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'Combine incentives for research with access to medication for the poor' -- Kofi Annan meets with pharmaceutical companies; AIDS treatment in developing countries.
UN Chronicle. 2001 Mar-May; 38(1): p..Secretary-General Kofi Annan met with six of the world's leading pharmaceutical companies on 5 April in Amsterdam, the Netherlands to agree on what further steps need to be taken to improve access of developing countries to better health care, and HIV (human immunodeficiency virus) and HIV-related medicines, as part of further action to combat acquired immune deficiency syndrome (AIDS), including prevention, education and research. The Secretary-General met with the Chief Executive Officers and senior executives of Abbott Laboratories, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Hoffman-La Roche and Pfizer. He was joined at the meeting by Gro Harlem Brundtland, Director-General of the World Health Organization, and Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS).The pharmaceutical companies have made significant progress individually in providing an expanded number of drugs to combat AIDS, including antiretrovirals and treatments for opportunistic infections. Prices have come down substantially as a result of the companies' individual actions. Mr. Annan urged them to continue and accelerate these initiatives. Special emphasis was placed on the least developed countries, particularly those in Africa, as well as the need for continued country-by-country negotiations in other developing countries. All recognized that qualified non-governmental organizations and appropriate private companies offering health care to employees and local communities should also be considered for increased accessibility to HIV/AIDS medicines. (excerpt)
International Journal of Health Planning and Management. 1997; 12:149-157.This note seeks to sharpen our understanding of co-ordination and its significance in healthcare management by offering a picture of an activity where information, incentives and the mixing of various (professional and other) cultures are key. The research design was policy driven, and concentrated on incentives, decision-making and information gathering/ dissemination activities particularly between individuals working across different types of organizations. Data are drawn from 40 primary interviews with mostly senior staff from organizations in two countries, USA and Thailand, internal and external corporate documents, over 1000 items from a Reuters database of news items, newspaper articles and press releases, as well as secondary academic articles. The interviews, which lasted from between 20 min to more than 3 h over two visits, constitute the main source of evidence for the issues discussed below. (excerpt)
Bulletin of the World Health Organization. 2005; 83:948-953.Despite impressive improvements in aggregate indicators of health globally over the past few decades, health inequities between and within countries have persisted, and in many regions and countries are widening. Our recommendations regarding research priorities for health equity are based on an assessment of what information is required to gain an understanding of how to make substantial reductions in health inequities. We recommend that highest priority be given to research in five general areas: (1) global factors and processes that affect health equity and/or constrain what countries can do to address health inequities within their own borders; (2) societal and political structures and relationships that differentially affect people’s chances of being healthy within a given society; (3) interrelationships between factors at the individual level and within the social context that increase or decrease the likelihood of achieving and maintaining good health; (4) characteristics of the health care system that influence health equity and (5) effective policy interventions to reduce health inequity in the first four areas. (author's)
The global eradication of smallpox. Final report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979.
