623 Berlin
\nTel: (49-30) 400-456 369\/Fax: -387
\nE-mail: renate.vonhoff-winter@baek.de
\nWebsite: www.bundesaerztekammer.de
\nGHANA E
\nGhana Medical Association
\nP.O. Box 1596
\nAccra
\nTel: (233-21) 670-510\/Fax: -511
\nE-mail: gma@ghana.com
\nHAITI, W.I. F
\nAssociation M\u00e9dicale Haitienne
\n1\u00e8re
\nAv. du Travail #33 \u2013 Bois Verna
\nPort-au-Prince
\nTel: (509) 245-2060
\nFax: (509) 245-6323
\nE-mail: amh@amhhaiti.net
\nWebsite: www.amhhaiti.net
\nHONG KONG E
\nHong Kong Medical Association, Chi-
\nnaDuke of Windsor Building, 5th Floor
\n15 Hennessy Road
\nTel: (852) 2527-8285
\nFax: (852) 2865-0943
\nE-mail: hkma@hkma.org
\nWebsite: www.hkma.org
\nHUNGARY E
\nAssociation of Hungarian Medical
\nSocieties (MOTESZ)
\nN\u00e1dor u. 36 \u2013 PO.Box 145
\n1443 Budapest
\nTel: (36-1) 312 3807 \u2013 311 6687
\nFax: (36-1) 383-7918
\nE-mail: motesz@motesz.hu
\nWebsite: www.motesz.hu
\nICELAND E
\nIcelandic Medical Association
\nHlidasmari 8
\n200 K\u00f3pavogur
\nTel: (354) 8640478
\nFax: (354) 5644106
\nE-mail: icemed@icemed.is
\nINDIA E
\nIndian Medical Association
\nIndraprastha Marg
\nNew Delhi 110 002
\nTel: (91-11) 23370009\/23378819\/
\n23378680
\nFax: (91-11) 23379178\/23379470
\nE-mail: inmedici@vsnl.com
\nINDONESIA E
\nIndonesian Medical Association
\nJalan Dr Sam Ratulangie N\u00b0 29
\nJakarta 10350
\nTel: (62-21) 3150679
\nFax: (62-21) 390 0473\/3154 091
\nE-mail: pbidi@idola.net.id
\nIRELAND E
\nIrish Medical Organisation
\n10 Fitzwilliam Place
\nDublin 2
\nTel: (353-1) 676-7273Fax: (353-1)
\n6612758\/6682168
\nWebsite: www.imo.ie
\nISRAEL E
\nIsrael Medical Association
\n2 Twin Towers, 35 Jabotinsky St.
\nP.O. Box 3566, Ramat-Gan 52136
\nTel: (972-3) 6100444 \/ 424
\nFax: (972-3) 5751616 \/ 5753303
\nE-mail: doritb@ima.org.il
\nWebsite: www.ima.org.il
\nJAPAN E
\nJapan Medical Association
\n2-28-16 Honkomagome, Bunkyo-ku
\nTokyo 113-8621
\nTel: (81-3) 3946 2121\/3942 6489
\nFax: (81-3) 3946 6295
\nE-mail: jmaintl@po.med.or.jp
\nKAZAKHSTAN F
\nAssociation of Medical Doctors
\nof Kazakhstan
\n117\/1 Kazybek bi St.,
\nAlmaty
\nTel: (3272) 62 -43 01 \/ -92 92
\nFax: -3606
\nE-mail: sadykova-aizhan@yahoo.com
\nREP. OF KOREA E
\nKorean Medical Association
\n302-75 Ichon 1-dong, Yongsan-gu
\nSeoul 140-721
\nTel: (82-2) 794 2474
\nFax: (82-2) 793 9190
\nE-mail: intl@kma.org
\nWebsite: www.kma.org
\nKUWAIT E
\nKuwait Medical Association
\nP.O. Box 1202
\nSafat 13013
\nTel: (965) 5333278, 5317971
\nFax: (965) 5333276
\nE-mail: aks.shatti@kma.org.kw
\nLATVIA E
\nLatvian Physicians Association
\nSkolas Str. 3
\nRiga
\n1010 Latvia
\nTel: (371-7) 22 06 61; 22 06 57
\nFax: (371-7) 22 06 57
\nE-mail: lab@parks.lv
\nLIECHTENSTEIN E
\nLiechtensteinischer \u00c4rztekammer
\nPostfach 52
\n9490 Vaduz
\nTel: (423) 231-1690
\nFax: (423) 231-1691
\nE-mail: office@aerztekammer.li
\nWebsite: www.aerzte-net.li
\nLITHUANIA E
\nLithuanian Medical Association
\nLiubarto Str. 2
\n2004 Vilnius
\nTel\/Fax: (370-5) 2731400
\nE-mail: lgs@takas.lt
\nWebsite: www.lgs.lt
\nLUXEMBOURG F
\nAssociation des M\u00e9decins et
\nM\u00e9decins Dentistes du Grand-
\nDuch\u00e9 de Luxembourg
\n29, rue de Vianden
\n2680 Luxembourg
\nTel: (352) 44 40 331
\nFax: (352) 45 83 49
\nE-mail: secretariat@ammd.lu
\nWebsite: www.ammd.lu
\nMACEDONIA E
\nMacedonian Medical Association
\nDame Gruev St. 3
\nP.O. Box 174
\n91000 Skopje
\nTel\/Fax: (389-91) 232577
\nE-mail: mld@unet.com.mk
\nMALAYSIA E
\nMalaysian Medical Association
\n4th Floor, MMA House
\n124 Jalan Pahang
\n53000 Kuala Lumpur
\nTel: (60-3) 40413740\/40411375
\nAssociation and address\/Officers
\nii
\nU2–4_WMJ_02_07.qxd 02.08.2007 09:02 Seite U3
\nAssociation and address\/Officers
\niii
\nFax: (60-3) 40418187\/40434444
\nE-mail: mma@tm.net.my
\nWebsite: http:\/\/www.mma.org.my
\nMALTA E
\nMedical Association of Malta
\nThe Professional Centre
\nSliema Road, Gzira GZR 06
\nTel: (356) 21312888
\nFax: (356) 21331713
\nE-mail: mfpb@maltanet.net
\nWebsite: www.mam.org.mt
\nMEXICO S
\nColegio Medico de Mexico
\nFenacome
\nHidalgo 1828 Pte. D-107
\nColonia Deportivo Obispado
\nMonterrey, Nuevo L\u00e9on
\nTel\/Fax: (52-8) 348-41-55
\nE-mail: rcantum@doctor.com
\nWebsite: www.cmm-fenacome.org
\nNAMIBIA E
\nMedical Association of Namibia
\n403 Maerua Park \u2013 POB 3369
\nWindhoek
\nTel: (264) 61 22 44 55\/Fax: -48 26
\nE-mail: man.office@iway.na
\nNEPAL E
\nNepal Medical Association
\nSiddhi Sadan, Post Box 189
\nExhibition Road
\nKatmandu
\nTel: (977 1) 4225860, 231825
\nFax: (977 1) 4225300
\nE-mail: nma@healthnet.org.np
\nNETHERLANDS E
\nRoyal Dutch Medical Association
\nP.O. Box 20051
\n3502 LB Utrecht
\nTel: (31-30) 28 23-267\/Fax-318
\nE-mail: j.bouwman@fed.knmg.nl
\nWebsite: www.knmg.nl
\nNEW ZEALAND E
\nNew Zealand Medical Association
\nP.O. Box 156
\nWellington 1
\nTel: (64-4) 472-4741
\nFax: (64-4) 471 0838
\nE-mail: nzma@nzma.org.nz
\nWebsite: www.nzma.org.nz
\nNIGERIA E
\nNigerian Medical Association
\n74, Adeniyi Jones Avenue Ikeja
\nP.O. Box 1108, Marina
\nLagos
\nTel: (234-1) 480 1569,
\nFax: (234-1) 492 4179
\nE-mail: info@nigeriannma.org
\nWebsite: www.nigeriannma.org
\nNORWAY E
\nNorwegian Medical Association
\nP.O.Box 1152 sentrum
\n0107 Oslo
\nTel: (47) 23 10 -90 00\/Fax: -9010
\nE-mail: ellen.pettersen@
\nlegeforeningen.no
\nWebsite: www.legeforeningen.no
\nPANAMA S
\nAsociaci\u00f3n M\u00e9dica Nacional
\nde la Rep\u00fablica de Panam\u00e1
\nApartado Postal 2020
\nPanam\u00e1 1
\nTel: (507) 263 7622 \/263-7758
\nFax: (507) 223 1462
\nFax modem: (507) 223-5555
\nE-mail: amenalpa@cwpanama.net
\nPERU S
\nColegio M\u00e9dico del Per\u00fa
\nMalec\u00f3n Armend\u00e1riz N\u00b0 791
\nMiraflores, Lima
\nTel: (51-1) 241 75 72
\nFax: (51-1) 242 3917
\nE-mail: decano@cmp.org.pe
\nWebsite: www.cmp.org.pe
\nPHILIPPINES E
\nPhilippine Medical Association
\nPMA Bldg, North Avenue
\nQuezon City
\nTel: (63-2) 929-63 66\/Fax: -6951
\nE-mail: medical@pma.com.ph
\nWebsite: www.pma.com.ph
\nPOLAND E
\nPolish Medical Association
\nAl. Ujazdowskie 24, 00-478 Warszawa
\nTel\/Fax: (48-22) 628 86 99
\nPORTUGAL E
\nOrdem dos M\u00e9dicos
\nAv. Almirante Gago Coutinho, 151
\n1749-084 Lisbon
\nTel: (351-21) 842 71 00\/842 71 11
\nFax: (351-21) 842 71 99
\nE-mail: intl@omcne.pt
\nWebsite: www.ordemdosmedicos.pt
\nROMANIA F
\nRomanian Medical Association
\nStr. Ionel Perlea, nr 10
\nSect. 1, Bucarest
\nTel: (40-1) 460 08 30
\nFax: (40-1) 312 13 57
\nE-mail: AMR@itcnet.ro
\nWebsite: ong.ro\/ong\/amr
\nRUSSIA E
\nRussian Medical Society
\nUdaltsova Street 85
\n119607 Moscow
\nTel: (7-095)932-83-02
\nE-mail: info@rusmed.ru
\nWebsite: www.russmed.ru
\nSAMOA E
\nSamoa Medical Association
\nTupua Tamasese Meaole Hospital
\nPrivate Bag \u2013 National Health Services
\nApia
\nTel: (685) 778 5858
\nE-mail: vialil_lameko@yahoo.com
\nSINGAPORE E
\nSingapore Medical Association
\nAlumni Medical Centre, Level 2
\n2 College Road, 169850 Singapore
\nTel: (65) 6223 1264
\nFax: (65) 6224 7827
\nE-Mail: sma@sma.org.sg
\nwww.sma.org.sg
\nSLOVAK REPUBLIC E
\nSlovak Medical Association
\nLegionarska 4
\n81322 Bratislava
\nTel: (421-2) 554 24 015
\nFax: (421-2) 554 223 63
\nE-mail: secretarysma@ba.telecom.sk
\nSLOVENIA E
\nSlovenian Medical Association
\nKomenskega 4, 61001 Ljubljana
\nTel: (386-61) 323 469
\nFax: (386-61) 301 955
\nSOMALIA E
\nSomali Medical Association
\n14 Wardigley Road \u2013 POB 199
\nMogadishu
\nTel: (252-1) 595 599
\nFax: (252-1) 225 858
\nE-mail: drdalmar@yahoo.co.uk
\nSOUTH AFRICA E
\nThe South African Medical Associa-
\ntionP.O. Box 74789, Lynnwood Rydge
\n0040 Pretoria
\nTel: (27-12) 481 2036\/2063
\nFax: (27-12) 481 2100\/2058
\nE-mail: sginterim@samedical.org
\nWebsite: www.samedical.org
\nSPAIN S
\nConsejo General de Colegios M\u00e9dicos
\nPlaza de las Cortes 11, Madrid 28014
\nTel: (34-91) 431 7780
\nFax: (34-91) 431 9620
\nE-mail: internacional1@cgcom.es
\nSWEDEN E
\nSwedish Medical Association
\n(Villagatan 5)
\nP.O. Box 5610, SE – 114 86 Stockholm
\nTel: (46-8) 790 33 00
\nFax: (46-8) 20 57 18
\nE-mail: info@slf.se
\nWebsite: www.lakarforbundet.se
\nSWITZERLAND F
\nF\u00e9d\u00e9ration des M\u00e9decins Suisses
\nElfenstrasse 18 \u2013 C.P. 170
\n3000 Berne 15
\nTel: (41-31) 359 \u20131111\/Fax: -1112
\nE-mail: fmh@hin.ch
\nWebsite: www.fmh.ch
\nTAIWAN E
\nTaiwan Medical Association
\n9F No 29 Sec1
\nAn-Ho Road
\nTaipei
\nTel: (886-2) 2752-7286
\nFax: (886-2) 2771-8392
\nE-mail: intl@med-assn.org.tw
\nWebsite: www.med.assn.org.tw
\nTHAILAND E
\nMedical Association of Thailand
\n2 Soi Soonvijai
\nNew Petchburi Road
\nBangkok 10320
\nTel: (66-2) 314 4333\/318-8170
\nFax: (66-2) 314 6305
\nE-mail: math@loxinfo.co.th
\nWebsite: www.medassocthai.org
\nTUNISIA F
\nConseil National de l\u2019Ordre
\ndes M\u00e9decins de Tunisie
\n16, rue de Touraine
\n1002 Tunis
\nTel: (216-71) 792 736\/799 041
\nFax: (216-71) 788 729
\nE-mail: ordremed.na@planet.tn
\nTURKEY E
\nTurkish Medical Association
\nGMK Bulvary
\nSehit Danis Tunaligil Sok. N\u00b0 2 Kat 4
\nMaltepe 06570
\nAnkara
\nTel: (90-312) 231 \u20133179\/Fax: -1952
\nE-mail: Ttb@ttb.org.tr
\nWebsite: www.ttb.org.tr
\nUGANDA E
\nUganda Medical Association
\nPlot 8, 41-43 circular rd.
\nP.O. Box 29874
\nKampala
\nTel: (256) 41 32 1795
\nFax: (256) 41 34 5597
\nE-mail: myers28@hotmail.com
\nUNITED KINGDOM E
\nBritish Medical Association
\nBMA House, Tavistock Square
\nLondon WC1H 9JP
\nTel: (44-207) 387-4499
\nFax: (44- 207) 383-6710
\nE-mail: vivn@bma.org.uk
\nWebsite: www.bma.org.uk
\nUNITED STATES OF AMERICA E
\nAmerican Medical Association
\n515 North State Street
\nChicago, Illinois 60610
\nTel: (1-312) 464 5040
\nFax: (1-312) 464 5973
\nWebsite: http:\/\/www.ama-assn.org
\nURUGUAY S
\nSindicato M\u00e9dico del Uruguay
\nBulevar Artigas 1515
\nCP 11200 Montevideo
\nTel: (598-2) 401 47 01
\nFax: (598-2) 409 16 03
\nE-mail: secretaria@smu.org.uy
\nVATICAN STATE F
\nAssociazione Medica del Vaticano
\nStato della Citt\u00e0 del Vaticano
\n00120 Citt\u00e0 del Vaticano
\nTel: (39-06) 69879300
\nFax: (39-06) 69883328
\nE-mail: servizi.sanitari@scv.va
\nVENEZUELA S
\nFederacion M\u00e9dica Venezolana
\nAvenida Orinoco
\nTorre Federacion M\u00e9dica Venezolana
\nUrbanizacion Las Mercedes
\nCaracas
\nTel: (58-2) 9934547
\nFax: (58-2) 9932890
\nWebsite: www.saludfmv.org
\nE-mail: info@saludgmv.org
\nVIETNAM E
\nVietnam Medical Association
\n(VGAMP)68A Ba Trieu-Street
\nHoau Kiem District
\nHanoi
\nTel\/Fax: (84) 4 943 9323
\nZIMBABWE E
\nZimbabwe Medical Association
\nP.O. Box 3671
\nHarare
\nTel: (263-4) 791553
\nFax: (263-4) 791561
\nE-mail: zima@zol.co.zw
\nU2–4_WMJ_02_07.qxd 02.08.2007 09:02 Seite U4
\n29
\nOFFICIAL JOURNAL OF
\nTHE WORLD MEDICAL
\nASSOCIATION
\nHon. Editor in Chief
\nDr. Alan J. Rowe
\nHaughley Grange, Stowmarket
\nSuffolk IP14 3QT
\nUK
\nCo-Editors
\nProf. Dr. med. Elmar Doppelfeld
\nDeutscher \u00c4rzte-Verlag
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\nBusiness Managers
\nJ. F\u00fchrer, D. Weber
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\nPublisher
\nTHE WORLD MEDICAL
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\nPublishing House
\nDeutscher \u00c4rzte-Verlag GmbH,
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\nBank: Commerzbank K\u00f6ln No. 1 500 057,
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\n50670 K\u00f6ln, No. 015 13330.
\nAt present rate-card No. 3 a is valid.
\nThe magazine is published quarterly.
\nSubscriptions will be accepted by
\nDeutscher \u00c4rzte-Verlag or the World
\nMedical Association.
\nSubscription fee \u20ac 22,80 per annum (incl. 7 %
\nMwSt.). For members of the World Medical
\nAssociation and for Associate members the
\nsubscription fee is settled by the membership
\nor associate payment. Details of Associate
\nMembership may be found at the World
\nMedical Association website www.wma.net
\nPrinted by
\nDeutscher \u00c4rzte-Verlag
\nK\u00f6ln \u2013 Germany
\nISSN: 0049-8122
\nEditorial
\nIt is with sadness that we open this issue of the WMJ with the obituary of Dr. Andre Wynen,
\nSecretary General Emeritus of the World Medical Association. However, it is timely that the
\nprinciples of the WMA and the issues he fought for are reflected in the report of the release of
\nthe doctor and nurses imprisoned and under sentence of death in Libya and by the emphasis
\nplaced by the Council in reaffirming the Declaration of Hamburg concerning Torture. Also, in
\nthe report of the 176th
\nWMA Council meeting the concerns expressed about threats to the
\nautonomy of physicians, of their patients and on the governing of the medical profession.
\nIn a world of constant and rapid change, we include reports on WHO and other international
\ninitiatives to contain increasing threats to public health, the problems of the shortages of health
\nprofessionals and on global partnerships to enhance the production of therapeutic agents.
\nIn the busy life of physicians engaged in day to day care of the sick and injured, while endeav-
\nouring to keep track of changes in knowledge and advances in technology, it is difficult to find
\ntime to reflect on the pressures which changing social attitudes place on the basic ethical tenets
\nupon which medical practice is based. In particular the increasing pressures imposed by eco-
\nnomic constraints impose a duty on physicians both individually and collectively to reflect and
\nact on the principles which should govern their professional activity. The role of national med-
\nical associations in stressing the importance of these messages to its members cannot be
\noveremphasised. As the WMA Secretary General indicates in his column, it is important to
\nrecognise that political objectives can be achieved in many insidious ways of which all physi-
\ncians need to be aware.
\nNew Chair of WMA Council
\nDr. Edward Hill was elected chair of WMA Council at the 176th
\nCouncil meeting. Dr. Hill, A
\nfamily physicians from Tulepo, Mississippi, Dr. Hill was President of American Medical
\nAssociation in 2005, had been Chair of the AMA Board of Trustees for three years. Qualifying
\nin medicine at the University of Mississippi he served as a general medical officer in the US
\nNavy and for 27 years practiced in the rural Mississippi Delta, later becoming Director of the
\nFamily Practice residency Programme at North Mississippi Medical Centre, the USA\u2019s largest
\nrural hospital. Dr. Hull developed and directed
\na local health programme which successfully
\nreduced the foetal mortality rate from one of the
\nhighest in the USA to below the national aver-
\nage.
\nDr. Hill has been President of the Mississippi
\nState Medical Association, President of the
\nMississippi Academy of Family Physicians,
\nDelegate to the American Academy of Family
\nPhysicians and President of the Southern
\nMedical Association. \u201cDr. Hill succeeds Dr.
