5 key moments from Margaret Chan's final WHO regional committee meeting

Member states endorsed several resolutions aimed at guiding countries in Western Pacific to address health issues and threats affecting the region at the 67th annual meeting of WHO’s regional committee.

This included new strategies to prevent and eliminate vector-borne diseases in the region such as dengue and malaria, an updated framework for member states in developing their core capacities on disease surveillance and response as per requirements under the International Health Regulations, and a new framework that would guide the region in dealing with the impact of environmental degradation and climate change on health.

There are several other key announcements, discussion points and conversations at the weeklong meetings worthy of attention:

1. The many questions on Zika.

The Zika virus was a huge topic for discussion during the meetings. Member states exchanged their own experiences on surveillance and control of Zika in their countries. But during a special briefing held to discuss the threats posed by the virus in the region, a member state raised a question that only emphasized how little information and evidence there is to address the Zika virus properly.

The representative from Korea asked WHO and the representative from the United States what the right guidance was in terms of the length of time men and women who’ve been to a country with known infection of Zika had to abstain from sex. Both WHO and the U.S., through its Centers for Disease Prevention and Control, recently made recommendations on the topic, but the representative said “there’s a big difference between the two recommendations,” particularly for women. The WHO recommended six months abstinence time for women, while CDC at least eight weeks.

No one was able to answer the question immediately.

Peter Graaff, director of emergency operations and Ebola response at WHO, eventually admitted that the WHO and the U.S. recommendations are “indeed slightly different” but that this is more of a reflection of the limited information the international community has of the Zika virus disease.

Margaret Chan seconded this afterwards, noting how the disease “is full of uncertainty,” which is why the WHO uses interim guidance to allow for it to evolve, she added.

“So if you feel that indeed, having different duration of advice to women and to men … and you choose a more conservative approach, I think that’s acceptable,” she said.

Earlier in the discussions, the director-general told member states that “there’s no replacement” for surveillance, testing, and mosquito control, as well as in working together on research and development in light of the uncertainties on Zika. She also reminded them to not only focus their attention on mosquito transmission, as there are other high risk activities such as sexual transmission and blood transfusion that could further the spread of the virus.

2. The elimination of lymphatic filariasis.

Before ending her speech during the opening session, Chan acknowledged the four countries in the region that have eliminated lymphatic filariasis, which causes abnormal enlargement of different human body parts resulting in pain and disability.

Earlier this year, WHO was able to validate the disease is no longer a public health problem in Cambodia, Cook Islands, Niue and Vanuatu. This means there are now six countries, including Sri Lanka and Maldives, which have eliminated the disease, a “remarkable health achievement,” according to the director-general.

The disease is still endemic in about 67 countries around the world.

3. The crucial role of diplomacy in IHR implementation.

The International Health Regulations has been the subject of scrutiny and calls for reforms, the latest following the Ebola outbreak in West Africa that revealed countries’ weak capacities in responding to such public health threats.

Critics have called for strengthened monitoring and evaluation of member states’ core capacities in detecting and responding to public health threats. Up until the most recent review on the IHR in 2014, member states conducted their own evaluations on their health systems. The committee tasked to review IHR implementation in 2014 however recommended WHO develop options that would allow for other ways of to assess states’ core capacities with “approaches that combine self-evaluation, peer review and voluntary external evaluations involving a combination of domestic and independent experts.”

In 2015, experts at a technical meeting discussed the development of a tool that would serve as a guide in conducting joint external evaluations, which involve teams composed of international and national experts.

The introduction of JEE introduced an independent dimension in assessing state core capacities, and Dr. Li Ailan, director of health security at the WHO Western Pacific office, told Devex that as many as 10 member countries in the region have already expressed interest in undergoing these joint external evaluations.

JEE remains a voluntary tool. States can continue to rely on self-reported assessments of their core health capacities, reflecting the difficult balance the WHO has to deal with in ensuring member states fully comply with IHR but without overstepping.

“We found that if we want to make it work, we should promote country ownership,” Ailan said. “If they say evaluation is to help them to know where they are and how to improve, and they don’t feel like this is like an external auditing type, they will feel it as valuable.”

Another way is by promoting the evaluations more as a means for member states to understand their systems and situations.

“The evaluation itself people were very weary before, because people interpret it as more accountability, but now we try to promote it as a learning culture globally,” she added.

Currently, based on self-evaluations, 20 out of the region’s 27 member countries and areas have met IHR’s minimum requirements.

4. Margaret Chan’s last annual regional meeting.

Tributes poured in for Chan as she attended her last regional committee meeting as director-general of WHO. Shin Young-soo, regional director for the WHO’s Western Pacific office, talked briefly of Chan’s early years and how she eventually became the “face of global public health.”

“Her combination of charm and straight-talk on sticky issues has made her a star in the diplomatic community and among global partners,” Young-soo said. “Her star power has raised the profile of WHO as the United Nations’ largest and most transparent agency,” he said, afterwards acknowledging how WHO is “among the most complex and difficult organizations to manage.”

“I think I speak for all the regional directors and ministers when I say she will be sorely missed,” he said in his opening speech.

The representative from Papua New Guinea recalled how Chan tried to open up opportunities for all member states at the organization, while Singapore noted how the position of director-general is very much a “thankless job,” and that Chan faced a number of trials and tribulations during her term.

In a brief response, Chan thanked the member states for giving her the privilege to head the organization for a decade. She said it has been a “humbling experience” but that she won’t be a “lame duck” in her final 8 months in office. Much can still happen before her term ends in June 2017, she added.

Think meetings are boring?Not at @WHOWPRO 67th regional mtg. Here’s what took place after lunch Monday #sittingnewsmoking @devex @WHO pic.twitter.com/7mftfGrzIS

— Jenny Lei Ravelo (@JennyLeiRavelo) October 11, 2016

After lunch that same Monday, Chan participated in a regional office initiative aimed at promoting physical activity among staff by dancing to the tune of the Bee Gees’ “Stayin’ Alive.”

5. The candidates for the next director-general of WHO.

Five of the six candidates in the running for the next WHO director-general were present at the regional meeting. They conducted meetings with member states and were given a chance to present their platforms, although this was closed to media.

Those in attendance were Philippe Douste-Blazy of France, Tedros Adhanom Ghebreyesus of Ethiopia, David Nabarro of the U.K., Sania Nishtar of Pakistan and Miklós Szócska of Hungary.

For more Devex coverage on global health, visit Focus On: Global Health