Geneva, Switzerland, WHO, 1980. 122 p. (History of International Public Health No. 4)The Global Commission for the Certification of Smallpox Eradication met in December 1978 to review the program in detail and to advise on subsequent activities and met again in December 1979 to assess progress and to make the final recommendations that are presented in this report. Additionally, the report contains a summary account of the history of smallpox, the clinical, epidemiological, and virological features of the disease, the efforts to control and eradicate smallpox prior to 1966, and an account of the intensified program during the 1967-79 period. The report describes the procedures used for the certification of eradication along with the findings of 21 different international commissions that visited and reviewed programs in 61 countries. These findings provide the basis for the Commission's conclusion that the global eradication of smallpox has been achieved. The Commission also concluded that there is no evidence that smallpox will return as an endemic disease. The overall development and coordination of the intensified program were carried out by a smallpox unit established at the World Health Organization (WHO) headquarters in Geneva, which worked closely with WHO staff at regional offices and, through them, with national staff and WHO advisers at the country level. Earlier programs had been based on a mass vaccination strategy. The intensified campaign called for programs designed to vaccinate at least 80% of the population within a 2-3 year period. During this time, reporting systems and surveillance activities were to be developed that would permit detection and elimination of the remaining foci of the disease. Support was sought and obtained from many different governments and agencies. The progression of the eradication program can be divided into 3 phases: the period between 1967-72 when eradication was achieved in most African countries, Indonesia, and South America; the 1973-75 period when major efforts focused on the countries of the Indian subcontinent; and the 1975-77 period when the goal of eradication was realized in the Horn of Africa. Global Commission recommendations for WHO policy in the post-eradication era include: the discontinuation of smallpox vaccination; continuing surveillance of monkey pox in West and Central Africa; supervision of the stocks and use of variola virus in laboratories; a policy of insurance against the return of the disease that includes thorough investigation of reports of suspected smallpox; the maintenance of an international reserve of freeze-dried vaccine under WHO control; and measures designed to ensure that laboratory and epidemiological expertise in human poxvirus infections should not be dissipated.
Report of the Expanded Programme on Immunization Global Advisory Group Meeting, 21-25 October 1984, Alexandria.
[Unpublished] 1985. 51 p. (EPI/GEN/85/1)This report of the Expanded Program on Immunization Global Advisory Group Meeting, held during October 1984, contains the following: conclusions and recommendations; a summary of the global and regional programs; a review of the Expanded Program on Immunization (EPI) in the Eastern Mediterranean Region; a review of country programs in Denmark, Brazil, and India; a report on the epidemiology and control of pertussis; and discussion of sentinel surveillance, surveillance of neonatal tetanus, polio, and measles, and research and development; and proposals for the 1985 meeting of the Global Advisory Group. The Global Advisory Group concluded that national immunization programs have made much progress, realizing some 30% coverage in developing countries with a 3rd dose of DPT. Yet, the lack of immunization services continues to extract a toll of 4 million preventable child deaths annually in the developing world. The Global Advisory Group indicated that the acceleration of existing programs is essential if immunization services are to be provided for all children of the world by 1990. Such acceleration calls for continued vigorous action to mobilize political support and financial resources at national and international levels. Considerable experience has been gained in most countries regarding implementation of immunization programs. The knowledge now exists to bring about major improvements in program achievement, yet gaps in knowledge exist in both technical and administrative areas. Action is needed in the following areas if programs are to accelerate sufficiently to meet the target: management of existing resources; use of intensified strategies; program evaluation; coordination with other components of primary health care; collaboration among international agencies; and regional and country meetings. To take maximum advantage of the benefits offered by vaccine, each country should take the necessary steps to include all relevant antigens in its national program. In particular, the universal use of measles vaccine should be encouraged. It also is of concern that some countries are not yet using polio vaccine and that others omit pertussis vaccine from their programs. Countries are urged to review their current practices about the anatomical site of intramuscular immunization. Taking into account the criteria of safety and ease of administration, thigh injection for DPT and arm injection for TT are recommended strongly. The Global Advisory Group reaffirmed its 1983 recommendation to use every opportunity to immunize eligible children.
[Unpublished] 1984. 27 p.The current status of the Control of Diarrhoeal Diseases (CDD) Program was reviewed, and activities related to the evaluation of country control programs, the assessment of potential diarrheal disease control interventions, and the program's operational research activities were examined. In the health services component, ciontinued efforts to promote the preparation of plans of operation for national CDD programs is recommended, as is continued use of the national CDD program managers training course. Concern was expressed that the level of use of oral rehydration therapy (ORT) appeared to be modest. Case management was endorsed as the major program strategy. The series of studies on interventions for reducing diarrhea's mortality and morbidity were welcomed. For evaluation purposes, it is recommended that the program develop additional criteria for monitoring increased access to and usage of oral rehydration salts (ORS) and the reduction of diarrheal mortality. Continued accumulaton and publication of information yielded by the program's survey of the impact of ORT in hospitals was recommended. In the research component, the growth of research activities is satisfying. While biomedical aspects have developed well, it might be necessary to relate them gradually to specific control interventions in the future. Further studies of improved ORS formulatons were recommended. High priority should also be given to the promotion of breast feeding, immunization, and water supply and sanitation. The underlying mechanisms that cause the intervention to reduce diarrheal morbidity or mortality should be clarified. Research is recommended on the promotion of personal and domestic hygiene, food hygiene, and improved weaning practices. Emphasis on the development and evaluation of vaccines against the causes of diarrhea is supported. Some changes in the balance of research activities should be made. Epidemiological weak.
