W O R L D H E A L T H

ORGANIZATION

ORGANISATION MONDIALE

DE LA SANTI!

RECilONAL OFFICE FOR THE L~'>:y'~'~~J"~~d~l BUREAU REGIONAL DE LA - EASTERN MEDITERRANEAN - MEDITERRANEE ORIENTALE

FEGIWAL COPN- FOR THE EASTERN f.IEDITEXW:\%AK

Sixteenth Session

SUB-COMMITTEE A

E M / R C I ~ A / P ~ O ~ . ~ i n . 2 22 Septenber 1966

Sub-Divi s i o r ~ on Programre

P'Il7WTXS OF THE SECOND MEETING

Held a t t h e S t a t e E%mk Building, Karachi on Thursday, 22 September 1966, a t 9.15 a.m.

. .

ORIGINAL: ENGLISH

1. Technical Nat ters ;

Technical PrcbLerns met i n Malaria Eradicat ion Programmes o f t h e Region; methodology of t h e i r s t u d i e s and scope f o r t h e i r s o l u t i o n

Page -

4

Smallpox Erad ica t ion

2. Cholera

Representatives of Member S ta t e s

Government

CmRUS

ETHIOPIA

FRANCE

~ e ~ r e s e n t a t i v e , Alternate o r Adviser

Dr. V. Vassilopoulos

H .E. Ato Tseghe

D r . C. Mofidi

IRAQ

JORDAN

KUWAIT

LIBYA

PAKISTAFI

snaDI: ARABIA

SOMALIA

sUDA1:

SYRIA

TUNISIA

UNITED ARAB RFPUEILIC

UNITED KINGDOM

mmd

D r . A. Arif

Dr. T. Karadchi D r . I. Hldjazi

Dr . A.R. A 1 Adwani M r . J . M . Behman

Mr. R. Heyder

Dr. A. Abdulhatg.

Dr PASS. Haque T)r M,K. Afridi M r . D.K. Power D r S,A, & n i c k Dr. N. Ahrned Dr. A.N. Khan Dr. S . Mahfuz A l i D r . A. Pervez D r S.N.Y. Bokhari Dr. M. Hasan Dr . A.A. Wyne D r . Z. Rahman D r . Z.H. Khan Dr. J . A . Khan D r . (Mrs.) S.B. Agha Dr. S.A.K.M. Hafizur Rahman D r . H. R- Dr k.l!.B. EEahnan

Dr- A . S . El Tabba'a

H.E. Haji Ismail Mr. A.F. A b r a r

Dr. M. Hamza

Dr. D.E. Chatty

D r . A.R. Farah Dr. M.T. Hachicha

D r . M.A.W. Shuh i D r . H.M. E l Kadi

Dr. C.R. Jones

H r . A.i-I. E l Shukani

World. I Ica l t l - i C~,+=dgi~~LlOn

Secretary t o ths Sdh -G3mnyLttee D r . A.H. Taba, Regionzl Director

Directo-. -,?f' I!e&.%-ti 55.3 :oe.r; - -?!LC . ~ P + O %.b .,- . . . . ...

-. . -.- .. . - . .-. ... . . . .- - ,

Malmiclcg.i:;t Dr. H . 2 - vzn der Kxay . .

United Nations en:', S?ecialZn,ed Aper,c;es - -- - -. -- --- - UIJITED fi:A:rICNS ~ ~ ~ E M P i ' i ~ , E J T pEIOGwpvp1E :"i=. , K. Kit atsni

UNITED 2JPTI'I.S Ti1LDmT ' S FUN" (UNTCEE j M r . G.S. Dillon

UNi lZD T\~ATIOI~S 3EL;EP AND FJOiiKS AGENCY FOR PAiZSTIiE EFTJGE3S (UNWA) D r . M. Sharif

3e~resenta t ives 2nd Ctservers of Ixternat ional Ron-Governmental, -------- ~ n d Inter; overmsnt sl Organizations -- -- ---

INTEmTATIONAL ASSrCIATION FOR THE PX€?\rEI;T10!< OF SLINDNESS Professor M.A. Shah (Representative )

IXrTEFUXATICPJAI, COPTP?n\lmI!EX FOR Maj or-General S .A. Mian (~epresen ta t ive ) MILITARY : EDICIXE A I D PKrlfilVlACY Lt . Colonel B. Hussein (~epresen ta t ive )

I f ~ ~ A T l 4 D T A L C' U?TCIi_ OF h W E S Mlss F. Plumhi (Representative)

INTEEJATIONAL CEIJT'AL FEDERATTOhI D r . H.E. SI& ( ~ e p r e s e n t a ~ l v e )

nmqTAT;OfiTfi 1 rrr7? YTPT 'U mrf: . *cOL'GY

GYNECGLOCY A ? T 3.SSTETSiCS D r . A .S. Choudhuri (Representative)

Mr. Faiz Ei Khuri (Observer)

JXAGm OF FEZ C3CSS SCSL3TES .Na$.or-General S .A. I.lian (~ep resen ta t ive ) L t . Colonel B. Hussein (~epresen ta t ive )

WORLG .X3DICAL ASSOCIA1'IC)N Di-. H.2. mar. (Representative )

UNITFED S'Y?ATEC NAT7AL fGDIC:EJ; PXSEAECH QNIT >NO+?, (LTS IJAXFXI 3) D r I,.@, Y4iller (Observer)

1. T E C X ~ J I X L ,i.,"T233: Item 10(a) an6 (b) of t h e ependa

,T.D , , ~ h n i c z i . .Lroble~s ?let i n a i a r i a ?radic,zt ion&crammes of the Region; I.isthodoicgy of t h e i r Studies and Soope f o r t h e i r Solut ion (Item iO ( a ) of tht Locnds - Docurllent' EMfi'cm

D r V!L8 Dm GAY ( l<a l a r io lw i s t , 95RO) introducing t h e document on b e h l f

of t he 2egionai Director , r e ~ r e t t e d t he absence of D r Lepes who had been

umvoidably d e t a i edr He sa id t ha t they would discuss technica l problems

of malaria e rad ica t ion and describe s tudies &ertaken and t h e i r e f f e c t on

a c t i v i t i e s , pa r t i cu l a r ly in Iraq, Pro g a m e s were usual ly wel l planned

with governmnt support, but could not a1wa;i.s he completed in t h e ti* a l lo t t ed .

