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WHO World Health Organization |
The UN in Russia is publishing excerpts from the interview given by Dr Mikko VIENONEN, Special Representative of the WHO Director General for Russia, to The Business Izvestia newspaper (Izvestia Publishing House of the Administrative Department of the President of the RF)
– What is the mission of WHO Office in Russia?
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Our mission is to implement public health promotion programs developed by the
WHO European Regional Office, located in Copenhagen, Denmark, in close collaboration
with the Russian Ministry of Health and regional partnering centers. Last year
the Russian government received about 5 million US dollars from the WHO. The
larger portion of these funds have been spent on TB control and humanitarian
aid programs conducted in the North Caucasus region (Ingush and Chechen Republics).
Like many other UN agencies, we participate in the HIV/AIDS control and healthy
life style promotion programs. Proper nutrition is one of the major health concerns
in Russia. The role of the government in this area is hard to overestimate.
Let’s take dietary salt iodination, for example. In the former Soviet Union
the situation was entirely under control. Today it has become a serious problem.
When children do not intake iodine in sufficient quantities, their development
begins to slow down dramatically. In Russia we are making efforts to lobby a
special law which will require all distributors – various corporations and joint-stock
companies – to iodinate dietary salt.
– What is particularly harmful for the Russian citizens’ health according to the WHO experts?
– Smoking is number one among most harmful things. In Russia 60% of men and 20 % of women are cigarette smokers. Why? Why don’t they understand they are killing themselves and those who happen to be nearby? 700 persons die of tobacco smoking and associated cardiovascular diseases and lung cancer every day! Many of those persons are under forty.
Alcoholism is a health danger number two. It must be pointed out, that there is no direct association between alcoholism and the quality of vodka. Many people drink as much as a bottle of vodka every day, causing a terrible damage to their heart, liver, brain and hormonal system…
– According to the State Duma, near 100,000 die only of low-quality vodka every year.
– This number is scary! However, whereas alcohol in small quantities may be good for one’s health, smoking is always harmful, irrespective of the number of cigarettes smoked. I would like to point out, however, that the WHO doesn’t advocate the introduction of "the Dry Law".
To my mind, number three among the major causes of mortality is "a disease of poverty" – a nickname of tuberculosis. It kills 30,000 patients annually. The WHO position in this regard is the following: today people should not die of tuberculosis! Particularly, in view of the fact, that effective and relatively inexpensive drugs have been recently developed. Four years ago, when I first came to Russia, the price per one TB drug package was as much as $80.00. Do you have any idea what is it’s current price? It is only $20.00! We informed the Russian manufactures that we would purchase TB drugs from foreign companies for lower price with a result that funds provided by the WHO for this purpose would then go to these companies. The Russian manufactures "surrendered" at once.
AIDS has become a primary health concern in Russia. According to the official data, at present 200,000 have been diagnosed as having AIDS in Russia. However, according to our experts, the real number of AIDS-infected persons in the country is more than five times higher.
All these people affected with AIDS, the majority of which are young, will die in the next 10 years. Drugs addiction is the main cause of "the plague of our century", affecting more and more of misfortunate drug users. Also, in many cases the disease has been sexually transmitted from one person to another. There is one specific feature of AIDS. While one may contact tuberculosis by chance, say, in the subway, by simply sitting nearby a patient with an acute form of the disease, AIDS itself chooses its victims out of the most irresponsible and careless persons. Young people think that to make love using a condom is something which deprives them of the real feeling of love (as they would often say, it is "something like trying to smell a flower with a gas mask over the face"). However, once they have already contacted AIDS, nothing will help them. The annual cost of sustaining the life of one person with AIDS is $10,000. In Russia people cannot pay such money. In part, for this reason in the next year the Word Bank plans to increase the portion of funds made available for Russia to conduct the AIDS control, health system development and tuberculosis control programs, while the portion intended for the North Caucasus region will be slightly decreased. It is obvious, however, that these amounts should not be regarded as fully sufficient. Like all other countries, Russia must rely on its inner resources in the development of the local health system.
– What is the situation in the Russian health sector, so to say, "a health rating" in Russia and other countries according to the evaluation of the WHO experts?
– Such a rating system does exist with a rating list including 191 countries. And Russia is number 131 on this rating list. Brazil, Bolivia, Guyana, Peru are close to Russia. Compared to your country, the situation is even worse in Honduras, Sudan, Burkina Faso, Kirgizstan, Turkmenistan, Tajikistan…
– What are structural gaps of the Russian health system as you see it?
– I wouldn’t take a role of a judge, nor speak on behalf of the WHO. I may only share some personal ideas.
To start with, Russia has many health systems, rather than one, and we call them "parallel systems". Taken as a whole, these systems are not very efficient, not to mention their economic value. Specialized hospitals for political elite, governmental officials, Ministry of Transportation employees, Academy of Science workers… It’s something absolutely unknown to the rest of the world! Many countries don’t even have special clinics for their Ministry of Defense staff. Military officers are using medical services provided by the general health system – this is a health policy of all over the world.
Another problem is the fact that regular prophylactic medical examination of children is regarded as a big achievement in Russia. The WHO doesn’t recommend such medical examinations. Regular prophylactic examinations make sense only in case you know for sure what to do next. However, if you cannot go ahead and treat a person, such preventive measures are meaningless; specifically, in Russia this campaign has become simply a formal ritual. Anyway, the WHO recommendations do not have any legal power. The WHO is an advisory, rather than a regulation agency.
– What are your relations with the Russian Ministry of Health?
– I think, Minister Yuri Shevchenko and other officials understand that we, the WHO representatives, are able to help your country in addressing many health sector problems.