\nYoram Blachar who, after four years, stood
\ndown from the post.\u201d
\nWMJ_2_29-56.qxd 02.08.2007 09:14 Seite 29
\nObituary
\n30
\nAndr\u00e9 Wynen, Secretary General
\nEmeritus of the World Medical Asso-
\nciation, a staunch protagonist and defend-
\ner of the medical profession and its
\npatients, its autonomy and professional
\nethics, died on 10th
\nJune, 2007, at the age
\nof 83. He was known and respected by his
\nprofessional colleagues and many others
\nworld wide for his promotion of the high-
\nest standards of med-
\nical ethics both in the
\npractice of medicine, in
\nthe care of the sick and
\nin the interests of
\nhumanity at large.
\nAndr\u00e9 Wynen, the son
\nof a civil engineer was
\nborn on the 8th
\nDe-
\ncember 1923. Brussels.
\nDuring the Second
\nWorld War, he was
\ncalled-up at the age of
\n16 to serve in the
\nRecruitment Corps of
\nthe Belgian Army.
\nFollowing the German
\noccupation, having failed to escape from
\nFrance to Africa he returned to Belgium,
\neventually joining the Resistance. He suf-
\nfered imprisonment first in Breendonk and
\nthen in Buchenwald concentration camps,
\nsurviving, despite his many terrible expe-
\nriences which included exposure to
\ntyphus, many victims of which he nursed.
\nOn his liberation and return to Belgium,
\nhe was found to have tuberculosis which
\nwas treated in Switzerland. It was not until
\n1947 that he was able to take up his med-
\nical studies again. He had completed his
\nfirst examination at the then illegal facul-
\nty in Namur in 1942, before he was
\nimprisoned, but after his recovery from
\ntuberculosis resumed his interrupted stud-
\nies, qualifying in 1950.
\nDr. Wynen\u2019s chosen professional career
\nwas that of surgery, practising as a gener-
\nal surgeon. He first practiced in Braine
\nl\u2019Alleud where he later built a small hos-
\npital and subsequently the 250 bed hospi-
\ntal with all its services. There he gained
\nconsiderable experience in traumatology
\nfrom road traffic accidents in the area.
\nAndr\u00e9 Wynen also operated at the Cavell
\nHospital, a private hospital in Bruxelles
\nwhere, following a major financial crisis
\nleading to its threatened closure, the work-
\ners trade union (including the hospital
\ndoctors who were members of the
\nAssociation Belge des
\nSyndicats M\u00e9dicaux of
\nwhich Dr. Wynen was a
\nfounder and for many
\nyears the President)
\nreacted against its clo-
\nsure by occupying the
\nbuilding for more than
\nthree months.
\nEventually, following the
\nintervention of the
\nMinister and negotia-
\ntions led by Dr. Wynen,
\nhis proposition for solv-
\ning the problems (based
\non the principles under
\nwhich Braine l\u2019Alleud
\nhospital had been estab-
\nlished) was accepted and with 37 col-
\nleagues, the non profit making \u201cInstitut
\nM\u00e9dical Edith Cavell\u201c was formed, ensur-
\ning continuity of medical care in this re-
\nestablished private hospital. This is one
\nillustration of his engagement on behalf of
\nhealth professionals and patients, ensuring
\nthe survival of the hospital and proper
\nconditions under which doctors and other
\nhealth workers could care for their
\npatients.
\nDr. Wynen played a major role in Belgian
\nnational medical politics not only in the
\nformation of the Association Belge des
\nSyndicats M\u00e9dicaux, but also Hospital
\nand other organisations. He was deeply
\ninvolved in the major conflict between the
\nphysicians and the government over a
\nreform of the Leburton Law. This would
\nhave penalised patients who chose to con-
\nsult a physician who had not accepted the
\nagreement with the social security system.
\nThe patients\u2019 freedom of choice for med-
\nical care was a principle which Dr. Wynen
\nregarded as a fundamental right of all citi-
\nzens, as did many of his colleagues. The
\ndefence of this principle led to a success-
\nful national doctors\u2019 strike, organised in
\nsuch a way that arrangements ensured the
\nprovision of urgent and emergency ser-
\nvices. Eventually the government agreed
\nto negotiations with the Medical Trade
\nUnion and the law was modified. A further
\nindication of Wynen\u2019s tenacity in defend-
\ning patients\u2019 care, occurred when he later
\nengaged with the government when it
\ntried to limit the number of installations of
\nscanners in Belgium. This involved him in
\na court case in which in the end he was
\nsuccessful, although it placed him at con-
\nsiderable personal risk. He was even pub-
\nlicly threatened with imprisonment.
\nOn the international scene Dr. Wynen was
\nequally active medico-politically as Head
\nof the Belgian Delegation and as President
\nof the Comit\u00e9 Permanent des Med\u00e9cins de
\nla CEE during the Belgian Presidency
\n1967\u20131970. He was also a Member of the
\nAdvisory Committee on Medical Training
\n(ACMT) of the EEC, a co-founder of the
\nEuropean Academy of Post-graduate
\nEducation and a participant in many other
\ninternational organisations.
\nDr. Wynen\u2019s devotion to the medical pro-
\nfession and deep concern with profession-
\nal standards, the ethical aspects of medical
\npractice (including its role as the advocate
\nof patients), was demonstrated by his con-
\ntinuing activity in the World Medical
\nAssociation (WMA). The WMA had been
\nfounded after the Second World War and
\nin a reaction to the horrifying breaches of
\nmedical ethics during that period, focused
\nits main activity on establishing world
\nwide international principles and codes of
\nmedical ethics. Andr\u00e9 Wynen had a dri-
\nving concern in the establishment of the
\nhighest standards of medical ethics to gov-
\nern the practice of medicine, the profes-
\nsional autonomy of its practitioners in the
\npreservation of life and the care of those
\nwho are sick. This duty of care was one
\nwhich could be detected throughout his
\nlife, from his early nursing care of his fel-
\nlow prisoners with typhus to his fights,
\nDr. Andr\u00e9 Wynen 1924\u20132007
\nWMJ_2_29-56.qxd 02.08.2007 09:14 Seite 30
\nObituary \/ Medical Ethics \/ WMA
\n31
\nBoth the World Medical Association and the
\nInternational Council of Nurses welcomed
\nthe release of the Palestinian physician and
\nthe five nurses who have been incarcerated
\nfor eight years, ultimately under sentence of
\ndeath in Libya. These health professionals
\nhad been accused by Libya of deliberately
\ninfecting more than 400 Libyan children with
\nHIV. Despite the clear evidence of a number
\nof leading world experts to the contrary, the
\nLibyan Courts found them guilty and ulti-
\nmately condemned them to death. Following
\nextensive representation from throughout the
\nworld and other interventions, the death sen-
\ntence has been dropped and all the health pro-
\nfessionals have left Libya for Bulgaria.
\nmany years later, to seek the release of
\nphysicians sick and imprisoned e.g.
\nunder the Pinochet regime in Chile, an
\naction in which he spared neither him-
\nself nor any other effort to achieve suc-
\ncess.
\nAs Chairman of Council and later for
\n17 years as Secretary General of the
\nWMA, Dr. Wynen contributed to the
\npreparation and adoption of the impor-
\ntant Declarations of Tokyo and
\nHelsinki and during a difficult period in
\nthe history of the WMA, greatly con-
\ntributed to its survival and renewal.
\nHis huge contribution to the work of
\nthe WMA was recognised by his col-
\nleagues all over the world when he was
\nmade Secretary General Emeritus. He
\nwas the recipient of a considerable
\nnumber of honours from many coun-
\ntries and only 18 months ago, his inter-
\nnational significance in medical care
\nwas recognised by his own government
\nwhen he was invested as a Grand
\nOfficer of the Order of Leopold.
\nSometimes controversial and always
\nformidable in his defence of the princi-
\nples on which both the duty and rights
\nof physicians are based, he was consid-
\nerate, kind and a good friend to many
\nacross the world. Dr. Wynen could
\nnever be thought of without his wife
\nNicole and his family to whom he was
\ndeeply attached. His partnership with
\nNicole was something to be envied.
\nIndeed following his serious cycling
\naccident, many would agree that his
\nremarkable recovery would not have
\nbeen possible without the outstanding
\nsupport of his wife, nor indeed would
\nhe have been able to continue his many
\nactivities without her support.
\nAndr\u00e9 Wynen\u2019s contribution to
\nadvancing the care of patients and
\ndefending health related human rights,
\nthe autonomy of his professional col-
\nleagues in the practice of medicine, the
\npromotion of high standards of med-
\nical education and of medical ethics,
\nwill be greatly missed both nationally
\nand internationally.
\nRelease of Palestinian Physician and
\nBulgarian Nurses
\nThe 176th
\nCouncil meeting took place this
\nyear in Berlin, Germany on 10-12th
\nMay
\n2007.
\nWhile the Council meetings associated with
\nthe General Assembly take place each year
\nin a different member state, this was the
\nfirst time for many years that the mid-term
\nCouncil meeting has taken place outside
\nFrance. The meeting was held in the
\nMeistersaal, Berlin at the invitation of the
\nGerman Medical Association and had the
\nbiggest ever attendance at a council meet-
\ning, 130 individuals from 16 countries.
\nDr. Kloiber, the Secretary-General, called
\nthe meeting to order and Professor Hoppe,
\nin welcoming the Council to Berlin, gave a
\nbrief outline of the history of the
\nMeistersaal in which the meeting was tak-
\ning place, following which Dr. Coble (a
\nPast President) gave an introductory talk
\nfor the benefit of new members of Council
\noutlining the way in which the WMA had
\ndeveloped since the Washington meeting in
\n2002. He said that major improvements in
\ngovernance were adopted in Santiago,
\nincluding the introduction of council orien-
\ntation guides, resulting in improved func-
\ntioning of council etc. and ensuring that the
\nvoice of the minority was heard. In Helsinki
\nthe Canadian Medical Association had pro-
\nposed the formation of a Business
\n176th
\nWMA Council meeting
\nCommittee stimulated by a previous survey
\nof the membership on their expectations of
\nthe WMA. This survey identified concerns
\nabout autonomy, the need to be strong on
\nPublic Health, on advocacy and outreach
\nespecially to NMAs, the other health pro-
\nfessions and the World Bank etc. This had
\nall been done.
\nSix months before the General Assembly
\nin Tokyo a search committee was estab-
\nlished by Council, resulting in the appoint-
\nment of a new Secretary General, Dr.
\nKloiber, the following year. Research con-
\ncentrated on improving outreach, regular
\nmeetings developed and individuals were
\nidentified who showed the qualities of
\nCaring, Ethics and Science, without which
\nhe commented \u201ccaring and ethics alone is
\nnothing but well-intended kindness, not
\nMedicine\u201d. These individuals were pre-
\nsented at the Santiago Assembly in the
\nbook \u201cCaring Physicians of the World\u201d
\n(CPW). They comprised individuals not
\nknown world wide but demonstrating
\nsocial qualities as well as those related to
\nactivities associated with professional
\nethics, medical science and practice. The
\nvolume \u201cCaring Physicians of the World,
\nlaunched in Santiago was also presented to
\nthe World Health Assembly. The CPW ini-
\ntiative extended outreach to NMAs and
\nincluded meetings in Africa, in Europe,
\nWMJ_2_29-56.qxd 02.08.2007 09:14 Seite 31
\nWMA
\n32
\nLatin-America, North America and the
\nAsian\/Pacific region. The question was
\nthen how to proceed? The book has now
\nbeen translated into Spanish in South
\nAmerica and the South African Medical
\nAssociation was organising a further meet-
\ning in Africa. \u201cWe need to increase the
\nability of the medical profession to
\nemerge.\u201d Dr. Coble announced that a
\ncourse on Leadership is being organised
\nlater this year for those with knowledge
\nand judgement and quoted Osler and
\nTolstoi as examples of the qualities of
\nthose able to inspire hope and trust. He
\nalso stressed that there was a need now to
\ninspire members of NMAs and was sure
\nthat the Leadership course would be a step
\nin this direction.
\nCouncil meeting
\nDr. Kloiber then formally opened the
\nCouncil meeting and called on the retiring
\nChair, Dr.Yoram Blachar, to address the
\nCouncil.
\nDr. Blachar
\nDr. Blachar recalled he had been active in
\nthe WMA for more than 10 years, as a
\nmember of Council, Chair of the Socio-
\nMedical Affairs committee and finally for
\nthe past 4 years Chair of Council. This was
\nat a time when members had expressed
\ndissatisfaction with the organisation\u2019s
\nactivities and in consequence the organisa-
\ntion underwent major change which, with
\nthe assistance of many members of coun-
\ncil, had taken place under his chairman-
\nship. He continued \u201cWith the hard work of
\nDr. John Williams and through many
\nworkgroups in which members had taken
\npart, we were able to revise and update the
\nweighty stock of Statements, Resolutions
\nand Declarations, to rescind and archive
\nthose which merited it and to reaffirm
\nthose Statements that were still relevant.
\nThe WMA also underwent an important
\nchange in governance. We were able to
\nestablish the Executive Committee and
\nkept the finance Committee updated with a
\nrunning account of the financial status of
\nthe association. As a result of the survey
\nconducted amongst you, we learned your
\npriorities for topics to be dealt with and
\nissues and problems to be raised on our
\nagenda. The crux of the WMA\u2019s activities
\nwas and remains the ethical area, but other
\ntopics such as health care reforms, physi-
\ncian autonomy, medical malpractice and
\nothers were given prominent place on our
\nagenda. In addition, a workgroup was
\nformed to implement the need to diversify
\nthe WMA\u2019s activities and expand its
\nsources of income beyond that of member-
\nship dues alone.\u201d
\nStressing that it was difficult to exaggerate
\nthe importance of WMA, he indicated that it
\nwas the central body shaping ethical princi-
\nples in medicine accepted worldwide.
\n\u201cDespite the changes experienced by the
\norganisation in the last few years it remains
\nthe most important meeting place of med-
\nical representatives from all corners of the
\nglobe. The problems faced by physicians
\nworldwide are similar, if not identical, in
\nevery country. We physicians are forced to
\ndeal with limited resources for expanding
\ntechnologies and new treatments and are
\nfaced with the end of the paternalistic era.
\nAll these factors and more, impact on the
\nrelationship between our patients and physi-
\ncians. This relationship has evolved into
\none of partnership in determining care, par-
\nticularly since in the age of the Internet,
\nmedical information has become accessible
\nto all through the click of a mouse. In addi-
\ntion, in an era when sacred cows are slaugh-
\ntered daily, we physicians are fodder for the
\nmedia\u201d
\nAddressing the constant threats to the pro-
\nfession, and observing that differences
\nbetween geographical areas and different
\ncountries can be stark, Dr. Blachar referred
\nto the existence of areas in which the severe
\nshortage of physicians was so bad that
\n\u201cbarefoot doctors\u201d had to be trained instead
\nof physicians, to the influence of economic
\npressures, to the heavy workload and to the
\ntransfer of some functions from physicians
\nto nurses and other paramedical profession-
\nals. In the context of the issue of physician
\nmigration, which was of importance to
\nWMA and to society as a whole, he said that
\n\u201cthis creates a serious shortage to the point
\nof endangering entire populations in certain
\ncountries where the \u201cbrain drain\u201d from
\npoorer less developed countries to more
\nestablished countries is acute. This issue
\nraises ethical questions which must be
\naddressed\u201d.
\nDr. Blachar expressed his thanks for his
\nterm as Chairman and his gratitude to the
\ntwo Secretary Generals with whom he had
\nhad the privilege of working. He referred to
\nDr. Delon Humans\u2019s contribution in bring-
\ning new life to the WMA, helping it to
\n176th
\nCouncil in session.
\nCont. p. 35
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 32
\nMedical Ethics
\n33
\nPREAMBLE
\n1. On the basis of a number of internation-
\nal ethical declarations and guidelines
\nsubscribed to by the medical profes-
\nsion, medical doctors throughout the
\nworld are prohibited from countenanc-
\ning, condoning or participating in the
\npractice of torture or other forms of
\ncruel, inhuman or degrading proce-
\ndures for any reason.
\n2. Primary among these declarations are
\nthe World Medical Association\u2019s
\nInternational Code of Medical Ethics,
\nDeclaration of Geneva, Declaration of
\nTokyo, and Resolution on Physician
\nParticipation in Capital Punishment;
\nthe Standing Committee of European
\nDoctors\u2019 Statement of Madrid; the
\nNordic Resolution Concerning Phy-
\nsician Involvement in Capital
\nPunishment; and, the World Psychiatric
\nAssociation\u2019s Declaration of Hawaii.
\n3. However, none of these declarations or
\nstatements addresses explicitly the
\nissue of what protection should be
\nextended to medical doctors if they are
\npressured, called upon, or ordered to
\ntake part in torture or other forms of
\ncruel, inhuman or degrading treatment
\nor punishment. Nor do these declara-
\ntions or statements express explicit sup-
\nport for, or the obligation to protect,
\ndoctors who encounter or become
\naware of such procedures.
\nRESOLUTION
\n4. The World Medical Association
\n(WMA) hereby reiterates and reaffirms
\nthe responsibility of the organised med-
\nical profession:
\ni. to encourage doctors to honour
\ntheir commitment as physicians
\nto serve humanity and to resist
\nany pressure to act contrary to
\nthe ethical principles governing
\ntheir dedication to this task;
\nii. to support physicians experienc-
\ning difficulties as a result of
\ntheir resistance to any such pres-
\nsure or as a result of their
\nattempts to speak out or to act
\nagainst such inhuman proce-
\ndures; and,
\niii. to extend its support and to
\nencourage other international
\norganisations, as well as the
\nnational member associations
\n(NMAs) of the World Medical
\nAssociation, to support physi-
\ncians encountering difficulties
\nas a result of their attempts to
\nact in accordance with the high-
\nest ethical principles of the pro-
\nfession.
\n5. Furthermore, in view of the continued
\nemployment of such inhumane proce-
\ndures in many countries throughout the
\nworld, and the documented incidents of
\npressure upon medical doctors to act in
\ncontravention to the ethical principles
\nsubscribed to by the profession, the
\nWMA finds it necessary:
\ni. to protest internationally against
\nany involvement of, or any pres-
\nsure to involve, medical doctors
\nin acts of torture or other forms
\nof cruel, inhuman or degrading
\ntreatment or punishment;
\nii. to support and protect, and to
\ncall upon its NMAs to support
\nand protect, physicians who are
\nresisting involvement in such
\ninhuman procedures or who are
\nworking to treat and rehabilitate
\nvictims thereof, as well as to
\nsecure the right to uphold the
\nhighest ethical principles
\nincluding medical confidentiali-
\nty;
\niii. to publicise information about
\nand to support doctors reporting
\nevidence of torture and to make
\nknown proven cases of attempts
\nto involve physicians in such
\nprocedures; and,
\niv. to encourage national medical
\nassociations to ask correspond-
\ning academic authorities to teach
\nand investigate in all schools of
\nmedicine and hospitals the con-
\nsequences of torture and its treat-
\nment, the rehabilitation of the
\nsurvivors, the documentation of
\ntorture, and the professional pro-
\ntection described in this De-
\nclaration.
\nWorld Medical Association Declaration Concerning Support for
\nMedical Doctors Refusing to Participate in, or to Condone, the Use of
\nTorture or Other Forms of Cruel, Inhuman or Degrading Treatment
\nAdopted by the 49th
\nWMA General Assembly Hamburg, Germany, November 1997 and
\nre-affirmed by the 176th
\nWMA Council, Berlin meeting 2007.
\nThe policy of the Declaration of Hamburg was reaffirmed by the Council at their 176th
\nmeeting in Berlin, stressing the need for it
\nto be given wider publicity (see p. 38).
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 33
\nWMA
\n34
\nreach greater visibility, strengthening ties
\nwith organisations such as WHO and mak-
\ning cooperation with the World Health
\nProfessions Alliance both a fact and an
\ngreat advantage. Dr. Blachar thanked Dr.
