WMJ 2 2016 WEB

COUNTRY
vol. 62
Medical
World
Journal
Official Journal of The World Medical Association, Inc.
ISSN 2256-0580
Nr. 2, June 2016
Contents
Bioterrorism.The Question is – When? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
203rd
WMA Council Session, Buenos Aires, April 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
WMA Council Resolution on Refugees and Migrants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
WMA Council Resolution on Zika Virus Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
World Health Assembly Week . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Council of Europe. Recommendation on Biobanks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Zika virus infection and pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Istanbul Symposium on War, Migration and Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Southeast European Medical Forum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Bulgarian Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Chinese Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Finnish Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Malaysian Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Myanmar Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Rwanda Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Slovak Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Swedish Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Swiss Medical Association (SMA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Medical Association of Thailand (MAT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Zambia Medical Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Editor in Chief
Dr. Pēteris Apinis, Latvian Medical Association, Skolas iela 3, Riga, Latvia
Phone +371 67 220 661
peteris@arstubiedriba.lv, editorin-chief@wma.net
Co-Editor
Prof. Dr. med. Elmar Doppelfeld, Deutscher Ärzte-Verlag, Dieselstr. 2, D-50859 Köln, Germany
Assistant Editor
Maira Sudraba, Velta Pozņaka; lma@arstubiedriba.lv
Journal design and
cover design by
Pēteris Gricenko
Layout and Artwork
The Latvian Medical Publisher, “Medicīnas apgāds”, President Dr. Maija Šetlere, Skolas street 3, Riga, Latvia
Publisher
The Latvian Medical Association, “Latvijas Ārstu biedrība”,
Skolas street 3, Riga, Latvia.
ISSN: 2256-0580
Sir Michael MARMOT
WMA President
British Medical Association
BMA House,Tavistock Square
London WC1H 9JP
United Kingdom
Dr. Donchun SHIN
WMA Chairperson of the Finance
and Planning Committee
Korean Medical Association
46-gil Ichon-ro
Yongsan-gu, Seoul 140-721
Korea
Prof. Dr. Frank Ulrich
MONTGOMERY
WMA Vice-Chairperson of Council
Bundesärztekammer
Herbert-Lewin-Platz 1 (Wegelystrasse)
10623 Berlin
Germany
Dr. Xavier DEAU
WMA Immediate Past-President
Conseil National de l’Ordre des
Médecins (CNOM)
180, Blvd. Haussmann
75389 Paris Cedex 08
France
Dr. Joseph HEYMAN
WMA Chairperson
of the Associate Members
163 Middle Street
West Newbury, Massachusetts 01985
United States
Dr. Masami ISHII
WMA Treasurer
Japan Medical Assn
2-28-16 Honkomagome
Bunkyo-ku
Tokyo 113-8621
Japan
Dr. Heikki PÄLVE
WMA Chairperson of the Medical
Ethics Committee
Finnish Medical Association
P.O. Box 49
00501 Helsinki
Finland
Dr. Miguel Roberto JORGE
WMA Chairperson of the Socio-
Medical Affairs Committee
Brazilian Medical Association
Rua-Sao Carlos do Pinhal 324,
CEP-01333-903 Sao Paulo-SP
Brazil
Dr. Ardis D. HOVEN
WMA Chairperson of Council
American Medical Association
AMA Plaza, 330 N. Wabash,
Suite 39300
60611-5885 Chicago, Illinois
United States
Dr. Otmar KLOIBER
Secretary General
World Medical Association
13 chemin du Levant
01212 Ferney-Voltaire
France
World Medical Association Officers, Chairpersons and Officials
Official Journal of The World Medical Association
Opinions expressed in this journal – especially those in authored contributions – do not necessarily reflect WMA policy or positions
www.wma.net
41
There is no way to stop scientific progress.Modern biology is a dou-
ble-edged sword. The key question is: whose are the hands holding
the biological agent, for example, an instrument for manipulating
the anthrax bacteria or the bird flu virus H5N1 genes? Typically,this
instrument would be locked up in a safeguarded laboratory located
in a developed democratic country. It is not good any longer if it
happens to be in the hands of avaricious researchers from a weak
and collapsing economy that are ready to sell it to a “trustworthy
and moneyed business partner from the East”.
A large amount of antibiotics in the armoury of a greedy owner of a
fish breeding farm, a gigantic poultry or pig farm is a hazard when
these people, ignoring international laws, start seeking for illegal
additional profit of a million dollars. This could possibly happen in
a country where labour is cheap and law is weak.
Bioterrorism threat is rapidly increasing worldwide. This is fuelled
both by political processes and scientific progress. The microorgan-
isms causing dangerous infectious diseases that can be used as bio-
logical weapons have been thoroughly researched, and the informa-
tion often is broadly accessible, including for potential terrorists.To
arrange a bioterrorism act is much less costly, less conspicuous and
therefore more realistic than any other type of broad-based attack to
a country or a group of countries.
Currently there is no uniform definition of terrorism that would
be correct from the legal aspect. As a matter of fact, terrorism is a
violent combat method that one group of people exercises against
another group of people having an alternative persuasion, with a
purpose to attain political, religious or other goals. Biological ter-
rorism or bioterrorism is a deliberate dissemination of a biological
agent, for example, a pathogenic microorganism, with the purpose
to cause a human disease and death, and to create confusion, panic
and fear in the society.
According to the experts, the use of biotechnology methods for ter-
roristic aims is an ever increasing reality; consequently, the risks of
bioterrorism are rapidly building up as well.The use of one or several
biological agents with terroristic aims is unavoidable. Under certain
circumstances, most of infectious diseases can be dangerous both
to an individual and to the society. However, some microbes are
especially hazardous,because they are highly contagious,pathogenic
and virulent. Human infections and parasitic diseases are particu-
larly dangerous. They have a capability of developing a malignant
clinical course, spreading rapidly, and in such situation an absence
of effective preventive measures and treatment will jeopardise the
health of each individual and the society in general.
According to the USA Department of Homeland Security, the
most dangerous microorganisms are Variola major, Bacillus anthra‑
cis, multidrug resistant Bacillus anthracis, Yersinia pestis, Rickettsia
prowazekii, the Ebola virus, the Marburg virus, Clostridium botu‑
linum toxine, Burkholderia mallei, Burkholderia pseudomallei, Fran‑
cisella tularensis.
To a large extent, people themselves have made these causal agents
resistant and have created mutations.The idea of any living being is
survival, and this is true in respect of an individual in short-term as
well as in respect of a group of similar individuals, such as species.
Life on the Earth is a struggle to survive, and it is on-going at mul-
tiple levels. As soon as man discovered antibiotics, bacteria started
their struggle to survive – they had an option to develop resistance
or to die.The strongest survived. From the physicians’point of view,
these robust and resistant bacteria are the bad ones, while from the
point of view of other bacteria they are the heroes.
Now it is time that man and the human race start their struggle to
survive in the occasion of a bioterrorism act or a highly resistant
pathogenic microbe or a modified virus stem spreads. Let me re-
mind you that in 2014 Yoshihiro Kawaoka from the University of
Wisconsin-Madison in the USA modified the H1N1 bird flu virus
stem that it is no longer recognised by a human immune system.
Such virus becomes exceedingly dangerous and is a potential causal
agent of a new pandemic!
The World Medical Association is the sole global organisation that
has the ability of creating a synthesis of medical, preventive, eco-
nomic and political aspects for preserving the continuity of man-
kind. We are facing serious challenges. Let us start with the “One
World, one Health” approach, and this year let us start waging war
against unjustified use of antibiotics on a global scale.
Pēteris Apinis, 
Editor in Chief, WMA
Bioterrorism.The Question is – When?
BACK TO CONTENTS
42
WMA News
Council
The 203rd
Council meeting at the Sheraton
Convention Centre in Buenos Aires, Ar-
gentina was officially opened by Dr. Ardis
Hoven, Chair of Council. Her first task was
to welcome Dr.  Jorge Lemus, Argentina’s
Minister of Health, to officially open the
proceedings.
Dr.  Lemus spoke about the new health
challenges facing the medical profession
and the importance of the social determi-
nants of health and issues such as poverty,
lack of health, housing and proper drink-
ing water.This meant that health and well-
being was an inter-sectorial matter where
they had to establish partnerships with
other sectors in order to meet their goals.
He had been emphasising the importance
of the social determinants for many years.
This was a key issue in tackling the prob-
lems of Argentina and the region, as well
as globally. At present the region was also
faced with the Zika virus, which was an
environmental matter due to the tropi-
calisation of the weather. These were is-
sues facing physicians and he hoped that
the WMA meeting would reach important
decisions.
Dr. Jorge Coronel, President of the Medi-
cal Confederation of the Republic of Ar-
gentina, welcomed more than 100 WMA
delegates from 35 national medical as-
sociations. He spoke about the need for
the active participation of physicians in
solving the problems facing Argentina,
including violence which was seen in hos-
pitals and clinics. There had been deaths
of physicians, which was a matter for
enormous sadness. It was also the fact that
physicians’ working conditions needed to
be improved. Doctors lacked the neces-
sary means and materials to take care of
patients.
Council
The WMA Secretary General Dr.  Otmar
Kloiber reported that there were two new
members of Council, Prof Brian. Owler
representing the Australian Medical As-
sociation, who was present, and Dr. Mark
Porter from the British Medical Associa-
tion, who was not able to be present, be-
cause of industrial action by the junior doc-
tors in England.
President’s Report
In his interim report, WMA President Sir
Michael Marmot reminded the meeting
that his mission as President was to encour-
age doctors’ involvement in the social de-
terminants of health and health equity. To
support this mission, he had set out three
aims – that the WMA issue a statement on
social determinants of health and health eq-
uity and produce a supporting publication
that would answer the question: “what do
we do?”; to promote regional networking;
and to support post-graduate education and
training.
He said the WMA statement had been is-
sued as the Declaration of Oslo and a docu-
ment had been introduced answering the
question from physicians about what they
could do. This emphasised five domains of
activity – education and training, seeing the
patient in a broader perspective, the health
service as employer and its impact on the
local community, working in partnership
and advocacy.
On networking, he reported keen interest
from most regions of the world and gave ex-
amples from the Americas, Africa, Europe,
Asia and Oceania.
Sir Michael concluded by saying that he had
been enormously impressed by the enthusi-
asm he had encountered among physicians
on the social determinants of health and he
ended with the words: ‘We are all working
in the cause of social justice and health’.
Secretary General’s Report
Dr. Kloiber submitted a lengthy written re-
port about the activities of the Association
over the past year. He spoke briefly about
new translations of the WMA’s Medical
Ethics manual. He also reminded Coun-
cil about two forthcoming meetings, the
World Health Professions Alliance Con-
ference on Regulation in Geneva (May 21
and 22) and the One Health Conference, in
Fukuoka, Japan (Nov. 10–11) together with
the Japan Medical Association and the Ja-
pan Veterinary Association.
Chair’s Report
Dr.  Hoven submitted her written report.
She referred to the Governance Work
Group and said that it was larger than
normal work groups because it was impor-
tant to have as much diversity as possible
in the representation. In addition to those
that had expressed an interest in participat-
ing, representation from the Junior Doctors
Network, the Associate members, and Past
Presidents and Chairs group had been in-
cluded in the work group. She looked for-
ward to their efforts on behalf of the WMA
and was optimistic that a more transparent
and representative organization would be
accomplished in order to maximize the As-
sociation’s advocacy and impact throughout
the world.
Referring to the WMA Expert Meeting on
Health Databases in Seoul that had been
held, Dr.  Hoven said she had been im-
pressed by the depth of knowledge of those
involved and the detailed examination of
information necessary to successfully com-
plete this work. She said it was imperative
that they listened to all the voices speaking.
She also looked forward to attending for
the first time the WMA Caring Physicians
of the World Medical Leadership, Com-
munication and Advocacy Course in Jack-
203rd
WMA Council Session,
Buenos Aires, April 2016
43
WMA News
sonville, Florida and said that this course
through the years had received great ratings
from those who have attended from nation-
al medical associations (NMAs).
Emergency Resolution
The Turkish Medical Association submit-
ted an emergency Resolution on Refugees
and Migrants, presented by Dr.  Bayazit
Ilhan. He said the Resolution was based
on a communique following the sympo-
sium held in February in Istanbul on War,
Migration and Health. Large numbers of
people were presenting at borders seeking
refuge or asylum. Some were fleeing war
zones or other conflicts, others were fleeing
from desperate poverty, violence and other
appalling injustices and abuse. The global
community was ill prepared for this mass
movement of people and had responded
by closing borders, seeking to turn back the
influx. What should physicians do in these
circumstances? He said the emergency Res-
olution included a number of recommenda-
tions emerging from the symposium.
Delegates agreed that the Resolution
should be considered by Council later in the
meeting.
Medical Ethics Committee
Dr.  Heikki Pälve (Finnish Medical Asso-
ciation) took the Chair.
The Committee received the Secretary
General’s oral report. Dr. Kloiber said sev-
eral important issues had emerged since
the Moscow Assembly. The first was the
occurrence of gene editing systems, which
had raised some ethical concerns around
the world. For the first time it gave the op-
portunity to do germ line changes in our
genetic inheritance and this was something
that had ethical implications and which the
WMA had to look into. The second item
referred to research ethics according to the
Declaration of Helsinki and the work of
ethics committees. These were issues the
WMA needed to consider.
The third item was the work being carried
out on medical ethics in times of armed
conflict, which had been referred to the Se-
curity Council of the United Nations.
Person Centered Medicine
The Committee received an oral report
of the Person Centered Medicine Work
Group, presented by Prof. Vivienne Na-
thanson (British Medical Association).
She said work was proceeding on the basis
of definitions drawn up by the group. She
hoped that by the next meeting they would
be able to present the committee with a
draft policy paper.
Health Databases and Biobanks
Dr.  Jon Snaedal (Iceland), Chair of the
Work Group on Health Databases and Bio-
banks, gave an oral report about the work of
the group considering a proposed Declara-
tion on Ethical Considerations regarding
Health Databases and Biobanks. Over the
past four years there had been several open
expert meetings and the document had
gone through almost a dozen revisions. He
proposed that the group’s current briefing
paper be circulated to NMAs and that the
Work Group be allowed to include discus-
sion with partners outside the WMA. He
hoped that WMA policy would be adopted
by the next Assembly in October following
another face to face meeting of the Work
Group.
The committee agreed to circulate the
proposed Declaration on Ethical Consid-
erations regarding Health Database and
Biobanks to NMAs, that comments be in-
vited from expert organisations outside the
WMA and that a further meeting of the
Work Group should take place in Septem-
ber to finalise a document to be presented to
the Council in Taipei.
Declaration of Geneva
An oral report was given by Dr.  Ramin
Parsa-Parsi (German Medical Association),
Chair of the Work Group considering the
revision of the Declaration of Geneva. He
said the group was planning a final draft for
consideration at the October 2017 General
Assembly session in Chicago, because he
did not want this work to be confused with
the current debate on the high level data-
base policy document. Further discussion
would take place at the committee meeting
in Taipei in October this year when a draft
document would be submitted. Fruitful dis-
cussions had been continuing and he urged
NMAs to complete and return the survey
that had been sent out on the use of the
Declaration of Geneva.
Participation of Physicians in
Pre-Natal Gender Selection
The Committee considered a Proposed
Revision of the WMA Statement on the
Participation of Physicians in Pre-Natal
Gender Selection submitted by the Swiss
Medical Association, which had been cir-
culated to all NMAs. This urges all NMAs
to recommend their national governments
to adopt laws and regulations that would
prohibit the use of prenatal sex-selection
for reasons of gender-preference. The
Statement calls for the installation of pro-
tection mechanisms for those physicians
who refuse to participate in pre-natal diag-
nostic tests and abortions performed solely
for reasons of gender preference, excluding
sex selection of a fetus or pre-embryo for
purposes of avoiding a severe sex-linked
disease.
After a brief debate it was agreed to send
the document back to the rapporteur to
analyze in relation to existing WMA policy
on related topics. If the substance of the
Statement is not sufficiently covered in the
existing policies, the Statement will be re-
considered by the committee.
Euthanasia and Physician
Assisted Dying
The Royal Dutch Medical Association,
together with the Canadian Medical
BACK TO CONTENTS
44
WMA News
­
Association, presented a proposed State-
ment on Euthanasia and Physician Assist-
ed Dying. Speakers from the two NMAs
said they were aware these issues were
very controversial. What was required was
a fair, open and respectful debate on the
diversity of views that existed on this issue
as well as scope and respect for diverging
views.
