- The Washington Times - Monday, August 4, 2003

Agency’s head focuses on ‘practical action plan’ to eradicate diseases

Dr. Jong-Wook Lee, new head of the World Health Organization, spoke to Washington Times special correspondent John Zarocostas in Geneva recently. Dr. Lee, 58, a South Korean, earned his medical degree at Seoul National University and a master’s degree in public health from the University of Hawaii. Before taking over as director general two weeks ago, he worked 19 years for the WHO in technical, managerial and policy positions, and made his mark spearheading the fight against tuberculosis and vaccine-preventable diseases of children.

Question: Dr. Lee, you were put in charge of the World Health Organization at a critical time, soon after the outbreak of SARS [severe acute respiratory syndrome] pushed the agency to the forefront of international public-health policy. What are your priorities?

Answer: Well, I said on a number of occasions that HIV/AIDS, tuberculosis and malaria will be among top priorities, especially HIV/AIDS. We are committed to putting 3 million HIV-infected people on anti-retroviral medicines by the end of 2005. This is a very big commitment. It has to be followed up. Another very big practical priority is polio eradication, which has been going on now for 15 years. And our target year is 2005. Last year, 1,918 polio cases were reported in seven countries.

Now we have to concentrate our efforts in these countries and complete the job. The other priority is the Millennium Development poverty-reduction goals agreed to in New York in 2000, which is a commitment by the heads of state of the world, and there are six health-related goals. So we again have to be part of that.

Q: President Bush promised to spend $15 billion in the worldwide fight against AIDS in his State of the Union message, and Secretary of State Colin L. Powell says AIDS is one his biggest foreign policy priorities. Where does the WHO fit in?

A: We are not starting from scratch or in a vacuum. There’s the global fund, UNAIDS, and before that started there was a WHO global program on AIDS. So we have long experience in dealing with AIDS.

Right now, what is different from the past is that we have the real possibility of providing medicines at affordable prices to the people who are in need. Previously in America and Europe, typically the cost of medicine for treating one person per year was about $10,000, which has now been reduced to about $300 using generic drugs.

But $300 per person per year is still too high. So the issue we have to work on is to reduce this or purchase the drugs and offer them free of charge to the people in need. The treatment is one thing, but the counseling, the prevention, condom use — these are all part of it.

We spent a lot of time [considering] whether it should be prevention or treatment, but now the view is we have to do all these things at the same time. We have to tell people how to prevent AIDS infection, and also at the same time we have to provide the counseling, the testing and also put people on treatment. We cannot talk of counseling and prevention when we can’t do anything if the person is [HIV] positive.

So all should go hand in hand. No more [of] this philosophical discussion, but some practical action. And then to take action also we need some kind of practical action plan, country by country, province by province. And we should also check what the global fund is doing.

You mentioned the $15 billion Bush-Powell initiative. This is a very important part of the whole activity. As you know, we brought in Jack Chow, who … was the representative in the State Department on this issue. [Dr. Jack C. Chow, previously ambassador and special representative of the U.S. secretary of state for HIV/AIDS, is now assistant director general of the WHO for HIV/AIDS, tuberculosis and malaria.] So if anybody understands or knows this Bush initiative, I doubt whether anybody understands it better than Jack Chow. So we are in a good position.

Q: The SARS outbreak moved markets, and suddenly governments started to look at health issues as a national-security priority. It changed the way health is perceived in Cabinets around the world. What are the lessons learned, and what is foreseen down the road?

A: Number one, it’s a public-health disease outbreak, not just some mundane health problem. Because it can cause great havoc to national economies, it’s become a security issue, and affected the hotel airline industry, and clearly it clicked it could be a national-security-economy issue. That’s one thing.

The other lesson we learned is that we have to shorten the lead time from the outbreak to the case detention. So every country now has to invest in their public health system. And also for us in the WHO, it was a wake-up call.

Now this problem has, in a sense, disappeared from our radar. We have to work in strengthening our capacity. One area is that we must elect some standard procedures on technical issues. We issue the travel guidelines, and then we need to have good procedural guidelines, so the who and how we come to a conclusion in the issue is the guidelines — standard procedures for issuing, which is very highly political, in the sense, and that will have a great impact on many countries.

Q: Could this have spillover benefits in dealing with other emergencies like a bioterrorist attack ?

A: That will not only be for SARS, but should also be able to deal with man-made as well as natural disease outbreaks. So if it’s a man-made disease outbreak — it might be bioterrorism or a laboratory accident — [standard procedures] should be able to deal with all sort of problems.

Q: Your agency recently got into hot water with some industry groups over pushing diet guidelines — what is a healthy diet, the obesity issue, and sugar consumption. Do you think too much focus is being placed in your agency?

A: When I visited Washington, Secretary [of Health and Human Services] Tommy Thompson was walking around with this pedometer, which measures how many steps he had been walking all day. So he is much concerned about this obesity issue [and] exercise issue. He is practicing what he has been preaching.

