To what extent does the WHO play a political and/or humanitarian role in countries whose political atmospheres exacerbate or ignore health problems? In other words, does the WHO ever act as a political intermediary in countries mired in regressive or harmful policies?

One of WHO’s primary roles is to assist its 192 member states in attaining the highest possible level of health. WHO has 147 country and liaison offices working daily in countries on this objective. WHO has also set public health standards on which member states have agreed through resolutions at the World Health Assembly. As public health advocates, we remind member states that investing in health is an investment in a country’s future. WHO has demonstrated that spending money now on health services now not only saves and protects lives—which is the most important aspect—but also leads to economic growth.

Of course, WHO also has an important coordination role to play in countries where there is conflict or an emergency. There the organization can provide expertise and advise authorities of the best way to help protect people’s health. In these situations we are particularly concerned with the most vulnerable: children, women, the disabled, and the chronically ill.

Pulitzer Prize-winning journalist Laurie Garrett sounded the alarm about increasingly antibiotic-resistant bacteria, noting that even strains of strep throat are becoming resistant. Do you agree with Garrett’s analysis, and to what extent is WHO engaged on this issue?

WHO is certainly concerned about the rise of resistance to medicines and is actively engaged in both drawing attention to the problem and finding solutions. This problem requires urgent action in both developing and developed countries. For example, WHO recently released a report on the rising rate of Multi-Drug-Resistant Tuberculosis, particularly in eastern Europe. New data in the report showed geographical concentrations of TB drug resistance across the Commonwealth of Independent States. Six out of the top ten global hot spots are: Estonia, Kazakhstan, Latvia, Lithuania, parts of the Russian Federation, and Uzbekistan, with drug resistance in new patients as high as 14 percent.

WHO is also working with a number of countries to assist in the transition from malaria medicines, which have lost some of their efficacy, to newer, more effective but more expensive combination medicines. The transition to a new medicines regimen is not a simple one, but it is essential. And of course, an essential aspect of the 3-by-5 HIV/AIDS treatment strategy will be to monitor for resistance to antiretroviral therapy, so we can stay in front of this critical issue.

What is the WHO’s stance on genetic engineering?

The latest advances in genome research could result in clinical applications for many diseases. However, genetic engineering technology, including modification of plant and animal genes, raises extremely important ethical, legal, and safety issues that merit careful monitoring and control. The potential risk must never be underestimated, and effective regulatory systems should be established. There is a need also for mobilizing more resources for genomic research in developing countries—something that is true for many areas of health research.

What implications might genome research have for the mitigation of global disease? Could it help to lower the cost of treatments?

Contemporary genome research will be an incalculable resource for the future of medicine. Also, many gene mutations that cause diseases have been identified and used as a basis for clinical diagnosis. Annually, 7.6 million children are born with a severe genetic disorder or birth defect, with 93 percent of these infants born in the developing world. There is abundant evidence that inborn errors of metabolism and inherited conditions such as blood disorders (thalassaemia, hemophilia, sickle cell disorder) could be con­trolled.

Significant progress has also been made in understanding the genetic basis of multi-factorial diseases and common chronic diseases such as cardiovascular dis­ease, cancer, diabetes, the major psychoses, dementia, rheumatic disease, asthma, and many others. Researchers believe that the information gen­erated by genomics will, in the long term, yield major benefits for many of these diseases and hence the development of completely new approaches to prevention and therapy. Researchers have already identified some of the genes responsible for drug resistance in pathogens leading to tuberculosis, AIDS, and malaria. The diagnosis of leishmaniasis and dengue fever has already been improved by the use of polymerase chain reaction (PCR) and non-radioactive DNA probes.

In the next decade, scientists expect drug doses may be tailored to the particular biochemical composition of a patient. Drugs will thus become more precisely designed and, eventually, more effective, with fewer side effects.

Would genetically engineered foods help to increase the production and distribution of agricultural products to the third-world? Or are genetically engineered foods more harmful than helpful?

Overall, WHO is involved in modern biotechnology in two major ways. The first is in the need to examine the potential opportunities for public health. Examples are crops nutritionally enhanced with vitamin A and crops with improved quality to reduce allergenicity. The second area we must examine concerns any potential negative effects on human health. To this end, WHO, along with the Food and Agriculture Organization of the United Nations (FAO), has hosted a series of ongoing consultations to examine the issues involved, but this work is still ongoing.

What is the WHO doing to address the issue of undernourishment and starvation-related deaths in impoverished countries?

The links between nutrition and health are clear, starting from infancy and continuing throughout life. But it is the first five years, when a child is growing and developing rapidly, that are critical. WHO works closely with several partners in this area.

For example, WHO and the United Nations Children’s Fund (UNICEF) share responsibility for reporting on the child nutrition-related Millennium Development Goal of halving the proportion of people who suffer from extreme hunger by 2015. To this end, WHO maintains a global database on child growth and malnutrition. Regular information gathering and dissemination help us determine where progress is being made and where children are falling behind.

WHO and UNICEF have recently developed a global strategy for infant and young child feeding—a road map of interventions with a proven positive impact—and we are guiding countries in its implementation and monitoring.