Following a lengthy debate about whether
or not to circulate the document among
NMAs, it was decided that it should be cir-
culated.
Quality Assurance in
Medical Education
Dr.  Steven Stack (American Medical As-
sociation) proposed a new Declaration on
Quality Assurance in Medical Education,
addressing the issue of the quality of un-
dergraduate medical education and medical
schools.
Delegates welcomed the document and the
committee agreed it should be circulated to
NMAs for consideration.
Classification of 2006 Ppolicies
The committee reviewed the recommenda-
tions received for revising medical ethics
policies for which it had been 10 years since
adoption or last revision.
It recommended the following actions:
Council Resolution on Organ Donation in
China
The committee agreed to reaffirm the Reso-
lution. Dr.  Kloiber said he would contact
the Chinese Medical Association to request
information on the current situation con-
cerning organ transplantation and whether
obtaining organs from prisoners was still
practiced in China.
Declaration of Geneva
The committee agreed that consideration of
the Declaration be postponed pending the
outcome of the Work Group on this docu-
ment.
International Code of Medical Ethics
The committee agreed that the Code be
postponed pending the outcome of the
Work Group on this document.
Declaration of Sydney
The committee agreed that the Declaration
on the Determination of Death and the Re-
covery of Organs be reaffirmed with minor
revisions.
Declaration on Therapeutic Abortion
It was decided to reaffirm the Declaration
with minor revisions.
Declaration of Tokyo with guidelines for
Medical Doctors concerning Torture and other
Cruel, Inhuman or Degrading Treatment or
Punishment in relation to Determination and
Imprisonment
It was decided to reaffirm the Declaration
with minor revisions.
Declaration of Venice on Terminal Illness
The committee agreed that this Declaration
undergo a major revision.
Declaration of Malta on Hunger Strikers
It was agreed that the Declaration should
undergo a major revision.
Statement on Combating HIV/AIDS and the
Medical Profession Statement on HIV/AIDS
and the Medical Profession
It was agreed that this Statement be re-
scinded and archived.
Statement on Child Abuse and Neglect
The committee agreed that this Statement
be reaffirmed with minor revisions.
Statement on Animal Use in Biomedical Re‑
search
It was agreed that this Statement be reaf-
firmed.
Statement on Patient Advocacy and Confiden‑
tiality
The committee agreed that this Statement
be reaffirmed.
Statement on Medical Ethics in the Event of
Disaster
It was agreed that this Statement be reaf-
firmed with minor revisions.
Statement on Weapons of Warfare and Their
Relation to Life and Health
It was agreed that this Statement be reaf-
firmed with minor revisions.
Statement on Assisted Reproductive Technolo‑
gies
It was agreed that this Statement undergo a
major revision.
Statement on HIV/AIDS and the Medical
Profession
It was agreed that this Statement undergo a
major revision.
Human Rights
Clarisse Delorme, the WMA’s Advocacy
Advisor, referred to the recent joint Turkish
Medical Association/WMA Conference on
War, Migration and Health held in Istan-
bul, and on related activities in Turkey and
Egypt.
Socio-Medical Affairs
Committee
Dr. Miguel Roberto Jorge (Brazil) took the
Chair.
Dr. Kloiber spoke about the global activity
on the social determinants of health and he
urged NMAs to involve themselves in this
area.
He also said they were still seeing a strong
reluctance to immunization around the
world.This included poor countries that did
not have enough resources to do immuniza-
tion, as well as a rejection in affluent coun-
tries sometimes based on weird arguments.
Sometimes, even physicians were involved
in spreading this reluctance.
He said that a number of NMAs had been
working on the issue of illegal drugs and
drug overdoses. There had been an increas-
45
WMA News
ing number of fatalities from illegal drug-
related use and from prescription drugs.
There was also a global tendency to legalise
drugs, for instance in some states in US.
Finally, he said that tobacco control had
not been properly addressed in many coun-
tries and there was still an agenda there for
NMAs to consider.
Health Care in Danger
Dr. Bruce Eshaya-Chauvin, from the Inter-
national Committee of the Red Cross and
coordinator of the Health Care in Danger
Project, reported on the recent activities of
the project.This included a resolution on the
ethical principles for health professionals in
conflict zones, which was to be discussed in
the UN Security Council.Delegates heard a
report on the activities of the WMA Work-
group on Health Care in Danger which had
met the previous day, including discussion
about further incidents of violence against
health care professionals.
Role of Physicians in Preventing
the Trafficking with Minors
and Illegal Adoptions
The Spanish Medical Association reported
that the Work Group had met the previ-
ous day. It had agreed on a proposal for a
WMA Statement on the Role of Physi-
cians in preventing Trafficking with Mi-
nors and Illegal Adoptions.This denounces
all forms of human trafficking, especially
those that involve children, and puts for-
ward proposals for action that physicians
could take.
It was agreed that the document should be
circulated among members for comments.
Armed conflicts
Dr. Dongshun Shin (Korean Medical As-
sociation) reported on the activities of the
Work Group that had been asked to look at
three proposals submitted to the Council in
Moscow – Territorial Disputes and Armed
Conflicts, Children in Armed Conflicts and
Triggering Armed Conflicts – with the aim
of preparing a single proposal. A new pro-
posed WMA Statement on Armed Con-
flicts, drawing on all these documents, was
the result.
The committee considered the new docu-
ment and agreed that it should be circulated
among NMAs for comments.
Occupational Health
Dr.  Mzukisi Grootboom (South African
Medical Association) reported on the ac-
tivities of the Work Group that had been
tasked with looking at three proposed poli-
cies submitted to the Council in Moscow –
Occupational Health, Workers Health
& Safety and Protection Reproductive
Health – with the aim of preparing a single
proposal. A new Resolution on Occupa-
tional and Environmental Safety as well
as Gender Aspects was submitted and the
committee agreed the document should be
circulated to NMAs.
Ageing
Dr. Nivio Moreira (Brazilian Medical As-
sociation) reported on the activities of the
Work Group on Ageing. It put forward a
proposal for a Statement on Ageing with
recommendations to improve the care of el-
derly people throughout the world. During
a debate, delegates discussed the need to in-
clude the provision of secondary health care
for the elderly, including the psychosocial
aspects of managing care. The committee
agreed that the document, as amended, be
approved by the Council and be forwarded
to the General Assembly for adoption.
Boxing
A proposed revision to the WMA State-
ment on Boxing was introduced by the
South African Medical Association. This
puts forward new recommendations for ad-
ditional action to be taken until boxing is
completely abolished. In a brief debate, it
was decided that the document was not yet
ready for adoption and it was agreed to cir-
culate the document to NMAs.
Tobacco
The Committee considered a proposed
revision from the Australian Medical As-
sociation of the WMA Resolution on the
Implementation of the WHO Framework
Convention on Tobacco Control.The docu-
ment, which recognizes the importance of
the Framework as a mechanism to protect
people from exposure and addiction to to-
bacco, was approved and the committee
agreed to send it to the Council for for-
warding to the General Assembly for adop-
tion.
Obesity in Children
A proposed WMA Statement on Obesity
in Children was submitted by the Israel
Medical Association. There was a debate
about whether this document should be
combined with the WMA’s more general
statement on obesity. It was also suggested
that the document should highlight more
prominently the social determinants of
health and the role of educating parents in
preventing child obesity.
The committee agreed to recirculate the
Statement to NMAs for reconsideration
and that the Statement on the Physician’s
Role in Obesity, currently under the 10
years’ review process, be examined at the
same time, to ensure coherence between the
two policies.
Physicians’ Right to Information
The committee considered the proposed
WMA Declaration on Physicians’ Right
to Information about the World Medical
Association and its Policies, submitted to
the Assembly in Moscow by the Russian
Medical Society. After considerable de-
bate, the committee recommended that
further consideration of the document be
postponed to the next meeting in Taipei in
October.
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46
WMA News
Professional Autonomy of Physicians
The committee considered the proposed
WMA Declaration on Professional Auton-
omy of Physicians as the Main Condition
for Implementation of the Human Right
to Health. The Russian Medical Society,
which originally submitted the document,
asked for the document to be withdrawn,
and this was agreed by the committee.
Fossil Fuel Divestment
The proposed Statement on Divestment in
Fossil Fuels was considered. The Statement
urges national medical associations to raise
awareness of the negative health effects
caused by fossil fuel pollution and climate
change, and to shift their investment port-
folios toward renewable clean energy gen-
eration.
After several delegates said that there were
still some issues to be resolved, the commit-
tee decided the Statement needed further
reconsideration and recommended that it
should be recirculated to NMAs for com-
ments.
Global Medical Electives
A proposed WMA Statement on Ethi-
cal Considerations in Global Medical
Electives was considered by the commit-
tee. The document from the Junior Doc-
tors Network proposes ethical guidelines
concerning medical trainees participating
in global educational experiences. After a
brief debate the committee recommended
the Statement be approved by the Council
and forwarded to the General Assembly
for adoption.
Health and Environment
Dr. Dongshun Shin, Chair of the Environ-
mental Caucus, reported on the activities of
the Caucus that had met earlier that day.
The meeting had focused on the outcome
and follow-up of the Inter-Governmental
Climate Change Conference in Paris in
December 2015 and on air pollution. He
said it was important to activate national
and regional action to raise concern on
these issues.
Friday April 29
The second day of the meeting
continued with the Socio-
Medical Affairs Committee
Female Genital Mutilation
The committee considered a proposed re-
vision of the WMA Statement on Female
Genital Mutilation Physicians. This en-
courages national medical associations to
become more active in campaigning to end
the practice of female genital mutilation.
Prof. Nathanson explained the changes of
wording to clarify the document’s advice to
physicians.
After a debate, the committee recommend-
ed that the document as amended be ap-
proved by the Council and forwarded to the
General Assembly for adoption.
Body Searches of Prisoners
The committee considered a proposed re-
vision of the WMA Statement on Body
Searches of Prisoners. This led to a debate
on clarifying the guidance for physicians
who are directed to conduct body searches
and the issue of consent. There was also a
discussion on the document’s reference to
searches involving transgender people.
Following the debates, the committee rec-
ommended that the document, as amended,
be approved by the Council and forwarded
to the General Assembly for adoption.
Cyber Attacks on Health and
other critical infrastructures
The German Medical Association submit-
ted a proposed Statement on Cyber-Attacks
on health and other critical infrastructures
arguing that the WMA and NMAs should
be urging governments to take all neces-
sary measures to guard against this threat.
Delegates were told that attacks on critical
infrastructure, including hospitals, were on
the rise, posing a threat to patients’ funda-
mental right to data privacy and safety. As a
result, it was essential to raise awareness of
this problem by anticipating and defending
against such cyber intrusions. It was argued
that physicians were simply not aware of the
extent of this problem, which included the
risk of records being manipulated.
The committee agreed to circulate the paper
to NMAs for consideration.
Zika virus
The Committee considered a proposed
WMA Statement on the Zika virus infec-
tion calling on the World Health Organ-
isation to work with disease control organ-
isations to better understand the natural
history and current epidemiology of the
infection. It was argued that this was an in-
ternational health emergency and was go-
ing to affect people throughout the world.It
was causing a great deal of distress and what
physicians needed was consistent advice to
use with their patients or for people think-
ing of travelling to affected areas. Delegates
debated whether there should be one state-
ment on pandemics as well as resolutions
on specific viruses. The committee agreed
that the Statement should be changed into
a Resolution.
During the debate that followed, various
amendments were agreed, and delegates
heard reports from Latin American NMAs
about the current situation in their coun-
tries, including the lack of information be-
ing received by physicians.
At the conclusion of the debate, the com-
mittee agreed that the document,as amend-
ed, should be forwarded to the Council for
approval.
Medical Tourism
The Israeli Medical Association submitted
a proposed Statement on Medical Tourism
47
WMA News
setting out protocols to protect the right of
foreign patients who receive medical treat-
ment abroad. The aim of the guidelines for
physicians is to protect patients receiving
treatment abroad from any attempt at harm,
fraud or unprofessionalism and to preserve
the principles of medical ethics for medical
tourists and local patients alike.
Delegates were told that there was an
emerging industry with health systems
around the world competing for foreign
patients. There was a need for some ethical
obligations to protect foreign patients from
being taken advantage of.
The committee agreed to circulate the doc-
ument to NMAs.
Medical Cannabis
The South African Medical Association
submitted a proposed new Statement on
Medical Cannabis. This declares that in the
absence of convincing scientific evidence on
the therapeutic effectiveness of cannabis,
there should be more rigorous research car-
ried out before governments decide to legal-
ise medical cannabis.
The committee agreed that the document
should be circulated to NMAs for com-
ment.
Classification of 2006 Policies
The committee considered the recommen-
dations received on the potential revision of
the SMAC policies for which it has been
10 years since adoption or last revision
It agreed that the following policies should
be rescinded and archived:
• the Council Resolution in support of the
Bolivian Medical Association
• the Statement on Professional Responsi-
bility for standards of Medical Care
It agreed that the following policies under-
go a major revision:
• the Resolution on Medical Assistance in
Air Travel
• the Resolution on Tuberculosis
• the Statement on Access to Health Care
• the Statement on Medical Education
It agreed that the following policies be reaf-
firmed:
• the Resolution on Child Safety in Airline
Travel
• the Resolution on North Korean Nuclear
Testing
• the Statement on the Role of Physicians
in Environmental Issues
It agreed that the following policies under-
go minor revision
• the Statement on Injury Control
• the Statement on Traffic Injury
• the Statement on Adolescent Suicide
• the Statement on Alcohol and Road
Safety
• the Statement on Physicians and Public
Health
• the Statement on Avian and Pandemic
Influenza
• the Statement on the Physician’s Role in
Obesity
• the Statement on the Responsibilities of
Physicians in Preventing and Treating
Opiate and Psychotropic Drug Abuse
The committee also agreed that a rappor-
teur be appointed to undertake a review
of the WMA’s general policies on alco-
hol.
Advocacy
Dr.  André Bernard (Canadian Medical
Association), Chair of the Advocacy Ad-
visory Group, reported on the activities of
the group, including a suggestion from the
Turkish Medical Association for holding a
World Day to recognize the issue of vio-
lence against health professionals. He said
that the group had considered how to take
this idea forward and recommended that
further work be carried out on the pro-
posal.
He also said the group was discussing the
more general issue of progressing advocacy
within the Association.
Finance and Planning
Committee
Dr. Dongshun Shin (Korean Medical As-
sociation) took the chair.
Membership Dues Payments
The Committee received a report from Mr.
Addy Hällmayr, the WMA’s Financial Ad-
visor, on Membership Dues Payments for
2015.
Financial Statement
Mr Hällmayr provided a detailed explana-
tion of the pre-audited Financial Statement
for 2015 and the committee received the
document as an interim financial statement
as it will be audited in June 2016. It agreed
that the interim Financial Statement for
2015 be approved.
WMA Strategic Plan
An oral report was given by the Secre-
tary General. He said that plans for a new
WMA strategic plan would be developed
from the input from three workgroups, the
Advocacy Advisory Group,Business Devel-
opment Group and Work Group on Gover-
nance Review.
Business Development
The Committee considered a report from
the Business Development Group, includ-
ing possible ways of expanding additional
resources through sponsorship within the
Association’s ethical guidelines and by es-
tablishing a foundation trust as a starting
point of discussion.
It was agreed that the group should contin-
ue to study this plan and report back to the
council in Taipei.
WMA Statutory Meetings
Plans were discussed for changing the
agenda for the 2018 General Assembly
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48
WMA News
in Reykjavik, Iceland. Dr.  Jon Snædal
suggested shortening the Assembly by
one day by changing the Scientific Ses-
sion to combine it with the international
conference, 13th
World conference on
Bioethics and Medical ethics before or
after the Assembly. This would be in
collaboration with UNESCO Chair of
Bioethics, WPA, WAML and local col-
laborators.
The committee agreed that the secretariat
together with the Icelandic Medical Asso-
ciation start to prepare for a medical ethics
conference in conjunction with 2018 Gen-
eral Assembly in Reykjavik and to report
back to the next meeting.
