Let me share with you a speech of Dr Brundtland at the opening of
TDR's STAC meeting this week. It has just appeared at WHO's Web page.
Host of tdr-scientists list
Dr Brundtland's speech at TDR's STAC
Dr. Gro Harlem Brundtland
World Health Organization
1 March 1999
21st Meeting of the Scientific and Technical Advisory Committee of
the Special Programme for Research and Training in Tropical Diseases
Dear Members of the Scientific and Technical Advisory Committee,
It is a pleasure for me to welcome you to WHO at a time which combines
continuity and change.
Continuity, because so much of what WHO has been doing for the health of
so many is worth while pursuing. TDR is a prime example of this. It is
an example of world class expertise. It is an example of what the best
of partnerships can bring to the advancement of technology, medicines
and alleviation of suffering.
Change because the world around us is changing and because WHO as an
Organization needs to reposition itself to make a real difference for
We are changing to better focus our work, to get better synergies
between related activities, to forge closer relations with our Member
States, to devise more effective partnerships with others.
We are changing to better cope with a mandate which Member States tend
to increase, whereas the resources remain restricted.
We are changing because any organization needs to constantly work to
become better -- more effective -- more passionate.
Among your documents you will find a description of our new structure,
based on clusters. We have grouped the previous individual programmes
into nine clusters -- and then we have turned what used to be more than
50 programmes into 32 departments.
TDR is located at the heart of the Communicable Diseases Cluster.
The mission of the cluster is as simple as it is daunting: to reduce the
impact of communicable diseases worldwide by leading the global effort
in prevention, control, surveillance and research.
Its mandate is broad, ranging from monitoring the emergence of new,
sometimes unknown, diseases to the possible eradication of those against
which we have efficient tools and strategies. It is a major challenge.
Communicable diseases remain the most common cause of death in the
world. Of the 52 million deaths worldwide per year, an estimated
one-third are due to infectious diseases. And we have all the evidence
to say that the main burden of communicable disease is carried by the
poor. WHO -- committed to the cause of equity and the fight against
poverty -- has to maintain the fight against communicable diseases as a
Of particular concern to us are the tropical diseases. Some call these
indigent diseases as they mainly affect the poor and do not get the
attention they deserve.
Our ambition is to do what we can to change that. The 24-year history of
TDR tells the story of how three international agencies, the World Bank,
the United Nations Development Programme, and WHO, jointly with other
loyal partners, have worked together to improve the health of those
affected by tropical diseases. TDR is rightly regarded as one of WHO's
success stories. You are a major player in that story. As TDR's highest
scientific committee, you have had a crucial role in keeping the
programme alive and dynamic, setting and updating its priorities and
TDR is indeed a special programme. Twenty-four years is no age. It is
still active and forward-looking, very relevant and, in fact, crucial,
to meet the challenges posed by tropical diseases.
All of these qualities will be needed, because there are major tasks
Let us first review the current setting:
* WHO's reorganization has created an atmosphere that favours change,
and we are fully committed to promote changes that will make a
difference where it matters - the health conditions of disease endemic
countries. Let us take advantage of this change process to strengthen
the impact of our efforts also in TDR's area.
* TDR has undergone its 3rd External Review, which made suggestions on
how to make this successful Programme even better. At the request of
its Joint Coordinating Board, TDR is working on a new Strategic Plan
with a long-term vision to guide the Programme in the next years,
incorporating the suggestions of the External Review.
As you know, TDR has two basic goals:
1. Promote R & D for the development of new and improved tools to
control tropical diseases.
2. Build research capacity of developing endemic countries through
training and institutional strengthening.
Research and training for disease control - a simple, clear and relevant
mandate, is as needed and as valid today as it was 24 years ago.
We desperately need new and better tools, tools that are effective,
appropriate and affordable, and we desperately need to increase the
scientific capacity of the countries that suffer the toll of tropical
Let me give you some examples. You know I have selected malaria and
tuberculosis as priorities among the communicable diseases. Since July
we have launched the Roll Back Malaria project and the Stop TB
* In relation to malaria, our target is to halve its burden through
interventions adapted to local needs, and reinforcement of the health
sector of the affected countries. This is a formidable task which will
require concentrated efforts to radically improve the health systems
of the poorest countries on earth - and to cope with the problem of
increasing resistance to the available drugs.
