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WHO Western Pacific Regional Committee, 48th Session, 22 September 1997: press conference with Dr Michael Wooldridge and Dr Sang Tae Han, Regional Director, Western Pacific Region, WHO

MASTER OF CEREMONIES: May I just introduce two people here for you. You all know the Minister, Dr Michael Wooldridge, and Dr Han, the Regional Director for the WHO in the Western Pacific Region.

I also would like to mention that some people have asked whether they could speak to particular delegations. I think the easiest way to handle that is if you get in contact with Lyn Dunlevy at the back, those of you who wish to, so that can be organised for you. But without anything further, I'll pass on to Dr Han.

DR SANG TAE HAN: We are very happy to be invited to Australia to convene an original committee meeting. This is the first time since Australia became a member of WHO, the World Health Organisation, that they invited our meeting here in Australia.

Australia, as you may know, has been the founding member of WHO, and they became a WHO member in February 1948. Ever since, Australia has been a very strong supporter of WHO's cause and its activities and programs. And we are very happy to be here.

The Western Pacific Region is composed of 37 countries and territories, and of course, being a huge area that I cover: from Mongolia to the north, down to Down Under here, and New Zealand; to Tahiti and Pitcairn Island in the east; and west would be somewhere in the western part of China.

And I cover about 1.6 billion population. And I have all sorts of countries: developed countries like Australia, Japan, New Zealand, now the Republic of Korea. And we also have lesser developed among the develop countries, LDC's. Population size of 1.2 billion of China, down to 2,100 in an island country of New Way *. So, from this you will also appreciate there are vast differences in socio-economic development status.

So, you mention it, I have everything in different size of countries. So the health problems as well. So, we have many health problems. Still the developing countries are suffering from the infectious diseases like malaria, parasitic diseases, et cetera. And the many countries who are showing faster development are now moving into the more non-communicable diseases of cardiovascular diseases, cancer, et cetera.

So, we have now the countries still suffering from communicable diseases, and these countries also started to recognise the non-communicable diseases, so they have a double burden, while the developed countries are suffering from other more developed country diseases, like non-communicable diseases.

Now, Australia, when I recruit the consultants to help other countries for international cooperation or technical cooperation, we employ consultants. And last year, 25% of consultants came from Australia. And we are asking the centres of excellence in the health field which are undertaking research activities, asking them to do some research activities for WHO, and out of such centres of excellence, 20% of WHO collaborating centres are located in Australia.

And Australia also serves as a resource for human resources development. They not only, as I said, give us consultants in the form of expertise, but also they receive trainees in the form of fellows or study tours, varying from a few years down to a few days even. So, Australia serves us as a very important resource for developing other countries of the region. So, these are some of the features that I like to give you, as a sort of introduction.

Australia has many problems, as you know. You may direct to the Minister. But I think, Minister, I'd like to cite one good example that the Minister has done. I had a joint press conference with him in April last year, in Canberra, when he just became Minister of Health And at that time, we discussed about the low coverage by immunisation to the Australian children. At that time, Minister Wooldridge said we have to do something. And now, I'm very glad to tell you that he's doing excellent things.

Of course, this morning, the Prime Minister mentioned that immunisation coverage is only 53% of the children. I think it's not a negligent part of the Government's efforts. I think it's also the parts we may have to share with the general public, because many parents may not like to bring their children for immunisation.

So, Dr Wooldridge has started "Immunise Australia". I think this campaign is a very important campaign, and this may serve as a good model for other developed countries, even your neighbouring country like New Zealand. They also showed lower coverage of immunisation, and in many other developed countries, and I think this will serve as a good model. And I'm sure with the success of this campaign, we'd like to share that success story for other countries where it can be applicable.

Also, I have yet to tune into the television, but I understand that there is a television public relations program that the Department of Health here has embarked, and I think this is also a very important initiative they have taken in order to implement this "Immunise Australia" campaign. And among others, I'd like to cite only good example that the Minister and his colleagues in the Health Department are doing. So, with this few introduction, I'm ready for any questions late on. Thankyou.

DR MICHAEL WOOLDRIDGE: I'll just speak very briefly. The World Health Organisation is an important body, and we are part of the Western Pacific Region. They have a meeting once a year, and in its 50 year history, this is the first time the regional meeting has been held in Australia. I've been elected Chairman of the meeting, so that is why I'm here.