Gen~-ral ly, thc causes f o r de iay , a l s o examined 'r)g the 'FSHO Expert Committee

on Maiaria i n its e ight r epo r t s , were technical , operat ional or adminis~l-a-

t i v e , or a conbinaticxl o f these fac tors . In par t icu lar , t echnica l d i f f i-

cu i t i e s required. spec i a i study. In i t s ten th report t he Txpert Com1nittee

had revie,lrecl those d i f f i c u l t i e s and 1 i s t ed them accord.ing t o et iology and

n:-:th6d~logy ?or t h e i r study 2nd in t e rp re t a t ion of r e su l t s . It a l s o providr d

a de f in i t i on of n prohlm area, reproduced i n the d o c m n t before t h e Sub-

Division (paze 1, paragraph 4) . Problem a rcas a s defined the re were charac-

t e r i zed by i a i i u r e t o in te r rupt transmission, and were ~lccordingly only

found during t h e a t t a c k phase. ? k t f a i l u r e was not t o be confused with

the occurrmcc of 2 r e s idua l focus of maiaria, which was t raceable t o

ope ra t ima l inadequacy i n t h e consolidation p b s e end usua l ly y ie lded t o

concerted action.

Ir, I raqy tlre resisrafice of k.stephonsi t o d i e l d r i n a:?d DDT was one of

t h e technical prcblemils s t u d i c d w i t h t h e assistance of the 'epionai gff ice

and t h e EIBO-58 team s ta t ioned i n Ecirut . Suscept ib i l i ty t e s t s had shcwn

t h a t res i s tance t 3 d i e ld r in was c o n ~ ~ i c t ~ , while DDT resis tance was of a much

lower order - not reaching t h c 100 pe r cent. Laboratorv s tudies had dellon-

s t r n t c d that DDT appiied at tho usual dnsaqe to A - s t ~ p h e n s i k i l l e d some

homozygous r e s i s t a n t insec ts besides the heterozygotes . Those obscrvnt ions

added w i g h t t o t h e decisicm t o resume res idua l DDT spraying i n Southern

Iraq i n 1963, supparted by other wasu re s , followed up by epidemiological

and en toxo lwica l obscwztions a s described i r t h e document (pages 3 end 4).

Those observations confirmed t h a t interrupt ion of t~- ,nsmission was achievcd

provided tha i spraying was donc cor rec t ly , wi th t o t a l and complete coverage

and suf f ic ien t dosages covering t h e whale trs.nsmission season. The operational

defec ts i n Fao had been due t o poor c o v e r q e during the f i r s t and second

rounds of sprqyiny, s o t ha t , i n f a c t , t he iiterruption of t ransniss ion was

not achievbd. (Irl LhaL c u ~ u ~ a c t i o n , he drew attention t o thc t n b l c s on

pages 12 and 13 o f the document). P f t e r correct ion of those defects , t h e

r e s u l t s xere a u i t e d i f f e r e n t .

The e f f ec t of t he DD'i' r e s idua l spraying was a l so evident from the graph on

page 19 of the d ~ c u m n t , where room dens l ty of A.stephensi was compared i n sprayed

and unsprayed bedrcczs 1:2 aasrah Liwa.

I n Iran, a f i e l d t r i a l with nalathion was belng conducted i n Bandar Abbas,

an area where A.stephensi wcts z'isc t he main v e c t o ~ i n the l t t t o r a l p l a ln s , and

A, f luv ia t i l i s i n the foo th i l l s . Analysis o f tho obzersrations aade between

October 196: and October 1955 had p rc~ i ?ed . encouraging entomological findings.

The general pa r z s i t e r a t e , observed beTore and one gear a f t e r spraying with

111dathio had otartcd, s'qowed no sie;ni'.icant change. A4minj s t r a t i v e d i f i i -

cul t ies had prevented execution of t ne t r i a l i n the T i r s t yew as planned.

Another f i e l d t r i a l l n t he Kazerou2 a r e l , covering a population of over

17,000 using rnedrcated s a l t showed encouraging r e s u l t s indicated t he p o s s i b i l i t y

of its f i t u r e use i n areas with s e t t l e d and moving populations during the a t t a ck

phase under s i m i l ~ ? conditions.

In the k i t e d Arab Republic a - , r ia l had been ca r r i ed out compasing t he

application of malathion, EHC and DDT i n an area where A.pharoensis had developed

high res i s tance t o DDT. Assessment of t ne malariometric da t a co l lec ted had

s h n m no s ign i f i c an t difference , while t he entomological r e s u l t s seemed only

to indrcate t h a t DlYP might s t i l l be superior t o t he o ther two insec t ic ides .

If anything, t h i s t r i a l proved t ha t one m s t be very c z e f u l i n se lec t ing

areas with low endemicity of malaria i f one was t o ob ta in dz t a of s t a t i s t i c a l

value . D r . SHUKRI (uni ted Arzb Republic) s a id t h a t h i s country 's malaria e rad ica t ion

programme had been included i n i t s second five-year p l v l f o r s o c i a l and economic

development, and continuing budgetary provision ha6 been approved by t he Council

of Ministers under the t h i r d p l v l s t a r t i n g i n 1972. An agreement had been signed

with WHO ea r ly i n 1966, m d it was e x ~ e c t e d t h a t a WE0 tear: woulri be assigned t o

revise the o ld 1959 plan anb t o nelp Implement the n e w u r l a , which -&as to bc applied

by stages covering t h e whole country i n eleven years. There were a t present

~pproximately 1,800 m r a l hea l th u n i t s with 700 t o come during t he second plan.

The preparatory phase was t o be based on those un i t s . The cost of t he p r o g r m e

was estimated a t ~t.bout 50 mill ion US D o l l ~ ~ s of which about 20 mil l ion f o r

imported supplies a2d equuiprrie~t. UNICEF was urgent ly requested t o contr ibute

the promised 5.2 mil l ion do l l a r s , and not t o reduce t he a l loca t ion .

There were t o be 72 malaria e rad ica t ion st2tttions, ma not 60 as f i r s t estimated.

Supplelrrentaxy personnel, equipment 3nd t r a r s p o r t were t o be found t o f a c i l i t a t e

the supervision of de tec t ion a c t i v i t i e s c a - r i ed out by t he r u r a l hea l th w-its.

The number of cases of malaria i n the country had been reduced from about

100,000 i n 1959 to about 8,0(?0 i n 1965. Active case detect ion i n a n extended

preparatory phase of three yews, s t a r t i ng i n 1960/67, was expected t o give even

be t t e r r e su l t s . The preparatory phase had s t a r t ed i n 1965/65 with the establ ish-

ment of a special larviciding campaign i n the Asian region t o guard w a i n s t the

poss ib i l i t y of introduction of Anopheles gambiae from Sudan on completion of the

d m . I n addition, 911 t ransport mr iv ing from the lakc was sprayed. The

Government of Sudar was cooperatirg through mezsures fo r eradicat ion of t h a t

vector i n an area extending for some 100 kilometres beyond the southern end of

the lake and through spraylng of Wadi Hallz o r t and t ranspvr- l l edv i i x fur ~ l l t 2

north.

W. MOFTDI (1ra.n) praised the paper which Dr. Van der KAAY had read. ile

wished t o add some d e t a j l s on the s i t ua t ion i n Iran obtained since i ts prcparat-

ion. Malaria era&lcation had s t a r t ed i n 1957 with a programme designed t o

operate by stages, Resistance of A.stephensi hr,s developed t o DMI by 1959.