Geneva, Switzerland, WHO,  27 p.This is the 1st interim report issued by the Diarrhoeal Diseases Control (CDD) Programme, summarizing progress in its main areas of activity during the previous calendar year. Most of the information is presented in the form of tables, graphs and lists. Other important developments are mentioned briefly in each section. The information is presented according to major program areas; health services; research; and program management. Within the health services component, national program planning, training, the production of Oral Rehydration Salts (ORS), health education and promotion are areas of priority activity. Progress in the rate of development of national programs, participants in the various levelsof training programs, and the countries producing their own ORS packets and developing promotional and educational materials are presented. An evaluation of the health services component, based on a questionnaire survey to determine the impact of Oral Rehydration Therapy (ORT), indicates significant decreases in diarrheal admission rates and in overall diarrheal case-fatality rates. Data collected from a total of 45 morbidity and and mortality surveys are shown. Biomedical and operational research projects supported by the program are given. Thhe research areas in which there was the greatest % increase in the number of projects funded were parasite-related diarrheas, drug development and management of diarrheal disease. Research is also in progress on community attitudes and practices in relation to diarrheal disease and on the development of local educational materials. The program's organizational structure is briefly described and its financial status summarized. The report ends with a list of new publications and documents concerning health services, research and management of diarrheal diseases.
[Unpublished] . 7 p.This document features the WHO Global Program on AIDS. The aim of the program is to develop, promote, support and coordinate research on social and behavioral factors influencing HIV transmission, and the way in which HIV/AIDS affect individuals, families and communities, in a manner that enhances national and international planning of control and prevention strategies. In order to attain this aim, 3 main themes of research development and support have been identified: 1) high-risk behaviors; 2) explanatory systems; and 3) coping responses. The research activities foreseen in all these areas include: 1) a combination of population-based survey research that is essentially descriptive of patterns of behavior, their prevalence, distribution, associated demographic and other characteristics; and 2) in-depth studies that seek to explore the role played by selected personal characteristics, as well as other determinants in influencing specific behavior and risks associated with HIV transmission. Furthermore, the purpose of the research activities is to enhance the development and application of policy and program alternatives. Within each of the research areas, there are plans to translate research findings into policy and program themes in ways that permit their rapid take-up by policymakers and program administrators.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1988; 66(2):143-54.Through a review of the work on the control of poliomyelitis carried out under the auspices of the World Health Organization (WHO) during the past 20 years, the importance of international collaboration is shown. Because of efforts in planning and coordinating, the production and control of the Sabin strains of the live oral vaccine provide safe, reliable, and potent vaccines. The cooperative efforts have included working not only with national control laboratories but with poliomyelitis vaccine producers in many countries. In the early 1970s, a Consultative Group of WHO became active. Their initial efforts included an extensive epidemiological study in 13 interested countries. Later, the group saw to studying the reliability of the marker tests used in the intratypic differentiation of