It was agreed that the 2018 Spring Coun-
cil meeting (Apr 26–28) be held in Riga,
Latvia and the 2018 General Assembly be
held in Reykjavik, Iceland (Oct 3–6) and
that Istanbul be the venue for the General
Assembly in 2019 and Tbilisi, Georgia be
the venue for the General Assembly in
2020.
It was agreed that the topic of the scientific
session at the General Assembly in Chicago
2017 be Assuring Quality in Undergradu-
ate Medical Education.
WMA Special Meetings
The Committee received an oral report from
Dr. Kloiber about two side events just be-
fore and during the World Health Assem-
bly in Geneva in May – the first a World
Health Professional Alliance conference on
Regulation on May 21 and 22, and on May
23 a joint conference with the ICRC on
Social Determinants of Health and Health
Care in Danger. He also said there would
be a One Health Conference, in Fukuoka,
Japan (Nov.10-11) together with the Japan
Medical Association and the Japan Veteri-
nary Association.
Associate Membership
Dr.  Joe Heyman, Chair of the Associate
Members Group, reported on the activi-
ties of the group. He said there had been
growth during the year and he spoke about
the new Google group which had been es-
tablished and had discussed many issues,
including death and dying, responsibili-
ties of ethics panels in clinical trials, fu-
ture governance and processes of the As-
sociated Members. He said these activities
provided a good platform which led the
Associate Members being part of WMA
membership as individuals. He encouraged
all members to become Associate Mem-
bers.
Junior Doctors Network
The Committee received the report of the
Junior Doctors Network. In his written
report, the JDN Chair, Dr. Ahmet Murt,
highlighted the JDN’s activities since
October 2015 and its future plans. He
said the priority of the JDN in the past
year had been to expand the member-
ship, both in quantity and its reach. Its
projects, initiatives and the meetings at-
tended all served this purpose. The JDN
mailing list now included more junior
doctors with a balanced representation
across all continents. Communications
with regional junior doctors’ organisa-
tions had been active. The JDN sought to
be one of the central organisations in the
field of postgraduate medical education.
The JDN had played an instrumental role
representing the WMA at several meet-
ings.
There had been a consensus among the
JDN Management Team since last year that
a Strategic Plan should be developed in or-
der to better prepare the JDN for the future.
A task force had been formed for this pur-
pose and its work was ongoing.
Dr. Murt concluded by saying that the JDN
was very concerned about the imposition
of contracts on junior doctors in England
which would have a negative effect on phy-
sicians’ welfare and also on patient safety.
He said he would like to express the JDN’s
support for the British Medical Associa-
tion’s actions in not accepting this imposi-
tion.
Past Presidents and Chair
of Council Network
The Committee received a report of the Past
Presidents and Chairs of Council Network.
Governance Review
The Committee received a report of the
Governance Review Work Group. Prof. van
der Gaag, Chair of the Work Group, said
five topics had been defined for workgroups
to focus on – involvement,inclusiveness and
representation; transparency and openness;
consistency, efficiency and quality of WMA
work; the status of Associate Members; and
affordability. He also referred to plans for a
survey to be carried out.
Revision of Rules Applicable to
WMA Associate Membership
The Committee considered a proposal to
consider Revision of Rules Applicable to
WMA Associate Membership and agreed
that this matter be referred to the Work
Group on Governance Review.
World Medical Journal
The Committee received the report of
WMJ Editor, Dr. Peteris Apinis. He said
that over the past year four journals had
been published, 35 articles, four interviews
and documents from the Council session
and the General Assembly. The length of
the Journal remained unchanged at 40
pages plus a cover page. The Journal was in
digital format and was also sent to libraries
in printed format. Demand for the paper
version was increasing. He said they were
now working to make the WMJ accessible
to a larger audience and to raise interest in
reading it. He hoped to be able to report
some progress at the General Assembly in
the autumn.
Public Relations
The Committee received the Public Rela-
tions Report for 2015/16.
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WMA News
Secondments/Internships
The Committee received an oral report
from the Secretary General. He reported
that the WMA continued with its intern-
ship programmes with the IFMSA which
had started in 2013, and with the Univer-
sity of Pennsylvania since 2014. A medical
student from Indonesia was now doing an
internship and further interns were expect-
ed to join during the year. Three bioethics
students from Pennsylvania would conduct
internships at the WMA office in the sum-
mer.
Saturday
Reconvened Council
Mohammad Wassim Maaz
The reconvened Council meeting began
with delegates standing for a minute’s si-
lence in memory of Mohammad Wassim
Maaz, the Syrian paediatrician, who had
been killed in an air strike at the al-Quds
hospital in Aleppo three days earlier.
Medical Ethics Committee
Refugees and Migrants
The Council considered the Resolution on
Refugees and Migrants introduced by the
Swedish Medical Association. This led to
a debate in which delegates heard reports
from the Turkish and Australian Medical
Associations about the refugee situation in
their countries. Having amended the word-
ing of the document,the Council agreed the
Resolution for immediate publication and
for forwarding to the Assembly for formal
adoption.
Physician Assisted Suicide
The Royal Dutch and Canadian Medical
Associations proposed postponing circu-
lation of their draft Statement on Eutha-
nasia and Physician Assisted Dying to al-
low workshops to be set up to debate what
was a very controversial issue. This led to a
lengthy debate about how such workshops
might operate. Following this, the Royal
Dutch and Canadian Medical Associa-
tions proposed that their draft document be
withdrawn to allow the debate to continue.
It was argued that this would allow time for
an open debate.
The Council agreed that the proposed
Statement should be withdrawn and that
the issue of how to progress the debate
should be considered by the Council Ex-
ecutive Committee.
Health Databases and Biobanks
The Council agreed that the proposed
WMA Declaration on Ethical Consid-
erations regarding Health Database and
Biobanks be circulated to NMAs, that
comments be invited from expert organ-
isations outside the WMA and that a fur-
ther meeting of the Work Group should
take place in September to finalise a docu-
ment to be presented to the Council in
Taipei.
Participation of Physicians
in Pre-Natal Gender
Selection
The Council agreed to send back the pro-
posed Revision of the WMA Statement on
the Participation of Physicians in Pre-Natal
Gender Selection to the rapporteur to ana-
lyze in relation to existing WMA policy on
related topics. If the substance of the State-
ment is not sufficiently covered in the exist-
ing policies, the Statement will be reconsid-
ered by the committee.
Quality Assurance in
Medical Education
The Council agreed that the proposed Dec-
laration on Quality Assurance in Medical
Education should be circulated to NMAs
for consideration.
Classification of 2006 Policies
The Council agreed to the Committee’s rec-
ommendations on classifying policies that
were 10 years old
Finance and planning committee
Membership Dues Payments
The Council approved the document on
Membership Dues Payments for 2015 and
the interim Financial Statement for 2015.
WMA Statutory Meetings
The Council agreed the recommended ven-
ues and dates for future meetings.
Socio-medical affairs committee
Doctors for Health Equity
The President referred to the draft report
‘Working for Health Equity: The Role
of Health Professionals’ on what doctors
could do on the issue of health equity and
the social determinants of health. The re-
port looked at the areas of education and
training, the health service as employer
and working in partnership and advocacy.
Sir Michael said that what he was seeking
from NMAs were examples of case stud-
ies of what had been happening in differ-
ent countries. A final version would then be
published.
Ageing
The Council considered the proposed
Statement on Ageing and approved the
document as amended.
Zika virus
The Council considered the proposed Reso-
lution on the Zika Virus Infection. A fur-
ther debate took place about the need to
include men as well as women among those
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50
WMA News
who need to be advised on this issue. This
was supported and the Council agreed that
the document,as amended,be approved and
forwarded to the General Assembly for for-
mal adoption.
It was also agreed that a separate general
document should be prepared on pandemic
management.
Role of Physicians in Preventing
the Trafficking with Minors
and Illegal Adoptions
The Council agreed that the proposed
Statement be circulated among members
for comments.
Armed conflicts
The Council agreed that the proposed new
Statement on Armed Conflicts should be
circulated among NMAs for comments.
Occupational Health
The Council agreed that the new Resolu-
tion on Occupational and Environmental
Safety as well as Gender Aspects be circu-
lated to NMAs.
Ageing
The Council agreed that the Statement on
Ageing be forwarded to the General As-
sembly for adoption.
Boxing
The Council agreed that the proposed
Statement on Boxing be circulated the
NMAs for consideration.
Tobacco
The Council agreed that the proposed
revision of the WMA Resolution on the
Implementation of the WHO Framework
Convention on Tobacco Control be for-
warded to the General Assembly for adop-
tion.
Obesity in Children
The Council agreed that the proposed
Statement on Obesity in Children should
be recirculated to NMAs for reconsidera-
tion.
Physicians’ Right to Information
The Council agreed that consideration of
the proposed Declaration on Physicians’
Right to Information about the World
Medical Association and its Policies be
postponed to the next meeting in Taipei in
October.
Professional Autonomy of
Physicians
The Council agreed to the request that the
proposed Declaration on Professional Au-
tonomy of Physicians as the Main Condi-
tion for Implementation of the Human
Right to Health be withdrawn.
Fossil Fuel Divestment
The Council agreed that the proposed
Statement on Divestment in Fossil Fuels be
recirculated to NMAs for comments.
Global Medical Electives
The Council agreed that the proposed
Statement on Ethical Considerations in
Global Medical Electives be forwarded to
the General Assembly for adoption.
Female Genital Mutilation
The Council agreed that the Statement on
Female Genital Mutilation be approved
and forwarded to the General Assembly for
adoption.
Body Searches of Prisoners
The Council agreed that the Statement on
Body Searches of Prisoners be approved
and forwarded to the General Assembly for
adoption.
Cyber Attacks on Health and
other critical infrastructures
The Council agreed that the proposed
Statement on Cyber-Attacks on Health
and Other Critical Infrastructures be circu-
lated to NMAs for consideration.
Medical Tourism
The Council agreed that the proposed
Statement on Medical Tourism be circu-
lated to NMAs for consideration.
Medical Cannabis
The Council agreed that the proposed new
Statement on Medical Cannabis be circu-
lated to NMAs for comment.
Classification of 2006 Policies
The Council agreed the recommendations
for reclassifying policies that were 10 years
old.
World Health Assembly
Clarisse Delorme reported on the work
being done to prepare documents for the
World Health Assembly the following
month.
Dr. Kloiber said that one issue that would
be raised at the WHA was that of the
health work force.The United Nations Sec-
retary General had set up a high level com-
mission to discuss this issue and in its evi-
dence to the panel, the WMA had stressed
the importance of the health work force as
an investment not a cost.The WMA looked
forward to the recommendations from the
Commission in order to help take this mat-
ter forward.
The Chair then brought the meeting to a
close.
51
WMA News
Recognizing that the WHO has designat-
ed the Zika virus infection a global health
emergency, the WMA provides the follow-
ing recommendations.
1. WHO should work with ECDC, CDC
and other disease control organisations
to better understand the natural history
and current epidemiology of Zika virus
infection.
2. Information should be disseminated
widely to advise and protect all women
and men who live in or must travel to
Zika-affected areas and who are con-
sidering becoming parents. Advice
should also include recommendations
for women who are already pregnant
who may have been directly exposed to
the Zika virus or whose partners live
Preamble
Currently, a very large number of people
are seeking refuge and/or asylum; some are
fleeing war zones or other conflicts, others
are fleeing from desperate poverty, violence,
and other injustices and abuses with po-
tentially very harmful effects to mental and
physical health.
The global community has been ill prepared
for handling the refugee crisis, including
addressing the health needs of those seek-
ing refuge.
The WMA recognizes that mass migration
will continue unless people are content to
stay in their birth countries because they see
opportunities to live their lives in relative
peace and security and to offer themselves
and their families the ability to live lives
with opportunities for fulfilment of various
sorts, including economic improvement.
The global community has a responsibility
to seek to improve the lot of all popula-
tions, including those in countries currently
with the poorest economies and other key
factors. Sustainable development will give
all populations improved security, and eco-
nomic options.
The WMA recognizes that warfare and
other armed conflict, including continuous
civil strife, unrest and violence, will inevi-
tably lead to people movement. The worse
the conflict the higher the percentage of
people who will want to leave the conflict
zone. There is a responsibility for the global
community,especially its political leaders,to
seek to support peace making and conflict
resolution.
The WMA recognizes and condemns the
phenomenon of forced migration, which is
inhumane and must be stopped. Such cases
should be considered for referral to the In-
ternational Criminal Court.
Principles
The WMA reiterates the WMA Statement
on Medical Care for Refugees originally
adopted in Ottawa, Canada in 1998 which
states:
• Physicians have a duty to provide ap-
propriate medical care regardless of the
civil or political status of the patient, and
governments should not deny patients
the right to receive such care, nor should
they interfere with physicians’ obligation
to administer treatment on the basis of
clinical need alone
• Physicians cannot be compelled to par-
ticipate in any punitive or judicial ac-
tion involving refugees, including asylum
seekers, refused asylum seekers and un-
documented migrants, or Internally Dis-
placed Persons or to administer any non-
medically justified diagnostic measure or
treatment, such as sedatives to facilitate
easy deportation from the country or re-
location.
• Physicians must be allowed adequate
time and sufficient resources to assess
the physical and psychological condi-
tion of refugees who are seeking asy-
lum.
• National Medical Associations and phy-
sicians should actively support and pro-
mote the right of all people to receive
medical care on the basis of clinical need
alone and speak out against legislation
and practices that are in opposition to
this fundamental right.
WMA urges governments and local au-
thorities to ensure access to adequate
healthcare as well as safe and adequate
living conditions for all regardless of their
legal status.
WMA Council Resolution on Refugees and Migrants
Adopted by the 203rd
WMA Council Session, Buenos Aires, April 2016
WMA Council Resolution on Zika Virus Infection
Adopted by the 203rd
WMA Council Session, Buenos Aires, Argentina, April 2016
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52
WMA News
in or have travelled to Zika-affected
areas.
3. Relevant agencies, including WHO,
should gather data on the efficacy of
different mosquito control methodolo-
gies, including the potentially harmful
or teratogenic effects of the use of vari-
ous insecticides.
4. Work on diagnostic tests, antivirals,
and vaccines should continue with an
emphasis on producing a product that
is safe for use in pregnant women and
public funding should be assured for
this research. When such products are
developed states should ensure that they
are available to, and affordable by, those
most at risk.
5. States which have witnessed the deliv-
ery of a number of babies with micro-
cephaly and other fetal brain abnormal-
ities must ensure that these infants are
properly followed up by health and oth-
er services, and provide support to fami-
lies seeking to cope with a child with
developmental abnormalities. Wherever
possible research on the consequences
of microcephaly should be published, to
better inform future parents, and to al-
low the development of optimal service
provision.
Mr. Nigel Duncan,
Public Relations Consultant,
WMA
The Sixty-ninth session of theWorld Health
Assembly, the supreme decision-making
body of the World Health Organisation,
was held in Geneva from May 23–28. Dur-
ing the week, delegates agreed resolutions
and decisions on air pollution, chemicals,
the health workforce, childhood obesity,
violence, non-communicable diseases, and
the election of the next Director-General.
As usual the meeting attracted to the Swiss
city a galaxy of world leaders, health min-
isters, chief medical officers, global leaders
from the health professions and countless
lobbyists. Thousands of delegates from the
WHO’s Member States attended the As-
sembly, including many WMA leaders.
Once again an enthusiastic group from the
Junior Doctors Network (JDN) were active
in presenting WMA policy on a wide range
of topics.
WHPA Regulation
Conference May 21–22
For the WMA, the week began with the
fourth World Health Professions Alliance
Regulation Conference, held at the Crowne
Plaza Hotel in Geneva. The two-day con-
ference, which attracted an audience of 260
people from 47 countries, focused on three
major areas – balancing regulation of in-
dividual health professionals and of health
services, health professional regulation and
trade agreements, and the Sustainable De-
velopment Goals.
The first speaker, Me André Gariépy, Com-
missioner for the Recognition of Profes-
sional Competence at the Government of
Quebec, Canada, delivered a talk entitled
‘International regulation rather than na-
tional regulation’. He said that globalization
and labour mobility were putting pressure
on the services sectors and said that calls for
simplification of regulation, aiming at in-
ternationalization of professions, were often
made. He discussed the different drivers for
internationalization of professions and said
that the universal good was a driver for the
profession.