\nKloiber who had brought to the WMA
\ngreater financial stability and organisation-
\nal and administrative efficiency, while
\nplanting the seeds of future growth and
\ndevelopment of the organisation. Closing,
\nDr. Blachar said\u201d I wish my successor as
\nenjoyable a candidacy as I experienced,
\nand I hope to have the opportunity to con-
\ntinue to contribute to this great organisa-
\ntion. Thank you for allowing me to serve
\nthe WMA\u201d.
\nDr. Kloiber thanked Dr. Blachar both for the
\nprivilege of working with him as Secretary
\nGeneral during the past two years and also
\nbefore that as a member of the
\nBundes\u00e4rztekammer. It had been obvious
\nthat Dr. Blachar wished to raise the WMA
\nto a new level and style of work. This had
\nbeen particularly difficult for WMA with
\nnot only the problems of governance and
\nfinance but also the changes taking place in
\nmedicine internationally. He thanked him
\nfor his friendship and trust which he had
\nmuch appreciated.
\nDeath of Dr. Odenbach
\nDr. Kloiber, after reporting apologies for
\nabsence, reported the sad death of Dr.
\nOdenbach. He had been a great supporter
\nand worker for WMA over a very long peri-
\nod, extending back to his first appearance as
\na student representative of the International
\nMedical Students Association nearly 55
\nyears ago, then as a member of the German
\nDelegation over the many years which fol-
\nlowed. He would be greatly missed.
\nCouncil stood in silent tribute.
\nContinuing, Dr. Kloiber observed that this
\nwas the biggest Council meeting ever, with
\n16 states being represented on Council
\ndirectly. He recognised 10 new members of
\nthe Council and welcomed as observers,
\nDr. Ren\u00e9 Salzberg (FMH), Dr. Reyes
\n(ICRC), Professor Orof Mezzich ( World
\nPychiatric Association) Mr. O Meretoja
\n(Confermel)
\nChair of Council
\nDr. Edward Hill (USA), Past President of
\nthe American Medical Association was
\nelected Chair of Council by acclamation.
\nDr Hill, acknowledging his thanks on being
\nelected, referred to the improvements in the
\nlast two years which were a tribute to a well
\nmotivated Secretary-General and to the
\nStrategic Plan. Faced with major problems
\nwhich would require evidence-based solu-
\ntions, there is a need to address some
\nNMAs\u2019 problems which will require more
\nstaff and new policies. He would do his
\nutmost to advance the work of the WMA.
\nVice-Chair of Council
\nDr. K. Iwasa (Japan) was elected Vice-
\nChair by acclamation.
\nTreasurer
\nDr. J. D. Hoppe (Germany) was re-elected.
\nCouncil then proceeded to elect members of
\nStanding Committees and Committee
\nAdvisers.
\nDr. Kloiber then introduced Ms. Seebohm
\nof the Bundes\u00e4rztekammer, the new Legal
\nAdviser, and paid tribute to the work of Ms.
\nLeah Wapner, Secretary General of the
\nIMA, who had provided assistance with the
\nlegal work during the interim period and
\nwould continue to give assistance. He
\nthanked the Israeli Medical Association for
\nmaking this possible.
\nReport of the President, Dr.
\nNachiappan Arumugam
\nDr. Arumugam said that in the last six
\nmonths he had met lots of members. Some
\nthought of WMA as a powerful body in the
\nmiddle of Europe. Others wonder who it is
\nand what it does. He had attended a number
\nof NMA meetings to meet them and discuss
\ntheir problems. Dr. Arumugam referred to
\nthe current challenges to the practice of
\nmedicine, the need to get people interested
\nand spoke about meetings he had attended
\nin South East Asia, Thailand and India, say-
\ning that he had found a general feeling of
\nneed to get to NMAs, promote activities
\nand present the challenges. In particular he
\nenlarged on the problems of globalisation,
\nmigration of physicians, problems associat-
\ned with EU legislation, with training and
\nthe privatisation of medical education, pay-
\nment systems and medico-legal problems.
\nThere was also the problem of differences
\nin medical ethics. He was grateful for the
\nopportunity which these visits had offered
\nto explore these issues with NMAs.
\nDr. Hill thanked the President for his report
\nand moved to the Secretary General\u2019s
\nReport.
\nSecretary General\u2019s Report
\nDr. Kloiber said that the written report (see
\nalso p. 43) was in a different format. It fell
\ninto two parts namely, a general part and
\nalso a part dealing with cooperation with
\nWHO which would be taken later in the
\nagenda. Some work had fallen to the
\nFinance and Planning Committee which has
\nhad more work to do, including the consol-
\nidation with finance. All the efforts have
\nbeen successful in this work which includ-
\ned control of Dues, support in Kind control
\nand Advocacy. There was better support of
\nrelations with NMAs.
\nThe biggest project had been \u201cCaring
\nPhysicians of the World\u201d (CPW), with the
\nbook CPW in Santiago, including sponsor-
\nship of the edition in Spanish launched in
\nMarch this year in Florida. With Dr. Coble
\nthere will be a Leadership Course in the
\nautumn. This would be at and with the
\nassistance of INSEAD, an international uni-
\nversity in Fontainebleau (France).
\nNominations for this course will be dealt
\nwith by an advisory committee and the new
\nexecutive committee.
\nTurning to the World Health Professions
\nAlliance Dr. Kloiber commented that his
\npredecessor had initiated this alliance with
\nthe Nurses and the Pharmacists \u2013 a very
\nclever and necessary move. It was easy for
\ninternational bodies to say of individual
\nprofessions \u201cyou are giving a very partial
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 34
\nWMA
\n35
\nview\u201d. The Health Professions Alliance is
\nthe answer to this. It doesn\u2019t mean giving up
\nthe individual positions of professions.
\nOften our problems are similar. WHPA has
\nheld two forums in 2004 and 2006. A com-
\nmon conference on Regulation is planned
\nfor May next year. He commented that in
\nthe Pacific, in Asia, in Europe and probably
\nin America, governments are becoming
\nincreasingly intrusive in regulation. There
\nwas a need to express our views on Self-
\nregulation.
\nDr. Kloiber concluded by saying that he had
\nbeen asked by the Chairman of Council to
\nwork on the Consolidation of Standing
\nDocuments and would ask Mrs. Melke
\nBorow (IMA) to give a brief report on this.
\nDr. Snaedal, President Elect, (Iceland MA)
\nspoke of a project in which the WMA had
\nbeen involved, namely the Istambul
\nProtocol. There had been a new invitation to
\nparticipate in the work.
\nDr. Hanson (CMA) in the context of
\nHuman Health Resources referred to \u201ctask
\nshifting\u201d and asked what was WMA\u2019s posi-
\ntion on this for the World Health Assembly.
\nWhile he agreed that there should be con-
\nsolidation with other Health Professionals
\nhe commented that we have individual
\nviews and in this context there may be prob-
\nlems, especially in \u201ctask shifting\u201d.
\nMr .J. Johnson (BMA), referring to the
\nRegulation Conference next year, said that
\nthey had problems in their own area in the
\naspects of organ transplantation. The
\nChMA Ethics Committee had discussed
\nseveral issues and principles which will
\nclarify the need to obtain written informed
\nconsent of the individual donor or his\/her
\nfamily before any donation can be made.
\nThe ChMA realises the importance of
\nemphasising ethical rules to those who par-
\nticipate in organ transplantation.
\nThe discussions with ChMA included con-
\nsideration of the matter of procurement of
\norgans from prisoners, which opened up
\nissues of Chinese culture and ethical prac-
\ntice. While at the same time the ChMA
\nmade clear their recognition of the human
\nrights of prisoners, there were cultural dif-
\nferences in the interpretation of these. Dr.
\nZhong also emphasised the strict laws
\nregarding the death penalty which now
\nrequired approval by the Chinese Supreme
\nCourt.
\nThe WMA delegation acknowledged the
\ncultural differences between the West and
\nChina, but reiterated the fact that interna-
\ntional ethical rules, including the WMA
\nStatement on organ transplantation, pro-
\nhibit the procurement of organs from pris-
\noners. The WMA delegation also main-
\ntained that there was no way of guarantee-
\ning that a prisoner is free from coercion
\npointing out that the prohibition in this
\nStatement protects prisoners\u2019 human
\nrights.
\nThe ChMA and WMA delegation agreed on
\nthe prohibition of organ trade and on the
\nneed for further work on ethical guidelines
\non organ transplantation in China, noting
\nthat there remain differences of opinion on
\nthe notion of free and informed consent and
\nharvesting of organs from prisoners.
\nFinally Dr. Blachar said that although dif-
\nferences between the two sides remained,
\nhe felt that China was moving in the right
\ndirection and was particularly encouraged
\nby the new law prohibiting organ trade.
\nIn a second meeting with the Vice-Minister
\nof Health, Prof. Huang Jiefu, the Chinese
\nGovernment position was explained.
\nEspecially the dependency on informed and
\ndocumented consent and but also the prohi-
\nbition of organ trade were two law projects
\nthe Chinese Government wished to persue
\nUK. He would welcome input from other
\nNMAs.
\nMrs. Malke Borow (IMA), referring to the
\nConsolidation of the Standing documents
\nsaid that they had tried to consolidate these
\nand make them readable in one document.
\nObviously revisions could be introduced
\nduring this process (for example the intro-
\nduction of Observer membership) and the
\npossible delegation of representation to
\nmember NMAs when the need for represen-
\ntation was geographically in their area.
\nThe Chair commented that proposals for
\nchange need to be submitted.
\nChina
\nDr. Blachar said that the delegation, which
\nincluded the President and Secretary
\nGeneral, had recently met with the Chinese
\nMedical Association (ChMA ) concerning
\nthe issue of organ transplantation. Dr.
\nZhong, President of the ChMA had given an
\noverview of the history of organ transplan-
\ntation in China, indicating that while the
\n1960\u2019s and 70\u2019s were not very successful in
\nterms of organ donation, the last couple of
\nyears had proved more productive due, in
\npart, to great advances in technology.
\nHowever, the legal framework for these sur-
\ngical procedures has not advanced as quick-
\nly as technology.
\nThe ChMA had done much work to formu-
\nlate and clarify guidelines on the ethical
\nParticipant of the 176th
\nWMA Council Meeting.
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 35
\nWMA
\n36
\nimmediately. After a long discussion Prof.
\nHuang indicated that he would support a
\nmove towards a ban on organs from prison-
\ners.
\nThe delegation recommended that further
\nnegotiations continue with the aim that the
\nChMA state its commitment to WMA ethi-
\ncal policy on consent and organ transplanta-
\ntion, and that the ChMA report back to
\nCouncil with an update at the General
\nAssembly.
\nThe Council approved the recommenda-
\ntion that the discussions continue with a
\nview to the ChMA stating its commitment
\nto WMA policy on organ transplantation
\nand consent. A further report would be
\nmade to the Assembly in Copenhagen in
\nOctober.
\nMr. J Johnson (BMA), commented that for
\nthe first time in a long period the ChMA
\nwas present at this Council meeting. He
\nalso reported that the BMA was organising
\na conference on Transplantation in London
\nwhich would include international experts.
\nFINANCE AND PLANNING
\nCOMMITTEE (FPC)
\nThe Chair of Council called the meeting to
\norder, welcomed new members, received
\napologies and the meeting approved the
\nminutes of the last meeting.
\nMr. J. Johnson (BMA) was nominated by
\nDr. Hanson (CMA) and was elected Chair
\nof the Committee by acclamation. In thank-
\ning the committee Mr. Johnson pointed out
\nthat in the United Kingdom, surgeons were
\nby custom addressed as Mister not Doctor,
\nalthough they were medically qualified!
\nFinance
\nThe report on the membership dues pay-
\nments was received and the Secretary
\nGeneral said that developments had been
\npositive and thanked NMAs for their help in
\nthis process. He reported that special
\narrangements for some NMAs continued
\nand the report was received. Following
\nsome discussion during which the Secretary
\nGeneral noted a recent improvement in pay-
\nment of dues arreas, reports on
\nComparative Dues and on Dues arreas were
\nreceived.
\nFinancial Statement
\nMr. Hallmayr presented the Pre-audited
\nStatement for 2006 noting that the fully
\naudited Statement would be available in
\nJune 2007. Dr. Bagenholm welcomed the
\ngood result and asked whether, neverthe-
\nless, we should be careful. M. Hallmayr
\nagreed, the trend must become a firm one.
\nThe Committee recommended that the
\nStatement be approved. This was later
\nadopted by Council.
\nBusiness Group.
\nExplaining that the Business Group was an
\n\u201cad hoc\u201d Group, Dr. Kloiber reported that in
\nthe past 18 months the activities had been
\nreduced to three, reinvestment in Portal
\ndevelopment, Meetings, and Future
\nInformation Technology. The content needs
\nto meet short, mid- and long-term problems
\nand include content management, on-line
\npayment by members and an on-line chat
\nboard.
\nConcerning conferences it is possible to
\nreduce costs. He drew attention to the fact
\nthat most other conferences bring in some
\nincome, and referred to the successful \u201cWell
\nDoctor\u201d conferences organised by the AMA
\nand CMA, held in Canada and the USAbien-
\nnially over the past four years. Following
\nfurther discussion, the BMA offered to host
\none next year and the Australian Medical
\nAssociation in 3 years time. There was very
\nlittle risk attached to these successful confer-
\nences and some profit.
\nThe Chair commented that the Business
\nGroup had proved its worth and during dis-
\ncussion the CMA offered to revise and
\nupdate the WMA website, a generous offer
\nwhich the Committee gratefully acknowl-
\nedged. It further discussed the Web Portal
\nand recommended that the mandate of the
\nBusiness Development Group be extended
\nand be authorised
\n1) to develop a business plan for a phased
\napproach to the establishment of a
\nWMA Web Portal,
\n2) to investigate corporate sponsorship for a
\nWMA Web Portal,
\n3) to proceed to develop a business plan for
\nfuture WMA meetings and conferences.
\nThis recommendation was later adopted by
\nthe Council.
\nWMA Meetings
\nThe committee received reports on the
\narrangements for the WMA General
\nAssembly in Seoul, South Korea in 2008
\nand for Copenhagen, Denmark in 2007.
\nAfter considering an oral report on planning
\nof future meetings and a presentation by the
\nIndian Medical Association on its plans for
\nthe General Assembly in 2009, it recom-
\nmended that Council should commend the
\ntheme for the 2008 Scientific Session to the
\n2007 Assembly as \u201cHealth and Human
\nRights\u201d.
\nMembership
\nThe Secretary General referred members to
\nthe written report and commented on the
\nstrong membership of associates in the USA
\nand in Asia In the discussion the Chair sug-
\ngested that it would be helpful if NMAs had
\ncopies of the form forAssociate Membership,
\nwhich was noted by the Secretary General.
\nThe report of the Associate Members was
\nreceived.
\nOUTREACH
\nPublic relations
\nThe report on Public Relations was
\nreceived.
\nThe Public Relations Consultant, Mr. Nigel
\nDuncan, urged NMAs to increase the use of
\npress releases as a mechanism for increas-
\ning the visibility of the WMA.
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 36
\nWMA
\n37
\nWorld Medical Journal
\nThe committee received a proposal to
\nchange the format of the World Medical
\nJournal, an offer for cooperation from the
\nNature Publishing Group and a paper
\nregarding the Title of the World Medical
\nJournal in its present format.
\nThe Chair said this was a major matter; the
\npapers were before the committee, includ-
\ning the proposal from Nature and a decision
\nmust be taken today.
\nThe Secretary General referred to the major
\neffort and changed format which had been
\nintroduced by the Editor and the need for
\nNMA input and support. As an internation-
\nal organisation WMA had to have an instru-
\nment of communication. He stressed that
\nthe World Medical Journal was an asset.
\nBoth the options before the committee pre-
\nsent the committee with a need to go ahead
\nwith exploring the possibilities. There
\nwould be a need for considerable discussion
\nof the proposals.
\nDr. Davis (America Medical Association),
\npresented a report on ideas for revamping
\nand relaunching the World Medical Journal
\nas a scientific journal, stressing that NMAs
\nshould be involved in this project.
\nHis proposal was to include original clinical
\nresearch, health services research, medical
\nethics and medical education, healthcare
\npolicy and public health in a peer reviewed
\njournal. Possible areas of special focus
\ncould include international comparisons of
\nhealthcare systems and their performance,
\nglobal spread of diseases and risks, globali-
\nsation of healthcare, health and human
\nrights, health impact of conflicts, medical
\nethics guidelines and medical education
\nstandards.
\nHe outlined further detail on governance,
\nweb-site, funding and the way forward. The
\npros and cons of the two options were pre-
\nsented and committee addressed the two
\nproposals before them.
\nDiscussions focused on the strategic objec-
\ntive of WMA publications, the audience
\nthey intended to reach, the value and repu-
\ntation of the title \u201cWorld Medical Journal\u201d
\nand whether the focus of the content of the
\njournal should be clinical in nature or relat-
\ned to medical ethics and human rights. The
\nWMJ Editor while agreeing that the propo-
\nsition was a compelling one and should be
\nexplored, pointed out that a change in focus
\nto clinical issues would represent a funda-
\nmental change in the policy of the journal.
\nAs his paper indicated, its function had
\nalways quite specifically excluded discus-
\nsion of clinical problems (see the introduc-
\ntion to the Handbook of WMA Declarations
\n1992 & 1996), and the proposed change
\nwould be a major change of policy. He also
\ndrew attention to the need for a vehicle for
\ncommunicating material relating to the
\nmain activities of the WMA in future, were
\nthe new proposal to be implemented.
\nAfter a long discussion during which differ-
\ning views were expressed, the committee
\nrecommended that:
\n1. The proposal to revamp and re-launch the
\nWorld Medical Journal with assistance
\nfrom NMAs be further explored, includ-
\ning seeking outside funding, be accepted.
\n2. That there be a further report to the next
\ncouncil meeting.
\n3. That the proposal to adopt a new clinical
\njournal published by the Nature
\nPublishing group as an official publica-
\ntion of the WMA, be not accepted.
\nIt was noted that, if the proposal above was
\nimplemented, in the interim period a new
\nhouse publication would be needed as a
\ncommunications vehicle for administrative,
\npolitical, ethical and other non-clinical
\nissues within the WMA, possibly a \u201cWorld
\nMedical Bulletin\u201d.
\n4. The report of the World Medical Journal
\nwas received.
\nThese recommendations were later
\napproved by council.
\nMEDICAL ETHICS
\nCOMMITTEE
\nDr. Kloiber convened the meeting of the
\nMedical Ethics committee and called for
\nnominations for the Chair. Dr. Bagenholm
\n(Sweden), was elected by acclamation.
\nDr. John Williams commenting on the oral
\nreport, said that he had retired in December
\nbut had done some work for the unit since
\nthen. An on-line course on Medical Ethics
\nsimilar to the course for prison doctors was
\nbeing prepared with the Norwegian Medical
\nAssociation. It was an interactive course
\nbased on the WMA Manual of Medical
\nEthics, and would be launched very soon.
\nTurning to the Manual of Medical Ethics he
\nreported that this had now been translated
\nMedical Ethics Commettee in session.
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 37
\nWMA
\n38
\ninto 13 languages and an Estonian transla-
\ntion was nearly ready. Some 220,000 copies
\nhad now been issued.
\nPolicy review
\nThe committee turned to work in progress
\nand considered the WMA proposal for a
\nRapporteur on the Independence and
\nIntegrity of Health Professionals. In
\nresponse to a question from the Chair, Prof.
\nNathanson (BMA), said that there had been
\nlittle progress in the past 10 years. There is
\na Special Rapporteur with a focus on Health
\nProfessionals but the work was difficult
\nbecause of the case load. She considered
\nthat it was important to keep this proposal
\nas the risk of health professionals losing
\ntheir independence was real because there
\nwere major pressures on professional to
\nbreech medical ethics. This view was
\nendorsed by Dr. Gallard (France), who
\ncommented that the reasons for the original
\nstatement had not gone away, there was a
\nneed for a special rapporteur. The
\nCommittee recommended that the State-
\nment undergo minor editorial revision by
\nthe British Medical Association and then be
\nreturned to the council with the committee\u2019s
\nrecommendation that it be reaffirmed.