A switch t o d ie ldr in w z s xa&e and resis tance t o it had developed by 1.961.

Subsequently an epideinic-had broken out i n 1962/63. It was hoped tha t operation

based on the experience obtained i n the ~ e s e a r c h programmes would start i n time

t o prevent a sirnil* occurpccce expected i n 1967/58.

Reviewing the findings of o b s c r v a t i o ~ s car r ied out i n I r an over the past

ten years, he sa id tha% resis t$nce of A.stephensi t o Dm could be overcome by

supplementary measures a t n ce r t a in leve l of insect infes ta t ion , Sut t h a t l eve l

had been e~ceeded I n the epidemics of 1957 and 1962. Special measures were

therefore planned for 1967 when the e~ idemic cycle reached ,another peak; one

of those measures wes the evalustion of the protect ive ef f ic iency of phosphorous

compounds and carbaiiztes . Kalathion sprzying i n the Bandar Abbas area , where technical d i f f i c u l t i e s

had z i s e n due t o the r e s i s t m c e of A.stephensi t o DDT znd d i e ld r in , and the

exophagic and exophilic hab i t s of A - f l u v i a t i l i s 2s well a s the ecology of the

inhabitants , had resul ted i n the disappearance of the f i r s t vector for four

months and of the second fo r sane period indoors, with redxction of its densi ty

fo? 2-4 weeks o u t d o ~ r s after s p r ~ y i n g . Thr: res idual e f f ec t of malathion i n

t h a t area was " ibo~t 1-6 weeks. The tox ic i ty of malathion for human population

was loTvr. The pmas i t e load had been reduced t o 50 per cent by October 1965,

snr? t o 15 per cent by Ju ly 1966, showing tha t the use of malathion might be

ef fec t ive i n ce r t a in areas and under ce r t z in conditions.

Baytex gave high k i l l i n g poiier, but was highly toxic f o r humans, which

rcduccd its vcluc f o r cper?tional use. DDVP cvoluatinns had heen mndc i n the

southern rcgior, sf Ir-.-. T31zd ~roveci ~ s y 'io use , but the + m e nf rfw?l?'-:

and C,rc air-change :-?te czde it l z s s e f f e c t i v t .

,The inscc t lc ide OFIS 33 had provcd a use fu l t o o l i n emergencies; i t had

been used i n 3 t r i a l i n Southern Ira?, with four cont rc l v i l l ages , where t rans-

mission c o n t i ~ u e d duping a seasot-. of upto nine months, m d whcre rrmy of t he

dwellings ycre thatchcd huts w i % h palq-leaf : iails. It had been found t h a t t he

A.stephensi densi ty ~ . s zcrc, i m e d i a t c l y z f t e r spraying, and upto f i ve mnths

no specimcn had seen caught. i n t he -ares, winlie i n ",he control v3 l l sges , a t t he

height of the sepson, up t o 15C specirr,e:~s 3-c! Sean caught g e r she i t e r . The

parasite r a t e i n the human population irdic-.tc?cl th5t tiler2 had hclcn no trms-

mission during t he period co;:cree by tbc Lass- Licide.

It therefore appeai-36 t h e t both ninl-ir,':ioc 33 rrerc. valuable i n an

em--rgency .&en f a i l ed .

Medicated s n l t was a l so e i f ec t i vc , m d with the usc o f those preventives

i n combination, it was hoped thnc erad ica t ion of mnlnrca csuld be achieved i n

the not too d i s t a n t f i t u r n , provided t h s t t he fievelopmc-nt of general hea l th

services contfnued ?pace.

The CHi44IFPAN, speaking as Rep~esentc?tive of Sudan, so id t h a t desp i te

resistance of A .gmbiae t o d i e ld r in , thc nalmic. p re -e ra i ica t ion programme was

proceeding well thcre , as was the developmerrt of t he necessarv hea l t h i n f r n -

struct,ure. The m a i ~ d i f f i c u l t i e s or" h i s country were fin'mcial, a d those

d i f f i c u l t i e s were insurmuntable without outs ide assis tance. The help whlch

UNICEF was g iv i rg i n p z r t i c u l m t o I r an m c ! Iraq was comcndable. He hoped

that UNICEF ,vould a l so extend assis tance t o S v d ~ n .

it was a l so hoped t h a t co-ordination meetings could be held with some Africnn

countries ir! t h s ne?2 tkture, i n order t o solve conmon problems r e l a t e d t o t he

programme . Dr . ARIF ( ~ r a q ) , said 31at d i f f i c u l t i e s had occurred i n Ir?q i n 1953 with

an outbrezk i n t he B a s r ~ ! Ci ty area o f an c:pidemic cmsod Sy A.stephensi, which

had disappewed fron t he region between 1958 and 1961, enabli-% t h e au tho r i t i e s

to place t he e rad ica t ion programme Lr- the consol idat ion phase i n 1961. Return-

ing t o t he a t t a c k phase i n 1964, residue1 sprayiw, with DDT had been resumed.

I n addition, l a z i c i d i r g with cmfie-oil a d gas-oi l i n pa r t i cu l a r i n the Fao

mea, had been introduced a t weekly i n t e rva l s and survei l lance a c t i v i t i e s were

reinforced.

Since t he resumption of a t tack mer,sures, t he epidemiological s i t u a t i o n i n t he

area had progressively improved d i s p i t e the continued high tolerance of the vector

to DIYT. I n the Fa0 area, however, a seasonal Ylare-up i n Autumn 1964 hzid caused

heavy incidence, pa r t i cu l a r l y in t he v i l l nee of Fa0 Diimlahs. TCJ el iminate tne

focus i n t h e population or" 7 500, addi-cional neasures were beicg applied i n

1966, using a thii-f i-our.? of spraying znd ~ 7 . 3 rounds of mass drug adrninistra-

tion. Accorciing t o recent resulzs a f t e r tk? applicat ion of two rounds of

spraying an6 one of drug adminiscrati-on, the s i t uz t ion had improved remarkably.

D r . VASSILOPOULOS (c-yprus) s a id tha t h i s c?unTry had been one of the f i r s t

t o eradicate malaria. No cases had occurred since 1950, although tnere had

beer, an imponted case i n 1956. Cypms c o n t i u e d t o spend 80 000 t o 100 000

do l l a r s on naintenance annually. A W O team had been invited t o confirm the

absence of t'ne disease i n the island.

Dr . A.Q.B. REIFINAN (Pakistan) said t h a t malaria eradicat ion i n Pakistan

was conducted by a semi-autonomous organization responsible f o r the two separate

programmes i n the East and West wings. The progr&nmes had s t a r t ed i n

1961-62, and there was only a s l i g h t delay i n West Pakistan, the main reasons

fo r which were the l a t e a r r i v a l of imported equipment and! supplies and

uncertainty about funds. A t present 80 mill ion people - 42 mil l ion i n

West Pakistan (83 per cent of i ts population), and 38 mil l ion i n East

Pakistan (68 per cent of its population) - were covered by the various phases of

the prugrnaiuiurien

Preparations were already being made f o r the maintenance phase, by

developing the m r a l heal th ser7rices. k p i l o t project was being car r ied out

i n each wing of the country t o deternine the manner of the fu ture in tegra t ion

of malaria eradication ;n the genera: heczlth services.

Approximately 220 mil l ion rupees have already been spent on the programmes.

Two t ra in ing centres in Dacca and Lahore wcrc giving ins t ruc t ions t o a l l

categories of malaria personnel, and same were also sent t o in terna t ional

t ~ i n i n g centres such a s those i n Manila and Lagos. 'dH0 and the United S a t e s

Agency f o r Internat ional Development were providing fellowships.

Those organizations were a lso providing advissry services, and the United

;Motes Agency f o r I n t e m t i o n a l . Development and UNICEF were a l so making funds

avai lable - #e l a t t e r f o r urgently needed suppl ies 3 r d equipolent.Pakistan

was very g;r&efil f o r t h a t assis tance.

so f a r no serious technical problcms had beer, encountered, but vigi lance

w a s kept up rigorously. Close l i a i son was maintained with bordering countries,

and a border meeting was t o be held with India and Burma very soon, arranged

by WHO. A meeting had been held the previous week with I r an and Turkey.

H e appealed f o r f inancia i assis tance, so t h a t malaria workers could f r e e

the country from the disease by 197L! o r 1975.

Re would bc glad t c give d e t a i l s of Pakistan 's programmes t o in teres ted

representatives.

Dr XACiIICHA ('b) said -chat so far there xere two mil l ion people l i v ing

i n malaria-fr-e areas i n l i is country - two-thirds of the population. Tunisia

used the c l a s s i ca l methods cf control: intensified larv ic ld ing and chemopro-

pPLylaxis. &t i n 1355 transmission had been founc! t o have resmcd i n ce r t a in

nrcao. TIIC Govr l - tnner i l GI Tunisla and thc Regional Office had been a lcr ted ,

and plme wzre being ma.& f o r an e ~ a d i c a t i o n campaim. I n cooperation with the

Regional Office s t a f f 3ild a short-term consultant, a p i l o t zone had been s e t up

in the coas ta l region of Sousse wlth a p?pulation of 120 000, using about

f i f t y 3f the avsLlable paramedical persoixrel. It was hoped t h a t pos i t ive r e s u l t s

would be achieved by 1968, when the preparatory phase was due t o end. I n 1967,

it was intended t o extend the p i l o t zone. H e appealed f o r assis tance t o meet

t i c heavy cost f o r the period 1967 C,o 1973, when it was planned t o spend aear ly

7 million do l l a r s on the eradicat ion pr~gramiie. He understood t h a t a programme

was a lso t o begin i n Libya i n 1968.

He congra-culatec: t3e representative of Iran on h i s report. He hoped that

Tunisia would be able t.3 pi-oduce s imi lar d e t a i l s i n the near future.

Dr . EL TABBA'A (Saudi Arabia) said t h a t pre-eradication a c t i v i t i e s i n h i s

loimtry showed resist-mcc of the vcctor t o d i e ld r in and illYil. The f indings

correspcndcd t o those made i2 tne niaigtfoouring areas of Iraq and Iran.

Dr. AF 'RDI ( ~ a k i s t a n ) sa id t h a t invest igat ions i n h i s country on the ef fec ts

of DDVP on ope vector had provided similar infomat ion t o t h t given i n I r a n ' s

report. fie confirmed t h a t t he e f f ec t s vcried gre?t ly with d i f f e ren t a i r c h a n g e

rates and with the kind ?f d~pieillngs peedominating i n a given zFea, a s well a s

riith the metho6 of applicat ion af the insect icide. He f e l t t h a t i n the " t r i b a l

belt" area of Pakistan, where individual spraying of houses was d i f f i c u l t , and

ivhere dwellings had l i t t l e venti l? ' i isn so t h a t the air-change Nas not rapid,

DDVP might be useful. T r i a l s i n s imi lar conditions had shown t h a t the e f fec t

of t ha t insec t ic ide was l i k ~ l y t o show i t s value a f t e r one, o r a t most two,

seasons. Fresh dispensers should be dis t r ibuted a f t e r six weeks. 'Pakistan

was gra tefu l fo r t he supplies of dispensers provided by WHO . Invest igat ions

showed tmnsmission t o be l a w i n the area where DDW had been used, and the

resul t s were more enoouraging than i n Nigeria and even Iran.

~ l ~ / R ~ 1 6 A / P r o ~ .Min. 2 page 10

k secord t r i a l was planned using 014s 33 for July 1967.

He had been interested in the remarks of D r Hofidi, representative of

Iran, espe cialxv concerning forecasting of epidemics 2nd the importance of

the difference i n vector behaviour hetween the inter-epidemic and epidemic

periods. There was a lesson tha t should be kept i n mind when dealing with

cyclic malaria.

iIe thanked D r van der h a y fo r h is preserrtation of the document before

the Sub-Division. He intended no criticism, b u t on the important question

of integration of malaria eradicat.ion with the generai health services ,

experience in the Uinajpur d i s t r i c t had shuwn tha t it was exceptionaiiy

hard t o w ork o u t neamres suited t o integration i n specific areas. He re-

tailed t h a t i n the United Arab Sepublic, f or example, t h e general health

services had reached an advanced stage of deveiopnent, and it was probably

l e s s d i f f i cu l t than i n l e s s developed countries t o a c h i 3 e integration.

Ais o, qa iar ia compirlled urgerrt action, whereas the intepration of eradication

i n th g ~ n e r a l health services was a long?-term process.

M r A3W (Soolalia) saic' that he was interested i n the account of f i e l d

t r i a l s of miathion i n Irar,. He would be g ra te fu l t o know whether medicated

s a l t stood 3 chance of success i n Samalia, where there was a larpe nomadic

population and where the p r a s i t e was not Plasmodium vivax but P. fa lc iparm.

D r HAQIX (Pakistan) asked representatives w h a t experience they had had

with the way i n which different insecticides affected culicines and f l i e s

d u r i n ~ antimalaria s>r,raying; people i n general did not d i f ferent ia te between

the vectors of nalaxia md other kinds of mosquitoes.

X r DILLON, Iies ident Director, U l J Z X F Esstern fiediterranean Re~ion , s aid

that ile f e l t embarrassed by s o many appeals f o r assistance, in view of the

paucity of funds i n h i s organization. The policy of Ui4ICF with r e ~ a r d t o

assistance t o such projects had been reviewed i n the neetlrg I n Bangkolc in

1964. On the basis of the decision reached then, countries having asked for

assistance had been informed of UWISEFfs inab i l i ty t.o continue in the same

manner. He rrould not attempt a detailed explanation of the si tuation, but

would confine himself by saying t h a t , i n the case of t h e United Arab Republic,

the U N I C T Secretariat had agreed i n 1960 to help t h a t country with i t s

nalaria eradication camp ig.n on the uncierstanding thzt it s ta r t ed the follminq

year. The Secretariat made a moral commitment of f ive million dol lars fo r the

six years beg inn in^ i n 1961, but the prorsmme had not s tar ted as planned,

and it had been impossibie t o keep the money aside a l l these years. Mean-

w h i l ~ , other requests f o r assistance i n other f i e ids had been received,

inciudinf scme f r s n the United Arab Ftepublic, a nc' the mane-7 had been used up.

KJI::T had air..a?g r e ched t h e point a t which it :ras a l loca t ing funds

on the srrenPth o f ~ t s finaocial ~ x p e c t x t i o n s , but its i n c o w h a l not kept

pace -,~Uil the requrs t s f 3r - iss is tanct . Thus, when the United ..rab Sepublic

was rca& t o s t a r t ~ t s proeraqne, WTST woull havc t o reconsider the

situatior: ir the l i ~ h t i?f funcis a7railebi.e t o it a t t h a t t i m e and the c r i t e r i a

la id dsin by t h ~ 3angkok i964 h a r d ~ e s s i o n .

As ZJISZF was unable t 3 rn~et, t h o denands of pro j cc t s already bein? a s s i s t ed ,

since %hey had n :%bii; of l a s t . l n lonzer than expected, he was not able t o

answer ~3a: 'anIs plea, 'JfiICZF was znxini~r t.n h ~ i p rotv-"tries w i t h hca l th

projects, but expc-r ie~ce shwed t h a t assis tance could no t be promised before

resources vere ~ v a i i a b i e . 3r b AID1 ( ~ a k i s t a n ) saic' t ha t he he? attended the m e ~ t i n g of the UNICEF

Txecuttitre h a r d re fer red t o by itr Dillon, qnd his rccol icc t ion was tha t a

resolution had 'real aclopced under MI?. i ch f i nanc i a l a s s i s bance i n malaria

eradicatior! FrogL-amnes wouid r o t he denied because a programw was a new

me but 3n.l:. i f UNICEF resources werc i lsuff i c i en t .

lk DILLOIi (KdICEF) , agreed wi th the previous speaker. A l l requests

for assis tance were giver, consideratio? and ass i s iancc was i~ ran t ed if two main

conditions ?.r,.rc? 72%: first, t h & ,RO agreed t h d qa i a r i a eradicat ion in a

country. was t schnica i ly feasibie; and secondiy) tht su f f i c i en t UNICEF fmds

w-re P - ~ a i i a b i - sn-? t h e c o u n t q conc~rnec! pa71 malaria a high p r i o r i t y i n

chiM health. To hzs -nc3llr-ctiun, both those poinks h .d been reviewed in

cons ic?erinrr the request Tram the Sudsn.

Dr i 9 ' 9 I D I (Iran) had understoo+ f rcx pa:e 22 of document 6~1/9~16/4 t h a t

DDT s?raying a l m e had i .'e rrupte d malaria transmission in southern Iraq.

However, frml ss=stcnents nade v r l i e r i n t h e wetir?~ it ep~ea rcd t h a t a

number cf a 6 d l t i 3 n a Tcasures - such a s nd-~anced survei i lance oper.itions,

I ~ r v i c i d i n g m d s o I n - h l d d s o + en necessary. ~ l e would appreciate

c l ~ r i f i c a t i c n a f ih- apmrcnt d iscrepancy t etvecn t h e documnnt ar,d the oral

statements.

Ur A X 3 (Iraq) ansxered t h a t i n F r e s t r i c t ed are- of southern Iraq (Fao)

it had prmsd mc.=.ssary t o u d c r t a k c a t h i r d round of DDP sprayink, followed

by two rounds of mass treatment and i a rv ic id ing with crude oil. and Fas o i l .

D r Vk:T DER W, k%O N a l a r i d o ~ i s t , said in a n s w - r t o t h e Ur?R Represen-

t a t i ve t hat was very pleased t o l ea rn t hat t h e UAR Government had made

the necessary provisions and plans and assured him t h a t the P ~ ~ i o n a l Office

wouid do a l l i n i ts power t o help.

E N / ~ c l @ / ~ r o g . ~ i n . 2 page 12

He w a s p a t e f u l t o the representat ive of I ran f ~ r the fur ther infomat ion

he had provided on the work carriecl odt i n h i s country. It was t rue t h a t

i n southern Iraq adui%ional neasurec had been required, but that applied only

t o a small problem area. The Fao area was a focus where noz only teclmical

problems were responsible f o r not acllieving int,erruption of transmission such

as: a number of imported cases 3f falciparum malaria had been detected; the

first round of spraying had been able t o -3ver only 35 per cent of t'ne house-

holds. It had therefore been decided LC coritinue operations, using Dm as the main weapon of at-cack, hut t3 support t h a t with addit ional measlires

such a s la rv ic id ing and mass dm€; ar?ininistration. The d i f f i c u l t y encountered

here had been more the r e s u l t of human fac tors r a the r than t o any defec t inherent

i n the proper use of DM' against Anopheles stephensi.

He f u l l y agreed with t h e Paklstzn representat ive as t o the importance of

in tegra t ing the malaria eradicaf,ioa services in to the basic public hea l th

s t ruc ture when the time was "ripe". Experience had shown t h a t where the

general hea l th services were not ready t o take f u l l respons ib i l i ty f o r carrying

out vigi lance a c t i v i t i e s , d i f f i c u l t i e s might a r i s e owing t o the f ac t t ha t ,

i f an area was f r e e of malaria and vigilance was not maintained thereaftel-

by t h e gtxxl-a1 heallh services, lmported cases would be missed and malaria

might f l a r e up again.

In connection with the So3alia representat ive 's remarks on the use of

medicated s a l t , he could not t e l l whether t ha t would prove the most successful

means of combating malaria i n Somalia. The ef fec t ive use of medicated s a l t

depended upon a cer ta in basic da i ly s a l t consumption by the population; if

l e s s than t h a t amount was consumed da i ly , it was necessary t o dose the salt so

h igh ly ' t ha t it became unpalatable and so was not taken. This was one of the

problems which were faced by the t r i a l i n northern Ghana, f o r instance.

Concerning +,ne questinn g ~ i t by Dr. H a q d e , campaigns involving the spraying

of res idual insec t ic ides were usual ly adapted by the habi t s of anopheline mos-

quitoes, which entered houses t o take a blood meal and res ted i n the house,

before and a f t e r feeding. F l i e s and culLcine mosquitoes had d i f f e ren t habi t s

and, although soma m i & t be k i l l ed by the res idual sprays, t h e i r control

by such means was unlikely.

