A range of heath issues came under scrutiny when Ministers of Health and their senior officials met last week at the World Health Assembly in Geneva. The assembly is the governing body of the World Health Organisation and it meets every year. It started in solemn mood on 22 May morning with the shocking news that the WHO’s Director General Dr. Lee Jong Wook had passed away just two hours earlier, following surgery two days earlier to remove a blood clot on his brain. Dr. Lee, a Korean, had been the WHO Director-General since July 2003 and he had been working at the WHO for 23 years, including in its tuberculosis programme. "It is very sad news," said the Spanish health minister when the Assembly opened. “Dr Lee was an exceptional person and an exceptional Director-General.” The process to elect a new Director General will start soon, and already names are being floated as to who should take over the world’s top health job. As the Assembly started, there was news that a case of human-to-human transmission of avian flu could have taken place when six family members died in Indonesia. The WHO officials were cautious, saying a human-to-human transmission could not be confirmed, but also that it could not be ruled out. Experts are worried that a flu pandemic can emerge when the flu virus evolves a strain that can be passed on among people. So far victims get the disease from contact with poultry. Issues discussed on avian flu included the degree of preparedness by countries to deal with a pandemic, the lack of availability of vaccines, whether the need for stockpiling of drugs has been exaggerated and whether the recommended medicine to treat the virus really works. A major concern running through the Assembly was the effect of patents on the cost of medicines. In particular, many governments expressed opposition to provisions in bilateral trade agreements that remove their ability to make cheaper generic drugs available through compulsory licensing and through the use of safety data provided by the companies producing branded drugs. The Assembly’s biggest decision was to set up a WHO working group to draw up a global strategy and plan of action to follow up on the recommendations made by a WHO commission on intellectual property and health, whose report was recently launched. The resolution establishing the working group noted that the patent system did not meet the need to develop new medicines to fight diseases that especially affect developing countries. The group will propose how to ensure resources and the basis for research and development relevant to diseases that affect developing countries. Today, most of the research is on medicines that sell in developed countries, while little funds go towards developing new vaccines, diagnostic tools and medicines for diseases such as AIDS, malaria and tuberculosis that kill millions in the developing world. The new working group is tasked with proposing an action plan to correct this situation, including by suggesting how to handle the problem of the effects of patents on the prices and availability of health products. Another big issue was what to do with the remaining stocks of smallpox virus which now reside in two centers in the United States and Russia under WHO supervision. Years ago, when smallpox was eliminated, the World Health Assembly authorized the two centers to maintain stocks of the dangerous virus with the aim of destroying them within a few years. However, despite many deadlines for destruction of the stocks, they remain and recently the US proposed to expand research using the virus, including genetic engineering of the smallpox virus. This had raised safety concerns among many governments. At last week’s meeting, many countries asked for a new deadline to destroy the stocks but this was refused by the US and Russia. Proposals to limit and control the research were also not acceptable to the US. As a result, the WHA could not reach agreement on how to deal with this subject, and transferred it to the WHO’s board for further discussion. Many countries, especially from Africa, highlighted the medical brain drain, with their doctors and nurses migrating to rich countries, after receiving expensive education. This has depleted the medical workforce in developing countries, placing heavier burdens on the over-worked personnel who remain and stressing the whole health system. Some countries asked for compensation from the countries receiving the medical personnel, and for ethical recruitment policies. In the end a mild resolution was adopted, urging the rich countries to help fund medical education in developing countries so that more doctors and nurses can be trained, that could serve the needs of the home counties as well as supply personnel for other countries. This is seen by many as an inadequate solution, for it might only increase the number of doctors and nurses to be trained in poorer countries but who would eventually migrate to rich countries. But more direct measures, such as disallowing out-migration of health personnel, or asking for compensation to the “source countries” that have trained the personnel at high cost, are considered too “sensitive.”