Intervention by Thai delegation
62nd World Health Assembly
18-22 May 2009
Agenda 11 Medium-term strategic plan, including Proposed Programme Budget
Intervention by Thailand delegation
Thank you Chair,
The Thai delegation commends the Secretariat for the clear and comprehensive draft
report on the Medium-term Strategic Plan 2008-2013 and proposed programme budget
After reviewing the amended MTSP and the proposed programme budget, my delegation
supports the revised strategic direction for 2008-2013 which emphasizes on six-item
health development and health security,
strengthening health systems, gathering and analyzing the evidence needed to
set priorities and measure progress, and
managing partnerships to achieve the best results in countries, and ensuring
good performance of WHO.
We also agree in employing the six core functions of WHO to guide the work of the
Secretariat, and to strengthen health systems of the member states by using the
principle of primary health care and promoting an integrated service delivery in order to
achieve better and more equitable health outcomes.
However, there are several concerns that we would like to raise;
1. The lack of resources and weakness of health systems in many member states;
particularly in developing countries is a key issue.
2. The weakness of some WHO regional offices also need to be taken into account as
this will lead to failure of WHO in providing appropriate technical support for
member states and national capacity strengthening as planned.
3. The capacity of WHO staffs, its flexibility and efficiency in internal management
of the organization in some regional offices is weak.
In the area of finance between 1998 and 2007 a significant increase in the specified
voluntary contribution – more than 70% of the total contributions is observed. Under
this circumstance, the flexibility of WHO in managing its resource across strategic
objectives is very limited. Also, the growing share of the specified voluntary contribution
reflects that the majority of WHO operations is to serve donor‟s interest, but not for
global health priorities and concerns and problems of member states. In this regard, my
delegation fully supports the direction of WHO in moving towards a larger share of
unearmarked voluntary contributions and negotiation with donors.
We also would like to comment on the 70%-30% principle which 30% of proposed
program budget 2010-2011 of WHO total budget would be allocated to WHO-HQ. We
strongly support the observation from PBAC that currently WHO-HQ is over funded.
Therefore, we disagree with securing 30 percent of WHO budget to allocate to WHO-HQ.
The amount of WHO-HQ budget should be accordance with its actual operational
Annex 4 Intervention by Thai delegation, 62nd WHA 1
In area of MTSP, we concur with the most strategic objectives but we have some
observations that we would like to address as follows;
1. On Strategic Objective 1, Indicator 1.1.2. WHO targets 160 member states to
introduce Hemophilus Influenza type B vaccine in their national immunization
program by 2013. In our opinion, this target is unrealistic. For one reason, the
vaccine is costly; therefore, this will be a big financial barrier for low- and middle-
income countries to access this vaccine and the goal is unlikely to be achieved. In
the context of Thailand, there is still lack of evidence on burden of disease from
Hemophilus Influenza B and its cost-effectiveness.
2. On Strategic Objective 3, Indicator 3.1.3 we support an increase countries‟ health
budget for mental health problems – more than 1% of total health budget. Lack
of fund for mental ill health issues is a serious problem in many developing
countries including Thailand. The rise of this budget will not only close the
treatment gap existing in the current situation but also generate increased
3. On Strategic Objective 4, maternal and child health improvement is very crucial
and it is a key health related MDGs 4 and 5. After reviewing this strategic
objective, we have observed that targeted number of several indicators seems to
be very low. Therefore, we urge WHO to double the targeted number if it is
4. On Strategic Objective 6, we strongly support WHO particularly concerning
comprehensive bans of smoking in public places and workplaces, and total bans
on tobacco advertisement as an important indicator. However, the targeted
number of countries in Indicator 6.3.2 and 6.3.3 is too low. We urge WHO to
double the number of targeted countries in these indicators. Also, we advocate
WHO to use tax increase on tobacco and alcohol as another indicator of this
5. On Strategic Objective 11, while the issues of combating counterfeit medical
products had been deferred to the next WHA, in the WHO Medicines Strategy
2008-2013 printed on 24 July 2008, the issue of combating counterfeit medicines
was indicated under the Organization-Wide Expected Results (OWER) 11.2
supporting countries in implementing the IMPACT strategy. Since the IMPACT was
questioned during the last EB meeting in January 2009 in terms of conflict of
interest and its composition, therefore the contents under OWER 11.2 regarding
IMPACT under the priority of combating counterfeits should be removed. This is
in line with the WHO promotion of good governance and transparency within and
outside the House.
In addition, WHO, by constitutional mandate is requested to dissociate and unlink
itself on the issue of pharmaceutical quality, which is health threat to the
population, from the issues of intellectual property rights violation, which are the
explicit goals and ambitions of the IMPACT. Meanwhile, the magnitude of the
scale of counterfeit medicines has been unclear; results of some studies are
based on selection-biased samples in favour of the high magnitude and size of
counterfeit medicines. WHO should reference its work from reviewed published
literature for which authors had clearly indicated no conflict of interests and free
from sponsors from pharma industry.
The recent whistleblowers' accusations published in the British Medical Journal of
a suspected, and later confirmed conflict of interest on use of medicine in treating
stroke patients in JAMA was notorious and an issue of trans-Atlantic debates.
Failure to enforce mandatory reporting conflict of interests by authors in any
scientific journal undermines the “public trust and confidence” while at the same
time discredit and self-destruction of these published journals. See recent update
Annex 4 Intervention by Thai delegation, 62nd WHA 2
of JAMA‟s conflict of interest policies at JAMA website (http://jama.ama-
assn.org/cgi/content/full/296/2/220). The situation creates “paranoid” senses
among policy makers whom we can, and should trust in this World. Therefore,
the citation of any findings should be under triple cautions in the world full of
conflicts of interest.