– Let’s talk about the problem of private clinics and their drug prescription policies. Physicians of a private clinic diagnosed clamidiosis in an elderly woman and prescribed a lot of drugs for the disease. They also provided the patient with the address of the pharmacy where she could buy the drugs. However, when the patient came to a public clinic it was found that she didn’t have this disease!
– The problem with private clinics and their special relations with selected pharmacies, treatment policies they use prescribing many drugs, which are absolutely useless for patients exists in other countries as well. Clearly, licenses issued for such "clinics" must be revoked. However, I would look into this problem from a wider angle. What are the drugs used to treat patients in Russia? I often ask patient to show me the drugs, which have been prescribed for them. And, to my great dismay, I find that they have to take a lot of drugs, sometimes, useless, and very expensive.
At the same time, the WHO has been working for a long time with drugs, which are essential. The list of essential drugs includes 350 items. That is all! Using a set of essential drugs, patients receive a high quality treatment. And these drugs are cheap.
Do you have any idea how many drugs have been registered in Russia? 10,000 drugs! This situation doesn’t symbolize prosperity, rather it calls for emergency! Various big and small companies have been making benefit from their suspicious experiments with the health of many Russian citizens, not to mention faked and defective drugs.
Just compare the following numbers: in Norway, one of the most prosperous countries of the world the product mix available in pharmacies includes 1000 items of drugs, in Finland they have a bit more – 2000. However, this country is number 31 on the rating list showing nations with well developed and underdeveloped health sector, as I have already mentioned. In Russia, which I repeat is number 131 on the list, the number of available drug items is five times higher. Just imagine, how many of these drugs may be useless and probably harmful. Using such pharmaceutical materials unscrupulous physicians formulate "a cocktail" which may be fatal for a patient. These "physicians" are crippling their patients, rather than curing them.
For those physicians, who are good and scrupulous, and I am sure, in Russia the majority of physicians are really good, I would recommend to look more often into the already mentioned list of 350 essential drugs developed by the WHO.
I haven’t yet told you about my feelings regarding my current position of a Head of the WHO Office in Moscow. I must admit, I really enjoy living in Russia. I have a feeling that I know and understand people. I am honored to work in Russia. I will always think of Russia as of our immediate neighbor and good friend, my second home, where I will be happy to come again and again.
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A team of international biosafety experts appointed by the World Health Organization (WHO) has recently completed an inspection of the smallpox research laboratory at the State Research Centre of Virology and Biotechnology (Vector) in Koltsovo, part of the Novosibirsk Region of the Russian Federation. The inspection team was pleased to note that all previous recommendations on procedures and safety had been addressed.
The team concluded that the facility can safely be used for work with the Variola virus (which causes smallpox) provided that current protocols are strictly applied. The team was also impressed by the dedication and the competence of the workforce at the facility. They were pleased to see that the building dedicated to work with Variola virus was being renovated. A follow-up visit is planned when that work is completed and the laboratories have been validated and are once again fully operational.
Vector is one of two WHO Collaborating Centres which currently house stocks of the virus which causes smallpox. The other is at the Center for Disease Control and Prevention in Atlanta, Georgia, the United States of America.
Under the terms of a series of resolutions passed by the World Health Assembly since the eradication of smallpox was officially confirmed in 1980, these facilities are regularly inspected by WHO-appointed biosafety teams. The most recent resolution, passed in May 2002, specifies that the purpose of the inspections is to confirm the strict containment of existing stocks and to ensure a safe research environment for work with the Variola virus.
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In November 2002 the Mission Team of five members representing
the WHO TB Control Programme in Russia, UNOPS 
as
well as the Russian Ministry of Health and Russian partnering medical institutions
went on an Assessment Mission to study the TB control situation in Evenkya.
The Mission was initiated by the Administration of Evenkya that had requested
the assistance of WHO. Russian Oil Company YUKOS, a signatory of the UN Global
Compact, supported the Mission financially as the planned TB control project
is a part of the long-term cooperation of YUKOS with the UN aimed at the development
of Evenkya.
Evenk Autonomous Okrug situated in Eastern Siberia is going through a hard time of administrative reform and social change trying to address the pressing issues of high unemployment, poor living conditions, alcoholism and deteriorating health of the population. As the Mission Team concluded, at this background, tuberculosis has become a primary health concern with the incidence more than two times higher than Russian average.
The goal of the Mission was to assess the quality and organization of detection, diagnostics and treatment of tuberculosis in the Okrug. The needs of the Okrug in terms of logistical support of the TB Control activities were explored. The Mission was targeted at preparation of a set of recommendations for improvement of TB Control activities within the WHO approach as well as identification of the additional elements of the project that should supplement TB control measures.
The Mission concluded that current TB control measures are insufficient and often poorly organized and monitored. In many situations effectiveness of treatment is directly linked to issues of transportation and communication, a serious concern in the vast territory that hardly has any roads and no phone connection between remote villages. It is evident that social problems represent a root cause of high TB incidence. Lack of motivation and social deprivation are particularly noticeable among inhabitants of remote villages, many of whom represent the ever-decreasing population of indigenous peoples of the North.
The results of the Mission were summarized in the Mission report in which the situation is analyzed and major recommendations are given that should lay basis for the formulation of the project document. The project that YUKOS is ready to finance at the initial stages, should aim at introducing the WHO approach to detection, diagnostics and treatment of TB; training local medical staff; re-equipping the TB laboratories and creating a sustainable system of TB control in the Okrug. In addition, several project components such as capacity building of local administrators, support of anti-alcoholism measures and promotion of local employment will contribute to improvement of social support within TB Control activities. The project implemented by WHO and managed by UNOPS is expected to commence in early 2003.