Dear Members and Observers of the Joint Coordinating Board,
We are gathered here as the highest governing body of a programme set up by the international community 25 years ago to develop new and improved ways of dealing with diseases that impede social and economic development in large parts of the world, diseases that disproportionately affect poor people and the least developed countries.
For the TDR group of diseases, the gap between the world's 20% poorest and 20% richest is wide. If the disease, age, and gender specific death rates among the poorest were equal to those of the richest, the number of deaths would be reduced by 97.5% for tuberculosis, 99.6% for malaria, and 99.9% for the others.
WHO's corporate strategy
In January 2000 I presented to the Executive Board our progress in developing a corporate strategy for the WHO Secretariat. The visions and values of health for all inspire WHO's corporate strategy. Its main message is to place health in a broader context - acknowledging that better health depends on contributions from outside as well as within the health sector.
We have put a greater focus on poverty and health.
Research and knowledge are central to WHO's corporate strategy. Setting the agenda for, and stimulating, research and development is now one of the core functions of the Organization. We need to manage information in order to assess the trends and compare the performances of health systems; we need to develop and test new technologies, tools and guidelines for disease control, risk reduction, health care management and service delivery.
That's why this session of the JCB is so relevant. Over the years TDR has been able to spur progress where the market forces did not respond. In health there are vital goods, services and values that the market will not deliver. In no area is the need for a modern, vigilant and effective public sector response stronger. WHO has to be in the forefront in arguing the case for global public goods.
TDR's strategy 2000-2005
In response to the challenges and opportunities in WHO's corporate strategy, TDR is now proposing a revised Strategy 2000-2005 for your analysis and decision. The core values of that strategy are:
- Good health is an essential foundation for social and economic development and access to basic health care is a human right - the enjoyment of the highest attainable standard of health is a fundamental human right.
- Research and development of means to combat disease and improve health must adhere to internationally accepted legal and ethical principles.
- Knowledge is a crucial element in health improvement, and the attainment of self-reliance in research and development in disease endemic countries is key to sustainability.
- Closing the global gap in research and product development, between the rich and the poor and marginalized populations suffering from neglected infectious diseases, requires collaboration and partnership between public and private sectors; and involvement of research, planning and implementing agencies at international, national and local levels.
Last year you took important first steps to shape the future TDR:
- You agreed with a major revision of its disease portfolio - the first in the life of the Programme. The addition of tuberculosis and dengue to the list of TDR diseases was a sound decision, your response to an epidemiological reality.
- You confirmed a need for us to seek not only new vaccines and drugs, but also new, affordable diagnostics with a format suitable for use in developing countries.
- You endorsed a renewed role for social, economic and behavioural research - a most necessary dimension in TDR's role and mandate.
- Finally, you approved a 2000-2001 budget that allowed work to start along these new directions - and you will be hearing the progress made during this past year.
This year your decisions may be even more far-reaching.
TDR's new Strategy represents a major step in fostering a closer relationship between research and control. We all recognize that a sound health research agenda should be nurtured by opportunities provided by science and technology as well as the needs of disease control programmes and health systems. But we have realized during the past years that this is easier said than done.
A major emphasis of the new strategy is therefore "implementation research." It proposes moving TDR's mandate beyond the traditional boundary between research and control. If accepted, this new strategy would require the strengthening of TDR's mechanisms for research capability. The new strategy proposes building solid bridges between research and control, exploring this poorly charted territory to assure smooth implementation of new tools.
Partnerships, governance and management
Being closer to control and adopting more dynamic disease portfolio and research agendas would create a strong synergy between TDR's proposed new strategy and WHO's corporate strategy - with benefits for TDR, WHO and public health.
This would strengthen what is already a solid partnership. TDR, at its 25th anniversary, is an excellent example of a partnership that has developed around a set of common values and concerns. It is a proof that strong partnerships can be shaped, built and kept strong and alive - if the purpose and the ideals are relevant, the partners are committed to common goals and suitable management and governance are in place.
This has been one of the reasons for the success of TDR: the governance structure and the transparency of the programme. TDR's Steering Committees and STAC have ensured scientific independence and complete transparency in dealings. The conclusions made by the Programme have always been able to stand up to international scrutiny.
But above all, I believe that the professionalism and dedication of the JCB has been a main determinant of success. You have mastered the delicate task of being the highest coordination body of the Programme - setting the overall direction - without becoming involved in day-to-day management.
On the other hand WHO, as the Executing Agency, has the responsibility of assuring the efficient management, transparency and visibility of the Special Programme. That's why a trust fund was set up many years ago and the contributions and expenditures from this fund are reported separately in the WHO financial report, presented to the World Health Assembly every two years.
When we met last year, I announced an increase in WHO's contribution to TDR of 25% in the current biennium. Since then I have further seconded to TDR a regular budget professional staff to handle the integration of tuberculosis into the new disease portfolio. Should this Board approve the inclusion of the Immunology Training Course, two further regular budget staff will be seconded to TDR and WHO will be close to reaching a 50% increase in contribution as compared to the 1998-99 biennium.
TDR is a co-sponsored programme and as such it benefits from the corporate efforts of all its co-sponsors - UNDP, World Bank, and WHO alike. Like other WHO departments, TDR will approach existing and potential new donors directly and bring them into partnership.
I am pleased to learn that the World Bank has kindly offered to host a meeting with current and potential new donors and partners of TDR in November in Paris. This is a most welcome example of renewed commitment.
Working together now and in the future
In these 25 years we have accomplished together what we would not have been able to do in isolation. WHO is looking forward to a renewed commitment and enlargement of the partnership that created and has kept TDR strong all these years.
For this purpose I propose that in the future the JCB Sessions also be hosted at the World Bank and UNDP headquarters in Washington and New York, and encourage you to explore whether sessions should also be held in disease endemic countries despite the increased cost. This could possibly reinvigorate our partnership, and our joint commitment.
Exploring the immense opportunities of science and technology to improve health of the poor is an even more relevant and pressing goal today than it was 25 years ago, when TDR was created:
- Science has provided us with incredible new discoveries and knowledge - the complete sequence of the human genome is about to be announced, new and powerful approaches have been developed to accelerate discovery and development of new drugs, vaccine and diagnostics, and radically new information and communication technologies are now at our disposal;
- But the challenges we now face in public health are also more formidable - the spreading of drug resistance, emerging and re-emerging diseases, increase in social and economic disparities in large parts of the world - with dramatic consequences on the health of poor and marginalized populations.
Together we can face the immense challenges ahead. This is what the world asks us, and this is what should guide our work today.