Mrs Hélène Leblanc, Head of Public and
International Affairs at the French Cham-
ber of Pharmacists, spoke about the Euro-
pean Union regulation of healthcare and
the implications for health care and health
professionals. She talked in particular about
qualification recognition and the need to
strike the right balance between the mobil-
ity of health professionals and allowing free
movement while protecting patients. She
said that health workers in the EU under
investigation in their own country could
simply move to another country and prac-
tice.This was a challenge for regulators.The
key was that competent authorities must
exchange information.
Dr. Elizabeth Wiley, Deputy Chair of the
WMA’s Junior Doctors Network, talked
expertly about the new generation of trade
agreements and warned they might un-
dermine efforts to achieve universal health
care and social accountability. She spoke
in particular about the Transatlantic Trade
and Investment Partnership and its impli-
cations for health care and health profes-
sionals.This new generation of agreements
were unprecedented in their size,scope and
secrecy. One of the most formidable chal-
World Health Assembly Week
Geneva May 23–28 2016
Nigel Duncan
53
WMA News
lenges in analyzing the agreements and
their implications for health professionals
and health systems, as well as engaging in
advocacy, was the lack of transparency. Ac-
cess to negotiating texts was limited – the
texts were generally not publicly available.
Civil society had to rely on leaked texts.
Opportunities for engagement were of-
ten quite limited as well and stakeholder
sessions were often poorly attended and
seemed to have limited impact.
She said the TTIP agreement might have
broad potential effects on public health
and national health and healthcare regula-
tion, including the supply, distribution and
movement of health care workers. Its con-
sequences needed to be weighed against the
relatively modest economic benefits. She
said that TTIP would put corporate inter-
ests above those of health.
Dr.  Wiley said that this new generation
of negotiations had occurred largely out-
side of existing World Trade Organisa-
tion structures. The purported goal of the
negotiations was to establish a new model
for all future agreements – and, de facto,
a new global trade governance frame-
work. The focus of the negotiations had
generally been reductions in non-tariff
barriers to trade, regulatory harmoniza-
tion with the goal of further liberalization
and ultimately economic growth. But a
key question for the health sector was at
what cost? She spoke about the Investor
State Dispute Settlement (ISDS) mecha-
nism providing a mechanism for inves-
tors to bring claims against governments
and seek compensation. It provided new
and novel opportunities for multinational
corporations to challenge domestic laws
that threatened their interests. There was
concern and some evidence that the mere
availability of ISDS might deter govern-
ments from adopting laws and regulations
that might be targeted for challenge by in-
vestors – and this included policies to ad-
vance universal coverage including access
to medicines.
With respect to health professions’ educa-
tion, she said there was speculation that
some provisions, including potentially
state-owned enterprise provisions, could
be used to incite privatization of higher
education.
Dr. Wiley concluded by saying that these
trade agreement negotiations might help
or hinder efforts to realize universal health
coverage and social accountability. There
were clearly risks. The health and health
care consequences of these agreements must
be weighed against potential economic ben-
efits.The implications for health and health
care needed to be considered in negotia-
tions and the health sector needed to en-
gage in these negotiations.
Dr. Carmen Catizone, Executive Director
of the National Association of Boards of
Pharmacy, talked about the effect of tech-
nology on health care regulation. Internet
web sites and the products and services
being offered by them were reshaping the
traditional delivery of care. There were
problems to be solved about the lack of
connectivity of devices. Less than one per
cent of all the world’s devises were actually
interconnected. There was also the wide-
spread availability on the web of illegal and
fraudulent drug sites. He spoke about the
Dot Pharmacy project that was accessible
to accredited organisations to fight coun-
terfeit drugs on the web. It was established
to regulate pharmacists online because 96
per cent of internet drug outlets were il-
legal.
Day Two of the conference looked at
balancing regulation of individual health
professions and of health services, and it
opened with a speech from David Ben-
ton, CEO of the National Council of
State Boards of Nursing. He set the
context of the changes facing regulators
and health systems and talked about the
emerging trends that regulatory bodies
needed to address. These trends could not
be addressed in isolation, but needed to
be considered as part of a comprehen-
sive approach to dealing with the reality
of a complex adaptive system. He spoke
about improvements in joint collabora-
tion and said that protecting the public
was not uniquely the responsibility of the
individual practitioner, nor was it the re-
sponsibility of the regulator, the educator
or even the employer. It was a shared re-
sponsibility in which they all had to play a
part. They were simply instruments in an
orchestra that collectively could achieve a
miracle.
Martin Fletcher, CEO of the Australian
Health Practitioner Regulation Agency,
spoke about regulatory principles in Aus-
tralia that helped the health system regu-
lators work together. The goal of protect-
ing the public from harm was shared with
many players, including governments,
service providers, professional associations
and health care consumers themselves.
Working together was not an optional
activity. It was a core activity. Dr. Marga-
ret Grant, former CEO of the Australian
Physiotherapy Council, talked about risk-
based approaches to regulation, which she
said had the potential to deliver a range of
benefits. But for health, it was relatively
new. She referred to moving from a light
touch to a right touch approach to regula-
tion and said that risk-based regulation of
health workers must seek and address the
root cause of the risk.
Katya Maznyk, CEO of the Canadian
Alliance of Physiotherapy Regulators,
stressed the need to focus on patients, pa-
tient outcomes and quality of care. She dis-
cussed collaborative initiatives that focused
on competencies, shared roles and respon-
sibilities and patient engagement to im-
prove the delivery of health services. She
explained how the physiotherapy profes-
sion used national accepted competencies,
shared standards of practice and a code of
ethics to promote quality and consistency
in regulatory practices. However, she ar-
gued that a barrier in inter-professional
BACK TO CONTENTS
54
WMA News
collaboration could be differential pay
structures for different professions.
The final session of the conference was on
the WHO’s draft global strategy on hu-
man resources for health. It began with
Jim Campbell, Director of the Health
Workforce Department at the WHO, ex-
plaining the background to the strategy.
He was followed by the last speaker, Sir
Michael Marmot, President of the World
Medical Association, whose well-received
talk was entitled ‘Sustainable Develop-
ment Goals: What is the impact on Hu-
man Resources for Health’. He spoke
about the goal to achieve healthy lives
and wellbeing for all at all ages. This was
not only a matter for the health sector but
was inter-sectorial. What was needed was
coherent action across sectors and society
on the social, economic, environmental
and political determinants of health. He
was absolutely sure that an educated and
dedicated health work force was vital to a
civilized society.
He said a key question he always asked was
’Why treat people and send them back to
the conditions that made them sick’. He
argued the need for social justice and the
creation of conditions for people to have
control over their lives. Health equity and
the social determinants of health were in-
extricably linked with sustainable develop-
ment. He wanted everyone to be concerned
about the inequalities of health between
and within countries. He illustrated his ar-
guments with statistics about differing life
expectancy throughout the world, mortality
statistics among under-fives and the impor-
tance of improving mothers’ education. He
said they should all be standing up for all
policies that were likely to have a positive
impact on health and a fairer distribution.
They needed to be advocates for policies
that would improve the health of popula-
tions and patients they served. And he
ended with his familiar mantra ‘Health is a
human right: Do something, do more, do
better’.
Following a panel discussion, the confer-
ence ended with a spirited summing up of
the two days of debate by Dr. Ardis Hoven,
Chair of the WMA. She said the discus-
sion had demonstrated that they must have
regulatory models that were flexible and
adaptable. They must keep the patient-cen-
tred focus and they must all collaborate and
remove barriers. A shared responsibility was
a core issue for all of them.
‘Insecurity and Social
Determinants of Health’
The following day, Monday May 23, a side
event was organised by the WMA and the
Junior Doctors Network, jointly with the
International Committee of the Red Cross,
held at the ICRC’s headquarters. The pur-
pose of the well-attended event was to iden-
tify social determinants of health as poten-
tial drivers of violence, to explore strategies
to address health challenges through SDH
in terms of prevention, ensuring safety of
patients and health professionals, and to
raise awareness of the relevance of SDH as
a way forward to protect health and prevent
insecurity.
The keynote speech was given by Sir Mi-
chael Marmot. He said that the different
aspects of insecurity were linked – social
insecurity, economic insecurity, political
insecurity and insecurity in terms of safe-
ty and peace. The social determinants of
health were the drivers of conflict as well as
the consequences of conflict and the driv-
ers of health inequalities. Insecurity came
from the detrimental effects on the health
of whole populations,on the social determi-
nants of health and on the effects of other
countries through refugees seeking asylum
and insecure borders.
Sir Michael argued that the direct effects
of conflict of death, physical and mental
morbidity and disability had to be added to
the considerable indirect effects due to the
breakdown of social life and infrastructure.
These included the destruction of educa-
tion and health systems, macroeconomic
and household economic losses, popula-
tion relocation and the destruction of social
networks and detrimental environmental
aspects.
He said that the main countries where the
world’s refugees came from were Syria, Af-
ghanistan, Somalia, South Sudan and the
Congo, all areas of great conflict. This mass
migration would continue unless and until
people were content to stay in their birth
countries because they saw the opportuni-
ties to live their lives in relative peace and
security.
He went on: ‘We need urgent action to pre-
vent the consequences on the health of a
whole population, the resulting problem of
refugees, insecure borders and the violation
of human rights. We need action to prevent
the random sexual violence that women
face, the great mortality and morbidity that
children suffer, the widespread loss of jobs
adults face and the collapse of health ser-
vice systems. The unrelenting poverty and
oppression that flow from conflict are inde-
fensible.’
Action was required across all sectors to
give every child the best start in life, to en-
able all children, young people and adults to
maximise their capabilities and have control
over their lives, to create fair employment
and good work for all, to create and develop
healthy and sustainable places and commu-
nities and to strengthen the role and impact
of ill health prevention.This, he argued, was
why it was important to tackle the social
determinants of health around the globe. In
short, a world where social justice was taken
seriously.
Also speaking was Dr. Elizabeth Wiley, on
behalf of the Junior Doctors Network. She
spoke about insecurity and health profes-
sional safety from a junior doctor perspec-
tive. As a network and community of junior
doctors, one of the areas of focus over the
55
WMA News
last few years had been the safety and well-
being of junior doctors around the world.
From colleagues across continents, regions,
countries and cultures, they had heard sto-
ries of physical and even sexual violence
and harassment in health care settings, and
these risks were amplified by conflict.Junior
doctors in rural areas were particularly sus-
ceptible to these threats
She said the relationship between the social
determinants of health and insecurity and
conflict was both undeniable and multi-
faceted and bidirectional, and created cre-
ates conditions under which the safety of
patients and health care workers might be
at risk. But there were no easy solutions to
protecting the safety of health care workers.
However, what seemed to be clear from a
junior doctor perspective was the imperative
to address the social determinants of health
as a preventive strategy to protect health
professionals.
Dr. Wiley highlighted two particular op-
portunities. First was the pending adop-
tion of the Global Strategy on Human
Resources for Health that week. It was
critical that member states and civil soci-
ety alike recognized the urgent need to en-
sure the safety of health professionals, for
the recruitment and retention of a robust,
fit-for-purpose global health workforce.
Second, another important opportunity
for prevention was in medical education.
Specifically, key concepts needed to be
fully integrated into medical education
around the social determinants of health,
insecurity and safety, violence prevention
and most importantly advocacy, because it
was their responsibility as health profes-
sionals to address health inequities and be
advocates for and with the patients they
served.
World Health Assembly
Throughout the week, delegates from the
Junior Doctors Network attended the main
Assembly sessions and presented a series
of interventions, setting out WMA policy.
They delivered speeches on topics includ-
ing air pollution, antimicrobial resistance,
promoting the health of migrants, health
workforce and violence against women.This
was accompanied by a mass of activity on
the WMA twitter site.
Assembly Resolutions
During the week the Assembly approved
new resolutions on WHO’s Framework
for Engagement with Non-State Actors,
the Sustainable Development Goals, the
International Health Regulations, tobac-
co control, road traffic deaths and inju-
ries, nutrition, HIV, hepatitis and STIs,
mycetoma, research and development, ac-
cess to medicines and integrated health
services.
The WHO Framework of Engagement
with Non-State Actors, adopted after
more than two years of intergovernmental
negotiations, provides the Organization
with comprehensive policies and proce-
dures on engaging with nongovernmen-
tal organizations, private sector entities,
philanthropic foundations and academic
institutions.
On Sustainable Development Goals del-
egates agreed a comprehensive set of steps
that lay the groundwork for pursuing the
health-related Goals. They agreed to pri-
oritize universal health coverage, and to
work with actors outside the health sector
to address the social,economic and environ-
mental causes of health problems, including
antimicrobial resistance.
On road traffic deaths and injuries delegates
adopted a resolution requesting Member
States to accelerate implementation of the
outcome document of the Second Global
High-Level Conference on Road Safety
2011–2020 held in November 2015, and on
nutrition they adopted two resolutions urg-
ing countries to make concrete policy and
financial commitments to improve people’s
diets, and calling on UN bodies to imple-
ment national nutrition programmes and
support monitoring and reporting mecha-
nisms.
Ihsan Doğramacı
Family Health
Foundation Award
The week ended when Sir Michael Marmot
was awarded the Ihsan Doğramacı Family
Health Foundation prize for his work in
family health. Accepting the award, he said
that the WHO need not dictate to Member
States what they should do. But instead, it
could play a key function simply by bring-
ing the evidence he had amassed into the
policymaking process.
‘Nobody has to listen to me,’ said Sir Mi-
chael. ‘But I can speak passionately about
the evidence. So, that is not telling people
what to do, but it is leading them to the
conclusions of what the evidence suggests
we should be doing.’
Mr. Nigel Duncan,
Public Relations Consultant,
WMA
BACK TO CONTENTS
56
Biobanks
Very recently, on 11 May 2016, the Com-
mittee of Minsters of the Council of
Europe (see box) adopted a revised rec-
ommendation on research on biological
materials of human origin1
.This new docu-
ment replaces a similar recommendation2
of the year 2006. Important provisions are
kept like “broad consent” or access to and
use of stored human biological material
without the free informed consent of the
donor only exceptionally under specific
conditions.
Such a research needed and will need in
the future a favourable opinion of an en-
1
 
Recommendation CM/Rec(2016)6
of the Com-
mittee of Ministers to member States
on rese-
arch on biological materials of human origin
(Adopted by the Committee of Ministers on 11 May
2016
at the 1256th meeting of the Ministers’ Depu‑
ties)
2
 
Recommendation Rec(2006)4 of the Commit-
tee of Ministers to member states on research on
biological materials of human origin (Adopted by
the Committee of Ministers on 15 March 2006 at the
958th meeting of the Ministers’ Deputies)
titled ethics committee and, if required by
national law, the approval of a competent
authority. There have been, during the
years of the elaboration of the new docu-
ment, several attempts to weaken specifi-
cally this latter provision, which has been,
however, confirmed as it stands since
2006.
As the previous one the revised recom-
mendation is based in the framework
of the Council of Europe given by the
Oviedo Convention3
and by the Addi-
tional4
protocol on biomedical research.
The recommendation is aimed to give a
synergy between the protection of the
human rights of the donor of the mate-
rial and the need of research based on
human tissues becoming more and more
important. It addresses all researchers in-
cluding researching physicians. It is up to
national legislators how and in which way
proposals of professional or other groups
– NGOs – are respected or followed dur-
ing the procedure of the implementation
of the recommendation into the legal sys-
tem.
This overview follows the structure of the
recommendation and is formulated narrow
to its wording, which is sometimes quoted,
to prevent any misunderstanding of the
legal instrument which covers research on
stored biological materials as defined by its
scope.
3
 
Convention for the protection of Human Rights
and Dignity of the Human Being with regard to
the Application of Biology and Medicine: Con-
vention on Human Rights and Biomedicine,
CETS No. 164
4
 
Additional Protocol to the Convention on Hu-
man Rights and Biomedicine, concerning Bio-
medical Research, CETS No.195
Scope
The recommendation applies to the ob-
taining of biological materials of human
origin for storage for future research pur-
poses, to the storage of such materials for
future research purposes and to the use in
a research project of those materials that
are stored or were previously obtained
for another purpose, including a previous
research project. It does not apply to em-
bryonic and foetal biological materials and
not to the use in a specific research project
of human materials removed for the sole
purpose of that project. (Covered by the
Research protocol, see footnote 4). As-
sociated personal data are included in the
scope. A definition of identifiable and non
identifiable biological material is given in
the text.