\nDeclaration of Hamburg
\nDuring consideration of the Declaration of
\nHamburg on Torture, Dr. Reyes (ICRC)
\nstressed that this Declaration needed to be
\nbetter known and the committee recom-
\nmended it be reaffirmed. This was later
\napproved by the Council, at which the
\nEditor indicated that it would be published
\nin the Journal and NMAs were invited to
\ngive it greater publicity.
\nLicensing of Physicians flee-
\ning Prosecution for Serious
\nCriminal Offences
\nThe committee also recommended that the
\nWMA Statement on Licensing of
\nPhysicians Fleeing Prosecution for Serious
\nCriminal Offences, be reaffirmed. This was
\nlater adopted by Council.
\nHuman Rights
\nThe Secretary General gave an oral report
\non Human Rights noting that the issue of
\nhuman organ transplantation in China had
\nbeen discussed earlier by the Council (see
\nabove). Dr. Snaedall (Iceland) reminded the
\ncommittee that WMA had participated in the
\nfirst phase of activity in relation to the
\nIstambul Protocol visiting and teaching in
\nfive countries. He reported that WMA had
\nbeen asked to participate also in phase 2 of
\nthis activity- financed by the European
\nUnion. Meanwhile Dr. Snaedall had visited
\nEgypt where he had been able to visit three
\nministries as well as NGOs. Although the
\nauthorities were reluctant, there was a pro-
\nject for training later this year in which he
\nfelt that WMA should participate. There was
\na need for ethical input into this training. He
\nalso noted that the Declaration of Hamburg
\nwas always on the table during these discus-
\nsions. In response to the Chair\u2019s question as
\nto what was being proposed, Dr. Snaedall
\ncommented that in the first project we had
\nbeen full partners with ICRC, while in the
\nsecond project, formal participation would
\ndepend on reimbursement of expenses.
\nProf. Nathanson (BMA), echoing these
\nviews, commented that documentation of
\nthe effects of torture is very important. A
\nbigger issue was abuse \u2013 interrogational tor-
\nture \u2013 which is extraordinarily pervasive. It
\nwould be worthwhile for WMA to partici-
\npate in this work and doctors who try to
\ndeal with this would appreciate support.
\nShe referred in particular to Zimbabwe
\nmembers being involved in assisting doc-
\ntors observing that the Zimbabwe represen-
\ntative on the ICRC had to take refuge in an
\nEmbassy. She mentioned that Dafur was the
\n1st project and there would be a report on
\nan Iraq project next time.
\nProf. Nathanson reported on a visit with
\nICRC to India to a conference on \u201cHealth of
\nDetainees and Prisoners\u201d at which there
\nwere participants from all over India.
\nParticipants reported that torture before trial
\nand in prison was common, but it was diffi-
\ncult to document torture during interroga-
\ntion. Both HIV\/AIDS and MDR-Tb were
\nmajor problems. The Indian Medical
\nAssociation had agreed to support doctors
\nboth at regional and national level. She
\ncommended NMA Prison doctors in India.
\nDr. Kumar (IMA) commented on the
\nimportance of the issue of the health of doc-
\ntors who may have psychological \/ mental
\ntorture. Dr. Kloiber commented that the
\nPrison Doctors Course continues and he
\nparticularly thanked the ICRC and Dr.
\nReyes for their work.
\nProposed Statement on Stem
\nCell research
\nThe Committee considered a proposed
\nWMA Statement on Stem Cell Research
\nfrom the Icelandic Medical Association
\nwhere this issue had been discussed, but
\nprogress had been delayed by Parliament.
\nAt the suggestion of the Chair the commit-
\ntee agreed to recommend that the statement
\nbe circulated to NMAs for comments and
\nthat these be referred to a small working
\ngroup to prepare revision for the next meet-
\ning, a recommendation accepted by council.
\nProposed Statement on
\nTelemedicine
\nDr. Jensen suggested that a proposed
\nStatement on Telemedicine be referred to
\nNMAs for comment. Dr. Willams reminded
\nthe committee of the long history of this
\nsubject and that this had been twice to
\nNMAs. The option would be to consider the
\ndocument as it is. The committee recom-
\nmended that the document on the table be
\nreferred to NMAs. This was later agreed by
\ncouncil.
\nProposed Statement on
\nHuman Tissue
\nTransplantation
\nGermany introduced a proposal for a state-
\nment on Human Tissue for Transplantation,
\nreferring to discussions in council and work
\ndone by the working group chaired by Dr.
\nVilmar resulting in the document now
\nbefore the committee. The new document
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 38
\nWMA
\n39
\nsupplements existing policy on organ trans-
\nplants. It covers not only issues but also
\nhuman cells which may be turned into final
\nproducts, in which there were large finan-
\ncial interests. The committee recommended
\nthat the document be circulated for com-
\nments to NMAs. This was later accepted by
\ncouncil.
\nFuture Work
\nA paper on priorities which listed a number
\nof possible topics for future work provoked
\nconsiderable debate. Dr. Davis (AMA) felt
\nthe list to be a good start and should be the
\nbasis for reflection before the Copenhagen
\nmeeting later in the year. Concerning a sug-
\ngestion that WMA should develop the ethics
\nunit into an Ethics Institute and stating that
\nthe AMA also had a goal of developing an
\nethics institute, using an analogy with the
\nWHO\u2019s work with Collaborating Centres he
\nsuggested that consideration should be
\ngiven to WMA working with NMA
\nInstitutes of Ethics. Prof. Nathanson (BMA)
\nagreed with the principle of working with
\nNMA Ethics committees. Turning to specif-
\nic topics she noted that there was no mention
\nof policy on \u201cDual Responsibility\u201d, also
\ncommenting in general that statements
\nshould deal with broad issues.
\nDr. Jensen (DMA), felt that there was a
\nneed to discuss ethical aspects of coopera-
\ntion with the Pharmaceutical Industry, mov-
\ning that a paper on this topic should be pre-
\npared for Copenhagen and that there should
\nbe exploration of an agreement with the
\nindustry. The Secretary General observed
\nthat there had been an agreement with the
\nindustry two years ago and appealed for
\nsuggested amendments or a new proposal
\non relations with the Pharmaceutical
\nIndustry. The Chair pointed out that the
\nCPME had guidance on this topic. The issue
\nwas not about ethics it was about collabora-
\ntion, to which Dr. Kloiber commented that
\nWMA had had an offer from the industry to
\ndo this which Council had rejected. It had
\nalso commented on the CPME\/IFPMA doc-
\nument and stated that shared governance
\nwas not acceptable. After further support
\nfor Dr. Jensen\u2019s views and information
\nabout the experience of other NMAs, the
\ncommittee proposed that: \u201cThe Danish
\nMedical Association prepare a discussion
\ndocument which would be discussed at the
\nnext meeting of the MEC and that the topic
\nof elaborating common guidelines between
\nthe WMA and the industry should be placed
\non the agenda of the next Ethics
\nCommittee.\u201d This proposal was adopted.
\nIt was reported that a paper on \u201cmedical
\nprofessionalism\u201d was in preparation and it
\nwas agreed that this would be updated and
\nthe topic of medical professionalism from
\nthe perspective of NMAs would be on the
\nagenda for the next meeting.
\nDr. Williams raised the question of the
\nimportance of promoting WMA policies
\nand how this was to be done. Dr. Kloiber
\nresponded that the office is planning to rein-
\ntroduce a printed Handbook as a loose leaf
\nbinder which NMA would then be able to
\nkeep up to date. It was hoped that this
\nwould be ready in October. Whether the
\nmaterial should be sent by mail or e-mail
\nhad yet to be decided and discussions were
\ntaking place with international organisa-
\ntions to promote WMA policies. He
\nappealed to NMAs to take WMA policies to
\ntheir Annual meetings so that they could be
\ndiscussed there, as happens in the AMA.
\nSuch actions were important to enhance the
\nglobal image of the WMA.
\nProf. Nathanson suggested asking Council
\nhow they had found policy useful in the past
\nyear and Dr. Haikerwal (Australia) reported
\nthat the Australian Medical association had
\nformally adopted WMA policy. The Editor
\nreferring to the policy of publishing impor-
\ntant statements in the WMJ, appealed to
\nNMAs to publicise policy in their Journals
\nand Dr. Kloiber emphasized the importance
\nof ensuring that NMAs\u2019 members under-
\nstood what was actual WMA policy.
\nDeclaration of Helsinki
\nIn discussion of a document on the advan-
\ntages\/disadvantages of updating the
\nDeclaration of Helsinki (DoH), Dr.
\nWilliams suggested that any review should
\nconsider an open approach to take account
\nof all stakeholders, and decide a course of
\naction. Even if there are no changes, a
\nreview would remind all interested parties
\nthat the DH exists. One should try to con-
\nvince them that all other declarations in this
\nfield are secondary to the Helsinki
\nDeclaration. He suggested that the process
\nof review could be done quickly and that
\neach NMA should be responsible for con-
\nsultation within its own country; the WMA
\ncould deal with International organisations.
\nDr. Kloiber said that the document was part
\nof the Strategic Plan. There were major dis-
\ncussions before the last revision, and
\nnumerous conferences worldwide. At the
\ntime there was difficulty in deciding the
\ndirection i.e. to protect the subject of
\nresearch. In Edinburgh it was recognised
\nthat some things were not dealt with such as
\nthe position of pregnant women in research.
\nWe were now in 2007 and we should start
\npreparation for a review in 2009\/10.,e.g.
\nlook at epidemiological and psychiatric
\nresearch We need to keep working if we
\nwant to keep ownership, look at document,
\ndecide the problems and make proposals.
\nDr. Snaedall (IMA) thanking Dr. Williams
\nfor his paper agreed that the DoH remained
\nimportant. The research community was
\ncatching up with new problems and we
\nneed to decide on new topics which need to
\nbe included.
\nProf. Nathanson (BMA) reminded the com-
\nmittee how difficult it was to get the DH
\nrevised. Edinburgh was a compromise. Did
\nwe really want to open this up now? She felt
\nthat we should not decide on new topics
\ntoday.
\nDr. Letlape (Past President) proposed that a
\nwork group be formed to review the
\nDeclaration of Helsinki with the goal of
\nidentifying lacunae without opening basic
\nissues. The committee made this recom-
\nmendation which was later approved by
\ncouncil.
\nOther business
\nDr. Kloiber introduced Professor Julian
\nMezzich, President of the World Psychiatric
\nAssociation (WPA), who explained that the
\nWPA incorporated 151 national associa-
\ntions, and stressed that ethics were of para-
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 39
\nWMA
\n40
\nmount concern to the Association. It had
\ntaken the decision to approach WMA with a
\nview to collaboration on ethical issues,
\nincluding the Madrid Declaration which
\nwas undergoing a three year review. It
\nwould also like to collaborate on broader
\nissues, such as a holistic approach
\n\u201cPsychiatry with and for the Person.\u201c He
\nhoped that it would be possible for this col-
\nlaboration to occur.
\nZimbabwe
\nDr. Letlape spoke about the challenges
\nbeing faced in Zimbabwe. Reporting doc-
\ntors detained and tortured he said that
\nSAMA had been asked to act and needed
\nguidelines.
\nDr. Kloiber commented that he had tried to
\nget reactions to these events from the
\nZimbabwe Medical Association (ZMA) but
\nhad failed to get any response. He asked for
\nguidance from SAMA on strategies for out-
\nreach to the ZMA and getting credible infor-
\nmation. In response to a suggestion that a
\nsafe approach would be to look at any rele-
\nvant existing policy he agreed but said that
\nwe didn\u2019t have information and we don\u2019t
\nwant to add to the problems of the ZMA.
\nSOCIO-MEDICAL AFFAIRS
\nCOMMITTEE
\nThe Chair of Council opening the meeting
\nand following adoption of the minutes of
\nthe Pilansberg meeting 2006, called for
\nnominations for the Chair of the Social
\nAffairs Committee to which Dr. Gomes do
\nAmiral was elected by acclamation.
\nProposed major revision of
\npolicies.
\nAntimicrobial Drugs
\nDiscussion of the proposed major revision
\nof the statement on Anti-microbial Drugs
\nwas introduced by the AMA and the com-
\nmittee agreed that this be circulated to
\nNMAs for comments.
\nFamily Planning and the right
\nof a woman to contraception
\nAfter a number of comments were made
\nincluding one that access to contraception
\nfor minors especially in emergency situa-
\ntions be added to the proposal. It was point-
\ned out that this was a sensitive and difficult
\nissue to address. It was agreed that the
\nStatement on Family Planning and the
\nRight of a Woman to Contraception be cir-
\nculated to NMAs for comments.
\nNoise Pollution
\nAfter discussion and minor editorial amend-
\nment, the committee recommended that the
\nstatement be forwarded to the General
\nAssembly for adoption. This was approved
\nby council.
\nEconomic Embargoes and
\nHealth.
\nThe committee recommendation that this
\nstatement be reaffirmed, was later approved
\nby council.
\nThe committee recommended that the
\nIsraeli Medical Association undertake
\nresponsibility for major revision of the
\nDeclaration on Continuous Quality
\nImprovement in Health Care.
\nHealth hazards of Tobacco
\nproducts.
\nAfter some discussion, it was agreed to rec-
\nommend that the current paper be circulated
\nto NMAs for comments and that major revi-
\nsion be undertaken by the AMA.
\nProhibition of Access of
\nWomen to Health Care and
\nprohibition of Practice by
\nFemal Doctors in Afghanistan
\nThe committee recommended that this doc-
\nument undergo major revision by MASA
\nwith the aim to make it more global in
\nscope.
\nNew business
\nDr. Davis presented an AMA proposal for a
\nStatement on Reducing Dietary Sodium
\nIntake, pointing out that most intake of
\nsodium was from processed foods. There is
\na need to achieve major changes in this and
\ntherefore the documents ends with recom-
\nmendations, in particular, a stepwise
\napproach to a 50% reduction of sodium in
\nprocessed foods. Pointing out that industry
\nwas not interested, he said the last recom-
\nmendation was to engage in discussion of
\nthe issue with governments, regulators and
\nother stakeholders.
\nThe committee recommended that the pro-
\nposal be circulated to NMAs for comments.
\nFuture Priorities
\nThe committee considered a paper on future
\npriorities and Dr. Williams pointed out that
\nunlike the MEC whose remit was limited to
\nMedical Ethics, SMAC had a very wide
\nremit. Suggested areas had therefore been
\ngrouped in the paper before the committee.
\nUnder headings such as medical education,
\nprofessional policies, public health and the
\ncommittee had to decide on focus areas. We
\nalready had some problems with the promo-
\ntion of WMA policies and had had some
\ndiscussion on this with WHO.
\nDr. Hill, the Chair of Council, said consid-
\neration was being given to having a small
\ngroup to develop Advocacy Agenda and
\nPolicy before the October meeting. We now
\nhave two programmes on Education and
\nconsideration could be given to pro-
\ngrammes for pandemic control and for
\n\u201cantimicrobial\u201d education. Dr. Hansen
\n(CMA) strongly supported the suggestion
\nof supporting work on Advocacy and the
\nrole of NMAs in influencing health policies
\netc. Prof Nathanson (BMA) supporting Dr.
\nHill, pointed out that this was a very com-
\nplex issue. The Secretary General referring
\nto earlier discussions on participatory roles
\ndiscussed at the World Health Assembly,
\nfelt that advocacy was an item which must
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 40
\nWMA
\n41
\nbe on the committee\u2019s agenda regularly.
\nCommenting on education he referred to the
\nfact that education had been a very active
\narea of WMA\u2019s work in the \u201870s at a time in
\nwhich World Federation on Medical
\nEducation had been formed. As Secretary
\nGeneral he was now on the Council of
\nWFME whose papers WMA normally
\nendorse. This does not however place a bar
\non WMA activity in education. Amongst
\nother issues raised during the debate an
\nappeal, supported by Germany and Korea,
\nwas made to NMAs to bring forward envi-
\nronmental health issues, an area in which
\nthe AMA had done a lot of work, France
\nraised the issue of both protection of
\npatients and the important issue of the
\nhealth of physicians and the need to exam-
\nine doctors physical fitness to practice and
\nit was pointed out that the AMA included
\nthis its ethical code.
\nApproving a motion that its agenda should
\ninclude a standing item on Advocacy, the
\ncommittee also recommended that a small
\nworking group develop an advocacy agenda
\nand a process for handling the various
\nWMA advocacy issues to be presented to
\nSMAC at its meeting in October. This was
\nlater approved by council.
\nResumed Council session
\nIn consideration of the Secretary General\u2019s
\nreport part two, Council engaged in a dis-
\ncussion of relationship with the WHO. It
\ntook note in particular of two items which
\nfigured in the agenda of the World Health
\nAssembly, namely Alcohol and Epidemic
\npreparedness. Attention was also drawn to
\nthe inclusion of NMAs in official delega-
\ntions of some countries and Council was
\nreminded that WMA was now back in offi-
\ncial relationship with WHO. This carried
\nwith it the obligation to support WHO poli-
\ncies. It was therefore essential that we were
\nrepresented and present throughout the
\nWorld Health Assembly meeting. It was
\nequally important that NMA\u2019s should bring
\nWMA policy to the attention of their nation-
\nal delegations. The Secretary General said
\nthat in the past two years there had been a
\ntrend to be part of the activities with WHO,
\nnotably in Tobacco control but also liaising
\nwith WHPA in the Patient Safety initiative.
\nHowever, while we were quoted as partici-
\npants none of the health professions
\nAssociation was in the Strategic Planning
\nGroup of the Global Alliance for Patient
\nSafety. He stressed the importance of the
\nIMPACT Group on Counterfeit medicines.
\nThen referring to the World Health report
\n2006 \u201cHuman resources for Health\u201d, Dr.
\nKloiber pointed out that in the context of
\nthe Global Alliance for the Workforce while
\nthere was reluctance to include the health
\nprofessions, eventually we were asked to be
\na participant. But again, none of the health
\nprofessions associations was placed in the
\ngovernance body which includes govern-
\nments and Global funds such as the Gates
\nFoundation etc. In fact there was an oppor-
\ntunity for partnership but no role in decision
\nmaking bodies.
\nThe donors currently follow the paradigm of
\n\u201ctask shifting\u201d and the need to employ a lay
\nworkforce. He was concerned that in this
\ncontext while this might have adverse effects
\non retaining physicians and other health pro-
\nfessionals, an economist during a technical
\ndiscussion at WHO had expressed welcome
\nfor this as he regarded them too expensive.
\nHe then referred to Primary care, the Alma
\nAta Declaration of WHO (1978) and the con-
\ncept of Targets. Primary Care was not only
\nimportant in Emergency situations but was
\nan essential part of all Health care systems.
\nHowever there was a feeling that one cannot
\nfocus only on primary care for a long time.
\nIn some rich countries where there have
\nbeen moves from an Agricultural to a
\nService Society over at least three decades,
\nin the service industries health care always
\nis the biggest segment. The poor countries
\nof this world are now forced to do the
\nchange from agricultural economies to ser-
\nvice economies in one step and in a very
\nshort time. However forcing them to stay
\nwith primary care only produces effective
\nblockade to build a viable service society.
\nDr Kloiber referred to the forthcoming
\nPrimary Care document which would need
\nto be studied with care and Dr. Letlape
\n(immediate past President) commented
\nwith reference to ARVs, etc. that Primary
\nMedical Care documents should be for
\neveryone and be equitable.
\nThe view was expressed that what was
\nneeded was the ability to advocate for
\nphysicians to be able to work with WHO
\nand help to resolve problems both at first
\nand third country level. There was a plea for
\nbetter advocacy policy.
\nDr. Kloiber responding said it was not a
\nblack or white picture. There are committed
\ntechnical staff at WHO who need to share
\ntheir frustration with you. At the same time
\nhe is optimistic about the new Director
\nGeneral, Dr. Chan. \u201cThe opening issue of
\nPrimary Care will have to deal with con-
\ncerns about its role. Referring to the fact
\nthat the UN system has to undergo change
\nChair of Council, Secretary General reflecting.
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 41
\nWMA
\n42
\nand this includes the WHO\u201d, he said, \u201cDr.