poliovirus stains of different origins. Additionally, they saw to standardizing tests for the neurovirulence of vaccine lots, including analyzing and recording results, and to ensuring that adequate supplies of vaccine will be available for the next 200 years. After 15 years of continual surveillance of vaccine-associated cases by WHO epidemiologists and clinicians, the findings show the following: Type 1 live poliovirus vaccine is almost never implicated in postvaccination paralysis; type 2 strain occasionally causes of paralysis in contacts of the vaccine, and type 3 strain causes most of the few cases of postvaccine paralysis. The occurrences of the cases from type 2 and 3 strains remains an enigma. Current research of the group suggests an even more effective vaccine may become available in the future.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1985; 63(2):241-8.The WHO memorandum outlines the present situation regarding pertussis vaccines, discusses ways to evaluate candidate vaccines, and identifies future research needs. Most existing whooping cough vaccines are whole-cell vaccines, combined with diphtheria and tetanus toxoid adsorbed on an aluminum or calcium carrier. As whole bacterial cells, they contain a complex array of at least 7 toxins and antigens, and display a narrow margin between potency and toxicity. The Japanese introduced an acellular vaccine, admittedly sometimes less potent, called the Precipitated Purified Pertussis Vaccine, in 1981. This material contains far less bacterial mass, notably less endotoxin, and consequently produces less fever, erythema and induration. WHO has not yet established minimum requirements for standardization; even the mouse potency assay may not be suitable. There are techniques, however, which will measure amounts of component antigens and toxicity. Conflicting results on assays of potency and immunogenicity will have to be resolved. Besides the obvious need for large clinical trials of defined vaccines, a whole range of research needs were suggested, from genetic studies of the organism to specific details of the host response. It is generally agreed that a less reactogenic and more effective pertussis vaccine is needed and feasible.
International Planned Parenthood Federation adds Norplant implants to its commodities list of approved contraceptives. News release.
New York, New York, Population Council, 1985 Oct 5. 3 p.On December 5, 1985, the Population Council announced that the International Planned Parenthood Federation (IPPF) has approved the inclusion of Norplant implants on its commodities list of contraceptives available to its affiliates. This action means that the Norplant method will be available to the 120 IPPF-affiliated national family planning associations once the contraceptive has been approved for distribution by regulatory authorities in each country. IPPF has indicated that it will supply the implants to agencies that: 1) have a sufficient number of health workers who have been formally trained in Norplant insertion, removal, and counseling techniques; 2) have suitable clinic facilities and adequate back-up and referral systems; and 3) can arrange training so that additional health workers will qualify to use this method. The Norplant method was approved by the IPPF Advisory Panel on September 8, 1985, following an 18-month period of review of all available scientific data. The Norplant system has been used in clinical trials in 25 countries involving over 25,000 acceptors. The Population Council has cited the inclusion of Norplant implants in the IPPF program as an important step in the worldwide availability of this contraceptive method. The Population Council has established regional training centers in Indonesia, Egypt, Chile, Brazil, and the Dominican Republic where health care personnel can be trained in techniques of insertion and removal of the impants as well as in counseling potential acceptors.
[Main objectives of the WHO Special Program on Human Reproduction] Osnovnye napravleniia Spetsialnoi Programmy VOZ po Reproduktsii Cheloveka.