I'm very happy to take any questions, or Dr Han can take any questions about WHO or its activities, or the meeting. Perhaps if there's any peculiarly Australian domestic questions, we could save them till the end, and get the WHO questions out of the way first. Thanks.

QUESTION: Dr Wooldridge, how do you feel in front of your colleagues from around the region about - how do you personally feel about the study of Indigenous health?

WOOLDRIDGE: I'm pleased that there are many good things happening in Aboriginal health. I think my colleagues from around the region would understand that change takes a long time to effect. If you have a look at New Zealand, Maori health was where we are today, 40 years ago, and it took the best part of 40 years to get Maori health up from an 18 year differential to a three year differential, which is where it is today.

I think the things we're going are a very basic public health approach. We're starting identifying a problem, looking at interventions, looking at how we can measure along the way of the changes we make. Where we agreed with the indicators of the states was actually a very important move, because for the first time, we'll be accountable. No-one's ever been accountable. Ministers have got up for 20 years and made great statements about what's going to happen, but no one's ever known whether they've worked or not.

For example, you might be surprised to know the rate of trachoma today, in spite of all the work of Fred Hollows and others, is just the same as what it was 20 years ago. And in some parts of Australia, the data we have on trachoma is worse than it was 20 years ago. Now, no Minister in ten or twenty years time, will be able to stand up and hide from that because of lack of knowledge.

So, while we obviously have a lot more to do, I think I'm quite proud amongst my colleagues in regional areas, because we're giving it a good go.

QUESTION: Dr Wooldridge, how important is it for Australia to set an example in the region on the issue of smoking, and given that particularly the tobacco companies seem to be targeting the underdeveloped world?

WOOLDRIDGE: Well, it's very important, certainly for ourselves. We have some of the strongest anti-tobacco legislation of any country in the world. And the Prime Minister mentioned in his speech this morning we've been somewhat successful. We've gone from 33% of the country smoking in 1985, to 25% of the country smoking in 1995, so that's pretty good.

I'm aware of what you say. The Chairman of WDHO Wills, in his annual report, talked about activity that tobacco companies have been taking in the Pacific region. One of the sessions we have later this week is specifically on tobacco. I haven't had the chance to get a perspective from my colleagues, but I certainly will be using this week as an opportunity to do that. I think Australia should be taking a lead.

QUESTION: The action plan on smoking specifically mentions trying to phase out smoking and tobacco advertising in the region by the year 2000. How does that sit with your government's continued exemption for the Grand Prix?

WOOLDRIDGE: Well, let's me just make it quite clear. We have some of the toughest anti-smoking legislation of any country in the world, and since I became Minister 18 months ago, we have administered it in a tougher way than the previous government did. We have rejected more events in the last 18 months than the previous government did in the last four years, so no-one can say we're not tough on smoking. We are implementing the Act in a very stringent manner.

For example, some of the exemptions we give, like in the recent Whitcross Round the World Yacht Race, for next year, the exemptions was limited to the hulls of two boats only. So, you know, there are some obligations that we have, if we want to be part of international sporting events, but I can assure you, we are implementing them tougher than most countries in the world, so we can certainly be proud of what we're doing against smoking.

QUESTION: Do you support a regional ban on tobacco advertising by 2000?

WOOLDRIDGE: Well, that's an event for individual countries to take up, but we are one of the leaders in the world in the banning smoking advertising, and I would certainly be encouraging other countries to do it.

QUESTION: Do you anticipate a ban in Australia by 2000?

WOOLDRIDGE: Well, we nearly have a ban now. As I said, we have one of the toughest regimes in the world. It is now being administered tougher under me than under any previous Minister. That's a pretty good start.

QUESTION: Minister, Australia is one of the leaders in research into HIV and AIDS. What are we doing to help our neighbours in that respect?

WOOLDRIDGE: That's a good question. Certainly, I was in Thailand Last month, and the WHO collaborating centre in Thailand has someone out of the Albion Street Clinic here in Sydney. And I must say, as I travelled through different parts of Asia, I was incredibly impressed at how well places like the Albion Street Clinic are known in the technical support those places have given. Is that the sort of thing you're talking about?

QUESTION: Yes. What sort of assistance are we giving? Obviously, someone from the Albion Street was there? Are we sending people over there?