Combating counterfeit or faked medicines is only one of many strategies to
assure patient safety. The limited public health resources are , therefore, should
be allocated to the real prioritized problem"
6. On Strategic Objective 11, we emphasize the importance of close collaboration
among Member States in order to tackle the problem of unmet quality of medical
products and technologies. The appropriate technology for quality testing is now
available and it should be equally shared among Member States through WHO
initiatives and appropriate mechanisms.
Finally, we would like to urge WHO to implement this MTSP seriously and effectively.
Also, we hope to see a strong monitoring and evaluation system in order to identify the
progress and see problem encountered of each strategic objective.
Thank you, Mr. Chair.
Annex 4 Intervention by Thai delegation, 62nd WHA 3
Agenda 12.1 Pandemic influenza preparedness: sharing of influenza viruses and
access to vaccines and other benefits
1st Intervention by the Thai Delegation (Dr.Sopon)
May 19th 2009
The Thai delegation applauds the DG and her team for their excellent work in response
to the multi-country outbreak of novel influenza A (H1N1) since April 2009. We also
applaud the DG proposal to establish international stockpiles of potential pandemic
vaccine physically available. Her strong leadership and the extremely hard work of WHO
technical staff had complement the spirit of global solidarity in collectively fight against
the disease that may devastated mankind. The social credit of the WHO has never been
this high, and this is our collective social asset towards a more peaceful and equitable,
trust based world.
Note that the report refers to H5N1 vaccine, but the current advent of H1N1 may result
in the global need for H1N1 pandemic vaccines; however, guided by scientific evidence.
The Thai delegation requests the DG to kindly ensure that “seed viruses of the novel
influenza A(H1N1)” when available, is promptly and equally shared to public and private
vaccine industries in developed and developing countries without any Intellectual
Property attached. We also request the DG with the support of better off member states
to ensure an equitable access to effective anti-virals and pandemic vaccine, once it is
available. This will be the proof of global trust based solidarity against private interests.
This will help rebuild the trust on the IHR and also the Global Influenza Virus Sharing
To ensure prompt dispatch of pandemic vaccines in critical moment, my delegation
proposes a number of regional stockpiles instead of one global stockpile.
In the light of global inequitable access to pandemic vaccine, whereby more than 90% of
global production capacity lies in Northern Americas and Europe, whereas the rest of the
world in particular African, Eastern Mediterranean and South East Asia regions do not
have such capacity. This would be discriminated against access to vaccines, together
with the inadequate health care systems, they would claim huge death tolls, in time of
To ensure equitable and timely access to a potential pandemic vaccine, my delegation
proposes the following principles for consideration:
1. Establish global and regional stockpile of potential pandemic vaccines.
2. The vaccine stockpile should be transparently managed by WHO with clear criteria
based on scientific evidence for effective delivery.
WHO should finalize the global consultation, with active participation by all concerned
members, in order to reach consensus on the most appropriate policy options, as well as
developing a Standard Operating Procedure to ensure effective management of the
vaccine stockpile, as soon as possible.
Our delegation would like to express our grave concern on the progress of the IGM which
still has some difficult pending issues related to legal framework. This is the result of the
loss of trust in the WHO Global Influenza Surveillance Network, due to the private
interest of some vaccine industries. The social cost of this loss of trust is immeasurable.
Our delegation would like to request, through you Mr. Chairman, to the DG and all
member states to bring back the „trust-based global public health spirit‟ to all our
collective effort in improving global health targets, including the fight against pandemic.
Annex 4 Intervention by Thai delegation, 62nd WHA 4
We should not let the mistrust and the difficult legal framework to block our global public
Thank you. Mr. Chairman
Agenda item 12.1: Pandemic Influenza Preparedness: Sharing of Influenza
Viruses and Access to Vaccines and Other Benefits
2nd Intervention by the Thai Delegation (Dr.Suwit)
May 21st 2009
Thank you very much Mr. Chairman
Much that we would like to cosponsor the draft resolution as proposed in the document
A62/A/Conf. Paper No.2, we finally declined to do so, in spite of the huge effort
contributed by dedicated members of the IGM including ourselves. Why? Because we
strongly feel that having a half finished and half heart resolution is to accept that we, the
public minded health leaders, once again succumb ourselves to other interests than
health, as our charismatic DG said on Monday which I would like to quote:
“Time and time again, health is peripheral issue when the policies that shape this world
are set. When health policies clash with economic gain, economic interests trump health
concerns. Time and time again, health bears the brunt of short-sighted, narrowly
focused policies made in other sectors”
Mr. Chairman, can you believe that after more than 2 years of IGM processes we still can
not have a full agreement in spite of the fact that this is related to the threat of
influenza pandemic which may kill hundreds of million of people in a few months as it
had demonstrated in the 1918 flu. Where is our public spirit? Where is our spiritual
commitment to global health? Why do we have to give up again and again to the non-
health interests to move ourselves towards the dead-end of a lose-lose outcome?
The IGM is the products of opening the “Pandora Box” as a result of mis-trust in the
GISN when developed countries are the gainers from the sharing of viruses by every
Member States in good faith on GISN and with their resources invested in their NICs.
Only rich people can afford to get flu shot and protected, while poor people have no
access due to high cost of vaccines, where they contributed to the seed virus. The
vaccine industry did not pay for the seed, but exploit the good faith of developing
countries. Some of the researchers also put their interests only on being the first to
publish and also selfishly filing the virus gene sequence related patents.
The losers are clearly – developing countries. It is thus legitimate that developing
countries rise up and claim for their legitimate rights to viruses and vaccines when their
obligations were met from sharing potential pandemic virus to the WHO CC.
However, what we have seen in the two year long IGM processes are that both
developed and developing countries use their lawyers, IP specialists to negotiate, join in
by influential NGOS and private sector. We see clearly that the public spirit for global
health has almost disappeared. We see is little love, compassion and considerate spirit in
the IGM. We see negotiators come to protect their interests, and put the world as a
whole at risk.