\nChan seems open to this. There should not
\nbe a crusade against WHO. We need to con-
\nvince them to help people and be careful
\nabout policies set up by politicians.\u201d
\nDr. de Leon (Uraguay) expressed concern
\nabout the threat to physicians from WHO.
\nHe congratulated Dr. Kloiber on his
\nremarks and agreed that task shifting could
\nbe a considerable threat to physicians. He
\nconsidered that the primary care team
\nshould always be led by a physician. At the
\nsame time there was a threat with the prima-
\nry care focus. WHO needs to look at every
\naspect of care. However Primary Care was
\nneeded in underdeveloped countries.
\nDr. Haikerval (Australia) referred to a
\nmajor battle with the Registration body in
\nAustralia. One needs to be careful with
\nwords. \u201cTask Substitution\u201d is not the same
\nas \u201cTask shifting\u201d. He also stressed that
\nthere must be someone who is responsible
\nfor taking over care and prevention.
\nDr. Bagenholm (SwMA) posing the question
\nhow do we influence WHO, said that some
\npolicies were good and some bad. We
\nshould not be too negative. We should try to
\nhave some technical input e.g. in the
\nInterministerial conference on Alcohol.
\nReferring to the USA Dr. Davis said they
\nhad problems of task shifting with Nurses
\nand Optomotrists, Midwives and
\nAnaesthetist assistants. He referred to seek-
\ning legal authority to do formal surgery
\nwith a scalpel and also problems associated
\nwith the Physicians Assistants stating that
\nwe can effectively protect care and quality
\nif our own house is in order.
\nDr. Williams reported that the Canadian
\nMedical Association has a policy on task
\ndelegation with appropriate training; he fur-
\nther commented that WHO staff say that the
\nExecutive Board makes policy and staff
\ncarry it out. NMAs need to work with gov-
\nernments. Nationally there was a need to
\ndistinguish the level at which decisions
\nwere made. Dr. de Leon (Uraguay) agreed
\nthat we should follow WHO moves and
\ntrends and try to be present as observers at
\nMinisterial Conferences. Dr. Lemye
\n(Belgium) was concerned about the relation
\nof WMA with WHO, seeking a more loose
\ncontact with the WHO:
\nEmergency Resolution
\nThe Council discussed a proposal for an
\nEmergency Council Resolution on the situ-
\nation in certain Latin American and
\nCaribbean states concerning the supply of
\nCuban physicians and the by-passing of
\nsystems set up to verify physicians\u2019 creden-
\ntials and competence. It was reported that
\nthe substance of this resolution had already
\nbeen subscribed to by all the Latin
\nAmerican States.
\nAfter a lengthy discussion the Resolution
\nwas adopted (see box on right).
\nDafur
\nDr. Blachar, expressing his concern that the
\nsituation in Dafur, on which the council had
\nadopted a Resolution in 2005, had continued
\nto deteriorate, proposed that the Council as
\nan Emergency Resolution reaffirm its con-
\ndemnation, which the council adopted.
\nWMA Council resolution in support of
\nthe Medical Associations in Latin
\nAmerica and the Caribbean
\nBerlin 10-12 May 2007
\nThere are credible reports that
\narrangements between the Cuban gov-
\nernment and certain Latin American
\nand Caribbean governments to supply
\nCuban Physicians to these countries are
\nbypassing systems, established to pro-
\ntect patients, that have been set up to
\nverify physicians\u2019 credentials and com-
\npetence.
\nThe World Medical Association is sig-
\nnificantly concerned that patients are
\nput at risk by unregulated medical
\npractices.
\nThere exist already duly constituted
\nand legally authorised medical associa-
\ntions within this region that are
\ncharged with the registration of physi-
\ncians and which should be consulted by
\ntheir respective Ministries of Health.
\nTherefore, the WMA:
\n1. Condemns any actions by govern-
\nments in policies and practices that
\nsubvert or bypass accepted standards
\nof medical credentialing and medical
\ncare;
\n2. Calls upon the governments in Latin
\nAmerica and the Caribbean to work
\nwith the medical associations on all
\nmatters related to physician certifi-
\ncation and the practice of medicine
\nand to respect the role and rights of
\nthese medical associations and the
\nautonomy of the medical profession.
\n3. Urges, as a matter of utmost concern,
\nthat the governments in Latin
\nAmerica and the Caribbean Region
\nrespect the WMA International Code
\nof Medical Ethics and the
\nDeclaration of Madrid, that guide
\nthe medical practice of physicians all
\nover the world.
\n11.5.2007
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 42
\nWMA
\n43
\nExtracts from Secretary General\u2019s report to
\nthe 176th
\nWMA Council meeting.
\nThe extracts from the Secretary General\u2019s
\nwritten report below are largely those not
\nincluded in his oral report to council given
\nin two parts. These are to be found in the
\nreport of the 176th
\nCouncil meeting on pages
\n34 and 35)
\nConsolidation of Finances
\nIn continuing the efforts of the year 2005 it
\nwas possible to foster the consolidation of
\nthe WMA finances throughout the year
\n2006. A further significant improvement of
\nthe situation was made possible by a rigid
\napplication of the measures we had initiated
\nthe year before.
\n\u2022 Financial control: This has been main-
\ntained with the counsel of the Treasurer,
\nthe Chair of the Finance and planning
\nCommittee and the help of the executive
\ntreasurer.
\n\u2022 Priority setting: The World Medical
\nAssociation has initiated and continued
\nonly such activities which we were able to
\ncarry out without loses or where the
\nimmediate value for the association was
\nobvious (e.g. the Ethics Unit).
\n\u2022 Reviewing contracts and business rela-
\ntions: Economic awareness remains an
\nimportant principle for all of our business
\nactivities. However, most contracts had
\nbeen revised or renewed in 2005.
\n\u2022 Rebuilding internal staff: Due to the
\nongoing consolidation process, the priori-
\nty for 2006 was on financial stability. The
\nregained financial security will allow for
\nre-staffing in 2007.
\n\u2022 Application of rules: Counseling with the
\nexecutive committee, the financial offi-
\ncers or the Sponsorship advisory
\nCommittee led to clear governance and to
\nfinancially sustainable partnerships and
\nsponsorship arrangements, thus reducing
\nSecretary General\u2019s report to the
\n176th
\nWMA Council Session
\nthe risk of financially non-sustainable
\nengagements or ethically questionable
\nliaisons.
\nCaring Physicians of the
\nWorld Initiative
\nSpanish Edition of the Caring Physicians
\nof the World Book
\nWhen we first introduced the Caring
\nPhysicians of the World Book in October
\n2005 we found a very friendly and warm
\nreception in Santiago de Chile right before
\nour General Assembly. The Latin physi-
\ncians’ community particularly embraced the
\nbook as a document for their work and gave
\nit a very warm welcome. Unfortunately, the
\nonly thing we had to offer at that point in
\ntime was an English edition. On March 27th
\n2007 we were able to present a Spanish ver-
\nsion of the book to the Inter-American
\nCollege in Miami, Florida. Like the original
\nEnglish version, the Spanish edition is now
\nwidely available.
\nAfter concluding a successful series of
\nregional leadership conferences, we have
\nlooked for models to implement a strategic
\noption to support the development of inter-
\nnational medical leadership. Some of our
\nconstituent members already offer leader-
\nship courses to their members or to their
\nofficers, while others do not. The WMA is
\npositioned as a global organization and has
\nits own particular challenges when address-
\ning the development of medical leadership
\nin that it has a multinational, multi-cultural
\nstructure. We have taken this as a challenge
\nfor developing a service that can be offered
\nin principal to all constituent members.
\nWorld Health Organization
\nStatus of the WMA
\nAs do other United Nations organizations,
\nthe WHO allows international Non-
\nGovernmental Organizations (NGOs) a spe-
\ncial status called \u201cNGOs in official relations
\nwith WHO\u00a0\u00bb. Under this status, an NGO
\nmay receive an invitation to make a short
\nintervention during the Executive Board
\nMeeting or the World Health Assembly. The
\nexact spoken text has to be handed in before
\npermission will be given.
\nThe WMA will be invited to expert meet-
\nings covering all the different topics the
\nWHO is currently dealing with. The partic-
\nipating experts are always requested to hand
\nin a detailed submission regarding potential
\nconflicts of interest, including possible pos-
\nsession of shares from tobacco or pharma-
\nceutical companies by the expert, the send-
\ning organization or his\/her spouse.
\nThe WMA has held this status with the
\nWHO since 1992 (again) and has to renew
\nit every third year. The renewal process
\nincludes detailed information from the
\nfinancial statement and the sources of
\nincome. A common work plan has to be set
\nup for the following three years.
\nThe Executive Board Meeting of WHO has
\nreaffirmed the status of the WMA as an
\nNGO in official relations with the WHO in
\nits January 2007 meeting.
\nHuman Resources
\nThe World Health Report 2006 dealt with the
\nquestion of human resources for health. The
\nauthors believe that the extreme shortage of
\nhealth professionals necessitates a strength-
\nening of the lay workforce for health.
\n\u201cCommunity health workers\u201c in many poor
\ncountries of the world are being charged with
\nmedical tasks to fulfill medical and nursing
\nroles especially in programs targeting
\nHIV\/AIDS, Tuberculosis and Malaria.
\nWhile there is certainly a demand for imme-
\ndiate action and for the inclusion of the infor-
\nmal workforce in some capacity, the overall
\nconsequences for the health care systems in
\ngeneral have not been thoroughly considered.
\nTogether with large donors like the Gates
\nFoundation, the Global Fund, the US
\nPresident’s Emergency Plan for AIDS relief
\n(PEPFAR), the World Bank and the World
\nMonetary Fund, the WHO is following the
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 43
\nWMA
\n44
\nparadigm of \u201ctask shifting\u201c to transfer com-
\npetencies from health professionals to lay
\npersons. This is of significant concern to the
\nWMA, particularly as it relates to issues of
\nquality of care and patient outcomes and the
\noverall development of the health care sys-
\ntems.
\nGlobal Alliance for the
\nWorkforce for Health
\nUnder the leadership of the WHO, the
\nGlobal Alliance for the Workforce for
\nHealth was founded in May 2006. During
\nthe preparation of this Alliance, the
\nPresident of the World Medical Association
\nrequested a formal participation of the
\nhealth profession in the construction of the
\nAlliance, which was denied. In the fall of
\nlast year we received an invitation to join as
\npartners, which we accepted. However, as
\nof April 2007 we still have no access to the
\ngoverning bodies of this alliance.
\nInternational Medicinal
\nProducts Anti-Counterfeiting
\nTaskforce \u2013 IMPACT
\nCounterfeit medical products produce mul-
\ntiple risks for medical safety:
\n\u2022 Their non- or sub-standard composition
\nmay lead to low or non-existing levels of
\nactive ingredients or their bioavailability.
\nTheir production is not controlled and
\nquality is by no means guarantied. They
\nmay even contain toxic components.
\n\u2022 Counterfeits may lead to completely erro-
\nneous medical judgments about the real
\ndrugs, as adverse effect or non-effective-
\nness may be attributed to the original
\nmedication thereby leading to treatment
\nchanges or discontinuation.
\n\u2022 If added to a current treatment scheme
\n(e.g. for the therapy of tuberculosis or
\nHIV infection) they may produce
\nextremely dangerous drug resistance.
\n\u2022 By reducing revenues for the legitimate
\nproducers of a drug, counterfeits reduce
\nthe ability to re-invest in research and
\ndevelopment.
\n\u2022 Counterfeits produce distrust in medical
\ntreatments and reduce compliance.
\nTogether with national governments, indus-
\ntry, patient groups, Interpol and the World
\nHealth Professional Alliance, WHO initiat-
\ned the International Medicinal Products
\nAnti-Counterfeiting Taskforce (IMPACT).
\nThis group has been formally installed in
\nOctober 2006 on invitation of the German
\nGovernment and tries to find political,
\njuridical, technological and informational
\nmeans to combat counterfeits in medicine.
\nThe health professions participate especial-
\nly in the field of providing and encouraging
\ninformation and communication about
\ncounterfeit medicines and avoidance of
\ncounterfeit products.
\nInternational Labor
\nOrganization \u2013 ILO
\nTogether with other healthcare organiza-
\ntions and the WHO, the World Medical
\nAssociation participated in a series of
\nroundtables on Diabetes and Social
\nResponsibility initiated by the Geneva
\nSocial Observatory and the ILO. The round-
\ntables discussed the role of employers,
\nemployees and their organizations in the
\nprevention and detection of diabetes. There
\nwas particular interest in models of good
\npractice for healthy nutrition and life style
\nsupport in the work environment. A special
\nfocus was also given to the roles of schools
\nin shaping nutritional habits and patterns of
\nphysical activity.
\nOnline Course on treatment
\nof multi-Drug-resistant tuber-
\nculosis (MDR-TB)
\nThe development of an online course on the
\ntreatment of multi-drug-resistant tuberculo-
\nsis is a joint initiative with the Foundation
\nfor Professional Development of the South
\nAfrican Medical Association and the
\nNorwegian Medical Association. It was
\nmade possible by a grant from Eli Lilly, Inc.
\nThe course has been completed and is avail-
\nable over the Internet under: http:\/\/lupin-
\nnma.net\/tb.html
\nIt is currently undergoing field-testing in
\nSouth Africa. Field tests with selected
\ngroups of physicians are also planned for
\nthe Philippines and Estonia. Further funds
\nhave been secured for translation of the
\ncourse materials into Russian, Chinese and
\nSpanish.
\nWorld Health Professions
\nAlliance (WHPA)
\nIn 1999 the International Council of Nurses
\n(www.icn.ch), the International Phar-
\nmaceutical Federation (FIP) (www.fip.org)
\nand the WMA founded the World Health
\nProfessions Alliance. The aim of the
\nalliance is to foster the cooperation of the
\nprofessional organizations and to augment
\nour advocacy work with the relevant inter-
\nnational organizations, particularly the
\nWHO, and the general public.
\nSince its inauguration, the WHPA has taken
\nan active role in the anti-tobacco initiative,
\nthe fight to protect human rights, the recog-
\nnition of the HIV\/AIDS pandemic and
\nagainst discrimination of the mentally ill. In
\na recent project the WHPA has drafted
\nguidelines for the competencies of interna-
\ntional health consultants. It has promoted
\nawareness on issues like antimicrobial
\nresistance, nutrition and health care for the
\nelderly. The WHPA has engaged in leader-
\nship issues and has often overcome objec-
\ntion of officials to speak with a \u201csingle\u201c
\nhealth profession.
\nThe WHPA intensively cooperates with the
\nInternational Alliance of Patient
\nOrganizations, IAPO (www.iapo.org), and
\nthe Global Alliance for Patient safety,
\nwhich is led by the WHO.
\nThe WHPA serves as a platform for various
\ndiscussions and initiatives in health care. It:
\n\u2022 Cooperates closely with the WHO and
\nindustry to combat counterfeit drugs and
\nmaterials, and it is part of the
\nInternational Medicinal Products Anti-
\nCounterfeiting Taskforce \u2013 IMPACT
\n\u2022 Discusses overlapping educational issues
\n\u2022 Serves as a common platform on health
\nprofessional issues with the WHO
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 44
\nWMA
\n45
\n\u2022 Bundles the interests of health professions
\nin relation to the Global Health
\nWorkforce Alliance
\nDuring the last few years, human resources
\nhave been a constant point of interest in the
\ninternational health debate. In poor coun-
\ntries as well as in rich countries, bad work-
\ning conditions are strong reasons for health
\nprofessionals to quit or migrate. Reports
\nabout stressful, often dangerous and under-
\nresourced working places do not increase
\nthe attractiveness of the health professions.
\nThe WHPA together with other partners
\nwishes to promote \u201cPositive Practice
\nEnvironments\u201c. We wish to show that
\nworkplaces in the health care field can be
\nmade safe and attractive by following the
\ngood examples that already exist.
\nEuropean Forum of Medical
\nAssociations and WHO \u2013
\nEFMA
\nLisbon, 20-21 April 2007
\nThe EFMA is the common forum of
\nMedical Associations of the WHO-Region
\n\u201cEurope\u201c and the WHO Euro in
\nCopenhagen. This year’s forum gained con-
\nsiderable political attention as the President
\nof the European Commission, Dr. J.M.
\nBarroso, and the regional director of the
\nWorld Health Organization, Dr. M. Danzon,
\nopened the forum. This has been a remark-
\nable change as during the last years the
\nforum did not receive the necessary atten-
\ntion of international politics and the WHO.
\nThe forum discussed among other issues:
\n\u2022 Health and Migration
\n\u2022 Obesity
\n\u2022 Disaster preparedness
\n\u2022 Anti-Tobacco Activities of EFMA\/WHO
\n\u2022 Health Systems and Policies and invest-
\nments in health
\n\u2022 Country reports
\nThe WMA legal advisor and Secretary
\nGeneral of the Israeli Medical Association,
\nAdv. Leah Wapner, has been appointed as
\nthe new Secretary General of the Forum.
\nJoint Commission
\nInternational \u2013 Hospital of
\nthe future roundtable
\nThe Joint Commission International is the
\ninternational arm of the American Joint
\nCommission (http:\/\/www.jointcommis-
\nsion.org\/), describing itself as the
\n\u201cnation’s predominant standards-setting
\nand accrediting body in health care\u201c. JCI
\noffers mainly accreditation and certifica-
\ntion to health care institutions and is with-
\nout doubt one of the most important insti-
\ntutions in the world in the field of health
\ncare quality.
\nWhile its main focus is still on hospitals, the
\nJCI has started a dialogue on the hospital of
\nthe future, trying to analyze and describe
\ninternational trends in hospital development.
\nIn a series of three roundtables, a group of
\nexperts from various fields involving hospi-
\ntal care tried to outline the developmental
\naspect from architectural designs, work
\nflows, social functions and interactions,
\nglobalization and migration of health profes-
\nsionals, to the core of the hospital function,
\nthe provision of care and medical services.
\nThe roundtables served as preparation for an
\ninternational conference debating the future
\ntrends in hospital development.
\nMicrobial Resistance Policy
\nSeminar
\nTogether with the AMA, the International
\nSociety for Microbial Resistance and the
\nGeorge Mason University School of Public
\nPolicy, the WMA co-hosted a conference
\non Microbial Resistance Policy. With a
\ngroup of experts on microbial resistance,
\nthe conference analyzed the need for policy
\ndevelopment in the field on October 23,
\n2006. The Conference started off with a
\nreview of the 1997 WMA policy on
\nMicrobial resistance and resulted in sug-
\ngestions for development, which were
\ntaken up by the AMA and are before the
\nWMA Council now as a redraft of the 1997
\nWMA policy.
\nIn addition, the George Mason School of
\nPublic Policy and the International Society
\nof Microbial Resistance are seeking the par-
\nticipation of the WMA in developing a cer-
\ntificate course for medical policy. This offer
\nis currently under consideration by WMA.
\nOther national or regional
\nmeetings:
\nThe Secretary General attended national
\nmeetings of the following WMA member
\nassociations or their regional groups:
\n\u2022 Standing committee of European Doctors
\n(CPME), Luxembourg 27. \u2013 28.10.2006
\nand Warsaw 16. \u2013 17.03.2007
\n\u2022 International Union against Tuberculosis
\nand Lung Disease, Paris 01. \u2013 02.11.2006
\n\u2022 European Conference on Environment
\nand Health, Paris 09.11.2006
\n\u2022 American Academy of Endocrinologists,
\nPhoenix 10.02.2007
\n\u2022 German-Russian Health Dialogue, Sochi
\n19. \u2013 21.03.2007
\nAdministrational Issues
\nConsolidation of Standing Documents
\nThe constitution and regulations of the
\nWMA are spread over 6 basic documents.
\nWhile there are good reasons to keep some
\nof the rules separated there is also a lot of
\nhistorical and non-logical separation in the
\ndocuments. Fractional amendments led to
\ninconsistencies and did not add transparen-
\ncy to our rules.
\nWith the help of our legal advisors, Mrs.