AKUSHERSTVO I GINEKOLOGIIA. 1984 Jul; (7):3-6.The WHO Special Program on Human reproduction was established in 1972 to coordinate international research on birth control, family planning, development of effective methods of contraception, and treatments for disorders of the human reproductive system. The Program's main objectives are: implementation of family planning programs at primary health care facilities, evaluation of the safety and effectiveness of existing birth control methods, development of new birth control methods, and development of new methods of sterility treatment. In order to attain these goals, the Program forth 3 major tasks for international research: 1) psychosociological aspects of family planning, 2) birth control methods, and 3) studies on sterility. Since most of the participating nations belong to the 3rd World, the Program is focused on human reproduction in developing countries. The USSR plays an important role in the WHO Special Program on Human reproduction. A WHO Paticipating Center has been established at the All-Union Center for Maternal and Child Care in Moscow. Soviet research concentrates on 3 major areas: diagnosis and treatment of female sterility, endocrinological aspects of contraception, and birth control prostaglandins.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1980 Feb 1; 55(5):33-4.At its final meeting in December 1979, the Global Commission for the Certification of Smallpox Eradication concluded that smallpox eradication has been achieved on a worldwide basis and there is no evidence that smallpox will return as an endemic disease. The 65th session of the WHO's Executive Board, held on January 25, 1980, endorsed these conclusions and made 19 recommendations covering the areas of vaccination policy, reserve stocks of vaccine, investigation of suspected smallpox cases, laboratories retaining variola virus stocks, human monkeypox, laboratory investigations, documentation of the smallpox eradication program, and WHO headquarters staff. Sufficient freeze-dried smallpox vaccine to vaccinate 200 million people will be maintained by WHO in refrigerated depots in 2 countries. WHO will ensure that appropriate publications are produced describing smallpox and its eradication, with special emphasis on the principles and methods that are applicable to other programs.
Development Forum. 1986 Jan-Feb; 14(1):3.China has accelerated its family planning efforts. In 1979 a national policy of 1 child per couple was launched and has been vigorously pursued. Thus far, China's program has had remarkable success. The rate of natural increase was nearly halved in 10 years, from 23.4/1000 in 1972 to 12/1000 in 1982. The average annual population growth rate fell from 2.37% in 1970-75 to 1.17% in 1980-85. Yet, the crisis is far from over. The total population numbers 1.063 billion. The national target is to keep it to 1.2 billion by the end of the century, an increase of less than 20%. On July 1, 1982, after 3 years of intensive preparation, more than 5 million enumerators began the biggest and 1 of the most accurate censuses ever undertaken. The perception of growth which produced the 1 child policy was heightened by the results, which showed China to be the world's 1st "demographic billionaire." The census made it possible to prepare population monographs for each of the 29 provinces and autonomous regions of China. The information gathered has stimulated further development of skills in survey design and analysis, data processing, and publication of population information. 3 new training centers have been opened to supply the demographers and statisticians for further census work. The key to China's population strategy is voluntary family planning practice based on accurate information. The State Family Planning Commission and family planning organizations at national and local levels have mobilized hundreds of thousands of community-based workers in massive family planning publicity and education campaigns. In a country where only 2% of the population has television, face-to-face communication is the norm. An extensive network of trained community-level workers is the basis of China's famous primary health care and preventive medicine system which has been so important in improving the country's health and extending life expectancy from under 40 years in 1950-55 to over 65 in 1980-85. The approach links well with the family planning philosophy. Long before an active family planning program was begun, maternal and child health care had included family planning as 1 means of assuring the health of mothers and children. So vast is China and so great its need that the UN Fund for Population (UNFPA) assistance for family planning is concentrated either on pilot schemes or on a "training of trainers" approach. In the 1st phase of UNFPA assistance, 8 maternal and children's hospitals were selected for UNFPA support in advanced care and training. The biggest share of UNFPA assistance to China in its 2nd phase goes to contraceptive development and production.