Mr. Chairman, what I describe is the historical moment and a good learning for us all. In
this critical juncture of deadlocks, we need wisdoms and peaceful mind of reflections. To
continue intellectual exercises, and negotiations in series of sessions would result in
further complication while held-hostage the world population at risk.
Annex 4 Intervention by Thai delegation, 62nd WHA 5
Mr.Chairman, What would the world lose if we do not have this resolution or even not
have an agreed framework?
Mr. Chairman, what happened in the past 6 weeks have shown that we may not need
any new framework at all. Since the beginning of the H1N1 pandemic, we see the
extensive effort at transparently sharing of viruses and their gene sequences by all
governments. Thanks to the leaderships of public health leaders in Mexico, US and
Canada, in spite of their great economic loss. We can access all the gene sequences
from database e.g. through the GISAID, which is much better and more extensive than
the former GenBank. The WHO collaborating centers like the USCDC and the UK NISBC
are also preparing the seed strains to share with any manufacturers.
We see the strong leadership and the tireless commitment of our wise and charismatic
DG in mobilizing active commitments from leaders around the world, including the UNSG
and the private sectors. Last week, when she called to Thailand and try to explain to our
minister the needs to continue to put our guard high and invest more on prevention and
preparedness, we have to request her to stop as we can hear her horse voices. She
must have called almost all minister of health in the world to talk to them by herself.
This is how our able DG has behaved in this critical situation. I am not sure how many
hours she sleeps.
We can see the initial success she has achieved, including the extensive sub-licensing for
manufacturing Oseltamivir from the patent holders, the commitment from all flu vaccine
manufacturers, the technology transfer for the vaccine capacity to developing countries.
With her leadership support we in Thailand start to have the capacity to produce Flu
vaccine at the pilot scale and is in the process of receiving technology transfer to
produce the Live Attenuated Virus Vaccines, which can increase the production by at
least 30 times. The near future success will allow us to produce up to 3 million doses of
pandemic LAIV per month. This may not enough for everyone but at least it can cover
those health workers, the security personnel, the officers and those who have to work
with mass public. With this limited capacity, Thailand commits to share 10% of the
products to WHO. Furthermore, our government also committed $40 million from our
own budget to build an industrial scale flu vaccine plant, with the technical support from
WHO. Without WHO leadership, we can not get the technology transfer, in spite of
countless trips and discussions with all private vaccine manufacturers.
Mr. Chairman, all these movements have occurred without a single new „framework‟ or a
even a new WHA resolution. But they occurred because we in 2007, have chosen the
right leader of this organization. It also occurred because one of the influential country,
has chosen their right president. So, instead of a resolution to accept a half done
framework which lead us no where, we may be better off deciding to let our charismatic
DG to be able to stay in office more than 2 terms or as long as she so wish, provided
that she still behaves well and obedient to us as she said on Monday.Having said all
these points, Mr. Chairman, the Thai delegation would like to propose two options:
Option 1. The assembly do not accept any resolution here and decide to terminate any
discussion or negotiation on this issue, and to move on with the existing WHO processes
of sharing the viruses and of tackling the problem, both short and long term. This should
be carried out with kind and considerate spirit to involve all partners, including some
new initiative like the GISAID. This option will be the proof of our global success or
failure to the „committed public spirit on global health‟.
Having a resolution or a framework is just another pile of papers to support the lawyers
to make their living, but may not guarantee any positive impact on global health, as
have many past resolutions have shown. As mentioned earlier, many good things can be
achieved without any resolution, based on strong leadership with „committed public spirit
on global health‟.
Annex 4 Intervention by Thai delegation, 62nd WHA 6
Option 2. We accept the draft resolution as proposed in the document A62/A/conf.
paper No.2 dated 20 May 2009 with the following amendments:
1) to put the „agreed parts of the Pandemic Preparedness Framework‟ as an annex to
the resolution, not only refer to it. This will allow everyone to have the same
understanding on what we have agreed without having to refer to any documents.
However, we should also put a phrase to allow the DG the flexibility to decide
otherwise based on global public health interests in time of emergency, when the
2) To delete the operative paragraph 1 sub-paragraph 2 and replace by the text such
as…. to request all member states to share the viruses according to the same
mechanism as they are sharing the seasonal flu viruses and to request the DG to
design a simple one page MTA to be attached to each transfer of material without
prior requirement for any signature from any one.
These two options mean that we should not continue the negotiations on this issue or
resume any IGMs. This will make public health to supersede the economic and legal
We can accept both Options,
However our preference is Option one. Option one will be a good proof whether we will
be successful or failed in exercising our public health spirit, which was very faint these
days, under the charismatic leadership of Madam DG.
Furthermore, Mr. Chairman, the financial crisis has mandated out government to cut
down all the international travel expenses. We have to mobilize financial support from
other sources, to support our negotiators to the last two IGM. We will not have additional
financial resources for further negotiation which do not have any guarantee on the
Once again, Mr.Chairman, I would like to call for the leadership of all public health
leaders here to bring back the „committed public health spirit of this organization‟ and to
invite those who do not have public commitment except financial interests to stay away
from our discussion.
Thank you so much for your kind patience,
Annex 4 Intervention by Thai delegation, 62nd WHA 7
Agenda 12.2 Implementation of the International Health Regulations 2005
Intervention by the Thai Delegation
My delegation welcomes the progress report by the Director-General. We commend the
DG and her team on continuous efforts to monitor the progress of IHR implementation.