\nLeah Wapner and Mrs. Malke Borrows, a
\nfirst draft of the consolidated Articles and
\nBylaws has been produced. The purpose of
\nthis consolidation is to enhance readability
\nand clarity, to reduce length and to elimi-
\nnate possible contradictions and illogical
\nrules.
\nFurthermore, the draft will provide sugges-
\ntions that will allow for the adaptation of
\nrules to recent developments and to the
\nnecessities of the work of the Association
\n(see also p. 35).
\nDr. Otmar Kloiber
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 45
\nFrom the Secretary General
\n46
\nby a physician. But where does the limit lie
\nand who drives it?
\nWe also have to note how just words change
\nour world. Our willingness to adopt new
\nlanguage when it comes under the veneer of
\npolitical correctness becomes a trap for our
\nprofession:
\n\u2022 We are called \u201cservice providers\u201c. That
\nis fine for those who wish to make us
\ndependent repair technicians. These peo-
\nple believe that we just have to do what
\nwe are being told (by our government,
\nhospital owner, insurance or managed
\ncare organization). Of course we serve our
\npatients, but we are caregivers and not just
\ntechnicians. We need and have to demand
\nprofessional autonomy or at least clinical
\nindependence \u2013 something service
\nproviders don’t have.
\n\u2022 We are being submerged under the term
\n\u201chealth workers\u201c. This produces the illu-
\nsion of exchangeability and the unimpor-
\ntance of learned professions.
\n\u2022 We speak about \u201ccustomers\u201c and
\n\u201cclients\u201c, but indeed we have to serve
\npatients. Patients do not have the autono-
\nmy of a customer (at least not when they
\nare really sick or injured) nor do we have
\nthe right to do business with them as a
\nmerchant can with his or her clients.
\n\u2022 We proudly call ourselves doctors, but
\nothers in the health care arena carry this
\ntitle also and suddenly a doctor of optom-
\netry, podometry or a PhD in nursing may
\nsay to a patient: \u201cI am your doctor\u201c. The
\nsix-year medical training makes us all to
\nphysicians and that is the common
\ndenominator. Even surgeons will have to
\nlive with it.
\n\u2022 We have allowed our governments to
\nabuse the term physician for other
\nhealth care professionals. Why do we tol-
\nerate this?
\nThe political strategy behind this is simple
\nand clear. It is to make physicians dispens-
\nable, to suggest that others can do the same
\nand to reduce access to high quality care. It
\nworks so well, because we ourselves are the
\nbest adapters to this type of language.
\nexpensive and donors want to rely on
\nlaypersons instead.
\nIt would be too easy to describe this change
\nin scope of practice as just the result of a
\nchange in technology or as a result of a
\ngrowing and unsatisfied demand for profes-
\nsional medical care. We ourselves have
\nbeen adding to this driving this change by
\n\u2022 the unwillingness by family practitioners
\nand other medical primary care givers to
\nprovide medical care during nights and
\non holiday. Our unwillingness to make
\nhome visits or to settle in rural areas
\nopened the window for primary care
\nnurses. It also allowed practice structures
\nto develop which in many regions or
\ncountries tended to endanger the
\npatient\/physician relationship, already
\nquite impersonal. This is especially the
\ncase when patients can no longer choose
\ntheir physician. In those settings the tra-
\nditional binding between a family and
\n\u201ctheir\u201d family physician does not exist
\nanymore.
\n\u2022 the unwillingness to perform repetitive
\ntasks ourselves have let to the emergence
\nof many paramedical professions like
\nanesthesiology technicians or nurses,
\nultrasound imaging assistance and others.
\n\u2022 the tendency to hyper specialize and at the
\nsame time to negate our general capacity
\nas physicians leaves ample space for oth-
\ners to fill this gap.
\nOf course many of these developments
\nhave taken place because of ridiculous pay-
\nment schemes or because work loads just
\ndid not allow us to do what we would have
\nconsidered as being good practice. Of
\ncourse it may sometimes be correct to
\ncharge a less qualified person with tasks
\nthat don’t necessarily need to be performed
\nWe all have been driven through selection
\nprocesses in school, admission tests, state
\nand board exams, audits, appraisals, recerti-
\nfication etc. There certainly is a high expec-
\ntation by the public and our patients con-
\ncerning the level of our knowledge, compe-
\ntency and skills. Yet more and more tasks
\nare being transferred or delegated to non-
\nphysicians, to persons with significantly
\nless or no qualifying training at all.
\nThis trend started decades ago with nurse
\npractitioners providing primary care instead
\nof GPs. It extended gradually to prescribing
\nby pharmacists, optometrists, psychothera-
\npists and other health professions. The most
\nrecent model is the most radical. The so-
\ncalled Task Shifting is mainly used in
\nHIV\/AIDS, tuberculosis and malaria care.
\nLaypersons are being deployed to initiate
\nand maintain complex treatments especially
\nin African countries, but also in other parts
\nof the world.
\nThese laypersons called \u201ccommunity health
\nworkers\u201c are often used in programmes by
\nthe big donors who finance treatment in
\npoor populations.
\nSometimes there are good reasons to
\nchange the scope of practice, to share com-
\npetencies and to use lay help. Over time
\nmany medical processes became very sim-
\nple often automated and safe so that neither
\nthe provision by nor the attendance of a
\nphysician is necessary any more.
\nOn the other hand in many African coun-
\ntries the physician to patient ratio is less
\nthan a tenth of the relation in the rich coun-
\ntries of this world. That means access to
\ncontinuing competent medical care is prac-
\ntically impossible for the majority of the
\npopulation. The use of nurses, midwifes and
\nother health professions for medical treat-
\nment is necessary. But in reality, even those
\nhealth professions are being seen as too
\nFrom the Secretary General\u2019s Desk
\nAbout Changing the Scope of Practice,
\nTask Shifting and the Proper Use of Words
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 46
\nWHO
\n47
\nWe will have to carefully define what is the
\nmedical domain and what can and should be
\ndone by others. We will have to find out
\nwho is best suited to take over certain func-
\ntions and we will have to make sure that
\nresponsibility goes with it.
\nWhat we define to be in the medical domain
\nand we are sure that it has to be done by
\nphysicians (not \u201cdoctors\u201c!) we will have to
\nfight for. it.
\nWe will have to lift the curtain on \u201crecerti-
\nfication\u201c and \u201crevalidation\u201c. With health
\npoliticians demanding on one hand stricter
\ncontrols on physicians and on the other to
\nimplementing task shifting, nothing other
\nthan hypocrisy may be left.
\nThis is not about payment and status. It is
\nabout the quality of medical care that is
\ngiven to our patients. It is about safety and
\naccess to real medical care and not a substi-
\ntute for it. Changing the scope of practice
\nsometimes reflects the progress in technol-
\nogy and methods, but sometimes the short-
\nage of resources. But more and more it
\nbecomes a silent technical approach of
\nrationing care.
\nIn a recent article from M\u00e9dicins Sans
\nFronti\u00e8res website entitled \u201cCoping with
\nhealth worker shortages: lessons and lim-
\nits\u201c, Joseph Ramokoatsi from Lesotho
\nwrote \u201cTask-shifting for rapid scale-up
\nmust be balanced against the need to pro-
\nvide quality care and should not become an
\nalibi for accepting shortages of skilled staff.
\nDonors are quick to support initiatives
\ninvolving lay health workers, but often
\nrefuse to fund measures to recruit and retain
\nhealth professionals.\u201c
\nseek high-level political backing for its rec-
\nommendations.
\nA recent study1
\nhas shown that the number
\nof foreign-trained doctors has tripled in sev-
\neral OECD countries over the past three
\ndecades. The number of foreign-trained
\ndoctors from countries with chronic short-
\nages of health workers is relatively small
\n(less than 10% of the workforce) in devel-
\noped countries. However, for some African
\ncountries, the migration of a few dozen doc-
\ntors can mean losing more than 30% of their
\nworkforce, even as basic health needs
\nremain unmet.
\nOther health professions are also affected
\nby this phenomenon. The study showed that
\nfrom Swaziland, 60 to 80 nurses migrate to
\nthe United Kingdom each year, while fewer
\nthan 90 graduate from Swazi schools.
\nGHWA partner and member Save the
\nChildren UK estimates that the United
\nKingdom saved \u00a365 million in training
\ncosts between 1998 and 2005 by recruiting
\nGhanaian health workers.
\nMs. Robinson summarized the need for
\nurgent action: \u201cWe cannot stand alone as
\nindividual countries continue to address
\ntheir own increased needs for health work-
\ners without looking beyond their shores to
\nthe situation these migrating workers have
\nleft behind in their homelands. We cannot
\ncontinue to shake our heads and bemoan the
\ndevastating brain drain from some of the
\nneediest countries on the planet without
\nforcing ourselves to search for \u2013 and active-
\nly promote \u2013 practical solutions that protect
\nboth the right of individuals to seek
\nemployment through migration and the
\nright to health for all people.\u201c
\nOne of the initiative\u2019s first priorities will be
\nto support WHO in drafting a framework
\nfor an International Code of Practice on
\nHealth Worker Migration, as called for by a
\nresolution of the World Health Assembly in
\n2004. This framework will promote ethical
\nrecruitment, the protection of migrant
\nhealth workers\u2019 rights and remedies for
\naddressing the economic and social impact
\nof health worker migration in developing
\ncountries. The Code of Practice will be the
\nfirst of its kind on a global scale for migra-
\ntion.
\n15 MAY 2007 | GENEVA \u2013 The Health
\nWorker Migration Policy Initiative held its
\nfirst meeting at the WHO headquarters in
\nGeneva. The initiative, led by Mary
\nRobinson, President of Realizing Rights: the
\nEthical Globalization Initiative, and Dr.
\nFrancis Omaswa, Executive Director of the
\nGlobal Health Workforce Alliance (GHWA),
\nis aimed at finding practical solutions to the
\nworsening problem of health worker migra-
\ntion from developing to developed countries.
\nWHO Director-General Dr. Margaret Chan
\nsaid, \u201cInternational migration of health per-
\nsonnel is a key challenge for health systems in
\ndeveloping countries.\u201c The new initiative has
\na Technical Working Group housed at WHO.
\nMedical Manpower
\nPractical solutions to tackle
\nhealth worker migration
\nThe Health Worker Migration Policy
\nInitiative is made up of two groups that will
\nwork closely together over the coming
\nmonths to develop recommendations. The
\nMigration Technical Working Group, which
\nis being coordinated by WHO, brings
\ntogether the International Organization for
\nMigration, the International Labour
\nOrganization, professional associations,
\nexperts and academics.
\nThe Health Worker Global Policy Advisory
\nCouncil, under the leadership of Ms.
\nRobinson and Dr. Omaswa and with
\nRealizing Rights serving as its secretariat, is
\nmade up of senior figures from developed
\nand developing countries. It will develop a
\nroadmap and a framework for a global code
\nof practice for health worker migration and
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 47
\nWHO
\n48
\nThe initiative will also promote good prac-
\ntices and strategies to enable countries to
\nincrease supply and retain their health
\nworkers more effectively. The new tools
\nand policy recommendations developed by
\nthe initiative will support better manage-
\nment of migration through North-South col-
\nlaboration.
\nDr. Omaswa emphasized the importance of
\naddressing both the \u2018push\u2019 and \u2018pull\u2019 factors
\nsimultaneously. \u201cHealth workers are a val-
\nued and scarce resource. Demand is
\nincreasing worldwide, but not enough are
\nbeing trained \u2013 in the developed or the
\ndeveloping world. Developing countries
\nmust prioritize health and health workers,
\nwith better working conditions and incen-
\ntives so its workforce can stay and be more
\nefficient, while developed countries must
\ntrain more of their youth and try to be self-
\nsufficient.\u201c
\nThe Health Worker Migration Policy
\nInitiative is due to make initial policy rec-
\nommendations by the end of 2008. Its oper-
\nations are co-funded and coordinated by
\nRealizing Rights, the Global Health
\nWorkforce Alliance, and the MacArthur
\nFoundation.
\nList of members
\nHealth Worker Global Policy Advisory
\nCouncil
\nCo-Chairs
\n\u2022 Hon. Mary Robinson, President,
\nRealizing Rights
\n\u2022 Dr Francis Omaswa, Executive Director,
\nGHWA
\nMembers
\n\u2022 Hon. Major Courage Quarshie, Minister
\nof Health, Ghana
\n\u2022 Hon. Erik Solheim, Minister of
\nInternational Development, Norway
\n\u2022 Hon. Patricia Aragon Sto Tomas, Minister
\nof Labor and Employment, the
\nPhilippines
\n\u2022 Hon. Rosie Winterton, Minister of State
\nfor Health Services, United Kingdom
\n\u2022 Dr Lincoln Chen, Director, Global
\nEquities Initiative, Harvard University
\n\u2022 Dr Anders Nordstr\u00f6m, Assistant Director-
\nGeneral, Health Systems and Services,
\nWHO
\n\u2022 Ms Janet Hatcher Roberts, Director,
\nMigration Health Department, IOM
\n\u2022 Mr Ibrahim Awad Director, International
\nMigration Programme, ILO
\n\u2022 Lord Nigel Crisp, Co-Chair, GHWA Task
\nForce on Scaling up Education & Training
\n\u2022 Dr Percy Mahlati, Director of Human
\nResources, Ministry of Health, South
\nAfrica
\n\u2022 Huguette Labelle, Chancellor, University
\nof Ottawa
\n\u2022 Dr Titilola Banjoko, Managing Director,
\nAfrica Recruit
\n\u2022 Prof. Ruairi Brugha Head, Department of
\nEpidemiology & Public Health, Ireland
\n\u2022 Ms Sharan Burrow, President, International
\nConfederation of Free Trade Unions
\n\u2022 Ms Ann Keeling, Director, Social
\nTransformation Programs Division,
\nCommonwealth Secretariat
\n\u2022 Mr Markos Kyprianou, Director General,
\nHealth & Consumer Protection, European
\nCommission
\n\u2022 Mr Peter Scherer, Directorate for
\nEmployment, Labour and Social Affairs,
\nOECD
\n\u2022 Prof. Anna Maslin, Nursing Officer,
\nInternational Nursing & Midwifery
\nHealth Professions Leadership Team,
\nDepartment of Health, United Kingdom
\n\u2022 Dr Mary Pittman, President, Health
\nResearch & Education Trust, American
\nHospitals Association
\n\u2022 Dr Jean Yan, Chief Scientist for Nursing
\n& Midwifery, WHO, chair of the
\nMigration Technical Working Group
\nHealth Worker Global Policy Advisory
\nCouncil Secretariat:
\n\u2022 Ms Peggy Clark, Managing Director,
\nRealizing Rights
\n\u2022 Dr Ita Lynch, Health Advisor, Realizing
\nRights
\nInternational Health Regulations
\nenter into force
\nNew opportunity to respond to internation-
\nal public health threats
\nGENEVA \u2013 The revised International
\nHealth Regulations (IHR) entered into force
\non Friday, 15 June 2007. The Regulations
\nconsist of a comprehensive and tested set of
\nrules and procedures which will help to
\nmake the world more secure from threats to
\nglobal health. They were agreed by the
\nWorld Health Assembly in 2005 and repre-
\nsent a major step forward in international
\npublic health security.
\nThe Regulations establish an agreed frame-
\nwork of commitments and responsibilities
\nfor States and for WHO to invest in limiting
\nthe international spread of epidemics and
\nother public health emergencies while min-
\nimizing disruption to travel, trade and
\neconomies. Under the revised IHR, States
\nwill be required to report all events that
\ncould result in public health emergencies of
\ninternational concern, including those
\ncaused by chemical agents, radioactive
\nmaterials and contaminated food.
\nIn the early 21st
\nCentury, demographic, eco-
\nnomic and environmental pressures have
\ncreated a unique combination of conditions
\nthat allow new and re-emerging infectious
\ndiseases to spread as never before. The
\nexperience of recent decades shows that no
\nindividual country can protect itself from
\ndiseases and other public health threats. All
\ncountries are vulnerable to the spread of
\npathogens and their economic, political and
\nsocial impact.
\nThe emergence of SARS in 2003 demon-
\nstrated as no previous disease outbreak ever
\nhad, how interconnected the world has
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 48
\nWHO
\n49
\nbecome and how rapidly a new disease can
\nspread. This shared vulnerability has also
\ncreated a need for collective defences and
\nfor shared responsibility in making these
\ndefences work. This is the underlying prin-
\nciple of the International Health
\nRegulations.
\n\u201cSARS was a wake-up call for all of us. It
\nspread faster than we had predicted and was
\nonly contained through intensive coopera-
\ntion between countries which prevented this
\nnew disease from gaining a foothold,\u201c said
\nDr. Margaret Chan, Director-General of the
\nWorld Health Organization. \u201cToday, the
\ngreatest threat to international public health
\nsecurity would be an influenza pandemic.
\nThe threat of a pandemic has not receded,
\nbut implementation of the IHR will help the
\nworld to be better prepared for the possibil-
\nity of a pandemic.\u201c
\nThe Regulations build on the recent experi-
\nence of WHO and its partners in responding
\nto and containing disease outbreaks. Recent
\nexperience shows that addressing public
\nhealth threats at their source is the most
\neffective way to reduce their potential to
\nspread internationally. The Regulations will
\nhelp to ensure that outbreaks and other pub-
\nlic health emergencies of international con-
\ncern are detected and investigated more
\nrapidly and that collective international
\naction is taken to support affected States to
\ncontain the emergency, save lives and pre-
\nvent its spread.
\nWHO has already developed and built an
\nimproved events management system to
\nmanage potential public health emergen-
\ncies. WHO has also built strategic opera-
\ntions centres at its Geneva Headquarters
\nand in Regional Offices around the world,
\nwhich are available round-the-clock to
\nmanage emergencies. WHO has also been
\nworking with its partners to strengthen the
\nGlobal Outbreak Alert and Response
\nNetwork (GOARN), which brings together
\nexperts from around the world to respond to
\ndisease outbreaks.
\n\u201cImplementing the IHR is a collective
\nresponsibility and depends on the capacity
\nof all countries to fulfil the new require-
\nments,\u201c said Dr. David Heymann, WHO
\nAssistant Director-General for
\nCommunicable Diseases. \u201cWHO will help
\ncountries to strengthen the necessary capac-
\nities to fully implement the Regulations.
\nThis is our responsibility and we expect that
\nthe entire international community is com-
\nmitted to the same goal of improving inter-
\nnational public health security.\u201c
\nWHO exercise to test global
\nsystem
\nIn June also, WHO will hold the first exer-
\ncise to sharpen its preparedness under the
\nterms of the revised International Health
\nRegulations. The exercise will verify new
\nprocedures for receiving, analysing and
\nresponding to information about potential
\npublic health emergencies. It will also
\nensure the effectiveness of policy direction
\nand coordination, information management
\nand risk assessment capacity and communi-
\ncations between the Regional and Country
\nOffices and Headquarters of WHO.
\nThe exercise will be the first of a series
\nmeant to test and improve the mechanisms
\nin place in and between Member States and
\nat different levels of WHO.
\nThe revised IHR require-
\nments include
\n\u2022\u2022 Notification. Greater openness
\ndemanded by a world in which serious
\ndisease events are increasingly visible.
\nThe Regulations recognize that media and
\nother unofficial reports often appear in
\nadvance of official notification of a public
\nhealth emergency of international con-
\ncern. To expedite the flow of timely and
\naccurate information, countries are
\nrequired to notify all events that may con-
\nstitute a public health emergency of inter-
\nnational concern within 24 hours of
\nassessment.
\n\u2022\u2022 Designation of National IHR Focal
\nPoints: world on 24-hour alert. Under
\nthe IHR every country is required to des-
\nignate a National IHR Focal Point,
\ncharged with providing to and receiving
\ninformation from WHO on a 24 hour
\nbasis, seven days a week.
\n\u2022\u2022 Establishment of core public health
\ncapacities to maximize surveillance and
\nresponse. Under the IHR, each country is
\ncommitted to develop and maintain core
\npublic health capacities for surveillance
\nand response. These capacities also
\ninclude outbreaks of chemical, radiologi-
\ncal and food origin. States are required to
\nestablish such core capacities as soon as
\npossible, with a deadline of five years
\nafter entry into force of the revised IHR.
\n\u2022\u2022 New recognized rights for international
\ntravellers. The IHR for the first time
\ninclude express requirements that interna-
\ntional travellers be treated with respect for
\ntheir dignity, human rights and fundamen-
\ntal freedoms when health measures are
\napplied. At the same time, they provide
\nfor examinations and other health mea-
\nsures as necessary to protect against the
\ninternational spread of disease.
\n\u2022\u2022 Cross-sectoral international collabora-
\ntion key to implementing IHR. WHO
\nneeds the support of all stakeholders to
\nensure international public health security.
\nThe IHR foster multi-sectoral global part-
\nnership to respond collectively in the face
\nof epidemics and other major health emer-
\ngencies.
\n\u2022\u2022 Threat-specific international pro-
\ngrammes to improve international
\nhealth security. The IHR provide for
\nstrengthening existing international dis-
\nease control programmes, addressing
\ninfectious diseases, food safety and envi-
\nronmental safety. These programmes
\nmake a vital contribution to the global
\nalert and response system as they allow
\ndevelopment of generic and threat-specif-
\nic capacities.
\nFor further information contact:
\nCristiana Salvi
\nCommunications Officer
\nIHR, Pandemic and Outbreak
\nCommunications
\nWHO, Geneva
\nTel.: +41 22 791 3583
\nMobile: +39 348 019 2305
\nE-mail: salvic@who.int
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 49
\nWHO
\n50
\nFollowing recommendations from the
\nExpert Committee on Essential Medicines,
\nthe World Health Organization has begun
\nwork to create a medicines list specifically
\ntailored to children\u2019s needs. A group of
\nexperts met in July 2007 to produce the first
\ninternational list of medicines to tackle dis-
\neases with high mortality and morbidity
\nrates in children.
\nThe Expert Committee made the recom-
\nmendation while meeting in Geneva to
\nupdate the general WHO Model List of
\nEssential Medicines. The list is published
\nand already includes some child specific
\nmedicines.
\nChildren suffer from the same illnesses as
\nadults but they are more seriously affected \u2013
\nparticularly in developing countries \u2013 by
\ncertain conditions such as respiratory tract
\ninfections, malaria and diarrhoeal diseases.
\nAn estimated 10.6 million children under
\nfive die every year, many from these treat-
\nable conditions. In 2005, 2.3 million chil-
\ndren under 15 years were HIV positive \u2013
\n700000 new infections had occurred over
\nthe twelve months.
\nIn spite of the huge need, there are few
\nmedicines made to measure for children or
\nthat can be easily consumed by a child. At
\npresent, children must often take portions of
\nadult tablets in a crushed form, with little
\nevidence of the efficacy and safety of the
\ndose. When medicines do exist in the right
\ndosage they are usually in syrup form,
\nwhich may pose supply, storage and pricing
\nproblems in developing countries.
\nThe challenge for children becomes more
\nacute when they are affected by a condition
\nrequiring combination therapy (several medi-
\ncines rather than one) such as for HIV\/AIDS
\nand malaria. In these cases, fixed dose com-
\nbination tablets are required (two- or three-in-
\none pills). While production of adult fixed-
\ndose-combinations is increasing, it is sorely
\nlacking for children. In addition, antiretrovi-
\nExperts recommend innovation for children\u2019s medicines
\nWHO 15th
\nessential medicines list published
\nrals for children are currently three times
\nmore expensive than the adult versions.
\nThe recommendation made by the Expert
\nCommittee for an essential medicines list
\nfor children will see WHO working with
\npartners to advocate innovation and
\nresearch into children\u2019s medicines, the man-
\nufacture of new dosage forms and new for-
\nmats, and ways in which information about
\nchildren\u2019s medicines can be conveyed to
\ncountries in a rapid, effective way.
\nThe plan to work on better medicines for
\nchildren was backed by Member States at
\nWHO\u2019s Executive Board meeting in
\nJanuary this year and was on the agenda of
\nthe World Health Assembly in May.
\nThe Expert Committee made a number of
\nimportant updates to the WHO Model List
\nof Essential Medicines. Five fixed-dose-
\ncombinations for adults were included for
\nHIV\/AIDS. Two of these come from the
\ngeneric industry while the remaining three
\nare produced by brand name companies. All
\nWHO recommended antimalarials were
\nalso added.
\nFive oral liquid formulations were included
\nfor children \u2013 three for epilepsy, one for
\nchildren born prematurely, and one new
\nmedicine for HIV\/AIDS, although in single
\ndose. Three other epilepsy medicines were
\nincluded in the form of chewable, dis-
\npersable tablets, a format which evidence
\nincreasingly shows to be effective for chil-
\ndren.
\nThe WHO List of Essential Medicines pro-
\nvides a model for countries to select medi-
\ncines addressing public health priorities
\naccording to quality, safety and efficacy
\nstandards. It helps governments address
\nproblems of cost and availability and pro-
\nvides guidance to the pharmaceutical indus-
\ntry on medicines needs globally.
\nGENEVA \u2013 The revised International
\nHealth Regulations (IHR) entered into force
\non Friday, 15 June 2007. The Regulations
\nconsist of a comprehensive and tested set of
\nrules and procedures which will help to
\nmake the world more secure from threats to
\nglobal health. They were agreed by the
\nWorld Health Assembly in 2005 and repre-
\nsent a major step forward in international
\npublic health security.
\nThe Regulations establish an agreed frame-
\nwork of commitments and responsibilities
\nfor States and for WHO to invest in limiting
\nthe international spread of epidemics and
\nother public health emergencies while min-
\nInternational Health Regulations enter into force
\nNew opportunity to respond to international
\npublic health threats
\nimizing disruption to travel, trade and
\neconomies. Under the revised IHR, States
\nwill be required to report all events that
\ncould result in public health emergencies of
\ninternational concern, including those
\ncaused by chemical agents, radioactive
\nmaterials and contaminated food.
\nIn the early 21st Century, demographic,
\neconomic and environmental pressures
\nhave created a unique combination of con-
\nditions that allow new and re-emerging
\ninfectious diseases to spread as never
\nbefore. The experience of recent decades
\nshows that no individual country can pro-
\ntect itself from diseases and other public
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 50
\nWHO
\n51
\nhealth threats. All countries are vulnerable
\nto the spread of pathogens and their eco-
\nnomic, political and social impact.
\nThe emergence of SARS in 2003 demon-
\nstrated, as no previous disease outbreak
\never had, how interconnected the world has
\nbecome and how rapidly a new disease can
\nspread. This shared vulnerability has also
\ncreated a need for collective defences and
\nfor shared responsibility in making these
\ndefences work. This is the underlying prin-
\nciple of the International Health
\nRegulations.
\n\u201cSARS was a wake-up call for all of us. It
\nspread faster than we had predicted and was
\nonly contained through intensive coopera-
\ntion between countries which prevented this
\nnew disease from gaining a foothold,\u201c said
\nDr. Margaret Chan, Director-General of the
\nWorld Health Organization. \u201cToday, the
\ngreatest threat to international public health
\nsecurity would be an influenza pandemic.
\nThe threat of a pandemic has not receded,
\nbut implementation of the IHR will help the
\nworld to be better prepared for the possibil-
\nity of a pandemic.\u201c
\nThe Regulations build on the recent experi-
\nence of WHO and its partners in responding
\nto and containing disease outbreaks. Recent
\nexperience shows that addressing public
\nhealth threats at their source is the most
\neffective way to reduce their potential to
\nspread internationally. The Regulations will
\nhelp to ensure that outbreaks and other pub-
\nlic health emergencies of international con-
\ncern are detected and investigated more
\nrapidly and that collective international
\naction is taken to support affected States to
\ncontain the emergency, save lives and pre-
\nvent its spread.
\nWHO has already developed and built an
\nimproved events management system to
\nmanage potential public health emergen-
\ncies. WHO has also built strategic opera-
\ntions centres at its Geneva Headquarters
\nand in Regional Offices around the world,
\nwhich are available round-the-clock to
\nmanage emergencies. WHO has also been
\nworking with its partners to strengthen the
\nGlobal Outbreak Alert and Response
\nNetwork (GOARN), which brings together
\nexperts from around the world to respond to
\ndisease outbreaks.
\nGlobal health partners mobilize
\nto counter yellow fever
\nUS$ 58 million GAVI contribution to prevent highly
\ncontagious disease in 12 West African nations
\n16 MAY 2007 | GENEVA \u2013 The effort to
\ncontain deadly yellow fever disease has
\nreceived a boost with the launch of a Yellow
\nFever Initiative backed by a US$ 58 million
\ncontribution from the GAVI Alliance.
\nLaunched during the World Health
\nAssembly currently meeting in Geneva, the
\nnew initiative will support special immu-
\nnization campaigns in a dozen West African
\ncountries at high risk of yellow fever epi-
\ndemics.
\nBetween the 1940s and 1960s, widespread
\nmass vaccination campaigns in some
\nAfrican countries had resulted in the
\nalmost-complete disappearance of yellow
\nfever. However, as immunization cam-
\npaigns waned, a generation of people grew
\nup with no immunity to the disease, and by
\nthe 1990s the number of annual cases had
\nrisen to an estimated 200,000 per year, with
\n30,000 deaths, and urban outbreaks were
\nstarting to occur.
\nYellow fever had returned as a major
\nscourge and, as urbanization progresses
\nacross Africa, the threat of a major epidem-
\nic looms ever larger. WHO estimates, for
\nexample, that this highly transmissible dis-
\nease could infect around one third of the
\nurban population, or up to 4.5 million peo-
\nple, in Lagos, Nigeria alone.
\nNow, thanks to the US$ 58 million GAVI
\nAlliance grant, immunization against yel-
\nlow fever will be kick-started. Over the next
\nfour years, the world\u2019s 12 highest-burden
\ncountries, all of which are in West Africa,
\nwill be able to implement special vaccina-
\ntion campaigns to immunize more than 48
\nmillion people.
\nGroundbreaking initiative
\n\u201cThe Initiative is a groundbreaker from
\nmany perspectives. Existing routine immu-
\nnization programmes target children. If we
\nwere to do only routine child immunization
\nfor yellow fever, we would need decades to
\nreduce the risk of epidemics and the inter-
\nnational spread of the disease,\u201c said Dr.
\nDavid Heymann, WHO Assistant Director-
\nGeneral for Communicable Diseases.
\n\u201cNow, however, thanks to the generous
\ngrant from GAVI, the Yellow Fever
\nInitiative will be able to vaccinate at-risk
\npopulations and thus quickly reduce the risk
\nof devastating outbreaks that could other-
\nwise threaten the region and the world.
\nWith this initiative, we will be working in
\nthe short and long term to strengthen prima-
\nry health care systems in the world\u2019s most
\nvulnerable region \u2013 Africa,\u201c added Dr. Mike
\nRyan, Director of the WHO Department of
\nEpidemic and Pandemic Alert and
\nResponse (EPR) in Geneva.
\n\u201cYellow fever is a particularly dangerous
\ndisease which kills up to 50% of those with
\nsevere illness. Every age group is at risk,
\nand vaccination is our crucial weapon to
\nprevent cases and epidemics. With the
\nGAVI Alliance contribution, affected coun-
\ntries have an exceptional opportunity, and
\nresponsibility, to protect their populations,\u201c
\nsaid Michel Zaffran, Deputy Executive
\n\u201cImplementing the IHR is a collective
\nresponsibility and depends on the capacity
\nof all countries to fulfil the new require-
\nments,\u201c said Dr. David Heymann, WHO
\nAssistant Director-General for Com-
\nmunicable Diseases. \u201cWHO will help coun-
\ntries to strengthen the necessary capacities
\nto fully implement the Regulations. This is
\nour responsibility and we expect that the
\nentire international community is commit-
\nted to the same goal of improving interna-
\ntional public health security.\u201c
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 51
\nWHO
\n52
\nhighest risk from the disease \u2013 Benin,
\nBurkina Faso, Cameroon, C\u00f4te d\u2019Ivoire,
\nGhana, Guinea, Liberia, Mali, Nigeria,
\nSenegal, Sierra Leone and Togo \u2013 and will
\nhelp create a stockpile of 11 million doses
\nof vaccine. Within the framework of the
\nInitiative, the 12 Member States and WHO
\nwill identify specific target populations to
\nvaccinate, with the aim of both preventing
\noutbreaks and managing epidemics, and
\nconsequently increasing immunization cov-
\nerage.
\nBackground
\nThe 12 countries taking part in the Yellow
\nFever Initiative are Benin, Burkina Faso,
\nCameroon, C\u00f4te d\u2019Ivoire, Ghana, Guinea,
\nSecretary at the GAVI Alliance, in announc-
\ning the GAVI contribution. \u201cGAVI is com-
\nmitted to working with all our partners,
\nboth globally and in the field, to ensure the
\nsuccess of the Yellow Fever Initiative in
\nAfrica.\u201d
\nVaccine too expensive
\nUntil now, vaccine has often been too
\nexpensive for countries to afford when faced
\nwith a host of competing health problems
\nand coverage rates in some West African
\ncountries are critically low. In Nigeria, for
\nexample, the coverage rate in 2005 was an
\nestimated 36%. However, it is recommend-
\ned that, to stop yellow fever infections from
\nspreading into an epidemic, immunization
\ncoverage must be at least 60\u201380%.
\n\u201cImmunization against yellow fever is all
\nthe more critical now because of increased
\npopulation movements in Africa. As we see
\nmore people moving to cities for work, but
\nreturning to their rural villages from time to
\ntime, we also see the possibility of yellow
\nfever epidemics multiplying,\u201c said Dr.
\nSylvie Briand, Project Manager of the
\nYellow Fever Initiative in WHO\u2019s EPR
\nDepartment.
\nA recent vaccination campaign in Togo has
\nshown how, under the umbrella of the
\nYellow Fever Initiative, it is possible to
\nquickly and effectively reach even remote
\npopulations and consequently prevent iso-
\nlated cases from spreading into an epidemic.
\nIn December 2006, WHO received notifica-
\ntion of three cases of yellow fever in north-
\nern Togo. As the last mass vaccination there
\nhad taken place in 1987, the population was
\nconsidered to be highly susceptible. By
\nFebruary 2007, the Togo Ministry of Health
\nand WHO, with financial support from
\nGAVI and from the Humanitarian Office of
\nthe European Commission (ECHO), and
\nwith the technical support of UNICEF and
\nvarious NGOs, had vaccinated more than
\n1.5 million people. A similar campaign was
\nthen conducted in two districts in southern
\nTogo after two cases of yellow fever had
\nbeen reported there at the end of January.
\nGAVI\u2019s grant to the Yellow Fever Initiative
\nwill cover the 12 countries which are at the
\nLiberia, Mali, Nigeria, Senegal, Sierra
\nLeone and Togo.
\nThe Ministries of Health of these 12 coun-
\ntries are being supported financially and
\ntechnically by a Yellow Fever partnership
\nwhich was launched in February 2006 and
\nnow includes WHO, UNICEF, GAVI,
\nM\u00e9decins Sans Fronti\u00e8res, the International
\nFederation of Red Cross and Red Crescent
\nSocieties, the Association pour la M\u00e9decine
\nPr\u00e9ventive (AMP), the Programme for
\nAppropriate Technology (PATH), the
\nEuropean Union Humanitarian Aid Office
\n(ECHO), the United States Centers for
\nDisease Control and Prevention (CDC), the
\nGlobal Outbreak Alert and Response
\nNetwork (GOARN) and the Institut Pasteur.
\nThe partnership continues to take on new
\nmembers.
\n6 JULY 2007 | NEW DELHI \u2013 The new
\n2006 estimates released today by the
\nNational AIDS Control Organization
\n(NACO), supported by UNAIDS and
\nWHO, indicate that national adult HIV
\nprevalence in India is approximately
\n0.36%, which corresponds to an estimated
\n2 million to 3.1 million people living with
\nHIV in the country. These estimates are
\nmore accurate than those of previous years,
\nas they are based on an expanded surveil-
\nlance system and a revised and enhanced
\nmethodology.
\nAs part of its continuing effort to know its
\nepidemic better, the Indian Government has
\ngreatly expanded and improved its surveil-
\nlance system in recent years and increased
\nthe number of population groups covered.
\nIn 2006, the government created 400 new
\nsentinel surveillance sites and facilitated
\nNational Family Health Survey-3, which is
\na population-based survey.
\n2.5 million people in India living with HIV,
\naccording to new estimates
\nImproved data from more sources gives better understanding
\nof AIDS epidemic in India
\nLaunching the third phase of the National
\nProgramme, Dr.Anbumani Ramadoss, Union
\nMinister for Health and Family Welfare said,
\n\u201cRevision of estimates based on more data
\nand improved methodology marks a signifi-
\ncant improvement in systems and capabilities
\nto monitor the spread of HIV, a sign of the
\nprogress we have made in understanding the
\nepidemic better. This is welcome progress.
\nUnfortunately, the new figures still point
\ntowards a serious epidemic with potential to
\nexpand if the prevention efforts identified in
\nthe NACP III are not scaled up rapidly and
\nimplemented in the desired manner. We must
\nremember that India has nearly 3 million peo-
\nple living with HIV. These are people facing
\nstigma, discrimination and irrational preju-
\ndice everyday of their lives and need all our
\nsupport and understanding.\u201d The Minister
\ncalled upon his colleagues in the medical pro-
\nfession and civil society organizations to fight
\nstigma and discrimination.
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 52
\nWHO
\n53
\nResulting from a more robust and enhanced
\nmethodology, the revised estimates will be
\nused to improve planning for prevention,
\ncare and treatment efforts. \u201cWhile it is good
\nnews that the total number of HIV infec-
\ntions is lower than previously thought, we
\ncannot be complacent. The steady and slow
\nspread of the HIV infection is a worrying
\nfactor. The better understanding of India\u2019s
\nepidemic has certainly enabled us to have
\nmore focused HIV prevention and treatment
\nstrategies and more effective deployment of
\nresources,\u201d said Mr. Naresh Dayal,
\nSecretary of Health and Chair of the
\nNational AIDS Control Board.
\nThe new methods developed for the revised
\nestimates have also been used to \u201cback-cal-
\nculate\u201d the prevalence for years since 2002
\nbased on the new set of assumptions and
\nmeasures. These figures allow a fair com-
\nparison of year-on-year trends in HIV preva-
\nlence. They show an epidemic that is stable
\nover time with marginal decline in 2006.
\nCommenting on the new estimates and
\nguarding against their misinterpretation,
\nSujatha Rao, Additional Secretary and
\nDirector General, National AIDS Control
\nOrganization said, \u201cThe calculation of fig-
\nures for several years using the new model
\nhelps us understand that the new lower esti-
\nmates do not mean a sharp decline in the
\nepidemic.\u201d Cautioning against an easing-off
\nthe momentum of the HIV response she
\nadded, \u201cUsing a similar methodology led to
\ndownward revision in estimates in some
\ncountries such as Zambia and Rwanda. We
\nwill convince all stakeholders to stay ener-
\ngized and to retain the hard-fought gains of
\nthe last decade.\u201d
\nShowing confidence in the commitment of
\nthe Indian leadership, Dr. Denis Broun,
\nUNAIDS Country Coordinator said, \u201cThe
\ntrends evident from the latest estimates val-
\nidate India\u2019s national AIDS strategy. Taking
\nencouragement from the new lower esti-
\nmates, the national authorities should
\nincrease the strength of their HIV pro-
\ngrammes. We must scale up efforts to reach
\nuniversal access to HIV prevention, care
\nand treatment. Though the proportion of
\npeople living with HIV is lower than previ-
\nously estimated, India\u2019s epidemic continues
\nto be substantial in numbers. Despite the
\nlower prevalence estimate, the cost of pre-
\nvention efforts required to control the epi-
\ndemic remains the same.\u201d
\nWHO Representative, Dr. Salim Habayeb
\ncommended the vision of the Government
\nof India in the last 15 years for addressing
\nthe HIV epidemic. He also commended the
\nefforts of the states, civil society, partner
\nagencies as well as the valuable role of the
\nmedia in facilitating the creation of an
\nenabling environment. \u201cThe HIV burden
\nremains substantial. India\u2019s efforts, espe-
\ncially those in prevention, are noteworthy
\nand should be further scaled up along with
\nprovision of universal access to treatment
\nfor those who need it.\u201d
\nHIV prevalence shows signs of slight
\ndecline among general population
\nWhile overall the HIV epidemic shows a
\nstable trend in the recent years, there is vari-
\nation between states and population groups.
\nThe good news is that in Tamil Nadu and
\nother southern states with a high HIV bur-
\nden, where effective interventions have
\nbeen in place for several years, HIV preva-
\nlence has begun to decline or stabilize.
\nNew pockets of high HIV prevalence identi-
\nfied
\nHIV continues to emerge in new areas. The
\n2006 surveillance data has identified select-
\ned pockets of high prevalence in the north-
\nern states. There are 29 districts with high
\nprevalence, particularly in the states of West
\nBengal, Orissa, Rajasthan and Bihar.
\nHIV prevalence continues to be high among
\nvulnerable groups
\nThe 2006 surveillance figures show an
\nincrease in HIV infection among several
\ngroups at higher risk of HIV infection, such
\nas people who inject drugs and men who
\nhave sex with men. The HIV positivity
\namong injecting drug users (IDU) has been
\nfound to be significantly high in cities of
\nChennai, Delhi, Mumbai and Chandigarh.
\nIn addition, the states of Orissa, Punjab,
\nWest Bengal, Uttar Pradesh and Kerala also
\nshow high prevalence among this group.
\nWhile data does suggest that HIV prevalence
\nlevels are declining among sex workers in
\nthe southern states, overall prevalence levels
\namong this group continue to be high, neces-
\nsitating a scaling-up of focused prevention
\nefforts among these groups. \u201cOnly by con-
\ntrolling the epidemic among the vulnerable
\ngroups can the dynamic of the epidemic be
\nbroken,\u201d said Sujatha Rao, Additional
\nSecretary and Director General, NACO.
\nRegulatory authority on safe blood being
\nestablished
\nUnderscoring the priorities, the Minister of
\nHealth called for strong measures to regu-
\nlate the blood collection and distribution
\nsystem in the country to make it world
\nclass. He stated that the Ministry of Health
\nis establishing a regulatory authority which
\nwill regulate access to safe blood at afford-
\nable prices.
\nFor further information, please contact:
\nIqbal Nandra
\nWHO Geneva
\nTel.: +41 22 791 5589
\nE-mail: nandrai@who.int
\nWHO publishes key world health statistics
\n18 MAY 2007 | GENEVA \u2013 WHO has pub-
\nlished World health statistics 2007, the most
\ncomplete set of health statistics from its 193
\nMember States. This edition also highlights
\ntrends in 10 of the most closely watched
\nglobal health statistics. It is the authoritative
\nannual reference for a set of 50 health indi-
\ncators in countries around the world.
\nIn her speech to the World Health
\nAssembly, the WHO Director-General, Dr.
\nMargaret Chan, focussed on the need for
\naccurate evidence and up-to-date statistics
\nas the basis for policy decisions. \u201cReliable
\nhealth data and statistics are the foundation
\nof health policies, strategies, and evaluation
\nand monitoring,\u201c she said. \u201cEvidence is also
\nthe foundation for sound health information
\nfor the general public… I regard the genera-
\ntion and use of health information as the
\nmost urgent need.\u201c
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 53
\nWHO
\n54
\n\u2022 Gaps in reliable information, and how
\nestimates of maternal mortality are
\nmade;
\n\u2022 The diseases that are killing people, and
\nthose that make them sick;
\n\u2022 The extent to which people can access
\ntreatment, the major risk factors for ill-
\nhealth, the human resources underpinning
\nhealth systems; and
\nThis volume, also available as an online
\ndatabase, should be on the shelves or the
\ndesktop of every health policy maker,
\nresearcher and journalist. It shows:
\n\u2022 How much money is currently spent on
\nhealth in comparison to regional burdens
\nof disease;
\n\u2022 Projected patterns of major causes of
\ndeath for 2030;
\n\u2022 Health outcomes in the context of demo-
\ngraphic and socioeconomic status of indi-
\nvidual countries.
\nWorld health statistics 2007 is the official
\nrecord of data produced by WHO\u2019s technical
\nprogrammes and regional offices. In pub-
\nlishing these statistics, WHO provides the
\nglobal evidence base for improvements and
\ncontinued challenges in global public health.
\nWorld Health Statistics 2007 can be accessed
\nonline at http:\/\/www.who.int\/whosis.
\nRoad traffic crashes are the leading cause of death for 10-24 olds
\nNew WHO report marks First UN Global Road Safety Week
\nGENEVA \u2013 Road traffic crashes are the
\nleading cause of death among young people
\nbetween 10 and 24 years, according to a
\nnew report published by World Health
\nOrganization. The report, Youth and Road
\nSafety, says that nearly 400 000 young peo-
\nple under the age of 25 are killed in road
\ntraffic crashes every year. Millions more are
\ninjured or disabled.
\nThe vast majority of these deaths and
\ninjuries occur in low- and middle-income
\ncountries. The highest rates are found in
\nAfrica and the Middle East. Young people
\nfrom economically disadvantaged back-
\ngrounds are at greatest risk in every country.
\nYoung males are at higher risk for road traf-
\nfic fatalities than females in every age
\ngroup under 25 years.
\nUnless more comprehensive global action is
\ntaken, the number of deaths and injuries is
\nlikely to rise significantly. Road traffic col-
\nlisions cost an estimated US$ 518 billion
\nglobally in material, health and other
\nexpenditure. For many low- and middle-
\nincome countries, the cost of road crashes
\nrepresents between 1-1.5 % of GNP and in
\nsome cases exceeds the total amount the
\ncountries receive in international develop-
\nment aid.
\nYouth and Road Safety stresses that the bulk
\nof these crashes are predictable \u2013 and pre-
\nventable. Many involve children playing on
\nthe street, young pedestrians, cyclists,
\nmotorcyclists, novice drivers and passen-
\ngers of public transport.
\nThe report points out that children are not
\njust little adults. Their height, level of matu-
\nrity, their interests, as well as their need to
\nplay and travel safely to school, mean that
\nthey require special safety measures. Also,
\nthe report says, protecting older youth
\nrequires other measures such as lower blood
\nalcohol limits for young drivers and gradu-
\nated license programmes.
\nAs part of the First United Nations Global
\nRoad Safety Week (23-29 April 2007),
\nWHO launched the report to draw attention
\nto the high global rates of death, injury and
\ndisability among young people caused by
\nroad traffic crashes. Youth and Road Safety
\nhighlights examples in countries where
\nimproved measures such as lowering speed
\nlimits, cracking down on drink-driving, pro-
\nmoting and enforcing the use of seat-belts,
\nchild restraints, and motorcycle helmets, as
\nwell as better road infrastructure and creat-
\ning safe areas for children to play have sig-
\nnificantly reduced the number of deaths and
\ninjuries.
\n\u201cThe lack of safety on our roads has
\nbecome an important obstacle to health and
\ndevelopment,\u201c said Dr. Margaret Chan,
\nWHO Director-General. \u201cOur children and
\nyoung adults are among the most vulnera-
\nble. Road traffic crashes are not \u2018accidents\u2019.
\nWe need to challenge the notion that they
\nare unavoidable and make room for a pro-
\nactive, preventive approach.\u201c
\nYouth and Road Safety is accompanied by a
\nsecond and more personal document, Faces
\nbehind the figures: voices of road traffic
\ncrash victims and their families. Developed
\njointly by WHO and the Association for
\nSafe International Road Travel, this book
\npresents first-hand accounts of the experi-
\nences of victims, their families and friends
\nfollowing road crashes. The stories place a
\nhighly moving human face on the statistics
\nprovided by many road safety reports
\naround the world. They reveal the physical,
\npsychological, emotional and economic
\ndevastation that occurs during the aftermath
\nof road traffic deaths and injuries. In partic-
\nular, these accounts deepen our understand-
\ning of the enormous suffering that occurs
\nbehind each death and injury every year.
\nThey also highlight some of the initiatives
\nundertaken by groups and individuals to
\nimprove road safety by sharing their con-
\ncern, frustration and anger in order to pre-
\nvent the same from happening again.
\nFaces behind the figures include:
\n\u2022 On 16 September 2002, Jane Njawe, 42,
\nwas travelling by car with two other peo-
\nple from Yaounde, the capital of
\nCameroon, to Douala in the north. An
\nhour into the journey, a bus driving in the
\nopposite direction tried to overtake a truck
\non a curve at high speed. Unable to see
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 54
\nWHO
\n55
\nany oncoming traffic, the driver smashed
\ninto the car, injuring everyone in it. While
\nJane\u2019s companions were taken to a nearby
\nhospital, she was inexplicably driven to a
\npoorly equipped bush clinic. A mother of
\nfour children, including a three-year-old
\nson, Jane died five hours later from lack of
\nblood. Jane\u2019s husband, Pius Njawe,
\nformed an organization called Justice and
\nJane to keep her memory alive and to pro-
\nmote road safety.
\n\u2022 On 29 August 2003, Balazs Geszti, a 24-
\nyear-old Hungarian butcher, returned
\nhome with his step-brother, Peter, in the
\nearly hours of the morning from a wed-
\nding. Both had been drinking heavily.
\nShortly after arriving home, Balazs
\nreceived a phone call from his girlfriend
\nasking him to attend another party. Racing
\nover in his car, he smashed into a concrete
\nbarrier at 140 km an hour in a 50 km zone.
\nBalazs was killed on impact. Peter is now
\na volunteer coordinator for Habitat for
\nHumanity. He believes that if Balazs had
\nnot been drinking \u2013 or speeding \u2013 he
\nmight still be alive today.
\n\u2022 In May 2002, Sateni Luangpitak, a motor-
\ncycle taxi driver in Thailand, collided into
\nanother vehicle. Sateni, now 28, was dri-
\nving at 80 km per hour. The collision threw
\nhim on to the pavement, where he hit his
\nhead and left shoulder. Despite wearing a
\nhelmet, Sateni lost consciousness. When
\nPrayoon Muangme, a friend, realized it
\nwould take too long for the emergency ser-
\nvices to come, he evacuated Sateni to a
\nnearby hospital. On arrival, however, he
\nlearned that no trauma facilities were
\navailable. Prayoon took his friend to yet
\nanother clinic. Sateni was lucky his helmet
\nhad protected his head and had suffered
\nonly light injuries. Nevertheless, his colli-
\nsion kept him out of work and reduced his
\nability to earn a living.
\nThe First United Nations Global Road
\nSafety Week was organized by WHO, the
\nUN Regional Commissions and partners in
\na bid to promote greater awareness of road
\ntraffic incidents and to give young people a
\nvoice. Spearheading the global campaign, a
\nWorld Youth Assembly will be held in
\nGeneva, Switzerland, where young dele-
\ngates from over 100 countries will gathered
\non to share their experience and plan joint
\nactivities for better road safety. World lead-
\ners including the UN Secretary-General
\nBan Ki-moon, the British Prime Minister
\nTony Blair and stars including Moby gave
\nmessages to the opening of the World Youth
\nAssembly.
\nWHO and UNAIDS issue new guidance on HIV testing
\nand counselling in health facilities
\nNew recommendations aim for wider
\nknowledge of HIV status and greatly
\nincreased access to HIV treatment and pre-
\nvention
\nLONDON \u2013 WHO and UNAIDS have
\nissued new guidance on informed, volun-
\ntary HIV testing and counselling in the
\nworld\u2019s health facilities, with a view to sig-
\nnificantly increasing access to needed HIV
\ntreatment, care, support and prevention ser-
\nvices. The new guidance focuses on
\nprovider-initiated HIV testing and coun-
\nselling (recommended by health care
\nproviders in health facilities).
\nToday, approximately 80% of people living
\nwith HIV in low- and middle-income coun-
\ntries do not know that they are HIV-posi-
\ntive. Recent surveys in sub-Saharan Africa
\nshowed on average just 12% of men and
\n10% of women have been tested for HIV
\nand received their test results.
\nIncreased access to HIV testing and coun-
\nselling is essential to promoting earlier
\ndiagnosis of HIV infection, which in turn
\ncan maximize the potential benefits of life-
\nextending treatment and care, and allow
\npeople with HIV to receive information and
\ntools to prevent HIV transmission to others.
\n\u201cScaling up access to HIV testing and coun-
\nselling is both a public health and a human
\nrights imperative,\u201c said WHO HIV\/AIDS
\nDirector Dr Kevin De Cock. \u201cWe hope that
\nthe new guidance will provide an impetus to
\ncountries to greatly increase availability of
\nHIV testing services in health care settings,
\nthrough realistic approaches that both
\nimprove access to services and, at the same
\ntime, protect the rights of individuals.
\nWithout a major increase in HIV testing and
\ncounselling in health facilities, universal
\naccess to HIV prevention, treatment and
\ncare will remain just a noble goal.\u201c
\nAdditional approaches needed
\nto expand access
\nUntil recently, the primary model for pro-
\nviding HIV testing and counselling has
\nbeen client-initiated HIV testing and coun-
\nselling \u2013 also known as voluntary coun-
\nselling and testing (VCT) \u2013 in which indi-
\nviduals must actively seek an HIV test at a
\nhealth or community-based facility. But
\nuptake of client-initiated HIV testing and
\ncounselling has been limited by low cover-
\nage of services, fear of stigma and discrim-
\nination, and the perception by many people
\n\u2013 even in high prevalence areas \u2013 that they
\nare not at risk.
\nCurrent evidence also suggests many
\nopportunities to diagnose HIV in clinical
\nsettings are being missed, even in places
\nwith serious HIV epidemics. While, there-
\nfore, expanded access to client-initiated
\nHIV testing and counselling is still neces-
\nsary, other approaches are also required if
\ncoverage of HIV testing and counselling is
\nto increase and, ultimately, universal access
\nto HIV prevention, treatment, care and sup-
\nport is to be achieved.
\nThe new WHO\/UNAIDS guidance was pre-
\npared in the light of increasing evidence
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 55
\nWHO
\n56
\nthat provider-initiated testing and coun-
\nselling can increase uptake of HIV testing,
\nimprove access to health services for people
\nliving with HIV, and may create new oppor-
\ntunities for HIV prevention. Provider-initi-
\nated HIV testing and counselling involves
\nthe health care provider specifically recom-
\nmending an HIV test to patients attending
\nhealth facilities. In these circumstances,
\nonce specific pre-test information has been
\nprovided, the HIV test would ordinarily be
\nperformed unless the patient declines.
\nProvider-initiated HIV testing and coun-
\nselling has already been implemented in a
\nrange of clinical settings in several low- and
\nmiddle-income countries, including
\nBotswana, Kenya, Malawi, Uganda and
\nZambia, as well as in pre-natal settings in
\nparts of Canada, Thailand, the United
\nKingdom, and the United States.
\n\u201cIf we are going to get ahead of this epi-
\ndemic, rapidly scaled up HIV treatment and
\nprevention efforts are critical \u2013 and
\nincreased uptake of HIV testing will be fun-
\ndamental to making this a reality,\u201c said Dr
\nPaul De Lay, Director of Monitoring and
\nEvaluation, UNAIDS. \u201cAt the same time,
\nand in all cases of HIV testing and coun-
\nselling, the 3 Cs \u2013 that is consent, confiden-
\ntiality and counselling \u2013 must be respect-
\ned,\u201c he added.
\nGuidance tailored to different
\ntypes of epidemics and health
\nfacilities
\nThe new WHO\/UNAIDS guidance advises
\nthat health care providers globally should
\nrecommend HIV testing and counselling to
\nall patients who present with conditions that
\nmight suggest underlying HIV disease.
\nAdditional guidance is tailored to local cir-
\ncumstances. In generalized HIV epi-
\ndemics1
\n, HIV testing and counselling
\nshould be recommended to all patients
\nattending all health facilities, whether or not
\nthe patient has symptoms of HIV disease
\nand regardless of the patient\u2019s reason for
\nattending the health facility. In concentrat-
\ned2
\nand low-level3
\nHIV epidemics,
\ndepending on the epidemiological and
\nsocial context, countries should consider
\nrecommending HIV testing and counselling
\nto all patients in selected health facilities
\n(e.g. antenatal, tuberculosis, sexual health,
\nand health services for most-at-risk popula-
\ntions). The guidance also includes special
\nconsiderations for HIV testing and coun-
\nselling for adolescents and children.
\nWHO and UNAIDS recognize that resource
\nand other constraints may prevent immedi-
\nate implementation of the guidance. The
\ndocument therefore provides advice about
\nhow to prioritize implementation in differ-
\nent types of health facilities.
\nThe new guidance builds on previous poli-
\ncy positions of WHO and UNAIDS and
\nresponds to a growing demand from coun-
\ntries for more detailed policy and opera-
\ntional advice in this area. Its recommenda-
\ntions were developed following a review of
\navailable evidence and a broad consultative
\nprocess with experts and implementers,
\nincluding submissions received from over
\n150 organizations and individuals.
\nOther key recommendations
\nOther key WHO\/UNAIDS recommenda-
\ntions for provider-initiated HIV testing and
\ncounselling in health facilities include:
\n\u2022 All HIV testing must be voluntary, confi-
\ndential, and undertaken with the patient\u2019s
\nconsent.
\n\u2022 Patients have the right to decline the test.
\nThey should not be tested for HIV against
\ntheir will, without their knowledge, with-
\nout adequate information or without
\nreceiving their test results.
\n\u2022 Pre-test information and post-test coun-
\nselling remain integral components of the
\nHIV testing process.
\n\u2022 Patients should receive support to avoid
\npotential negative consequences of know-
\ning and disclosing their HIV status, such
\nas discrimination or violence.
\n\u2022 Testing must be linked to appropriate HIV
\nprevention, treatment, care and support
\nservices.
\n\u2022 Decisions about HIV testing in health
\nfacilities should always be guided by what
\nis in the best interests of the individual
\npatient.
\n\u2022 Provider-initiated HIV testing and coun-
\nselling is not, and should not be construed
\nas, an endorsement of coercive or manda-
\ntory HIV testing.
\n\u2022 Implementation of provider-initiated HIV
\ntesting and counselling should be under-
\ntaken in consultation with key stakehold-
\ners, including civil society groups,
\nacknowledging that what works and is eth-
\nical will inevitably differ across countries.
\n\u2022 When implementing provider-initiated
\nHIIV testing and counselling, equal
\nefforts must be made to ensure that a sup-
\nportive social, policy and legal framework
\nis in place to maximize positive outcomes
\nand minimize potential harms to patients.
\n\u2022 A system that monitors and evaluates the
\nimplementation and scale-up of provider-
\ninitiated testing and counselling should be
\ndeveloped and implemented concurrently.
\nAs countries work towards universal access
\nto HIV prevention, treatment, care and sup-
\nport, the new guidance on provider-initiated
\nHIV testing and counselling offers an
\nimportant opportunity to introduce new
\napproaches and improve the standards of
\nHIV testing and counselling in both public
\nand private health facilities. Together with
\ntheir partners, WHO and UNAIDS will con-
\ntinue to help countries expand access to the
\nfull range of HIV testing and counselling
\nservices, as well as to other needed health
\nsector interventions against HIV\/AIDS.
\nFor further information, please contact:
\nLondon
\nWHO, Anne Winter, Tel.: +41 79 440 6011
\nE-mail: wintera@who.int
\nCathy Bartley, Tel.: +44 20 8694 9138
\nMobile: +44 7958 561 671
\nE-mail: cathy.bartley@bartley-robbs.co.uk
\nGeneva
\nWHO, Iqbal Nandra, Tel.: +41 22 791 5589
\nMobile: +41 79 509 0622,
\nE-mail: nandrai@who.int
\nUNAIDS, Yasmine Topor, Tel.: +41 22 791
\n3501, Mobile: +41 76 512 8853, E-mail:
\ntopory@unaids.org
\nWMJ_2_29-56.qxd 02.08.2007 09:15 Seite 56<\/p>\n"},"caption":{"rendered":"

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