New York, New York, UNFPA, 1984 May. xii, 156 p. (Report No. 67)A Needs Assessment and Program Development Mission visited the People's Republic of China from March 7 to April 16, 1983 to: review and analyze the country's population situation within the context of national population goals as well as population related development objectives, strategies, and programs; make recommendations on the future orientation and scope of national objectives and programs for strengthening or establishing new objectives, strategies, and programs; and make recommendations on program areas in need of external assistance within the framework of the recommended national population program and for geographical areas. This report summarizes the needs and recommendations in regard to: population policies and policy-related research; demographic research and training; basic population data collection and analysis; maternal and child health and family planning services; management training support for family planning services; logistics of contraceptive supply; management information system; family planning communication and education; family planning program research and evaluation; contraceptive production; research in human reproduction and contraceptives; population education and dissemination of population information; and special groups and multisectoral activities. The report also presents information on the national setting (geographical and cultural features, government and administration, the economy, and the evolution of socioeconomic development planning) and demographic features (population size, characteristics, and distribution, nationwide and demographic characteristics in geographical core areas). Based on its assessment of needs, the Mission identified mjaor priorities for assistance in the population field. Because of China's size and vast needs, external assistance for population programs would be diluted if provided to all provincial and lower administrative levels. Thus, the Mission suggests that a substantial portion of available resources be concentrated in 3 provinces as core areas: Sichuan, the most populous province (100,220,000 people by the end of 1982); Guandong, the province with the highest birthrate (25/1000); and Jiangsu, the most densely populated province (608 persons/square kilometer. In all the government has identified 11 provinces needing special attention in the next few years: Anhui, Hebei, Henan, Hubei, Hunan, Jilin, Shaanxi and Shandong, in addition to Guangdong, Jiangsu, and Sichuan.
In: State of the world 1985. A Worldwatch Institute report on progress toward a sustainable society [by] Lester R. Brown, Edward C. Wolf, Linda Starke, William U. Chandler, Christopher Flavin, Sandra Postel, Cynthia Pollack. New York, New York, W.W. Norton, 1985. 200-21.The demographic contrasts of the 1980s are placing considerable stress on the international economic system and on national political structures. Runaway population growth is indirectly fueling the debt crisis by increasing the need for imported food and other basic commodities. Low fertility countries are food aid donors, and the higher fertility countries are the recipients. In most countries with high fertility, food production per person is either stagnant or declining. Population policy is becoming a priority of national governments and international development agencies. This discussion reviews what has happened since the UN's first World Population Conference in 1974 in Bucharest, fertility trends and projections, social influences on fertility, advances in contraceptive technology, and 2 major family planning gaps -- the gap between the demand for family planning services and their availability and the gap between the societal need to slow population growth quickly and the private interests of couples in doing so. The official purpose of the 1984 UN International Conference on Population convened in Mexico City, in which 149 countries participated, was to review the world population plan of action adopted at Bucharest. In Bucharest there had been a wide political schism between the representatives of industrial countries, who pushed for an increase in 3rd world family planning efforts, and those from developing countries, whose leaders argued that social and economic progress was the key to slowing population growth. In Mexico City this division had virtually disappeared. Many things had happened since Bucharest to foster the attitude change. The costly consequences of continuing rapid population growth that had seemed so theoretical in the 1974 debate were becoming increasingly real for many. World population in 1984 totaled 4.76 billion, an increase of some 81 million in 1 year. The population projections for the industrial countries and East Asia seem reasonable enough in terms of what local resource and life support systems can sustain, but those for much of the rest of the world do not. Most demographers are still projecting that world population will continue growing until it reaches some 10 billion, but that most of the 5.3 billion additional people will be concentrated in a few regions, principally the Indian subcontinent, the Middle East, Africa, and Latin America. What demographers are projecting does not mesh with what ecologists or agronomists are reporting. In too many countries ecological deterioration is translating into economic decline which in turn leads to social disintegration. The social indicator that correlates most closely with declining fertility across the whole range of development is the education of women. Worldwide, sterilization protects more couples from unwanted pregnancy than any other practice. Oral contraceptives rank second. The rapid growth now confronting the world community argues for effective family planning programs.
Geneva, Switzerland, WHO, 1980. 412 p.This report on the world health situation comes in 2 volumes, and this, the 2nd volume, reviews the health situation by country and area, with the additions and amendments submitted by the governments, and an addendum for later submissions. Information is presented for countries in the African Region, the Region of the Americas; the Southeast Asia Region, the European Region, the Eastern Mediterranean Region, and the Western Pacific Region. The information provided includes the following areas: the primary health problems, health policy; health legislation; health planning and programming; the organization of health services; biomedical and health services research; education and training of health manpower; health establishments; estimates of the main categories of health manpower; the production and sale of pharmaceuticals; health expenditures; appraisal of health services; demographic and health data; major public health problems; training establishments; actions taken; preventive medicine; and public health.