General provisions
General provisions address different as-
pects of the research in view. The physical
risks arising from removal of biological
materials for storage for future research
should be minimised. Other risks for the
donor and, where appropriate, for the
family or for persons in the same group
as the donor, related to research activi-
ties, in particular the risks to private life,
should be minimised also. Risks should not
be disproportionate to the potential ben-
efit of the research activities. Appropriate
measures should be taken to prevent dis-
crimination against, and to minimise the
likelihood of stigmatisation of, any person,
family or group. Refusal to give consent to
or authorisation for the removal, storage
or research use of biological materials or
the withdrawal or alteration of the scope
of the consent or authorisation should not
lead to any form of discrimination against
the person concerned, in particular regard-
ing the right to medical care. Biological
materials of human origin should not, as
such, give rise to financial gain. Confiden-
tiality on any information of personal na-
Elmar Doppelfeld
Council of Europe
Recommendation on Biobanks
GERMANY
57
Biobanks
ture collected in removing, storing or using
biological material or in obtaining by the
research must be safeguarded according to
the rules for the protection of private life.
This provision applies also in transfer of
biological materials. Member States are in-
vited to improve the interest of the public
on research on biological materials by ap-
propriate information. Member States are
free to introduce wider protection than is
stipulated in the recommendation.
Obtaining and storage
for future research
Introductory remarks. Obtaining human
biological material for future research
can in a specific manner violate human
rights. Therefore this recommendation en-
tails rather strong and detailed provisions.
These provisions address different central
fields. Valuable information is the appro-
priate basis for a free informed consent
of the donor of the biological material. If
this person is not able to consent accord-
ing to law, e.g. because of age or disease,
“free informed consent” is substituted by
“authorisation”. The manner and the pro-
visions for that authorisation differ from
State to State. Therefore the recommen-
dation as a legal instrument uses a rather
specific wording to cover these different
regulations: “authorisation of his or her
representative or an authority, person or
body provided for by law”. To facilitate
the understanding of this article the ex-
pression “legal representative” is used ad-
dressing the various regulations. However
independent from any internal regulation,
the legal representative receives the same
information and exercises the same rights
as the represented person if being able to
consent. Usually consent or authorisation
are given for specific research projects. In
contrast specific research projects are not
yet identified in the moment of storage of
material for future research. It is accepted
more and more that an autonomous person
or the legal representative can consent also
to this situation on the basis of appropriate
information (see below). The person may
define restrictions of the scope of the re-
search and may ask to be contacted before
any other use of the material. To safeguard
human rights the donors are insured that
the material is only used for research proj-
ects reviewed by an ethics committee and,
if required by law, approved by a compe-
tent body. These two basic conditions for
broad consent are taken over from the for-
mer recommendation. Finally: consent or
authorisation is needed for the use of dif-
ferent materials: those removed specifically
for future research, materials already used
for research and afterwards stored and ma-
terials removed for other purposes than re-
search, e.g. for diagnosis or treatment, of-
ten known as “left overs.” For person from
whom this material has been removed the
term “donor” is used in this text.
Information
Prior to consent to or to authorisation for
the storage of biological materials for fu-
ture research, the person concerned or, in
case of a donor not able to consent, the
legal representative should be provided
with comprehensible information that is
as precise as possible in view of the na-
ture of any envisaged research use and
the possible choices that he or she could
exercise, the conditions applicable to the
storage of the materials, including access
and possible transfer policies and any rel-
evant conditions governing the use of the
materials, including re-contact and feed-
back .The donor or the legal representative
should also be informed of the rights and
safeguards provided for by law, and specif-
ically of his or her right to refuse consent
or authorisation and to withdraw consent
or authorisation at any time. This infor-
mation should also include any possible
limitation on withdrawal of the consent
or authorisation. Prior to the removal of
biological materials the donor or the le-
gal representative should be provided with
additional information specific to the in-
tervention carried out to remove the ma-
terials.
Biological materials from
persons able to consent
Biological materials should only be re-
moved for storage for future research with
Council of Europe
The Council of Europe, established in 1951, should not be confused with the European
Union. Both maybe considered as “intergovernmental bodies” with different intentions.
The Council with its 47 Member States, representing around 830 Millions of citizens,
has the main mission to promote and to harmonise human rights and fundamental
freedoms. To this aim the Council uses Conventions and Additional protocols to these
Conventions. This treaties enter only into legal force by signature and ratification of
a Member State to safeguard the democratic procedure and basis. In contrast to the
EU the Council has no right to issue regulations with binding force for its Member
States. Recommendations may be considered as a proposal to the Member States how
to regulate specific fields. They are however, in structure and content imbedded in the
legal framework.
When implementing legal provisions of the Council of Europe the national legislator
decides how and to which extent proposals from NGOs will be accepted.
GERMANY
BACK TO CONTENTS
58
the prior, free, express and documented
consent of the donor given the informa-
tion as outlined above. Biological materials
previously removed for another purpose
– sometimes addressed as “left overs in
clinical routine”  – should only be stored
for future research with the consent of the
person concerned as provided for by law.
Whenever possible, consent should be re-
quested before any removal of biological
materials. Biological materials previously
removed for another purpose and already
non-identifiable may be stored for future
research subject to authorisation provided
for by law.
Biological materials from
persons not able to consent
Research on biological materials from per-
sons not able to consent, e.g. minors or
adults with specific diseases, may be justi-
fied. However the obtaining and the use of
these materials require specific protective
provisions. Biological materials from these
persons who, according to law, are not able
to consent “should only be obtained or
stored for future research having the po-
tential to produce, in the absence of direct
benefit to the person concerned, benefit to
other persons in the same age category or
afflicted with the same disease or disorder
or having the same condition, and if the
aims of the research could not reasonably
be achieved using biological materials
from persons able to consent.” Under this
precondition, quoted from the recommen-
dation, biological materials should only be
removed from a person not able to consent
if the removal only entails minimal risk
and minimal burden and with the written
authorisation for such removal given by
the legal representative. The necessary au-
thorisation should be specific to the inter-
vention carried out to remove the materials
and as precise as possible with regard to the
envisaged research use. Biological materi-
als previously removed for another purpose
from a person not able to consent should
only be stored for future research with the
authorisation given in the same procedure
as mentioned above. Whenever possible,
authorisation should be requested before
any removal of biological materials. There
are specific provisions for the authorisa-
tion procedure. If the person not able to
consent is an adult, he or she should, as far
as possible, take part in the authorisation
procedure. If the person not able to con-
sent is a minor, his or her opinion should
be taken into consideration as an increas-
ingly determining factor in proportion to
age and degree of maturity. Any objection
by the person not able to consent should be
respected. Any wishes previously expressed
by such a person should be taken into ac-
count. Where a donor, not able to consent
in the moment of removal of biological
material, attains or regains the capacity to
consent, reasonable efforts should be made
to seek his or her consent for continued
storage and research use of his or her bio-
logical materials. Biological materials pre-
viously removed for another purpose from
a person not able to consent and which are
already non-identifiable may be stored for
future research subject to authorisation
provided for by law.
Right to withdraw consent
or authorisation
The donor of identifiable biological ma-
terials stored for future research should,
without being subject to any form of dis-
crimination, in particular regarding the
right to medical care, retain the right to
withdraw consent at any time or to alter
the scope of that consent. When identifi-
able biological materials are stored only,
the person who has withdrawn consent
should have the right to have, in confor-
mity with national law, the materials and
associated data either destroyed or ren-
dered non-identifiable. The donor consid-
ering withdrawing consent should be made
aware of any limitations on withdrawal of
his or her biological materials.
The legal representative having authorised
the storage for future research of identifi-
able biological materials removed from a
person who is not able to consent, should
have the same rights as listed above. There
should be no form of discrimination for
the donor, in particular regarding the right
to medical care. Where a donor attains or
regains the capacity to give consent, he or
she should have the rights to withdraw the
authorisation under the conditions as out-
lined.
Removal of biological
material from a deceased
person
Biological materials should only be re-
moved from the body of a deceased per-
son for storage for future research with
the consent given during life or with au-
thorisation provided for by law. Biological
materials should not be removed if the de-
ceased person is known to have objected
to it.
Governance of collections
General conditions
The storage of biological materials to be
used for future research should only be
done in a structured manner and in ac-
cordance with principles of governance
as laid down in the recommendation. The
person and/or institution responsible for
the collection should be publicly known.
Transparency and accountability should
be the leading principles of the manage-
ment. To this end information on speci-
fication, access to, use and transfer of the
stored material should be publicly avail-
able. Before any change of the purpose of
a collection an independent examination
of its compliance with the provisions of
the recommendation should be carried
out. As consequence of this examination
may result the requirement of renewed
Biobanks GERMANY
59
consent or a renewed authorisation in re-
lation to the change of the purpose. Each
sample in the collection should be appro-
priately documented and traceable. For
an appropriate documentation informa-
tion on the scope of any consent or au-
thorisation is necessary. Quality assurance
measures should be in place concerning
an appropriate security and confidential-
ity during establishment of the collection,
storage, use and for the case of transfer of
biological materials.Transfer of the whole
or of part of the collection as well a its
closure may only be performed following
established procedures in accordance with
the original consent or authorisation. The
exercise of the right to withdraw consent
or authorisation needs updated informa-
tion on management and use of a collec-
tion. This information should be available
therefore for the persons concerned, the
donor or the legal representative. For
more public acceptance of a collection are
advisable regular reports on past or en-
visaged activities, information on access
granted to materials and on progress in
research projects using the stored samples.
The publication of a summary of findings
on completion of each research projects
will contribute to the public acceptance of
collections.
Individual feedback
Article 10 of the Oviedo Convention un-
derlines for the health field the right of a
person “to know or not to know”, which is
taken up by the recommendation. In line
with this provision clear policies are re-
quired to inform on findings relevant for
the health of the persons detected in the
use of their biological materials. The same
information should be given when persons,
who are not able to consent, are the source
of the material. This feedback should take
place within a framework of appropriate
health care or counselling. The wishes not
to be in formed on these findings should be
observed.
Access
For safeguarding an appropriate access to
and use of stored biological materials by re-
searchers clear conditions should be set up
and documented. These conditions should
include the respect for any restrictions de-
fined by the donor or during the procedure
of authorisation.Transparent policies of ac-
cess and oversight of a collection should be
published. Appropriate access mechanisms
may contribute to maximise the value of
collections. Traceability of the use of the
stored materials can have an additional
benefit.
Transborder flows
Research on human biological materials
as all research is carried out in an inter-
national context, exchange of samples
between researchers working in differ-
ent States with often different levels of
protection is common. In relation to this
fact the recommendation requires that in
case of any transfer of materials to an-
other State an appropriate level of pro-
tection is ensured. This can be achieved
by the law of the accepting State. As a
solution are also considered legally bind-
ing and enforceable instruments adopted
and implemented by the parties involved
in the transfer for future research activi-
ties. To this end may serve a documented
and signed agreement between the sender
of the materials and the recipient. The
agreement should include statements on
consent or authorisation and on relevant
restrictions as defined by the donor or by
the legal representative.
Oversight
A collection may be established only after an
independent examination of its compliance
with the provisions of the recommendation.
Once established a collection should be
subject to an oversight proportionate to the
risks for the donors of the materials stored
in that collection. The specific aim of this
oversight is safeguarding the rights and in-
terests of the donors in view of the research
activities of the collection. The recom-
mendation entails oversight mechanisms,
understood as minimum items. Object of
such an oversight is the implementation of
security measures and of procedures on ac-
cess to, and use of, biological materials. The
above mentioned system of annually reports
is another object. The oversight includes
any changes in the risks to the donors of the
collected material. As a result the revision
of policies may be requested. The provision
of appropriate information to the donor or
to the legal representative responsible for
a given authorisation on changes in the
management of the collection is part of the
oversight. This is a condition for exercising
the right to withdraw. Another important
issue for the oversight are development and
implementation of feedback policies in-
cluding a regular review. Oversight mecha-
nisms may be adapted to evolutions of the
collection and of its management.
Use of biological materials
in a research project
General provisions
This chapter of the recommendation can
be considered as meeting point of require-
ments of research and of protective provi-
sions. As a basic principle is accepted that
biological materials can only be used if the
envisaged research project is within the
scope of a given consent or authorisation.
If this condition is not fulfilled consent or
authorisation to use the material for that
specific research project should be sought.
To this end reasonable efforts are required
to contact the donor or the person or in-
stitution entitled to give an authorisation.
It may happen that a person, in the mo-
ment of removal of biological material
or later on , expresses the wish to be no
more contacted. This wish should be ob-
Biobanks
GERMANY
BACK TO CONTENTS
60
served. In case of unsuccessful attempts
of these contacts the biological materials
may be used if an independent evaluation
states the fulfilment of the following con-
ditions as a whole. Evidence is provided
that reasonable efforts have been made to
establish the above mentioned contacts –
a sole declaration of the researcher is not
considered as sufficient. The research proj-
ect addresses an important scientific inter-
est and is in accordance with the principle
of proportionality. The aim of the research
can only be achieved using these materials
which can not be substituted by materials
for which consent or authorisation can be
obtained. Finally it is not known that the
donor or the legal representative has ex-
pressly opposed such research use. These
are of course rather strong conditions for
scientific use of materials without consent
or authorisation. The recommendation
tries to open the way in a distinct frame
to bind a decision on specific conditions to
enable a synergy of the needs of research
and of the protection of individuals. Iden-
tifiability and non-identifiability play a
major role in research. The use of material
in an identifiable form should be justified
in advance in the research protocol to be
submitted for examination. Rendering ma-
terials non-identifiable may be considered
as an easier way for their use. However the
recommendation requires that rendering
materials non-identifiable is depending
on the consent of the donor or of the legal
representative . Both of them may define
restrictions which must not be violated
using these materials when rendered non-
identifiable. The recommendation address-
es specifically the attention to any authori-
sation by law.The research use of biological
materials removed of persons not able to
consent is object of a controversial discus-
sion. The recommendation entails the fol-
lowing provision, elaborated in line with
the Oviedo Convention and the Addi-
tional protocol concerning biomedical re-
search: “Biological materials from persons
who, according to law, are not able to con-
sent should only be used for research hav-
ing the potential to produce, in the absence
of direct benefit to the person concerned,
benefit to other persons in the same age
category or afflicted with the same disease
or disorder or having the same condition,
and if the aims of the research could not
reasonably be achieved using biological
materials from persons able to consent.”
Independent review
The recommendation requires an indepen-
dent review of research proposals using
biological materials. This review follows
the system established in the research field.
By an independent examination scientific
merit, importance of the aim and the ethi-
cal acceptability of the research have to be
proved. No research should be undertaken
without this examination. This examination
is usually carried out by an ethics commit-
tee according to national law. The recom-
mendation states explicitly that national
law may in addition require approval by a
competent body. Principles concerning eth-
ics committees are contained in Chapter
III of the Additional Protocol concerning
biomedical Research (see footnote 4). The
recommendation proposes Member States
to apply these principles to the review of
the research project within its scope. Re-
view procedures should be flexible and may
therefore be adapted to the nature of the re-
search and to the possible identification of
the donors.
Availability of results
The recommendation tries to prevent the
well known “silent death or silent disap-
pearance” from research projects. Therefore
on completion of a project a report or sum-
mary should be sent to the ethics committee
or the competent body and to the collection
granting the materials. Another well prob-
lem is the scientific publication of results.
It seems that researchers legally cannot be
forced to publish results of their research.
The same difficulty was met during the
elaboration of the Protocol concerning bio-
medical research (see footnote 4). The rec-
ommendation uses a nearly identical word-
ing: “The researcher should take appropriate
measures to make public the results of re-
search in reasonable time.”
Closing remarks
Research on human biological materials
addresses two fields of problems: the re-
moval of the donor and the scientific use.
Whereas it is unanimously accepted that
the removal needs consent or authorisation
the conditions for use are still in discus-
sion. It is argued, that there is no physical
harm to a person if his or her materials,
separated from the body, are used. How-
ever the idea is since decades adopted also
that the donor should have the right to de-
fine this use – treatment and/or research.
The way for the protection of this right
is object of controversial discussions. The
recommendation agreed by 47 European
governments shows a solution respecting
as far as possible the different positions
and national legislations.