Having reviewed document A62/6 and other related documents, my delegation
appreciates the significant progresses made in relation to IHR implementation by
Member States through consistent support by WHO. However, the assessment indicates
low utilization rate of Annex 2 of the IHR 2005. Eighteen months since the date of entry
into force of the Regulations on 15 June 2007 until 31 December 2008, there were only
133 events initially reported by National IHR Focal Points for which only 11% of them
were disease notifications/ information sharing required by the Regulations. This
information indicates that the National IHR Focal Points are not yet a major source of
early warning. This issue needs urgent improvement.
Nevertheless, in the current multi-country outbreaks of 2009 influenza A (H1N1), in
particular the influenza alert level 5, the IHR has demonstrated an essential tool to track
the epidemics globally in real time. This is the first time in history that we receive daily
notification of new cases simultaneously through WHO communication networks.
National IHR focal points around the world work closely to inform global public the
situation of the disease. IHR is the only most effective tool in bringing all countries
together to build up a common “global defense”
The important factor for controlling global outbreaks is not only timely communication
between national IHR focal points in each country, but also prompt and adequate
information sharing among neighbouring countries or countries at destination and origin
of international traveling whereby the novel influenza outbreaks took place. Encouraging
concurrent informal communication among national IHR focal points in the situation of
public health emergencies, additional to current practice of communication via IHR
country contact point and WHO regional office, will minimize unnecessary time lags and
assure timely response to the rapid transmission of influenza and other infectious
To meet this objective, a trust-based system for information sharing between member
states in the geographical vicinity should be promoted, for example, those 6 countries in
Mekong Basin Sub-region, in order to complement the delayed bureaucratic official
At the time of the global outbreaks of novel influenza A virus, the scientifically sound
control measures should be implemented at the ports of entry of member states. Exit
screening by affected areas will significantly reduce the possibility of wide spreading
among the travelers.
In addition, case surveillance, early detection and containment of imported cases need
an appropriate practice in all member states, guided by WHO‟s standard guidelines.
Finally, Thailand appreciates the continuing supports from WHO, and reaffirms our
commitments towards full implementations of the IHR 2005.
Thank you Mr. Chairman
Annex 4 Intervention by Thai delegation, 62nd WHA 8
Agenda 12.3 Prevention of avoidable blindness and visual impairment
Intervention by the Thai Delegation
Intervention by Thai delegation
Thai delegation commend the report on “Prevention of avoidable blindness and visual
impairment”, it was comprehensive and adequate in calling actions by countries,
international partners and WHO secretariat.
We also pay tributes to the continued effort by the DG and her team in achieving the
global initiative for the elimination of avoidable blindness called “Vision 2020: The right
to sight”; although the road towards this achievement is not paved by roses.
We fully endorse the resolution contained in A62/7. The endorsement of the action plan
for the prevention of avoidable blindness and visual impairment will provide a strong
foundation for three stakeholders: country, international partners and WHO to
synergistically contribute their efforts to achieve Vision 2020.
However, having reviewed the action plan, we have a number of comments as followed:
Paragraph 5b, facilitate the preparation of evidence-based standards and guidelines for
cost-effective interventions. We felt that there is ample international evidence compiled
by Disease Control Priority in Developing Countries (DCP2) chapter 50 on loss of vision
and hearing. There is no need for country to assess their own cost effectiveness
evidence, but efforts should be given to apply these evidences from DCP2 to suit their
Paragraph 5e, collect, analyse and disseminate information systematically on trends and
progress made in preventing avoidable blindness globally, regionally and nationally. We
felt that there is a need to include lessons learned from country innovation and success
and failure, so that one may not repeat the same mistakes.
On paragraph 58, develop an eye-health workforce through training programmes that
include a community eyehealth component. We felt this is not adequate, there is a need
for the role of paramedics, in particular in the context of limited number of
ophthalmologist. We recommend that operations researches are required to test the
role of paramedics in the assessment of the effectiveness of screening of diabetic
retinopathy through telemedicine, with supervision by ophthalmologists.
On Paragraph 59: ample evidence indicates increasing diabetic prevalence. In DCP2, DM
prevalence would increase from 5.1% in 2003 among adult 20-79 yeas, to 6.3% in
2025, alarmingly a 24% increase. We cannot under-estimate the contribution of diabetic
retinopathy to blindness worldwide, in addition to infectious.
On paragraph 68, we felt there is a need to focus also on the childhood blindness for
which there is a huge and life-long ramification to the quality of life and productivity.
Having reviewed evidence, there is no clear information on the impact of Vitamin A
deficiency in lactating women contributing to the night blindness in women and potential
impact on their babies; then there is a need for further investigations.
On paragraph 73, a number of contributing factors should also be included, for example,
the use of drugs in pregnant women.
Thank you Mr.Chairman
Annex 4 Intervention by Thai delegation, 62nd WHA 9
Agenda 12.4 primary health care including health system strengthening
Intervention made by Thailand delegation
Thank you Mr. Chairman,
Thailand fully aligns itself to the statement made by the delegation of Nepal and India on
behalf of SEA countries. We also commend the Secretariat for a clear and
comprehensive report on this topic, and welcome the resolution EB 124.R8 & R9.
My delegation supports the four broad policy areas for essential changes in primary
health care, which include dealing with health inequities by moving towards universal
coverage, putting people at the centre of service delivery, integrating health into public
policies through multi-sectoral collaboration, and providing inclusive leadership for health
From our experience, for 30 years, the strenghts of Thailand in improving primary
health care include: the nationwide distribution of health service units to all district and
sub-district levels which lead to universal provision of essential health services for
people and communities. Another strenght of primay health care improvements in
Thailand is the establishment of heallth volunteers who can communicate health
information to the people in rural areas, provide health promotion and public health
interventions, and surviellance for health threats and disease in the communities.
My delegation strongly supports Chile‟s position to have the plan of implementation on
four strategies for improving primary health care and report to the 63 rd WHA.
We also support Nepal‟s and Indian‟s interventions to amend the EB resolution 124.R8 as
In operative para1 subpara3, page2, at the end of paragraph, we would like to insert the
words „while ensuring effective referral backup to secondary and tertiary care‟.