Bulletin of the Pan American Health Organization. 1983; 17(2):212.A World Health Organization (WHO) sponsored scientific meeting concludes that hepatitis B vaccine presents unique opportunities for preventing a common type of human cancer by vaccination. Should these prospects be realized, it would be the 1st time an important human cancer has been prevented in this way. The 5-day meeting, held in February 1983, brought together specialists in biostatistics, epidemiology, molecular biology, pathology, virology, and vaccine development and production from 16 countries. The topic at the meeting was liver cancer, one of the 10 most common cancers in the world and one of the most prevalent cancers in developing countries. The evidence for the implication of hepatitis B virus in the etiology of primary liver cancer is based upon epidemiologic and geographic observations of a strong association between hepatitis B infection and this form of cancer and also upon recent results of molecular biology studies showing integration of hepatitis B viral DNA into the host's genetic material. About 80% of all liver cancers are thought to occur as a result of infection with hepatitis B virus. Actual development of such cancers is believed to proceed through a series of intermediate stages, including establishment of a persistent infection with the virus, the hepatitis B carrier stage, and integration of the virus into the host genome. Worldwide, survival, and persistence of the hepatitis B virus depends on a huge reservoir of human carriers, estimated conservatively to number over 200 million. Prolonged "shedding" of the virus by a portion of these carriers and its transmission to others by various routes helps to account for the high incidence of the disease. In many parts of the world perinatal infection and infection in early life play a very important role in transmission and often lead to continuing infection. Feasibility studies conducted in recent years in several countries with 2 newly developed hepatitis B vaccines demonstrated that immunization of babies can prevent natural infection with hepatitis B virus and also can prevent development of a persistent hepatitis B infection. It seems an appropriate time to take international action to plan and initiate a number of field intervention trials with the new vaccines among populations known to have high prevalence of hepatitis B infection, the hepatitis C carrier state, and liver cancer.
WHO Special Programme of Research, Development and Research Training in Human Reproduction (HRP): summary review of programme activities and recommendations on future policies and management. Report by the SAREC reference group for HRP, November 1982.
Stockholm, Sweden, SAREC, 1983 Apr.  p.This document, a summary view of the Reference Group for Human Reproduction (HRP) developments and achievements over the years, is based on the consideration of results from the 1981 assessment of the program by the Swedish Agency for Research Cooperation (SAREC). An attempt is made to outline broadly the responsibility of the World Health Organization (WHO) in the field of human reproduction research and family planning at large and to define the specific role and time perspective of HRP as a special program. Sweden played an active role in the creation of HRP and since the start has financed a substantial part of the project. HRP was established as a Special Program within WHO, implying the existence of a specific task and a time horizon. HRP was created in 1971, a time of rapidly increasing international efforts to encourage family planning activities in developing nations. Its objectives included contributing to the development of safe and effective contraceptive methods suitable for widespread use especially in the developing countries. Program objectives and activities have grown more complex. HRP activities now include the clinical testing of current contraceptive methods and methods in development, development of new contraceptive methods, health services research, a program of research on infertility, and the strengthening of national scientific resources. HRP has created a network of centers for clinical testing in a number of countries. This network has made possible the testing of methods in different social, cultural, and nutritional settings. To clinical tests of contraceptives should be added assessments of health services implications of the introduction of the methods, including the medical services needed for treatment of risk cases. While not in itself responsible for supporting basic research as a major activity, HRP could play an initiating and mediating role in the contraceptive research and development process. This role should focus on strengthening the links between research strategy and actual experience of family planning in developing countries. In terms of the HRP management structure, the program needs a new structure, one which clearly defines the responsibility for making decisions in different respects and provides for a direct and balanced influence of both developing countries and donors.