WOOLDRIDGE: Yes, well, we do quite a lot. In terms of foreign aid, we fund quite a number of specific HIV projects right around the region. My trip last month was specifically focused on HIV in a simple practical way. We were talking with the Asian Development Bank about making health, specifically sexual health, part of any project the Asian Development Bank runs in the region. We provide technical expertise. So, again, I think we certainly pull our weight on that. Dr Han, is there anything you could add?

DR HAN: Australia is one of a few countries where they have shown a decrease in HIV and AIDS incidence. And we have been using Australia's again resources in training a clinical management aspect: doctors and nurses team training. We also use collaborating centres to support other countries in the region, as a reference and also playing the supporting role. And their program contents also, for example, injecting drug users' program that you have in Australia is one of the very excellent models which other countries should adopt.

So, in many respects, the Australian HIV program is contributing to the slowing down of HIV-AIDS incidence in other parts of the region and world.

QUESTION: You talk about slowing down, but these figures in the document that we've been given show that it looks like there's going to be an explosion in most other countries in the region, except for Australia and New Zealand, and I think Japan. This slowing down isn't really happening, is it?

DR HAN: No, try to slow them down. Because you cannot stop it. I think we have to face that such infection will continue. But what we are aiming at is we cannot say we will stop, just like any other communicable diseases, but we can only try to lower the curve of increase, rather than let it go. That's what I meant by slowing down.

QUESTION: But what impact would that explosion in the rest of the region have on Australia itself? I mean, the figures for Australia look like they stay the same. I mean, we all travel round a lot these days. Aren't we all going to affect each other?

DR HAN: But you have to assume Australians are different from others. You have a better education, you have better advice, you know what to do, how to look after yourself. But that is a basic difference between yourself and some people in other countries. And that made a difference in bringing down the number of incidents in Australia.

QUESTION: How terrible will that AIDS epidemic be in your region?

DR HAN: In my region, you see, it's very difficult to say, in my region, because I don't cover Indonesia, I don't cover Thailand, me and my centre. So, if you talk about Asia as such, then there will be a very serious explosion. But in my region, now the powder-keg type of area will be Cambodia, Vietnam, part of Laos.

But of course, the neighbouring country of Thailand, they have a serious problem, but they are doing their best. And also ..(inaudible).. India we have serious problems, and that will be the epicentre - Minister Wooldridge used the word 'epicentre' of AIDS in the near future, in Asia.

QUESTION: What's your prediction for the Pacific in terms of AIDS?

DR HAN: The Pacific in our region, that I am responsible for, 37 countries in area, I don't think it will be very, very serious, as in our neighbouring region. This I can say.

QUESTION: Why not?

DR HAN: Why not? First of all, I'd like to say all countries are very alert, and they are doing their best to contain it, to slow down the epidemic. And also we have the educational level of the population, which may be slightly better than other regions. Because this is basic for many, many things, educational literacy rate, which is quite high in my region, in many countries, except a few pockets of the hinterland, so to say.

And also, they have the cultural background which may be slightly different from some of the countries in our neighbouring region. So, these factors all put together, I think our region is doing very well, and the speed of spread will be not as fast as other regions, or neighbouring regions.

QUESTION: The annual report says that there's been a reduction in external funding for HIV-AIDS programs in the region, and that this is a matter of concern in an expanding epidemic. How serious is that reduction in funding?

DR HAN: You know, until 1995, WHO has what is called Global Program on AIDS - GPA. But from January 1996, the United Nations established a program called the UNAIDS. And this is hosted * by six United Nations agencies. One of them is WHO.

So, when this new agency was established to deal with the HIV-AIDS, of course, they had a teething period. So, in fact, we have the executive director of UNAIDS present at this meeting, Dr Peter Peal *, and he'll be discussing the HIV-AIDS tomorrow.

And because of this teething period problem, many countries are not able to receive the amount of funding that they needed, as was the case under GPA. So there was a difficulty in funding aspect, but I hope in the near future, that aspect will be solved.

QUESTION: The Federal Government in Australia recently derailed attempts to trial heroin. What are your thoughts and the committee's thoughts on this?

DR HAN: That's a very difficult question.

QUESTION: Do you believe that trialling heroin is an avenue to trying to overcome the problem?

DR HAN: I'd like to learn from the experience. Put it that way.