Everybody, health leaders and others, are … conscious of this, so … we have to come up with good guidelines and good recommendations, which will benefit the people, and also it has to be convincing to all the leaders.

I’m sure that some industry might not like what we are saying, because it might affect sales and so on. But this should be a secondary consideration. We have to come up with [recommendations that] can stand against criticism, which means it has to be based on good science.

At the same time, I don’t want to demonize industry because, frankly, sometimes they are not aware of [the issues]. I’m sure when we issue this kind of view based on the science, they will try to adopt new scientific findings. For them, reducing sugar content should not be too much of a problem, but for the sugar industry, of course, they have some problem.

But we have to base all these arguments on the science. From the WHO’s point of view, we cannot really doctor these findings or views because one interest group disputes them.

Q: Do you think it’s connected to the Framework Convention on Tobacco Control adopted this May by member countries of the WHO?

A: Already we’re setting global norms and standards, but we are not a supranational government. I am sure that with the tobacco convention, there is much concern. And I will not easily undertake another convention like the tobacco convention. So I will be very, very careful. Tobacco is a very special case.

Q: How will the tobacco convention be implemented?

A: Forty-five countries have now signed onto this, and clearly this is a very important chapter. And in terms of implementation, at least, there will not be any argument what should we do. Some will be slow, some will be quicker. But clearly price — the rising cigarette price — the size of the [warning against smoking in tobacco] advertisements … are issues on our desk for implementation. So those who are slow in implementing these recommendations will feel some guilt.

But there is also the issue of smuggling because of local price differences between the countries and regions; this is one of the issues we have to deal with. Now we have some common, level ground, so implementation will be a long march, but at least we know what to do.

Q: You spent a big part of your career in the field, so you have a hands-on approach at the village [and] community level. In your inaugural speech, you mentioned you want to focus on the country level. What do you see as the gaps that need to be filled in Asia, Africa, Latin America, and can you do it without an infusion of extra funds and resources?

A: We’re not a funding agency; we’re a specialized technical agency. So working with the governments, other stakeholders, with the donors, if we can point out the gaps and bring the case to the donors, this is what we want. It’s not always that we want rich countries to bring money to WHO. But if we can broker some of this for the [poor] countries, we would be happy.

Q: What are three key issues that a policy-maker should be aware of and make a top priority?

A: I think that they all know. One issue which is now faced by all developing countries is the human-resources crisis. There are simply not enough nurses, doctors and other health workers, because in poor countries, well-trained people tend to migrate to rich countries. So there is a brain drain — a very big issue.

We cannot rely on the noble intentions of health workers. There are some market-economy principles that apply in retaining or losing [qualified] people. This health manpower crisis is really a big issue.

And another issue: At the typical health center, one or two nurses are responsible for doing [work involving] HIV/AIDS, TB, malaria, giving immunizations, providing prenatal care and filling out all these forms. All this simply cannot be done.

So we must put resources into the country. For example, in the case of HIV/AIDS, it is not only the money for buying drugs and testing, or testing equipment, but we also have to support manpower training. It’s a very important issue.

The other issue is the same issue: The health system which is overwhelmed with HIV/AIDS and so on. Pressured by principled, well-funded programs like HIV/AIDS, we might end up doing HIV/AIDS [programs] at the expense of other more routine but very important activities. So again, how to balance these activities? Not only the very visible, but also the more routine. How to maintain and strengthen the system is a very important issue.

Q: Most of research into new medicines, about 90 percent, is done in rich, industrialized countries, and only a fraction is done in developing countries. How do you get research on diseases affecting most of the world’s population?

A: It’s a very important issue.

Hypertension drugs, anti-cancer drugs, even Viagra: When one company makes billions of dollars of profit, other companies come in and in no time provide several brands of drugs on this. At the same time, we have little progress on tuberculosis, malaria and HIV/AIDS.

So it’s very difficult to attract huge research interest for those diseases prevalent in Third World countries. That’s why in WHO, we have malaria ventures to attract new malaria drugs, TB diagnostics which the [Bill & Melinda] Gates Foundation is funding, and then also tropical diseases where the numbers are not big enough to warrant massive investment there. These are the ones we are brokering and coordinating. But it is a very important issue.

Q: Do you see any solution coming from the Sept. 10-14 World Trade Organization ministerial conference in Cancun, Mexico, on access to essential drugs [for poor nations], and what would be your recommendations?

A: Initially it was a logjam, but now what I see is some converging to points of agreement, consensus — not exactly to specifics, but to the range of options. So clearly, right now the discussion has become more specific, [where] before it was more philosophical and abstract. …

For example, how should we prevent the parallel importing of these drugs, given or provided at low price to the developing country, [to keep them from] coming back to the point of origin?

Thus the specific experience in Europe: The company SmithKline Becham [now GlaxoSmithKline] provided some drugs that came back to the Netherlands, and they found out about it. So now the issues became more practical, pragmatic, which means we can find some solution. …

The pharmaceutical companies in the rich countries don’t want to be seen as greedy and just profit-oriented at the expense of all these dying people. … So we have a real chance for agreement.

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