Prof. Elmar Doppelfeld MD
Former Chairman of the “Steering Committee
on Bioethics (CDBI)” of the Council of Europe
Member of the German delegation
to the DH‑BIO (Former CDBI)
of the Council of Europe
Chairman of EUREC (European
Network of Research Ethics Committees
E-mail: elmar-doppelfeld@t-online.de
Biobanks GERMANY
61
Zika Virus
FEDERATIVE REPUBLIC OF BRAZIL
Description of the Evidence Colection
Method:
The literature review of manuscripts was held
in the databases Medline, Embase and Co-
chrane, using the terms (MeSH terms) indi-
vidually or grouped structured according to
P.I.C.O. (“Patient”,“Intervention”,“Control”
and “Outcome”) methodology. After carefully
reading the titles and abstracts, only articles
containing relevant information to the com-
ponents of P.I.C.O.were included.The stud-
ies were analyzed for relevance and level of
evidence according to the Oxford Centre for
Evidence Based Medicine [1] (D) table.
Grade of recommendation
and strength of evidence
A.
Experimental or observational studies
of higher consistency.
B.
Experimental or observational studies
of lower consistency.
C.
Case reports/non-controlled studies.
D.
Opinions without critical evaluation,
based on consensus, physiological stud-
ies,or animal models.
Objective:
This guideline is intended for physicians,
nurses,public health officials and patients at
risk of infection with Zika virus, with the
purpose of assessing the effects on the pe-
riod of pregnancy and postpartum.
Conflict of interest:
No conflict of interest was declared by the par-
ticipants in the development of this guideline.
Introduction
Zikavirus,firstisolatedin1947inrhesusmon-
keys, is an arbovirus, member of the Flaviviri-
dae family. First found in humans in Nigeria
in 1954, for 50 years was described as a cause
of sporadic human infections in Africa and
Asia, until in 2007 an epidemic took place in
Micronesia [2,3] (C). More recently in Brazil,
The Ministry of Health,as verified by the data
provided by the Live Births Information Sys-
tem – SINASC, has recorded substantial in-
crease in the number of cases of microcephaly
after a high incidence of infection.The clinical
features and natural history of Zika infection
are based on a limited number of case reports;
however, it is clear that vertical transmission
of the virus can occur during pregnancy, as
seen in a series of reports of cases of micro-
cephaly among children whose mothers were
infected with Zika virus [4,5] (C) [6] (D).
In view of these aspects, the development of
clinical guidelines regarding the knowledge
acquired to date on an association between
infection with Zika virus and its effects on
pregnancy and childbirth is imperative in
order to delimit and advise on panoramas
related to preconception counseling, pre-
natal, labor, postpartum and newborn care.
Objectives
Prepare a clinical guideline that includes, in
light of current scientific evidence available,
answers to clinical questions structured
according to the components of P.I.C.O.
(P [Patient]; I [Intervention]; C [Compari-
son]; O [Outcome]).
Material and Methods
The evidence used to evaluate the occurrence
of infection with Zika virus during pregnancy
was obtained according to the following steps:
preparation of the clinical question, structur-
ing of the question, search for evidence, criti-
cal evaluation and selection of evidence.
Structured questions
1. During pregnancy,what is the association
between Zika virus and microcephaly?
2. What is the association between Zika
virus and Guillain-Barré syndrome? Is
it different during pregnancy? Can it af-
fect the fetus?
3. What are the symptoms in pregnant
women with suspected Zika virus in-
fection? Are they different than in the
general population?
4. How to make a definitive diagnosis of
Zika virus infection during pregnancy?
5. What is the treatment for Zika virus in-
fection during pregnancy?
6. How is the follow-up of pregnant wom-
en infected with Zika virus done?
7. What are the precautions to be taken
with babies born from pregnant women
with a history of Zika virus infection?
8. What care is required for newborns diag-
nosedwithmicrocephalyduringpregnancy?
Zika virus infection and pregnancy
Florentino Cardoso Giovanni Cerri Antonio Salomão Wanderley Bernardo Ricardo Simões Renata Buzzini
BACK TO CONTENTS
62
FEDERATIVE REPUBLIC OF BRAZIL
Zika Virus
Databases consulted
Primary scientific databases consulted were
Medline, Embase and Cochrane using the
terms “Zika Virus” and “Pregnancy” individu-
ally or grouped. A manual search from the ref-
erences of narrative reviews was also performed.
Chart1 displays the number of studies retrieved
from each scientific database until 2/23/16.
Chart 1. Number of studies retrieved by pri-
mary database
Database Number of studies
PubMed-Medline 173
Embase 171
Cochrane 0
Inclusion criteria for
studies retrieved
Selection of studies, assessment of titles and
abstracts was conducted by two researchers
(R.S.S. and W.M.B.) both independent and
blinded. Whenever the title and the summary
were not enlightening, researchers sought the
full article. Case reports, case series and guide‑
lines were included in the evaluation.Narrative
reviews were included in the reading with the
purpose of retrieving reference that could have
been lost in the initial search strategy. Physio-
logical reports or studies based on animal mod-
els,as well as those unrelated with our P.I.C.O.
components, were not included. Only articles
whose full text was available were included in
the guideline. We included studies available in
Portuguese,English,French or Spanish.
Studies retrieved
After entering the search strategy in the pri-
mary databases the assessment of titles and
abstracts led to the selection of 288 studies.
Evidence selected
The studies considered for full text read-
ing were assessed according with the set
inclusion and exclusion criteria, P.I.C.O.,
language and availability of the full text
(Figure 1).
1. During pregnancy, what is
the association between Zika
virus and microcephaly?
In Brazil, a possible association between
Zika virus infection during pregnancy and
microcephaly has been under investigation
since October 2015 when the Ministry of
Health reported an increase in the number
of cases of microcephaly close to 20 times of
that previously reported (approximately 0.5
cases for each 10,000 live births) after an
outbreak of this virus [10,11] (D). This re-
port made the Pan American Health Orga-
nization (PAHO) publish a warning about
the increased occurrence of microcephaly in
Brazil [12] (D).In the same year,the PAHO
reported viral genome identification using
reverse transcriptase technique followed by
polymerase chain reaction in real time (RT-
PCR) in amniotic fluid samples from two
pregnant women whose fetuses had micro-
cephaly identified during ultrasonography
performed during prenatal monitoring. In
addition, the Zika virus RNA was identi-
fied in various tissues, including the brain,
of a child with microcephaly who died in
the immediate neonatal period [13] (D).
These events led to new alerts issued by the
Ministry of Health of Brazil, the European
Centre for Disease Prevention and Control
(ECDC), and the US Center for Disease
Control and Prevention (CDC) on a pos-
sible association between microcephaly and
the recent outbreak of Zika virus infection
[14,15] (D). The first case of congenital
malformations (microcephaly) found in the
European Union and which is associated
with infection by Zika virus during preg-
nancy, was published in February 2016 [4]
(C). The report was that of a case of fetus
with microcephaly, whose mother had Zika
virus infection in the first trimester of preg-
nancy after a trip to Brazil [4] (C).
The sudden increase in the number of chil-
dren born with microcephaly associated
with brain damage typically seen in congen-
ital infections in regions where newly circu-
lating virus outbreak occurred, as well as the
identification of viral genome in amniotic
fluid, are suggestive of a possible causal re-
lationship. Also, neurotropism of this virus
is known since 1952, found in studies using
guinea pigs [16] (C) [17] (D). However,
some questions are necessary to understand
and validate the relationship of cause and
Pubmed/Medline
n=173
Embase
n=171
Cochrane
n=0
Duplicate articles
n=56
Articles selected for detailed reading of
the full text n=288
Articles selected to be included
in the guideline n=30
Studies excluded
because they were
not related to the
components of
P.I.C.O. (n=171);
physiological
studies or animal
models (n=46); lack
of full text (n=41)
Included
Eligibility
Search
Search
Figure 1. Flowchart for study selection
63
effect. The first point refers to the preva-
lence of the historical birth of infants with
malformations of the central nervous sys-
tem in Brazil, which is about five cases per
100,000 live births, less than the estimates
recently made of 10 to 20 cases per 100,000
live births.This may indicate the occurrence
of underreporting of microcephaly in the
country [18] (D).Thus, any active search for
this congenital malformation would be able
to increase its prevalence, with a clear excess
in the number of cases. Another point re-
lated to the increase in the number of cases
would be the change in diagnostic criteria,
accepting as microcephaly cases of head
circumference measuring less than 33 cm,
and possibly explaining a situation of over-
diagnosis. Since the infection with Zika vi-
rus in newborns and pregnant women was
not confirmed by laboratory tests at first,
another relevant question is that the history
of nonspecific rash referred to during preg-
nancy is subject to recall bias and may have
incurred potential misclassification regard-
ing exposure to Zika virus.Regardless of any
controversies to confirm, or not, the role of
Zika virus in the genesis of cases of micro-
cephaly, measures to prevent infection with
this virus are necessary and unquestionable.
2. What is the Association Between
Zika Virus and Guillain-Barré
Syndrome? Is it Different During
Pregnancy? Can it Affect the Fetus?
Guillain-Barré syndrome (GBS) is a neu-
rological disease that consists of an acute
autoimmune inflammatory demyelinat-
ing polyneuropathy. This is the leading
cause of widespread flaccid paralysis in the
world with an annual incidence of 1 to 4
cases per 100,000 inhabitants [19] (D). It
typically appears in two to three weeks after
nonspecific viral infection. The occurrence
of neurological syndromes after infectious
processes by dengue virus and chikungunya
has been described since the late 1960s, and
with Zika virus infection since 2007, espe-
cially after the outbreaks in Micronesia and
in French Polynesia [2] (C).
In the primary databases consulted, there is
only one case report on French Polynesia in
which GBS was diagnosed in a patient in-
fected with Zika virus.The report showed the
first case of GBS manifested seven days after
febrile illness characterized as Zika virus in-
fection based on serological results [20] (C).
The association between Zika virus infec-
tion and Guillain-Barré syndrome still
needs confirmation through analytical stud-
ies. One factor that hinders greater under-
standing about this association in Brazil is
the lack of epidemiological data specific to
this syndrome.
3. What are the symptoms in pregnant
women with suspected Zika virus
­
INFECTION? Are they different
than in the general population?
It is estimated that 80% of people infect-
ed with Zika virus do not develop clinical
manifestations as seen from epidemiologi-
cal studies,however,when they appear,signs
and symptoms usually are fever, pruritic
maculopapular rashes, non-purulent con-
junctivitis, fatigue and myalgia, and joint
pain in the extremities (wrist/ankle), often
associated with edema. Other unspecific
manifestations that may be reported are
headache, retro-orbital and abdominal pain,
diarrhea, vomiting, constipation and cough
[3,4,21-24] (C). No sign is pathognomonic
of infection with Zika virus.
Studies specifically evaluating the population
of pregnant women infected with Zika virus
are rare in the literature. However, a case se-
ries conducted in Brazil revealed that 72.4%
(n = 21) of the women experienced rash;
44.8% (n = 13) had fever; 37.9% (n = 11) had
arthralgia; with headache in 17.2%, and pru-
ritus in 13.8%. All pregnant women denied
ophthalmologic manifestations [23] (C). In
this study, other causes for the symptoms
were excluded such as infection with cyto-
megalovirus, rubella, herpes virus, syphilis,
toxoplasmosis and HIV. Nevertheless, the
major problem in this assessment would be
the sample which was made for the con-
venience of women who showed signs and
symptoms suggestive of infection with Zika
virus. Another point of great limitation for
the interpretation of these results is the lack
of statistical analysis which would make it
impossible to claim that the percentages or
findings are exclusive to this population or
if they can be extrapolated to all presumed
infections with Zika virus [23] (C).
4. How to make a definitive diagnosis
of Zika virus INFECTION
during pregnancy?
Information about laboratory abnormalities
during Zika virus infection are scarce in the
literature, but leukopenia, thrombocytope-
nia, elevation of serum lactate dehydroge-
nase, and elevated markers of inflammatory
activity such as C-reactive protein are re-
ported [25,26] (C).
A limiting factor that hinders a direct bio-
logical diagnosis, especially using molecular
biology techniques, and may be related to
false-negative results is that the Zika virus
genome is made of ribonucleic acid (RNA)
which is very fragile. The Zika virus can be
isolated in cell cultures such asVero cells,and
its identification is done by indirect immu-
nofluorescence. However, this technique is
reservedforspecializedlaboratories[24](C).
Immunoenzymatic test (ELISA) for detec-
tion of immunoglobulins (IgG and IgM) and
plaque-reduction neutralization test (PRNT)
can be used. But there is a problem related to
serological testing which is the possibility of
cross-reactivity as a result of previous infec-
tion by other flavivirus [4] (C) [27] (D).
The identification of viral genome by re-
verse transcriptase followed by real-time
polymerase chain reaction (RT-PCR) from
RNA directly extracted from the patient’s
serum and preferably collected up to the
sixth day of the disease is the most sensi-
tive and specific method for diagnosis of
Zika virus infection [4,29] (C) [28] (D).
One must be aware of the possibility of
false-negative results since,contrary to what
is observed for other viruses, the restricted
circulation of Zika virus has limited the
knowledge about its actual genetic diversity.
Zika Virus
FEDERATIVE REPUBLIC OF BRAZIL
BACK TO CONTENTS
64
5. What is the treatment for Zika virus
INFECTION during pregnancy?
There are no vaccines, preventive drugs, or
specific antiviral treatments for Zika virus
infection. Treatment is generally support-
ive and may include rest, hydration, non-
steroidal anti-inflammatory drugs or non-
salicylic analgesics used on an individual
basis after careful clinical evaluation. Given
that clinical diagnosis is not conclusive, and
even serological analysis may fail, the use of
salicylates as analgesics should be discour-
aged because of the increased risk of hem-
orrhagic events described in hemorrhagic
syndromes, as in other flavivirus infections.
The pathophysiology of cutaneous mani-
festations remains unknown, but antihista-
mines may be of benefit to patients, acting
as a sedative and not as an agent to treat the
cause of the itching [30] (D).
6. How is THE follow-up of
pregnant women INFECTED
WITH Zika virus done?
Pregnant women tested positive for Zika
virus infection (identified by RT-PCR or
detection of IgM/IgG immunoglobulins)
should be referred for high-risk prenatal
care. There are no studies with an appro-
priate design plan for the monitoring of
pregnant women diagnosed with Zika virus
aiming to assess the prognosis or quality of
life. However, if the fetal ultrasound exami-
nation is normal in women tested positive
for Zika virus infection, both physician and
patient should considerer scheduling ultra-
sounds serially every 3 to 4 weeks to moni-
tor fetal anatomy and growth [31] (D).
7. What are the precautions to
be taken with babies born from
pregnant women with a history
of Zika virus INFECTION?
Targeted diagnostic tests to identify Zika
virus infection should be recommended for
infants with microcephaly or intracranial
calcifications born to women who traveled
to or lived during pregnancy in areas where
the virus circulates; or children born to
mothers with positive or inconclusive results
for Zika virus infection. A newborn is con-
sidered congenitally infected if viral RNA
or antigen is identified in any samples pre-
sented for analysis, including testing of am-
niotic fluid or placental cord blood analysis.
For newborns with laboratory evidence of
possible congenital infection with Zika vi-
rus, further clinical evaluation and monitor-
ing are recommended. In these cases, clini-
cal history, physical examination including
measurement of head circumference,length,
weight and assessment of gestational age,
are needed.Neurological abnormalities,skin
rashes, dysmorphic features, splenomegaly
and hepatomegaly should be evaluated.
Ophthalmologic evaluation and otoacoustic
emission examination should be conducted
before hospital discharge or within a month
after birth [32] (C).
For children with microcephaly or intra-
cranial calcifications, additional evaluation
should include consultation with a pediatric
neurologist.Test for other congenital infec-
tions such as syphilis, toxoplasmosis, rubel-
la, cytomegalovirus and herpes simplex vi-
rus infections should be requested. Genetic
causes should also be investigated, as well
as maternal substance abuse, exposure to
ionizing radiation, use of teratogenic agents
and infections in general [33] (D).
8. What care is required for
newborns diagnosed with
microcephaly during pregnancy?