In operative para1 subpara5, page3, it could be amended as follows:
……to train and retain adequate numbers of health workers, including non-professional
community health workers with appropriate skill-mix, able to work in a multidisciplinary
context, in order to respond effectively to people‟s health needs.
In operative para2, subpara3, page 3, we may add the words “in achieving universal
coverage, access and strengthening health systems‟ after the words „good practice‟.
In operative paragraph 2, to insert a new sub-paragraph 4 bis.
4 bis. To ensure health system strengthening and revitalizing primary health care as a
priority program in the next Program Budget 2010-11.
We strongly endorse the resolution on primary health care including health system
strengthening with the above suggestions.
Thank you Mr. Chairman.
Annex 4 Intervention by Thai delegation, 62nd WHA 10
Agenda 12.5 Social Determinant of Health
Intervention by Thai delegation
Thank you, Mr.Chair
Thailand aligns itself with the intervention made by delegate from Sri Lanka on behalf of
11 Member States in South-East Asia Region.
Thailand, again, appreciates the report of the Commission on Social Determinant of
Health, and would like the international community to make the most benefit out of this
My delegate want to clarify the amendments read by Sri Lanka on behalf of 11 Member
States in South-East Asia Region, as followed
1. In preamble para, insert the new sub paragraph reads
Noting the three overarching recommendations of the Commission on Social Determinant
of Health; to improve daily living conditions; tackle the inequitable distribution of power,
money and resources; and to measure and understand the problem and assess the
impact of action
2. In preamble para, insert the new sub paragraph reads
Mindful of the needs for global governance mechanisms to support Member States in
provision of basic services essential to health and the regulation of goods and services
with a major impact on health, and the needs for market responsibility;
3. In operative paragraph 2, we would like to insert new subparagraph , that would read
to adopt health equity as a core global development goal and use a social determinants
of health indicators framework to monitor progress, and to devise global governance
mechanisms in addressing the social determinants of health and reduce health
4. In Operative paragraph 3 Urge Member States, we would like to add new
subparagraph that would come before the first sub para. This would read
to tackle the health inequities within and across countries through political commitment
on “closing the gap in a generation” as a national agenda, and establish national
institutional mechanisms to coordinate and manage inter-sectoral action for health in
order to mainstream health equity in all policies, and where appropriate by using health
and health equity impact assessment tools
5. In Operative paragraph 3, we would like to delete the sub para 2 and replace with
the new sub para that would read
to take into account health equity in all national policies and to establish and strengthen
universal comprehensive social protection policies, universal health care, and universal
availability of and access to goods and services essential to health and well-being, in
order to effectively address social determinants of health
6. in Operative paragraph 4 sub paragraph 3. we would like to insert a clause in the
beginning of this sub para, that would read to institutionalize social determinants of
Annex 4 Intervention by Thai delegation, 62nd WHA 11
health as a guiding principle and , and then continue with to implement measures,
including objective indicators and so on
7. In Operative Paragraph 4, we would like to add new sub para that would read
to support the primary role of the Member States in the provision of basic services
essential to health and the regulation of goods and services with a major impact on
health of the population;
8. Lastly, in Operative Paragraph 4, we would like to add new sub para that would read
to study the feasibility and benefit of various modes of good global governance to
support Member States in providing goods and service essential to health and regulation
of goods and services with a major impact on health, and report back to the 65th World
Thank you Mr.Chair
Annex 4 Intervention by Thai delegation, 62nd WHA 12
Agenda 12.6 Monitoring the achievements of the health-related Millennium
Intervention by the Thailand delegation
The Thai Delegation admires and thanks the Secretariat for the comprehensive
document A62/10. It reports the global progresses and vice versa on the non-
progresses of the achievement of health-ralated MDGs at the halfway towards the target
year of 2015. The report clearly assesses the important bottlenecks and identifies
strategies how to accelerate achievements as committed by all Member States.
Two-thirds and three-quarters reduction on various child and maternal mortality targets
is not applicable to countries who had achieved a very low level of mortality. It is not
possible further reduce as committed. Thailand adopts the OECD U5MR targets of 7 per
1000 live-births by 2015. In addition, Thailand decided to focus effort to improve health
in specific vulnerable population such as selected highland and southern most areas.
Lancet 2008; volume 372 page 950–61 reported that since Millennium Development
Goal baseline year 1990, Thailand has demonstrated the highest average annual
reduction in U5MR, 8·5% per year, and has substantially reduced its MMR, and is on
track for MDG4 and 5. The total fertility rate is also low. Very high coverage of
immunisation and skilled birth attendance was achieved in the 1990s with low inequity.
Lessons from Thailand foster the principle of universality and health equity.
Achievement of MDG is attributable to the functioning Primary Health Care with
adequate skill-mix of different cadres of health workers. Functional primary healthcare
is better accessed by the rural poor. Universal access is the major determinant of health-
related MDG achievement.
There was a severe imbalance in the level of investment across MDG, especially by
Global Health Initiatives who put in huge amount of financial resources, in particular
PEPFAR and Global Fund, focusing solely on HIV/AIDS (MDG6); while no resources on
poverty and malnutrition (MDG1) and maternal mortality (MDG5). HIV investment
focused mostly on care and treatment while country lost sight on prevention. GHI must
harmonize, allow countries to manage resources transparently and observe country‟s
MDG5b on universal access to reproductive health services was recently endorsed. At
country level, to achieve MDG5b, there is a need for intersectoral actions. In addition,
access to safe medical abortion is a major problem in most developing countries.
The world is facing four concurrent crises: food, fuel, financial and now flu crisis. In
financial crunch, Overseas Development Assistance is reduced, government revenue also
reduced; this situation poses severe constraint in continued achievement of health-
related MDG. Without strong political and financial commitment, health budget would be
cut and MDG would not be achieved as committed.
Annex 4 Intervention by Thai delegation, 62nd WHA 13
Agenda_12.7_Climate change and Health – Thai position
Intervention made by Thailand delegation
Thank you Mr. Chairman,
The Thai delegation fully aligns ourselves to the statement made by the delegation of
Maldives on behalf of South East Asia countries and supports the amendment of the
resolution EB 124. R5.
Climate chage unquestionably have already had impact on our region and it is most
likely to be more severe in the near future. The priority should be given to objective 4 of
the workplan and immediate action should be taken. The major program review is also
critical to monitor the progress and achievement of the workplan in order to improve
future implementation and reduce impact of climate change on health.
Thank you, Mr. Chairman.
Annex 4 Intervention by Thai delegation, 62nd WHA 14
Agenda item 12.8 Global strategy and plan of action on public health,
innovation and intellectual property.
Intervention by Thai delegation
As mandated by the resolution WHA61.21, the Thai delegation commends the secretariat
in its efforts to propose the timeframe and estimate funding needs for the 8 elements of
the global plan of action on public health, innovation and IP. It is a major achievement
so that this Assembly may conclude the global plan of action.
Having reviewed document A62/16 Add.3; my delegation fully supports the proposed
stakeholders pending from the previous Assembly unresolved stakeholders in ten specific
actions. This is a result of informal consultation among key Member States for which my
delegation attended the consultation, and thanks to Canada who hosted and Norway who
convened such consultation. My delegation honors the recommendation from that
However, on item 5.1(c) there is no lead stakeholders, for which we foresee that no
actions would be taken. Despite the fact that there is no explicit lead stakeholder
mandated by the POA, to facilitate the work on this action, my delegation strongly urges
WHO to implicitly take the leading role in conjunction with other relevant international
partners. On item 5.1(e), there is no lead stakeholders, however, this is under the
legitimate responsible by national Government to take relevant actions in strengthening
education and training in IP application and management.
Having carefully reviewed document A62/16 Add.1 on proposed timeframe; we welcome
the effort given by the Secretariat. However, my delegation recommends that specific
actions 1.1 should be rapidly concluded in a few years, for example by 2011, and
continued to update the gaps. In addition, high priority should be given to specific
action 5.1, 5.2 and 5.3; as these are feasible to implement, and they are major gaps at
country level. Lead stakeholders should consider to front-load invest in these three
specific actions. For example by 2012, capacities in IP application and management
should be significantly improved.
Having carefully reviewed document A62/16Add.1 on estimate funding needs; my
delegation requests the secretariat to kindly clarify the following questions.
1. How WHO manages to mobilize funding need of 2 billion USD for 8 elements, for
example from regular budget and extra-budgetary resources.
2. Would the global plan of action including the total resources requirement for 2008-
2015 be integrated into the MTSP (2008-13), or the revision of MTSP?
Paragraph 8 of document A62/16Add.1, it is major challenge, despite the fact that total
annual global spending of 160 billion USD on health R&D, and only 3% were spent on
diseases disproportionately affects developing countries. To achieve the global plan of
action in Table 2, this requires scaling up from 3% to 12%, a four times increase
annually. This is a major challenge how all relevant stakeholders in particular
pharmaceutical industries help to re-orient spending for R&D on diseases which are
disproportionately affect developing countries?
Having considered carefully Conference paper number 4; my delegation fully support the
draft resolution, and wish to amend as followed:
Operative paragraph 1 subparagraph 2, strike out updated and replaced by proposed
Annex 4 Intervention by Thai delegation, 62nd WHA 15
Insert a new operative paragraph 5. It reads as followed:
5. REQUEST the Director-General:
(1) to conduct a major program review of the global strategies and plan of action in
2014 on its achievement, remaining challenges and recommendations on the way
forwards to the Assembly in 2015 through the Executive Board.
Thank you. Mr. Chairman
Annex 4 Intervention by Thai delegation, 62nd WHA 16
Agenda 12.9: Prevention and control of multidrug-resistant tuberculosis and
extensively drug-resistant tuberculosis
Intervention by Thai delegation
Thailand appreciates the secretariat‟s report on “Prevention and control of multidrug-
resistant tuberculosis and extensively drug-resistant tuberculosis” and draft resolution
proposed by the delegation of China.
Having reviewed these documents, my delegation has the following observations.
With reference to the Stop TB Strategy (2006) page 9, to control MDR/XDR TB, it is
unavoidable to address the high-quality DOTs which is one of the six principles in STOP
The epidemiological data of MDR/XDR TB are not well established in most countries, for
example, prevalence, profile, treatment outcome are grossly lacking. This requires a
huge improvement in health information systems, including patient registries to guide
evidence based policy interventions.
The laboratory capacity to diagnose and assess the sensitivities to TB medicines is
essential to guide appropriate clinical management. However, laboratory capacities in
most developing countries need significant investment and improvement.
Having reviewed draft resolution, my delegation has the following five amendments
I. In the preamble part to insert 2 new preamble paragraphs after paragraph 9, it
would read as
Preamble 9bis to read: Concerned that the disease transmission occurs mostly in
community where there is lacking of appropriate infection control in place. This new
preamble will support the operative paragraph 1 subparagraph 1 (i)
Preamble 9ter: Recognizing an urgent need for substantial increases in funding for
research and development of new diagnostics, medicines and vaccines for tuberculosis
while ensuring affordability of these new products by unlinking cost of research and
development and the prices of health products. This is consistent with specific action
5.3a of the Public health, innovation and intellectual property: global strategy and plan
of action, in document A62/16 Add.1 page 19.
II. In operative paragraph
Operative paragraph 1 sub-paragraph 1(a) after the word the vulnerable groups we wish
to briefly describe specific population groups, by adding such as prisoners, mineworkers,
migrants, drug users, alcohol dependents, then followed by … as well as the
Operative paragraph 1 sub-paragraph 1 to add two new paragraphs 1(j) and 1(k) as
Annex 4 Intervention by Thai delegation, 62nd WHA 17
1(j) Establishing national target in order to accelerate access to treatment according to
WHO guidelines, by the MDR and XDR Tuberculosis patients. This new subparagraph j
will address the very low access rate to care as reflected in the Preamble paragraph 8.
1(k) Strengthening health information systems for monitoring epidemiological profile,
and achievement in the prevention and control of MDR and XDR TB;
Operative paragraph 1, add a new sub-paragraph, 1bis. It would read
1bis. To enhance quality and coverage of DOTS in achieving 70% detection rate and
85% success rate of Tuberculosis treatment, thereby preventing secondary MDR TB;
Operative paragraph 2, add a new sub-paragraph 5bis
Subparagraph 5bis To explore and promote a range of incentive scheme of research and
development, including the de-linkage of the cost of research and development from the
price of medical products.
Operative paragraph 2, subparagraph 7 there is some error, to report through the EB to
the 62nd Assembly, as today is 62nd session of the Assembly. My delegation recommends
to amend as followed:
To report through the Executive Board to the Sixty-third and Sixty-fifth World Health
Assemblies on the overall progress made on STOP Tuberculosis including MDR and XDR
Thank you. Mr. Chairman
Annex 4 Intervention by Thai delegation, 62nd WHA 18
Agenda 12.10 Progress Report on technical and health matters (A62/23)
Agenda 12.10 A – Poliomyelitis: Mechanism for management of potential risks
Interventions by Thai delegation
May 20th, 2009
The Thai delegation welcomes the excellent report on poliomyelitis by the Secretariat.
We appreciate the hard works done by local health workers and WHO polio eradication
team, particularly those who work in the security-compromised areas of polio endemic
The progress report indicates the worsen situation, especially with the international
importations of polio cases into 12 countries that were polio-free for many years. In
2008, a total of 1,655 poliomyelitis cases were reported in 16 countries. This figure
represents 26% increase in the number of polio cases compared to 2007 (1,315 cases).
Recognizing the serious situation of multi-country polio outbreaks in 2008, my
delegation has comments and suggestions as follows:
First, the continuous circulations of 3 serotypes of poliovirus in Nigeria pose an increased
risk of sustainable local transmission as well as potentials of international spread, given
a low coverage of oral polio vaccines at 61% and a number of cross border populations.
This is an emergency situation that needs concerted actions by all parties.
We realize that every nation is at risk of re-introduction of poliomyelitis unless there is
no wild polio virus circulating in the world. So the efforts should be prioritized to stop the
transmission of polio virus in endemic areas as well as prevention of re-introduction of
polio into polio-free countries.
Second, the international spreads of wild-type polio virus highlight the needs for full
implementation of International Health Regulations (2005) in order to facilitate timely
case reporting and rapid containment of the disease in non-endemic area. Multi-country
poliomyelitis outbreak liked to the same source of infection is a real public health
emergency of an international concern and needs prompt responses by national and
international health agencies.
The last case of poliomyelitis in Thailand was over 10 years. However, Thailand reaffirms
our commitment towards polio eradication and continues to maintain a high coverage of
4 doses of OPV in children under 15 years in order to prevent the disease transmission.
Thank you. Mr.Chairman
Annex 4 Intervention by Thai delegation, 62nd WHA 19
Agenda 12.10 B - Smallpox eradication: destruction of variola stocks
Interventions by Thai delegation
My delegation commends the progress report on smallpox eradication prepared by the
Secretariat. The report highlights significant progresses on smallpox research and the
results of inspection at the two repositories. It is important to learn from the inspection
teams that the variola stocks kept in the 2 authorized repositories are with high security
and safety both at the VECTOR center in the Russia Federation and at US Centers for
Disease Control and Prevention.
This report also indicates that 691 vials of smallpox virus kept in Russia in 2008. Such
information is not available in this report although an inspection by the WHO biosafety
team was carried out at US CDC in March 29. My delegation looks forward to seeing
information of this inspection mission, especially the number of vials of variola virus kept
at US CDC.
Thank you Mr. Chair
Annex 4 Intervention by Thai delegation, 62nd WHA 20
Agenda 12.10 F Strengthening of health information systems (resolution
Intervention by Thailand
Thank you Mr. Chairman,
The Thai delegate takes note on the progress report on strengthening of health
information systems, and appreciates the progresses have made on this important issue.
We also appreciate findings from the secretariat‟s and country‟s reports which indicate a
significant increase in the collaboration between national statistical offices and health
ministries in many countries, and an increase in the allocation of domestic resources for
health information system strengthening. This indicates the increasing concerns of
member states for improving their own health information systems. However, we look
forward to see an active and important role of WHO in supporting and strengthening the
health information system of the member states.
Thailand supports WHO and the Health Metrics Network to provide continuing support for
the updating of the Framework and standards for country health information system.
Thank you, Mr.Chair
Annex 4 Intervention by Thai delegation, 62nd WHA 21
Agenda 12.10 G Working toward universal coverage of maternal, newborn and
child health interventions (resolution WHA58.13)
Intervention by the Thai delegation
My delegation thanks the secretariat for the comprehensive progress report which clearly
demonstrates the remaining challenges on inequitable access to quality MNCH services.
It identifies the most important bottleneck of health-system deficiencies, in particular
shortage of health workforce, and weakness of vital registration. Actions to improve
service coverage are also identified.
In Thailand, we have achieved the MDG 4 and 5 already. The current major challenge is
access to sexual and reproductive health services, especially among youth and
teenagers. They still lack of proper access to and use of sexual and reproductive health
services due to various barriers on supply and demand sides as well as other factors
outside the scope of health service.
According to UNICEF 2008 report on State of World‟s Children, table 9 page 146;
prevalence of child marriage in Thailand was 20% (12% in urban and 23% in rural); this
results in high rates of teenage pregnancy of 20%. Youth and teenagers have limited
knowledge and awareness in protecting themselves from unplanned pregnancy. There is
a major social barrier on unmarried youths and teenagers in using family planning
services in particular in public health sector.
We welcome WHO activity indicated in para 73 on page 14 of document A62/23 in
evaluating the effectiveness of approaches to increase access to services, such as
abolish user fees for maternal and child health services, contracting out of reproductive
health services and performance-based payment schemes.
Nevertheless, these supply side approaches ineffectively reach youth and teenagers.
Cost-effective interventions on demand side should be identified and seriously and
continuously applied to the target group.
Although countries such as Thailand has achieved universal access to healthcare
including sexual and reproductive health services, other social determinants and barriers
in access to these services have to be addressed through inter-sectoral actions in order
to achieve MDG5b.
Thank you Mr Chair.
Annex 4 Intervention by Thai delegation, 62nd WHA 22
Agenda 12.10 I: Rational use of medicines (resolution WHA60.16)
Interventions by Thai delegation
We welcome the progress report on“Rational use of medicines” and WHO support despite
the notion that the resources are being sought for member states to implement the
We are very much interested in WHO work in the pilot countries reported in the progress
report as well as the establishment of a Global steering committee. We would like to
seek more details from the secretariat on these two important matters.
In addition, Thailand would like to comment that WHO current activities seem to focus
more on the rationale use of specific groups of medicines such as psychotropic medicines
and antibiotic use for pneumonia, rather than redesigning the systems or mechanisms
involved, which perhaps are the root cause of the irrational drug use problems.
As clearly stated in the resolution, the problems of drug use demand full functions of
health authorities in regulatory and enforcement as well ashealth care professionals and
patients.. Consequently, health authorities should receive adequate funding.adequately
funded, and the legislation should also be in place. Health care professionals should
perform rationally and ethically, while patients should be well informed with balanced
information. Unfortunately, those situations are not the case. There is a real need to
strengthen systems and mechanisms to maxinuze utilization of all stakeholders‟capacity
in promoting rational use of medicines.
In many countries, pharmacies providing services professionally are underutilized by the
public health care system. My delegation, therefore, urges WHO to explore strategies to
bring professional pharmacies to better serve the public health care system.
Consequently, we would have more hands to accelerate WHO goals to be accomplished.?
Thailand, has been working on promoting our professional pharmacies to provide variety
of health care services. Evidence from our research showed impressive inputs from those
pharmacies. For examples, increasing coverage of screening diabetic patients,
promoting smoking cessation, correction of drug related problems. Although the results
are on the research scale but they are promising.
In addition, the campaign of “Antibiotic Smart Use” in Thailand can be another example
showing an importance of having a mechanism to synergize stakeholders‟ capacity. The
campaign does not focus only on providers in hospital but incorporates pharmacies and
consumers as one package. The success of this campaign is being expanded to a wider
In conclusion, Thailand appreciates all WHO efforts in promoting rational use of
medicines but we, at the same time, urge WHO to pay more attention in exploring the
appropriate systems and mechanisms to mitigate the problems of rational use of
Thank you for your attention, Mr. Chairman.
Annex 4 Intervention by Thai delegation, 62nd WHA 23
Agenda 12.10 J. Better medicines for children (resolution WHA60.20)
Interventions by Thai delegation
My delegation appreciates the progress report made by the Secretariat and thanks WHO
for the recognition of this issue. Apparently, better medicines for children is vital and it
should be one of thetop priorities in health agenda.
Thailand recently participated in the survey to identify appropriate dosage and strengths
of medicines for children; and rooms for improvement have been found. Apart from
research on appropriate formularly for children, there are still gaps of availability
involving with drug authority licensing. Thus, Thailand would like to see the closer
monitoring of WHO on the progress of the “International Regulatory Working Group”
which has been formed as the outcome of the pre-conference held before the 2008
International Conference of Drug Regulatory Authorities.
Finally, my delegation would like to see more proactive campaign of WHO on “Make
medicine Child size”.
Thank you , Mr. Chairman .
Annex 4 Intervention by Thai delegation, 62nd WHA 24
Agenda 12.10 K. Health technologies (resolution WHA60.29)
Interventions by Thai delegation
My delegation deeply concerns with health technologies since it is an important issue
attributable to the increase in health care costs and effectiveness of health resource use,
amidst the financial crisis.
Thailand recognizes the complexities lie under the issue of health technologies. We also
support the directions indicated in the progress reports especially the application of
technology assessment to justify country‟s needs and optimize the appropriate use of
While we appreciate WHO works, we would also like to urge WHO to build up capacity of
member states in this area of health technology assessment. From the Thai
experiences, establishing a public unit for health technology assessment is vital for
improving policy decision in health resource use, for example, a number of works from
the health technology assess unit – the Health Intervention and Technology Assessment
Program (HITAP) - in the selection criteria of national drug list, the national guidelines
for economic evaluation on health technology, selection of cost-effective health
interventions in the benefit package of public health insurance schemes.
However, in terms of supply side, Thailand has a comment. The WHO focuses on the
guidelines for health care equipment donation and procurement should cover the issue of
“remanufacturing” medical devices.? A developing country like Thailand has difficulties
in evaluating the quality of the so-called “remanufacturing” medical devices. Therefore,
we would like to urge WHO to facilitate the discussion and establishing clear scope and
assessment guidelines for this special type of medical devices.
Thank you, Mr .Chairman, for your kind attention.
Annex 4 Intervention by Thai delegation, 62nd WHA 25