He agreed with the Suds? representat ive a s t o the importance of coordination

between countries. The Aegional Office o r g a ~ i z e d a number of coordinatory

meetings between d i f f e ren t countries. For instance, there were regular meetings

between Syria, Lebanon and Libya, between Jordan and Saudi Arabia, between I raq

and Iran, between Burma, India and Pakistan, and between Syria and Turkey.

Tunisia had also received a request t o attend a meeting with Algeria and Morocco.

The Regional Office would not hes i t a t e t o organize s imi lar meetings betwea? other

countries If they were thought necessary.

The CHAIRMAN then put forward the following d r a f t resolut ion f o r consideration:

The 3ib-Cornmq t t e e ,

I I a l r ig studied +;he document, 1,:: t'ne z b ~ v c s u b j a o t siibmittee by the Rcglsnal Director;

Kavir~lj: a lso taken note o f tha informatic;rl 07i m ~ ? l z r ~ a c ~ a d i c a t l ~ n p r~ i r l i l ad i r l i'ne Reglonal Ulrec-53r'r; Annicai Rap<.~rt;

fibting with satisf'actLoii the plwgress i n mnlsria. eradicat inn and pre-eradicztion programmes o i Kke Aegisn, m d par t icu lar ly tne s t eps taken by additional eel ern be^ Stz tes t o launch maiarla eradicat ion programmes ;

: I~ t ing elso the d i f f i c u l t i e s encountered i n some of the rnalaria era- dicat ion pronamTes a s evidenced by the c~teblis4.~?1ent of t r~nsmiss ion i n areas or ig ina l ly considered f r ee o r already frced from the disease;

Having witnessed the successful r e su l t s obtalned i l l in te r rupt ing the transmission of malarfa by resuned DDT spraying i n southern Ir,aq, where t i e l oca l vector has developec! resis tance t o hydrocarbon insec t ic ides ,

i. m R E S L % S appreciation f o r the contributions o f the Member Sta tes par t icu lar ly of the new subscribers to rnelaria e r ~ d i c a t i o p , towards the Region's e f fo r t s t o eradicztc malaria;

2. URGES the Go~~ernments t o continuc to provide t h e required administra- t i ve , t e c h i c a l and f inancia l support t o malaria eradicat ion u n t i l the f i n a l goal is reached and t o make every e f f o r t Ln ensuring accurate ope- rations in order t o prevent the possible reintmduction of th2 disease in to or ig ina l ly f r e e o r already freed nreas;

3. R E C W N D S t h a t t he poss ib i l i t y of DM' spraying ba considared as an ef fec t ive a t t ack rn;asure -h. areas having vector resis tance pro5lems s imi lar to those i n southern Iraq;

4. REQUESTS the Regional Director t o provide assictance for spac ia l studies i n problem areas whenever required.

Dr. MOFIDI ( I ran) thought t ha t the f i n a l paragraph of the preamble and

operative paragraph 3 f a i l e d t o give a t rue picture of what had happened i n

southern I raq and suggested t h a t they be amended t o include reference t o t h e

additional measures t h a t had had t o be taken there.

H.E. Mr. T m (Ethiopia) wondered whetger the d r a f t resolut ion should

incorporate some expression o f appreciation f o r tne research a c t i v i t i e s i n malaria

that were being conducted i n several countries of the Region.

EM/RC~~A/P~O~ in. 2 page 14

Dr. HACHICA (Tunisia) agreed with the suggestion of the Iran representative,

particularly in view of the lattsr's fo~ecast of malaria outbreaks in years

to come.

After furthcr discussion, if; was agreed that a working party composed

of the representatives of Ethiopia, I'an, Iraq, Pakistan, Tunisia and the

UAR should prepare an amended draft resolution in the light of the views

expressed.

Later in thc meetinn, Dr. AFRIDI (Pakistan) speaking on behalf of

the working party stated that they suggested amending the final paragraph

of the preamble to read:

"~aving witnessed that successful results were obtained in izterruptine; the transmission of malaria in southern Iraq, where the local vector had developed resistance tao hydrocarbon insecticides, by resuming DMT spraying, in combination with otncr measures as necessary, "

and operative paragraph 3 to read:

llRECOMMENDS that the posdbility of DDT spraying in combination with other neaswes be considered as an effective attack measure in areao having veotor rosistanco problems similar to those in southern ~req;"

The v?gr!cing party also suggested the insertion of a new penultimate

pa%graph to the preamble reading:

" ~ o t i n ~ witn appreciation tile valuable research ~ctivitics being carried out in the Region in the field of malaria eradication;".

Decision: The draft resolution, as amended, was adopted.

SMALLPOX ERADICATION (Document ET.I/RC~~/~) Agenda item 10(b)

The FEGIONAL DIRECTOR, introducing- document EM/RCI~/~, stated that

unfortunately smallpox continued to exist in some parts of the world, including

the Eastern Mediterranean Region, and that the Eleventh World Health Assembly

in 1958 had adopted a resolution with a view to concentrating the efforts

on the eradication of the di-sease. The Eighteenth World Health Assembly had

declared the world-wide eradication of smallpox to be a major objective, and

final approval for a ten-year eradication programme had been given by the

Nineteenth World Wealth Assembly, which had allocated $2.4 million to start

the programme in 1967 as part of the regular programme of WHO.

There was no doubt t ha t smallpox w a s an eradicable disease, a s was shown

by the points l i s t e d sn pages 2 and 3 cf the document, i .e . the d i a p o s i s

of the diatase bcing r e l a t ive ly easy; Che f a c " L i i ~ ~ therc were no c a r r i e r s

of t h o discasc; the ?nly Mlswli r*esc;-vnir was mn; the pcriod s f the disease

during which the pa t lan t coriunicatsc: tlzL discase was only a Pew weeks'

duratios; the majar cndeniic Zoci st211 exis t ing were well-'krlmin and a t l a s t

t& fact t ha t there :v2s now 2~milzs l - . z h1.mL;- pc t in t frceze-dried vaccine.

He pointccl 3 U t t k ~ t ':pI!j_3 ;;as willir,,?; ti; a s s i s t c ~ u n t r i ~ s i n carrying out vaccine

potericy Lab Ls did ~~'gdridIllzl~~g VaCC i.llr2 ??oCIUC~LC!~.

Smallpox eradicatilsn would benef i t not only Those codntries wherc t h e

disease was endemic but a l so those where it might be only occasionally

imported as it wnuld relictve them bsth of anxiety and of the need t o car ry

out regular vaccination p r o g r m e s , which were cos t ly and sometimes Dve

rise t o complicat ions.