Because of the wide variety of differential
diagnosis ranging from other congenital
infections, genetic abnormalities, familial
microcephaly, and more, it is imperative
to confirm the diagnosis of Zika virus in-
fection in microcephalic newborns. Thus,
careful history should answer the following
questions: maternal history (intrauterine in-
fections, placental insufficiency, pre-existing
maternal diseases); maternal exposure to
ionizing radiation or potentially terato-
genic agents (drugs, alcohol, smoking, etc.);
drugs used during pregnancy; presence of
skin rash and other signs and symptoms
of infection during pregnancy; and family
history. Complete physical examination of
the newborn should be performed, with the
measurement of head circumference,length,
weight and gestational age assessment, also
including a detailed neurological examina-
tion. Ophthalmologic evaluation within
1 month after birth is recommended, in-
cluding retinal assessment, since abnormal
ophthalmologic findings such as macular
abnormalities and optic nerve disorders are
reported in microcephalic children with
possible congenital infection with Zika vi-
rus [23,24] (C). The mother must also be
tested for Zika virus infection, in case this
was not done during pregnancy.
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10. Centro de Operações de Emergências em Saúde
Pública sobre Microcefalias. Monitoramento
dos casos de microcefalias no Brasil. Available
from: http://portalsaude.saude.gov.br/images/
pdf/2015/novembro/30/coes-microcefalias-
–informe-epidemiol–gico—se-47.pdf.
11. Brazilian Ministry of Health. Ministério da
Saúde investiga 3.852 casos suspeitos de micro-
cefalia no país. [cited 2016 Feb 12]. Available
from: http://portalsaude.saude.gov.br/index.php/
cidadao/principal/agencia-saude/22145-ministe-
rio-da-saude-investiga-3-852-casossuspeitos-de-
microcefalia-no-pais.
12. Pan American Health Organization. Epide-
miological alert. Increase in microcephaly in
the northeast of Brazil – epidemiological alert.
Washington, DC: World Health Organiza-
tion, Pan American Health Organization, 2015.
Available from: http://www.paho.org/hq/index.
php?option=com_docman&task=doc_view&Ite
mid=270&gid=32636&lang=en.
13. Pan American Health Organization. Neuro-
logical syndrome, congenital malformations,
and Zika virus infection. Implications for public
health in the Americas – epidemiological alert.
Washington, DC: World Health Organiza-
tion, Pan American Health Organization, 2015.
Available from: http://www.paho.org/hq/index.
php?option=com_docman&task=doc_view&Ite
mid=270&gid=32405&lang=en.
14. European Centre for Disease Prevention and
Control. Rapid risk assessment: microcephaly in
Brazil potentially linked to the Zika virus epi-
demic.Stockholm: European Centre for Disease
Prevention and Control, 2015. Available from:
http://ecdc.europa.eu/en/publications/Publica-
tions/zika-microcephaly-Brazil-rapid-risk-as-
sessment-Nov-2015.pdf.
15. CDC. Recognizing, managing, and reporting
Zika virus infections in travelers returning from
Central America, South America, the Caribbe-
an, and Mexico. CDC Health Advisory. Atlanta:
US Department of Health and Human Services,
CDC, 2016. Available from: http://emergency.
cdc.gov/han/han00385.asp.
16. Calvet G, Aguiar RS, Melo AS, Sampaio SA, de
Filippis I, Fabri A, et al. Detection and sequenc-
ing of Zika virus from amniotic fluid of fetuses
with microcephaly in Brazil: a case study. Lancet
Infect Dis. 2016. pii: S1473-3099(16)00095-5.
17. Dick GW. Zika virus. II. Pathogenicity and
physical properties. Trans R Soc Trop Med Hyg.
1952; 46(5):521-34.
18. EUROCAT European Surveillance of Con-
genital Anomalies.Prevalence tables.Ispra,Italy:
EUROCAT European Surveillance of Con-
genital Anomalies; 2015. Available from: http://
www.eurocat-network.eu/accessprevalencedata/
prevalencetables.
19. Yoshikawa H. [Epidemiology of Guillain-Barré
syndrome]. Brain Nerve. 2015; 67(11):1305-11.
20. Oehler E, Watrin L, Larre P, Leparc-Goffart I,
Lastere S, Valour F, et al. Zika virus infection
complicated by Guillain-Barré syndrome – case
report, French Polynesia, December 2013. Euro
Surveill. 2014; 19(9). pii: 20720.
21. Heang V, Yasuda CY, Sovann L, Haddow AD,
Travassos da Rosa AP, Tesh RB, et al. Zika vi-
rus infection, Cambodia, 2010. Emerg Infect Dis.
2012; 18(2):349-51.
22. Olson JG, Ksiazek TG, Suhandiman, Tri-
wibowo. Zika virus, a cause of fever in Central
Java,Indonesia.Trans R SocTrop Med Hyg.1981;
75(3):389-93.
23. de Paula Freitas B, de Oliveira Dias JR, Prazeres
J, Sacramento GA, Ko AI, Maia M, et al. Ocular
findings in infants with microcephaly associated
with presumed Zika virus congenital infection in
Salvador, Brazil. JAMA Ophthalmol. 2016. [Epub
ahead of print]
24. Heang V, Yasuda CY, Sovann L, Haddow AD,
Travassos da Rosa AP, Tesh RB, et al. Zika vi-
rus infection, Cambodia, 2010. Emerg Infect Dis.
2012; 18(2):349-51.
25. Zammarchi L, Stella G, Mantella A, Bartolozzi
D, Tappe D, Günther S, et al. Zika virus infec-
tions imported to Italy: clinical, immunological
and virological findings,and public health impli-
cations. J Clin Virol. 2015; 63:32-5.
26. Cao-Lormeau VM, Roche C, Teissier A, Robin
E,Berry AL,Mallet HP,et al.Zika virus,French
polynesia, South pacific, 2013. Emerg Infect Dis.
2014; 20(6):1085-6.
27. Mansfield KL, Horton DL, Johnson N, Li L,
Barrett AD, Smith DJ, et al. Flavivirus-induced
antibody cross-reactivity. J Gen Virol. 2011;
92(Pt 12):2821-9.
28. Scaramozzino N, Crance JM, Jouan A, DeBriel
DA, Stoll F, Garin D. Comparison of flavivirus
universal primer pairs and development of a
rapid, highly sensitive heminested reverse tran-
scription-PCR assay for detection of flaviviruses
targeted to a conserved region of the NS5 gene
sequences. J Clin Microbiol. 2001; 39(5):1922-7.
29. Balm MN, Lee CK, Lee HK, Chiu L, Koay
ES, Tang JW. A diagnostic polymerase chain
reaction assay for Zika virus. J Med Virol. 2012;
84(9):1501-5.
30. European center for disease prevention and con-
trol. [cited 2016 Feb 19]. Available from: http://
ecdc.europa.eu/en/healthtopics/zika_virus_in-
fection/factsheet-health-professionals/Pages/
factsheet_health_professionals.aspx.
31. Oduyebo T, Petersen EE, Rasmussen SA, Mead
PS, Meaney-Delman D, Renquist CM, et al.
Update: Interim Guidelines for Health Care
Providers Caring for Pregnant Women and
Women of Reproductive Age with Possible Zika
Virus Exposure – United States, 2016. MMWR
Morb Mortal Wkly Rep. 2016; 65(5):122-7.
32. Ventura CV, Maia M, Bravo-Filho V, Góis AL,
Belfort R Jr. Zika virus in Brazil and macular at-
rophy in a child with microcephaly.Lancet.2016;
387(10015):228.
33. Staples JE, Dziuban EJ, Fischer M, Cragan
JD, Rasmussen SA, Cannon MJ, et al. Interim
Guidelines for the Evaluation and Testing of
Infants with Possible Congenital Zika Virus
Infection – United States, 2016. MMWR Morb
Mortal Wkly Rep. 2016; 65(3):63-7.
34. Ventura CV, Maia M, Ventura BV, Linden VV,
Araújo EB, Ramos RC, et al. Ophthalmological
findings in infants with microcephaly and pre-
sumable intra-uterus Zika virus infection. Arq
Bras Oftalmol. 2016; 79(1):1-3.
Brazilian Medical Association
Florentino Cardoso,
President of the Brazilian Medical Association
E-mail: presidente@amb.org.br
Giovanni Cerri,
Scientifc Director of the Brazilian
Medical Association
E-mail: giovanni_cerri@uol.com.br
Antonio Salomão,
Professor of Gynecology,
University of São Paulo
E-mail: antoniosalomao@uol.com.br
Wanderley Bernardo,
Guideline Scientific Editor of the
Brazilian Medical Association
E-mail: wmbernardo@usp.br
Ricardo Simões,
Member of the Guideline Program,
Brazilian Medical Association
E-mail: ricardo.simoes@amb.org.br
Renata Buzzini,
Member of the Guideline Program,
Brazilian Medical Association
E-mail: renata@cardapioterapia.com.br
Zika Virus
FEDERATIVE REPUBLIC OF BRAZIL
BACK TO CONTENTS
66
REPUBLIC OF TURKEY
NMA News
The Turkish Medical Association and its lo-
cal body the Istanbul Chamber of Medicine
in collaboration with the World Medical
Association hosted a very important event
on 26–27 February 2016 in Istanbul on the
recent global migration crisis. The “War,
Migration and Health: What Should Phy-
sicians Do?” symposium agenda included
many aspects of the crisis, offering solutions
as well. See Flyer of the Symposium.
The Symposium started with key speeches
framing the burden as a global issue. Prof.
Sir Michael Marmot, President of the
World Medical Association, opened the
Symposium with his marvelous key speech
highlighting the inequalities in the world.
From beginning to end, excellent speeches
from distinguished guests were presented.
Humanity, health, ethics, economic and
other aspects were discussed during the
Symposium.
About 200 participants from 17 countries
participated in the Symposium. Medical
Associations from Germany, Greece, Bel-
gium, France, the United Kingdom, Israel,
Sweden, Switzerland, the Turkish Republic
of Northern Cyprus, Lithuania, Norway,
Poland, Ukraine, representatives of medi-
cal organizations from the US, Albania and
Uganda, representatives of international
organizations (United Nations Population
Fund (UNFPA), Médecins Sans Fron-
tières (MSF), Physicians for Human Rights
(PHR), Junior Doctors Network (JDN),
World Health Organization (WHO)-Tur-
key, Presidency of Migration Management, 
Disaster and Emergency Management
Authority (AFAD), Peoples’ Bridge Asso-
ciation, Peace Association,Turkish Medical
Students International Committee  (Turk-
ish MSIC),Turkish Psychiatry Association,
Turkish Thorax Association, Association of
Public Health Specialists (HASUDER),
Turkish Nurses Association, and Associa-
tion of Social Workers Migration) [2] dis-
cussed migration as a result of the war with
all its effects.
Main messages given in the Symposium are
listed below:
1. About the current situation:
a. Global inequality is a very significant
challenge and creates health gap.
b.
Migration, very closely linked with
war, has been occurring and is deter-
mined by inequalities, the economic
crisis, and other unlisted determinants
of health.
c. Millions of people have to move from
home countries to other places because
of war and other compelling life threat-
ening conditions.
d.
Threats are occurring for migrants
while leaving their homelands on their
migration path, and while adapting to
their “new” lands.
e.
Children, women, disabled people,
aged people have double burden in
their struggle aiming to survive.
f. The problem is not local. Global agen-
da is needed for solution.
2. About the major goal(s):
a. Ending the underlying conditions re-
sponsible for the migration of people.
b. Guarantee of life and travel conditions
for migrants.
c. Human dignity should be protected for
all affected people.
d. Human rights should be guaranteed to
all individuals.
3. About the responsible bodies:
a. State-level public authorities have the
major responsibility to provide human-
itarian conditions for everyone.
b.
Municipalities should support state-
based services.
c. Recommendations,guidelines and dec-
larations of international organizations,
e.g. the United Nations and the World
Medical Association, should be used in
full without any exception.
d.
Collaboration with public authorities
and civil society should be created.
4. About the physicians’ role(s):
a.
Physicians have role(s) in facing the
difficulties of armed conflict(s).
b.
Physicians have significant role(s) in
organizing and providing healthcare
services to individuals and communi-
ties in dire conditions.
Istanbul Symposium on War, Migration and
Health
Bayazit Ilhan Dilek Aslan
67
REPUBLIC OF TURKEY NMA News
c.
Physicians providing services should
not be hampered due to any reason. All
precautions should be taken in this re-
gard.
d.
Physicians should struggle for human
dignity.
e. Physicians should advocate for peace at
the global level as they are the voice of
humanity.
In conclusion, the Symposium gave the orga-
nizers and participants a chance to discuss
the “war” and “migration” issues in a very
broad perspective. In this sense, solutions
were discussed realistically and sincerely.
The Symposium was full of hope that the
recommendations will be implemented in
real life.
The Symposium ended with accepting a
communiqué including all the discussed
problems and solutions [3]. The Sympo-
sium website (warmigrationhealth.com) is
still active including all the details and vid-
eo records of the speeches in English and
Turkish.
The Turkish Medical Association and its
local body the Istanbul Chamber of Medi-
cine were honored to collaborate with the
World Medical Association in organizing
such a symposium on a very hot topic for
the Global Health Agenda.
Hopefully, outputs of the Symposium
would contribute to solving the problem(s)
in the very near future.
Doctors as the voices of solidarity and peace
will work continuously in this regard…
References
1. [Cited 2016 June 07] Available from http://
www.wma.net/en/50events/20otherevents/99p
astotherevents/92Istanbul2016021/index.html.
2. [Cited 2016 June 07] Available from http://war-
migrationhealth.com/?lis=en
3. [Cited 2016 June 07] Available from http://
warmigrationhealth.com/kategori/commu-
nique-287.html
Bayazit Ilhan, MD,
President, Turkish Medical Association
E-mail: ilhanbayo@yahoo.com
Dilek Aslan, MD,
Turkish Medical Association, Bureau
of International Affairs, member of the
Symposium organizing committee
E-mail: diaslan.dr@gmail.com
SYMPOSIUM
26-27 February 2016
Istanbul / Turkey
warmigrationhealth.com
——————————
• War, migration and social determinants
of health
• Medical problems related to migration
• Experience of Turkey and TMA’s
activities
• Policies of countries and institutions
related to migration
• Women and War
• Presentations of physician
organisations
BACKGROUND
The World Medical Association
together with the Turkish Medical
Association and the Istanbul Chamber
of Medicine will hold a Symposium on
War, Migration and Health, following an
emergency resolution adopted by the
WMA General Assembly in October
2015 on this critical issue.
Many countries face significant
problems maintaining effective health
and social care systems and are
unable to respond to the basic needs
of refugees and migrants. War and
internal conflicts in countries of origin,
extreme poverty in transit countries,
and limited resources and political
pressure in rich destination countries
are just some of the obstacles
inhibiting action. The resultant impact
is that refugees and migrants face
severe difficulties in securing food,
shelter and access to healthcare.
PARTICIPATION
the WMA wishes to address these
problems in an international
symposium, and therefore urgently
requests your participation in order to
learn from your experience including.
the health problems of refugees and
migrants, access to healthcare,
government reactions and responsive
policies, experiences of healthcare
workers, NMAs and NGOs,
observations and recommendations.
Please see the website for details.
warmigrationhealth.com
War
Migration
and
Health
BACK TO CONTENTS
68
Southeast European Medical Forum
SEEMF is a legal non-for-profit entity. It
is registered under Bulgarian legislation.
SEEMF President is Dr. Andrey Kehayov –
President of Bulgarian Physician Association,
vice-presidents are Prof. Pavel Poredos – Pres‑
ident of the Slovenian Medical Association and
Dr.  Oleg Musii – Member of Parliament of
Ukraine and President of the Ukrainian Med‑
ical Association, Secretary General – Dr. Styli‑
anos Antypas, Athens, Greece.
SEEMF Board
President: Dr. Andrey Kehayov, Bulgaria
Vice-Presidents:
Prof. Pavel Poredos, Slovenia; Dr.  Oleg
Musii, Ukraine
Secretary General: Dr. Stylianos Antypas,
Hellas
Members:
Dr. Din Abazaj, Albania
Dr. Fatmir Brahimaj, Albania
Prof. Veselin Borisov, Bulgaria
Dr. Valiantsina Hancharova, Belarus
Prof. Gia Lobzhanidze, Georgia
Prof. Slobodan Tomic, Montenegro
Prof. Dusko Vasic, Republic Of Srpska
Prof. Sinisa Miljkovic, Republic Of Srpska
Dr. Aizhan Sadykova, Kazakhstan
Dr. Zokhid Abdurakhimov, Uzbekistan
Prof. Abdullah Khudaybergenov, Uzbekistan
Dr. Nariman Safarli, Azerbaijan
Dr. Romeo Scerbina – Moldova
Prof. Jaroslav Blahos, Czech Republic
Dr. Gligor Tofoski, Macedonia
Dr. Goran Dimitrov, Macedonia
Dr. Athanasios Exadaktylos, Hellas
Prof. Milan Milanov, Bulgaria
Member-countries: Bulgaria, Slovenia,
Hellas, Albania, Belarus Georgia, Monte-
negro, Republic Of Srpska, Kazakhstan,
Uzbekistan, Azerbaijan, Moldova, Czech
Republic, Macedonia
The Southeast European Medical Forum
(SEEMF) was founded at a meeting in So-
fia in 2005 by medical organizations of Al-
bania,Bulgaria,Greece,and Macedonia as a
society of organizations of physicians from
Southeast European countries – neighbor-
ing countries with similar problems. The
meeting adopted Statutes. Decision was
taken to invite other organizations from the
region to join.The name of the organization
was agreed upon.
SEEMF was later joined by the medical as-
sociations of Slovenia, Republic of Srpska,
Montenegro, Ukraine, Georgia, Kazakh-
stan, Belarus, Uzbekistan, Azerbaijan, Mol-
dova, Czech Republic.
Its purpose is to promote the partnership
of the medical profession in the member-
countries, to discuss common problems
and to find solutions; to enable exchange
of experience, strengthen the relations and
elaborate common approaches in all fields
of activity of the medical organizations;
to develop continuous medical educa-
tion through medical congresses and other
forms of mutual activity; to assist its mem-
bers for improvement of their medical and
management-related qualification; to es-
tablish contacts and partnership with other
international organizations.
Main Goals
1. To unite and assist its members for
achievement of their common aims;
2. To enable exchange of experience and
develop common approaches in all fields
of activity of the medical organizations;
3. To promote in the Southeast European
countries the best possible medical edu-
cation, medical practice and healthcare;
4. To strengthen the relations between the
medical organizations of the Southeast
European countries;
5. To strengthen the relations between the
physicians from the Southeast Euro-
pean countries and the exchange of ex-
perience with their colleagues from the
EU member-countries;
6. To assists its members for improvement
of their medical and managerial quali-
fication;
7. To establish contacts with similar orga-
nizations;
8. To defend the rights and interests of
physicians, healthcare establishments,
and medical professionals before the
legislative, executive and legal authori-
ties by submission of drafts and stands
on regulations, legal proceedings, etc.
As of 2010 SEEMF intensified its activities
and is holding at least two Board Meetings
and a Congress each year.
The First SEEMF Congress took place in
Varna, Bulgaria in 2010.
It focused on different specialized topics
as well as on Patient Safety and Health Is-
sues and Health Policies under Conditions
Southeast European Medical Forum
Andrey Kehayov
69
Southeast European Medical Forum
of Economic Crisis. Participants from 14
countries attended the event and presenta-
tions were made by outstanding physicians
and representatives of medical science, in-
cluding Prof. Enis Ozyar from Turkey and
Prof. Peter Schwarz from Germany. The
meeting adopted the following
The Second international medical congress of
SEEMF was held in the period 7–11 Sep-
tember 2011 in Nesebar, Bulgaria.
The main Congress topics were:
• Diabetes and Complications
• Cardiovascular Diseases
• Infectious Diseases
• Oncologic Diseases
A Round Table was held on “Health Re-
forms and Funding”
Dr.  Wonchat Subhachaturas, President of
the World Medical Association welcomed
the Congress participants and presented the
World Medical Association.
The first awards Outstanding Physician of
Southeast Europe were granted to Prof.
Gencho Nachev, Bulgaria and Prof. Jovan
Tofoski, Macedonia
The Third international medical congress of
SEEMF took place in Belgrade, Serbia in
the period 12–15 September 2012.
Reports on major topics, namely cardiology,
diabetes, oncology and Immunization in the
21st century aroused great interest among the
participants.The agenda included discussions
on “Health and health systems in Southeast
Europe in the 21st Century” and “National
medical associations and chambers in South-
eastern Europe – the role of professional self-
regulation.” A significant number of partici-
pants shared their views on these issues.
During the Congress a Board Meeting was
held at which changes to the SEEMF Stat-
utes were adopted and elections were held
for Board leaders. SEEMF President, two
Vice-Presidents and Secretary General
were elected.
The Fourth international medical congress
of SEEMF took place in Portoroz, Slovenia
in the period 11–15 September 2013 with
participants from over 20 countries and fac-
ulty of about 60 outstanding professors in
different medical fields.
The Congress was organized in partnership
with the Slovenian Medical Association,
and was attended by guests from Albania,
Azerbaijan, Belarus, Bosnia and Herze-
govina, Bulgaria, Croatia, Germany, Greece,
Kazakhstan, Latvia, Macedonia, Serbia,
Slovenia,Turkey, Ukraine and Montenegro.
Self-evident of the reputation that the
SEEMF has, as well as of the need of medi-
cal professionals to share their thoughts and
experience was the fact that the medical as-
sociations of Azerbaijan and Moldova were
accepted as members of the organization.
The multidisciplinary scientific agenda of
the Congress was focused mainly on the
fields of cardiology, diabetes treatment, or-
gan transplantations and oncology. Many
interesting topics were debated at a round
table discussion on the issues of healthcare
funding and the role of professional orga-
nizations. The high value of reports, lectur-
ers and topics was the fact that participants
were granted European certificates with the
score of 15 credits.
The Fifth international medical congress of
SEEMF was held in the period 10–14 Sep-
tember 2014,in Ohrid,Macedonia.The main
scientific topics were: Oncology, Diabetes
mellitus, Cardiology,Calamity Medicine
The Public Health Impact of immunization
and vaccine prophylaxis – challenges and
priorities
The Round Table was dedicated to e-health;
realities, problems and financing of health
systems in SE Europe.
2014 created a new opportunity for
the Southeast European Medical Fo-
rum (SEEMF) to expand its reach and
strengthen its recognition. The Forum ac-
cepted a new member – the Czech Medi-
cal Association, which has 34 000 doctors
as its members. At the opening of the
Congress, which was hosted by the city
of Ohrid, Macedonia, the president of the
SEEMF Dr. Andrey Kehayov said a sig-
nificant scientific forum was about to take
place. “Regardless of the political situation
we provided the idea that doctors have
to stand united because they all have one
mission in every country – treat their pa-
tients. Communication among doctors is
of vital importance to help them improve
their experience,” Kehayov said. The Fifth
Congress of SEEMF honoured the most
worthy doctors of Southeast Europe, as
well as organisations and structures that
supported the Forum.
The Fifth SEEMF Congress also issued a
resolution, based on all the reports present-
ed at the Congress, in the fields of oncol-
ogy, cardiology, infectious diseases, disaster
medicine, and immunisation. Because of
the vital significance of preventive measures
the Congress issued an appeal for the na-
tional immunisation calendars in Southeast
Europe to be adapted to the best immuni-
sation practices of the European Union, in
order to achieve quality protection of chil-
dren health. Doctors recommended that a
certain number of vaccines be introduced
to the universal mass vaccination: pneu-
mococcus vaccines, human papillomavirus
vaccines, rotavirus vaccines and vaccines
against meningococcal meningitis. The
underfunded health systems of the coun-
tries in Southeast Europe would not secure
equal access to quality healthcare.Therefore,
all the states in the region should turn the
improvement of their health sectors into a
topmost priority.
BACK TO CONTENTS
70
According to the President of the SEEMF
Dr.  Andrey Kehayov, the resolution re-
flected all that had been shared with the
participants in the numerous lectures and
reports, as well as the experience the col-
leagues had shown to each other. Important
problems were defined and addressed to the
medical associations in respective countries
and the institutions responsible for solving
such issues. The participation of Standing
Committee of European Doctors President
Dr. Katrín Fjeldsted allowed for the reso-
lution to be reviewed by all European and
international medical associations.
SEEMF also passed a declaration of in-
ternational significance, in which doctors
of Southeast Europe declared themselves
against the decision to drop toxic chemicals
in the Mediterranean Sea after the destruc-
tion of Syria’s chemical weapons’caches.“As
professionals we have the fundamental goal
of protecting people’s health. Recognising
all possible dangers of such a decision we
declare that we are categorically opposed to
an action that could jeopardize the life of all
people inhabiting the area,” the declaration
said.
Sixth international medical congress of
SEEMF was held in the period 9–13 Sep-
tember 2015, Odessa, Ukraine
Southeast European Medical Forum
(SEEMF) held its regular Sixth Interna-
tional Congress in Odessa Ukraine from
9.09 to 12.09.2015. The event was orga-
nized jointly with the Ukrainian Medical
Association, which celebrated its 25th an-
niversary.
The Forum was attended by over 750 rep-
resentatives from more than 15 countries.
President of the World Medical Association
Dr. Xavier Deu welcomed the participants.
Scientific reports in the field of cardiovas-
cular diseases, oncological diseases, repro-
ductive health and other socially significant
diseases were presented by distinguished
experts from Bulgaria, Ukraine, Georgia,
Belarus,Latvia,Poland,Macedonia,Greece
and Slovenia. Military medicine and ca-
lamity medicine were among the topics
discussed. The participants in the round-
table discussed the aspects of doctors’ pro-
fessional autonomy. Dr. Xavier Deu shared
the experience of the French Medical As-
sociation.
Dr. Andrey Kehayov- President of SEEMF
presented the activities of SEEMF and ex-
pressed his expectation about the effect of
the Congress significant scientific contribu-
tions.
Dr. Maciej Hamankevich, president of the
Supreme Medical Council presented the
professional autonomy of the Polish doctors
and dentists.
During the event a meeting of the Board
of SEEMF was held. Dr.  Stylianos Anti-
pas from the Hellenic Republic was elected
Secretary General of the Forum, with a
mandate until 2017.
Four new members were elected in the
Board of the organization – Prof.Milan Mi-
lanov, president of Sofia Branch of the Bul-
garian Medical Association, Dr. Anastasios
Eksadaktilos – Chairman of Thessaloniki
Medical Association and two representa-
tives of the Macedonian Medical Organi-
zation- Dr.  Goran Dimitrov, chairman of
the Macedonian Medical Association and
Dr. Gligor Tofoski. The board resolved that
next year the organization will hold two
congresses – one in Georgia and one in the
Hellenic Republic.
The Board approved the traditional award
nominations in the field of medicine, such
as outstanding physician of Southeastern
Europe, for contribution to public health
development, etc.
Dr.  Oleg Musii Chairman of the Ukrai-
nian Medical Association and member
of the Verkhovna Rada was awarded for
contribution to the development of Public
Health. The President of the World Medi-
cal Association Xavier Due was awarded
for his outstanding contribution to the
development of international medical co-
operation. Prof.Krasimir Gigov, Secretary
General of the Bulgarian Red Cross was
awarded for contribution to the develop-
ment of public health. University Hospital
“Saint Catherine” by CEO Prof. Gencho
Nachev and Prof. Milan Milanov, presi-
dent of the Metropolitan Medical College
were honored for contribution to the de-
velopment of SEEMF. Dr. Nikolai Tish-
chuk of Ukrainian Medical Association
was honored with the award for many years
of work in the interest of the medical pro-
fession. Dr. Stylianos Antipas – SEEMF
Board member was honored for his ac-
tive position on environmental protection
and public health issues. Acd. Prof. Lu-
bomir Pyrgi from Ukraine, Prof. Svetoslav
Schnittke, from Belarus and Prof. Ketevan
Nemsadze, corresponding member of the
Georgian National Academy of Sciences
were honored for contribution to medical
science development.
International Cooperation
SEEMF leaders have taken part in a num-
ber of international meetings, the most
important of which being the European
Forum of Medical Associations and WHO
and the WMA General Assembly.
SEEMF Awards
Outstanding Physicians Of Southeastern
Europe
Prof. Jovan Tofoski – 2011
Prof. Gencho Nachev – 2011
Prof. Pavel Poredos – 2013
Prof. Katica Zafirovska – 2014
Acad. Wladimir Ovtscharoff – 2014
Prof. Dimitri Kordzaya – 2014
Acad. Prof. Lubomyr Pyrih – 2015
Southeast European Medical Forum
71
2011
1. Dr.  Stylianos Antypas – Award For
Contribution To Healthcare Improve-
ment In Southeastern Europe
2. Dr.  Oleg Musii – – Award For Con-
tribution In The Field Of Healthcare
Management And Policy
3. Dr.  Vladimir Lazarevic – Award For
Contribution To The Development Of
Seemf
4. Dr. Wonchat Subhachaturas – Award
For Contribution For The Develop-
ment Of International Medical Col-
laboration
2012
1. Prof. Wladimir Ovtscharoff – Award
For Contribution To Healthcare Im-
provement In Southeastern Europe
2. Dr. Din Abazaj – Award For Contribu-
tion To The Development Of Seemf
3. Prof Dusko Vasic – Award For Contri-
bution To The Development Of Seemf
2013
1. Prof. Goce Spasovski – Award For
Contribution To Medical Science And
Education In Southeastern Europe
2. Dr.  Aizhan Sadykova – Award For
Contribution To The Development Of
Seemf
3. Prof Gia Lobzhanidze – Award For
Contribution To The Development Of
Seemf
4. Assoc. Prof. Dr. Mateja Kaja Ježovnik,
Md, Phd, Department Of Vascular Dis-
ease, University Medical Centre Lju-
bljana, Ljubljana, Slovenia
2014
1. Prof. Dr. Tzekomir Vodenicharov, Md,
Phd, Dsci, Dean Of The Public Health
Faculty, Sofia Medical University, Bul-
garia – Award For His Contribution To
Public Health Development In South-
eastern Europe
2. Dr. Katrin Fjeldsted, Cpme President –
Award For Her Distinguished Contri-
bution To The Development Of Euro-
pean Medical Organizations
3. Prof. Jaroslav Blahos, Md, President Of
The Czech Medical Association, Em.
President Of The World Medical Asso-
ciation – Award For His Contribution
To Public Health Development
4. Prof. Dr. Milan Milanov, President Of
The Sofia Branch Of The Bulgarian
Medical Association – Award For His
Distinguished Contribution For The
Development Of Seemf
5. Dr.  Todor Cherkezov, Md, Ceo Of
Mphat “Dr.  At. Dafovski” Hospital,
Bulgaria – Award For His Distin-
guished Contribution For The Devel-
opment Of Seemf
6. Prof. Dr. Aleksej Duma, Shtip Medical
Faculty, Macedonia – Award For His
Active Work To The Interest Of The
Medical Profession
7. Dr.  Zokhid Abdurakhimov, Phd, Ex-
ecutive Director Of The Medical Asso-
ciation Of Uzbekistan – Award For His
Contribution For Seemf Enlargement
8. Bulgarian Red Cross – Award For The
Support Ad Distinguished Contribu-
tion For The Development Of Seemf
9. Actavis Company – Award For Their
Repeated Support Of Seemf Con-
gresses
10. Novartis Company – Award For Their
Repeated Support Of Seemf Con-
gresses
2015
1. Dr.  Oleg Musii, President Of The
Ukrainian Medical Association – Award
For Contribution To Public Health De-
velopment
2. Dr.  Xavier Deau, Wma President –
Award For His Distinguished Contri-
bution For The Development Of Inter-
national Medical Collaboration
3. Dr. Mykola Tyshchuk, Ukrainian Med-
ical Association – Award For His Active
Work To The Interest Of The Medical
Profession
4. Dr.  Stylianos Antypas, Seemf Board
Member – Award For His Active Posi-
tion On Environmental Protection And
Public Health Issues
5. Prof. Sviataslau Shnitko, Belarus –
Award For His Contribution To Medi-
cal Science Development
6. Prof. Ketevan Nemsadze, Correspond-
ing Member Of The Georgian National
Academy Of Sciences – Award For Her
Contribution To Medical Science De-
velopment
7. Assoc. Prof. Krasimir Gigov, Bulgarian
Red Cross Secretary General – Award
For His Contribution To Public Health
Development
8. Prof. Milan Milanov, Bulgarian Medi-
cal Association – Award For His Con-
tribution To The Development Of The
Southeast European Medical Forum
9. