Memorandum by the Swiss Federal Office
of Public Health
Thank you for your invitation to provide evidence
to your committee which I accept with pleasure. First of all I
give a view word to my background for better interpretation of
my views expressed in my personal capacity. I have a double background
in medicine and international relations. After working as clinical
physician for an international environment and health NGO I joined
government service 5 years ago. During this time as head of international
affairs of the Swiss Federal Office of Public Health (corresponding
to the ministry of health) I have been leading the Swiss delegation
to many WHO and OECD meetings and negotiations. I was and am lead
negotiator during the negotiations of the International Health
Regulations and the Intergovernmental Working Group on Public
Health, Innovation and Intellectual Property Rights. I chaired
the drafting groups of the World Health Assembly leading to Resolutions
WHA 58.3 on the Adoption of the International Health Regulations
and WHA 59.24 on Public Health, Innovation, Essential Health Research
and Intellectual Property Rights: Towards a Global Strategy and
Plan of Action.
INPUTS TO
YOUR QUESTIONS
1. The globalized world has increased in vulnerability.
People and therefore infectious agents travel faster and more
often. Despite significant improvements in the fight against infectious
diseases the threats are still present and will remain so. In
addition the just in time production concept and other economic
integration and globalisation tendency have increased the vulnerability
of the economic system. Furthermore information travels faster
in a way we know of epidemics around the world which were in earlier
times simply ignored. Nevertheless I would not speak of a crisis
since the control systems are also improving.
2. (no answer)
3. The Global Outbreak Alert and Response
System GOARN of WHO is the key system functioning overall very
well. Through the IHR this system has now an adequate legal backing.
4. (no answer)
5. We need to push further the horizontal
strengthening or health systems and therein the strengthening
of capacities for epidemic surveillance and response. Vertical
disease specific efforts will remain necessary but have to be
better integrated in the horizontal efforts to strengthen health
systems.
Poverty remains the main risk factor for any
disease. Economic development and poverty reduction is therefore
also crucial in the fight against infectious diseases.
6. The Swiss Federal Office for Public Health
plays in Switzerland a similar role to the Department of Health
in the UK. In Switzerland we have together with the cantons the
main responsibility for the surveillance and control of communicable
diseases. The main responsibility within the Swiss administration
for the support of developing countries lies with the Swiss development
cooperation SDC. In order to strengthen policy coherence we have
elaborated jointly with colleagues in foreign affairs and development
cooperation the Swiss Health Foreign Policy signed by the ministers
of health and foreign affairs:
Several of the objectives are directly linked
to the four diseases:
1. Strengthen the international monitoring
networks for communicable diseases (e.g. pandemic influenza) through
rapid implementation of the International Health Regulations (IHR).
7. Strengthen the normative role of WHO.
9. Improve international access to essential
drugs—both recognized and newly developed.
14. Make appropriate contributions to eliminating
the three significant poverty-related diseases—AIDS, tuberculosis
and malaria (MDG 6)—paying particular attention to gender
issues.
7. (no answer)
8. (no answer)
9. (no answer)
10. The question is asked in a dangerous
way. Balancing short term health gains (through the use of DDT
to fight malaria) and long term health threats (by the bioaccumulation
of all POPs like DDT) need careful balancing and an active search
for alternative solutions.
11. The coordination of WHO, FAO, OIE, the
World Bank and the UN System coordinator (www.influenza.undg.org/)
as key actors is working well compared with other cases of collaboration
of intergovernmental organisations (or indeed inter-ministerial
collaboration).
The particular challenge with the fight of H5N1
bird flu and the linked human pandemic threat is rather in the
historically grown sector system in most governments. In industrialized
countries usually health ministries, development ministries and
defence ministries all have budgets in the billions. Health ministries
are using the large budgets they have for domestic health issues.
Development ministries are investing in their long term development
priorities and in immediate humanitarian aid. Defence ministries
spend their billions on the classical security issues. The animal
epidemic of bird flu and the threat of a human influenza pandemic
fall between these competences. Health ministries don't have the
international budgets, development ministries see pandemic preparedness
neither as immediate humanitarian emergency nor as long term development
goal (why invest in a potential threat if we don't have enough
money to fight the actual diseases ...) Defence ministries don't
have the appropriate toolbox nor mandates to invest heavily in
this major human security threat. Through the intergovernmental
organisations and the ad hoc series of meetings of the International
Partnership on Avian and Pandemic Influenza IPAPI in Washington
DC, Vienna, Delhi, Beijing, Bamako and next October in Cairo major
efforts of international donors are undertaken. Much more will
be needed.
Finally the media and political attention to
the issue was probably exaggerated in autumn 2005 and risk to
become too small currently.
12. (no answer)
13. (no answer)
14. The current patent system can be impeding
the access to existing medicines in the short run, but is absolutely
necessary as key incentive for research and development as a basis
for access to new medicines in the long run. Much progress has
been made in recent years in access to medicines through public
private partnerships, bulk purchasing, differential prizing, the
implementation of the Doha declaration, voluntary action by the
researching pharmaceutical industry, the development of the generics
industry, etc. More efforts will be needed. A comprehensive global
strategy and plan of action is currently under negotiation by
the WHO intergovernmental working group on public health, innovation
and intellectual property rights. This process is important but
constantly under danger from too simplistic positions of "patents
are good" or "patents are bad". Major efforts will
be needed by governments, intergovernmental organisations, industry,
the private sector, civil society, academia, philanthropy, etc.
for the implementation of this action plan. Access to medicines
as a complex issues depending on a long chain of factors in the
so-called innovation chain and by far not only on intellectual
property: Basic & applied research on all diseases, drug development,
production in the appropriate galenic form and good quality for
an affordable prize, a distribution chain, health systems sufficiently
staffed capable of delivering treatments, etc.
15. (no answer)
16. IHR (2005) are a historic agreement
bringing the global system to fight public health emergencies
of international concern truly into the 21st century. The agreement
does currently not need a revision but vigorous efforts for its
implementation. The national capacity building in accordance with
Annexe 1 of IHR will be key for implementation. One of the few
weaknesses of the IHR is the fact that there is no assurance for
countries in need to receive necessary support in building their
capacity, especially when this task competes for resources with
many other pressing needs.
17. The IHR apply to events irrespective
of their origin and therefore also for deliberate use. Deliberate
use of infectious agents might result in two simultaneous crisis:
an epidemic and a security crisis. These two aspects should be
dealt with separately but need nevertheless coordination. The
lead of the international management of the health crisis should
remain with WHO through the IHR mechanisms independently of the
origin of an epidemic.
18. Over the last 20 years there was on
average yearly a new or emerging infectious disease, many of which
are of animal origin. Therefore we need to remain vigilant and
prepared for new unknown diseases. The algorithm of annexe 2 of
IHR is an adequate instrument for the recognition of new diseases.
1 February 2008
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