QUESTION: Well, you'd like to learn from it, so you support the idea of it?

DR HAN: Well, we can try anything which will be beneficial to the target group. I didn't say I'm supporting, but I'd like to learn. If it turns out a very good trial, why not learn from it? If it turns out to be bad, again we learn lesson from the failure. So, I think we are open in learning what any country would like to embark on. I' d like to learn. Yes.

QUESTION: Dr Han, just a work on malaria. From your statistics here, it appears there are 40,000 fewer detected cases of malaria in the region, from '94 to '95. That must be good news. And what has made that difference?

DR HAN: We have a very big malaria program in Indochina, Laos, Cambodia, Vietnam, also in China. And in the Pacific Islands we have a very special program in the Solomon Islands. So, in these islands, and other countries where it is malaria endemic, they went back to basics. Okay, don't be bitten, first of all. If you are bitten, you have a fever, have a good medical care. So this is a basic thing.

So, in order to do that, the WHO has encouraged the use of bed nets. And we have been distributing bed nets to the many, many population in the region. And it is not the plain bed net, but bed nets impregnated with promethran *, insecticides. So, once you impregnate it, I think it will last about six months effective.

So, with wider use of the mosquito bed nets, I think that has contributed a great deal. Plus, the individual's responsibility that they don't like to be bitten. Because, you know, even if you have a bed net when you sleep, you can be bitten before going into the bed net in the evening. So, this is the education that we are doing.

And in the case of Honiara City, or the Solomon Islands, we have put in the steel pipes to drain the river, Metannic * River, which was clogged because of sandbanks in the river mouth, and that whole river was acting as a mosquito breeding place. So, we have put in the Australian made steel pipe to put in there, of a diameter 1.2 metres. And now water is flowing, it does no longer act as a mosquito breeding area.

Plus we had instituted very exceptionally, that whole population of Honiara to receive the prophylactic dose of medication. I went there, and I talked together with the Minister of Health of the Solomon Islands. So, with this and insecticide spraying, all others, I think we are able to contain a lot of incidence.

WOOLDRIDGE: I'll just make some brief comments, to add to what was said about HIV. There are some positive things happening in the region too, and Thailand has an extraordinarily good response to HIV. And that shows even a country with a massive problem that is developing can still have a serious response to the illness.

And a country like Australia has things, for example, that we can learn from Thailand. Thailand, has far better data, far better sentinal * testing than we do. They know exactly what's going on in different segments of the population. So, that's very impressive. Indonesia, the rate of increase of HIV looks like being much lower than was predicted 12 or 18 months ago. So, there are some positive things happening in our region.

As to the threat to Australia, yes, there is a threat from travel, and we have been working very hard in our AUSAID projects with sex workers in different parts of the region. And as well as doing something to help the country, that's also very much in our personal interest, because a lot of these destinations are where our brothers, sisters, friends, go for holidays.

Finally, the threat to Australia, I think the most direct threat to Australia will come through what happens in Irian Jaya Papua New Guinea. And in fact, in Indonesia, the second highest rate of HIV after Jakarta is in a fishing village on the Southern coast of Irian Jaya, called Mararki *. There are reports that HIV is increasing very rapidly in the Daru Fly * region of Papua New Guinea. There are 30,000 visits a year from this region into Northern Australia, protected by an international treaty.

So, that is where a potential threat lies, and we've realised this, and if you have a look at the Aboriginal sexual health strategy that we released a couple of months ago, it focuses very much on sexual health. It will be largely targeted in Northern Australia, and to try and prevent what could be a problem in the future. Thankyou.

QUESTION: Dr Wooldridge, do you actually think those targets are achievable in Indigenous health, or are they just figures ..(inaudible).. ?

WOOLDRIDGE: No, we deliberately set targets that we thought were achievable. I'm very concerned not to promise the world and then fall dramatically short, as other people have done in Aboriginal health, previously. I think every time you fail, you make it a little bit harder to succeed the next time.

They were targets that we thrashed out with Aboriginal groups and with the states, and they're targets that all can be achieved with current knowledge. What will depend on whether we achieve them or not is the effort that states, territories, Aboriginal organisations are prepared to put in. But they were deliberately set up to make us reach further than we have. They're not easy targets, but every one of them we thought should be achievable with present knowledge.

If you'll excuse us, thank you.

*Phonetic spelling.