* The situation is also very serious with regard to the spread of
tuberculosis. Drug resistance is spreading, some countries are facing
problems in relation to the implementation of the DOTS strategy, and
the association of tuberculosis with HIV/AIDS is cause of great
We could dramatically change the pattern if new tools became available.
For example, recent studies show us the impact new effective tools could
have on tuberculosis by the year 2030:
* a new vaccine with 50% efficacy could lower tuberculosis incidence by
36 million cases and mortality by 9 million deaths;
* a single-contact treatment could avert 24 million cases and 11 million
* active case finding by using mass miniature radiography could save 23
And let us at this stage only leave to our imagination the far-reaching
consequences of a good malaria vaccine.
All our knowledge is about the past -- but all our challenges lie in the
future. This is what stimulates researchers and scientists to make an
extra effort. So let us look briefly into that future.
We are again facing an old dilemma: Should we invest in dreams, such as
a malaria vaccine, or should we concentrate our resources on better use
of existing tools?
I want to reiterate once more: Research is essential. Decades ago a
polio vaccine was also just a dream, and the debate was raging between
those idealists who fought for it and those who wanted better iron lungs
and rocking beds to alleviate the intense suffering of polio victims. As
we approach polio eradication - made possible by the development of
effective oral vaccines - we forget how difficult the decision was to
keep investing in a dream that no one knew could become a reality.
Let us keep some of the dreams alive.
We definitely need new knowledge to fight tropical diseases. We need to
know our enemies better. These are:
* The pathogens that cause the diseases;
* The vectors that transmit them;
* The factors that undermine our defences against infection; and
* The environmental, social, economic and behavioural determinants that
help disease propagation.
New knowledge, however, is not enough - we have to transform that
knowledge into tools for disease control. We need:
* new and improved drugs, vaccines and diagnostics that can be afforded
by the poor;
* new and improved interventions, suitable for adoption by the health
systems of poor countries;
* better methods for vector control that do not further exacerbate the
environmental situation of our planet.
TDR will be 25 years old next year as we enter a new century -- a new
millennium. We will commemorate this Jubilee not only with festivities.
We will demand that TDR assume new duties, tasks, challenges and
responsibilities. To be very direct -- to assume more hard work.
TDR's new Strategic Plan, which will guide its future path, will be
presented in full to the Joint Coordinating Board this June. It will
focus on these new challenges and work with us in developing approaches
to undertake them. I count on you to carefully analyse the options
presented in the draft plan, discuss their implications and help TDR to
make the right choices. Among the options we are proposing is to expand
TDR's disease portfolio to include tuberculosis and dengue.
During this meeting, you will be presented with the reasons why we think
TDR must expand its mandate to include these two infectious diseases. To
me it is clear; carefully expanding the mandate means living up to TDR's
achievements. Carefully expanding the mandate means strengthening our
ability to make a difference.
We also need your help with another matter. Before I took office, I met
with the group of outside experts that conducted the Third External
Review. They told me that TDR has worked hard and effectively to
accomplish its mandate. And I know that it has done so using only
catalytic resources, or seed money.
TDR could do better, and more, if we could mobilise additional funds.
I am fully committed to do what I can to make this happen. In the long
run I can think of few more cost-effective investments in health.
* I do so when I ask our Member States not to adopt a budget which
decreases our resources and pulls towards a downsizing of WHO and
limited ability to deliver the work that the same Member States expect
us to do.
* I will do so as we continue to raise money in the belief that WHO can
merit a larger share of the voluntary contributions Member States and
others are willing to commit to health and development.
* I will do so when I will continue our achievements of the last 8
months and further rationalise the way we operate at Headquarters,
Regional and country levels, to save precious resources and to
redirect even more funds from administrative areas to our technical
Getting more funds and renewed support from Member States, donors and
other partners is of course our task - but you do have a share in the
effort and responsibility.
Your sound advice is crucial to TDR and the Communicable Diseases
cluster - and therefore to WHO. We are partners committed to better
world health. Your work, as TDR's top scientific experts, will impact on
the Programme's performance and that of WHO.
I am looking forward to receiving your advice. I wish you success in
your deliberations, and I wish TDR a bright future, as it approaches its
25 years of existence and as it looks ahead to new challenges and
opportunities into a new century.
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