An irnportant par t oI' the document was the sect ion which outlined the

d i f f i cu l t i e s t h a t might be encounterrd by the snallpox eradicat ion p r o g r m e

i n the Eastern Mediterranean Region. These included a lack of basic infarm-

ation on the prevalence and. iacidanco cf tho diccnsc; a lack of groper

planning, proper administ .- Lion and proper organization of the programme;

a lac!; of funds an< snppllos; a shortage ?f tcained personnel, including

vaccinators; the possible use o f vaccine of doubtful potency; and incomplete

coverage of the population. 1.1 conr~ection w i t h the l a t t e r point, he emphasized

tha t 100 per cent coverage was the goal t . ~ be zimed a t . It w a s also most

important t h a t the progressof any smaZlpox eradicat ion programme s h ~ u l d be

continususly eveluated from the very s t a r t .

The document a l so referred t o chemoprophylaxis; t h i s w a s intended, of

course, merely a s an addit ional measure fo r use among such groups a s contacts

of patients .

Integrat ion of the smallpox eradicat ion progral!lme in to the basic hea l th

- services of a countr j was eminentl; desirable wherever those services were

well organized and were i n a posi t ion to absorb the addit ional work.

In conclusion, lie again s t rcssed tl-t iTi0 was ready t o a s s i s t countr ies

in the planning o f eradicat i?n programmes, i n imprwing t h e i r vaccine

production, i n assessing the smallpox s i t ua t ion and i n conducting eradicat ion

campaigns. He recalled t ha t subs tant ia l sums had been al located t o smallpox

eradication i n the inter-countrj programme f o r 1957 and 1968.

l 3 ' 4 / ~ ~ 1 6 A / ~ r o ~ . ~ i n . 2 / page 16

Dr. MALZlICX ( ~ z k i s t a n ) sa id tha t i l l %st Pakrstan on2 ?f the biggest

problems encountercc! Ln the smallpox eradicat ion campzip had been the

resis tance of the populatios t o vaccination; it was c l ea r that education

of the populetion was imperative.

East Pakistan ras an area o f ~mcllpox endemicity wlieere epidemics

occurred a t in terva ls ?f four ts s;x :.-zrs. I n 1930-51 t h ~ e had been

60,000 cases with 40,009 deaths ar.:' i n 19Y(-56 100,000 cases with 60,000

deaths. In 1961, a pr~grnnme had b w n s i r r t z d eirztin: a t 10Cfi vaccination

followed by sp",ematic r e v a c c i n n t i ~ : ~ u::zt f r~cze -d r i ed vaccine, which was

now produced i n Dacca a t a r a t e 3f 1.2 n i l l i o n doses wekly . This programme

had resul ted i n a c3nsiacrable declille i n snallpox but - f ~ r twwc main reasons - not i n i ts elimination. The f i r s t wrts tho large popdlation movements across

the Indian border. It was nqtable t hz t t h ~ 1951 and 1956 outbreaks had

coincided with pa r t i cu l a r ly la rge bordcr movements; such movements were

f a c i l i t a t e d by t he agreement between India and Pakistan not t o i n s i s t

t ha t persons entering one country from the other should car ry vaccination

ce r t i f i ca t e s . Tl?c second reason was the i n a b i l i t y t o achieve t o t a l coverage

of the population owing t-, d i f f i c u l t i e s i n communication and ts some l a x i t y

i n supervision.

He agreed with the Regi<~nal Director on the p e a t importance of continuous

evaluation i n order t o determine how an eradication programme was progressing.

I n Pakistan, a p i l o t project had been s t a r t ed t o f ind out how best t o apply

the experience and principles of malaria eradication survei l lance t o smallpox.

H e was gra tefu l t o MI0 fo r i t s support of tne e r a d i c a t i m programme i n

Pakistan and was hopeful t h a t the Organization m i & t now be able ti? provide

addit ional assis tance with the p r o d u c t i ~ n of vaccine, with the evaluation of

f i e l d work and with the t ra in ing of vaccinators, and other personnel.

The CHAEWAN, speaking i n h i s capacity a s representat ive of Sudan, sa id

t h a t a WHO c ~ ~ n s u l t a n t on smallpox was being made avai lable t o tkn Sudan and

another t o West Africa, fron whence most of the Sudanese cases were imported.

He wonderec? whether it would not have been advisable f o r the same man t o

cover both areas. H e a l so notcd tha t there was a d i f f e rence i n t h ~ timing

of the a t t ack phass i n the two arcas, t h a t i n Sudan t o begin i n 1967 and t h a t

i n West Africa i n 1966. Final ly, h~ wondered whether WHO could not make

avai lable &-ea te r f i nanc ia l aid t o the Sudan f o r i ts smallpox eradicat ion

a c t i v i t i e s ; he suygcsted t h a t it might be equitable f a r WHO t o cover approxi-

mately 3% of t h t o t a l expenditure.

Tne REGIOPaL 9 E C Y O F . sa id %at S?-iO c.onsultcnl,s were of ten avai lable

for short peris& only e r~d tha t , by chmcz , it had nnly bccn possible t o

arrange for the sport-~crin ?raplapent -if , ~cpa ra t c conscltants f o r the Sudan

and West Africa. As t o the tir9ing -f ]2erations, it vras most important t o ensure

proper c3ordination betvqeen the African and Eastern Mediterranean Regions, and

WO hoped t o achieve t h a t by cowdinatory rncctings and by the prompt dissemina-

tion of information. He doubted whether rore f inancia l assis tance could be

furnishad fc;r t h c S ~ d a e s e smallpox eradicat i2n programme; qui te la rge sums

had already been al located i n thc 1967 and 1968 'oucigots and it wao expected

that they 5iauLd ensure a subs tant ia l arndunt of supplies and equipment.

He thanked the Pakistan representative f o r h i s expos6 of t he s i t ua t ion

in East Pakistan and exgrcssed the hope t h a t the combined e f fo r t s of the Pakistan

Government and WHO urould r e s u l t i n f i n a l eradication.

The CHAlRPIIAX then propose6 the adsption of the following d r a f t resolut ion;

The Sub-committee,

iiaving studied with i n t e r e s t the dscment on smallpox eradicat ion presentee by the Regional Director;

Hecognizing the importance of smallpox eradlcat ion programmes i n the Region as part ~f the global eradicat icn programme:

Being aware of thc Resolution 3f the Nincteenth World Health Assembly on the Smallpox Ziradication Pro;;ramrmr~lc;

Recalling the need f o r adequate )basic hea l th services f a r the maintenance phas c ;

Having noted wiYi in t e re s t the smallpox eradication propamme included i n the Proposed Programme and Budget Esttmates fo l- 1968 f o r the Eastern Mediterranean Region,

1. COMMENDS the Organization on its e f f o r t s t:? eradicate smallpox on a global basis;

2. URGES countries which plan t o strengthen cJr i n i t i a t e smallpox eradication programmes t o take the necessary s teps t; begin the work as soon a s possible;

3. REQUESTS Member Sta tes t o provide adequate material and technical support f o r the rea l iza t ion o f thc programme;

4. EXPRESSES i ts sa t i s f ac t ion with the work car r ied out by the Organization concerning smallpox eradication;

5. REQUESTS the ~ e ~ i j n a l Director, with the cooperation of a l l Member States, t o coordinate the smallpox eradicat ion pro@ame i n the Region.

The d r a f t reso111t.i on w a s adopted.

2. CBCLV&

Dr A J X I D I (Pakistan) p ryosed tha t t he Sub-Divisian should pass a

resolut ion drawing a t t e n t i o n t o t he inadequacies of the In t e rna t i ona l

Sani tary Reguh.tions i r l respect of cholera. I n present-day epidemiological

conditions, t h e r e w ~ s r i s k of cholera froin food imports and from t r a v e l l e r s

by a i r . k reso lu t ion wouid impress upon WHO t h e need t o r e v i s e t h e Aepu-

l a t ions.

The Rt'GIQi AL D IRECTOR r e f e r r ed t he meeting t o Rules 8, 9 and 10 of t he

Rules of "rocedure, and to h i 3 prcviou~ chtemerrt durin~ the first day of

t h e meeting when t h e Sub-Committee approved t hc provisional agenda. He

reca l led t,hat it then agreed t o cover t h ~ quest ion on cholera under

item (6) of t h e agenda, i.~. discussion on t h e Annual ileport of the Regional

Director. I n f a c t f u l l and comprehensive d i s c u s s i m s d id take place when

h i s r epo r t was discussed and he benefited much from tho views of t h e repre-

sen ta t ives . Hmev r, should t h e m e t i n g s o desire , t h e question of cholera

couid be fur ther discussed by t h e Sub-Division on propmme.

D r HkQUE (Takistan) agreed t h a t t i e qu j s t i on of cholera was of extreme

importance i n t he Region. I f , howevcr, a reso lu t ian was paqsed, it might

encourar e countr ies t o p o beyond the In te rna t iona l Tani tary Regulations, on

the ground tht thc Zepional Corni t tee was of t h e opinion t h a t t he Reguht ions

were iriadequate.

D r AFRIDI (Pakistan) , while renl izini . t h s t D r Haquets point had ccn-

s iderab le v a l i d i t y , f e l t t h a t t h e r e so lu t i on couid d o no ham. then t he

epidemic of choler3 broke out i n 194:, excessively s t r i c t neasures were

taken. Hc did not blame any countrv f o r t r y inp t o prevent a danperous

disease l i k ~ c h d e r ~ f m ~ cnter inq its t c r r i t o r v , but there were l i m i t s

beyond whic t h e y s h ~ u i d not go, and r €vision of t he In t c rna t i cna l Sani tary

Regulr t ions w o u l d h ~ l r t? d c f j n ~ t h m .

The SFIkL+d.N asked whether it imuid not he s u f f i c i e n t t o have a f u l l

record of t h c d i scuss ions in t h e minutes ins tead of 3 resolut ion.

D r I:%DULtiJ)I: (Libya) said t h a t t he r e w o d d be a r i s k of goin.? beyond

the InteLmational 3nni ta .y Repulntions whether t h e i r rev is ion was cmsidercd

o r not. T ~ L passing of a reso iu t ion wouid not. r e s u l t in excessively

s t r i c t wzsures bein? takcn over and above those alrear'y takcn, but would

strengthen t h e case f o r r ccms ide rz t ion of t hz provisions of cholera i n t h e

Regulations.

EM/'RCl&/Pmg. Min. & page 19

R r ri3FmI (I -an) suggcst ~d t h a t i f any reso lu t ior. is t o b e passed,

it shmid bt c i r c u i c l t ~ d t o reprcstr l ta t ives i n advance and in a d r a f t f o m

for i ~ t c r c1iscussion.

D r ( I raq) agreed w i th Dr Haque t h s t a reso lu t ion might cause

countries t o ignore th,: provisions of t h e Int t^rnat ionnl i 'ar,itary 3egulations.

Tile i?;"-ICh,,L DILLCTOd sa id t h a t t o h i s kno~~iledge, and a s confirmed by

D r Dorollc, the 3irector-General intY2nds t o k - v ~ t h e w h o l ~ question of

Internztionii. Sani tary Rcguht i m s w i t h r e g a r d t o cholera and its possible

revisioc, studied by k E 0 h t c r n z t i m x l Quar~.ntine qnd y ~ r t l n c n t expert

Gmqittces. Howcvtr, i n h i s opinion ? ~ d wi th t h e lacunae s t i l l ex i s t i ng

in our s c i e n t i f i c knowledge on chol - rz , i t xzs by no mcms cc r t a in t'nat

these cmmit tees , oncc he ld , would necessarily decide i n t h e end t o make a%-

subs t an t i a i ravision. Kuch rescarch work was goin? on about t h e epidemiology

of c h o l ~ r a , espec ia l ly t h e c a r r i e r s t a t u s 2nd t he immunqenic value o f t h e

differcf i t vaccines. H- f e l t thcrzfxrc t h a t , even i f a n s- xpres s i on of regre t

f o r axcessivs measures were pivan i n t h e preamble t o t he reso lu t ion , t h e

oper2tivt parlgraph however worded, c o d d bc in te rpre ted tit illply some gromd

and j u s t i f i c a t i o n t o countr ies f or goln: b ~ y o n d t h c ; iaeulat ions, and t h a t ,

he thought, w ~ s not ac7~isabl.c a t t h i s s t a g ( . HL tht l refsre suggested t h a t

if t h~ 7ommittc.c would bc s s t i s f i z d .:ith .am i i s e r t i o n i n t h e Sub-Coinmitteefs

report (unclcr the dlpcussion o E t h e ?.. ionnl D ~ r t - c t o r l s annual repor t ) of a

request t o kiixself t o brinp t h i Z~rnrni'~ico's point of v i m and cmmerrts t o

the Dire -tor-Gcn r a i l s a t t en t i on , he mid b~ pieascd t o do so.

D r EL T1Fi3bh1k (Saudi Arabia) f c i t mat, count r ies must, t ake s t rong

measures t o prevent n danprous dlsease i i k e cholera froq crossing t h e i r

borders, i n tht: i n t e r e s t both of themsclvcs and of o%ht:r countries.

The CHLI3bY&j wondered whether it might not be s u f f i c i e n t for t h z rtegional

Director, as su-ogested bv himself, t o t ransmit t h e comments and suggcs t lms

made a t t h e x e t i n g t o t h e Directcr -Gcncrni without passinp a resolut ion.

D r ERDI (Pakistan) sa id t h s t t he v i t a i point was t h a t Heac'

shouid be c3gnizant o f thc s i t u a t i o n and of the n-cd t o review t h c In te r -

nat ional Sani ta ry 2egulati ons. He thcref ar withdrew h i s prcposal, pro-

vided t h a t t he g i s t of t h e discussions iqas pass~2d on t o t h e a p p r o p r ~ a t e

au thor i t i es .

It was s o agrccd.

The m e e t i n s cloaed F.& 112.15 p.m.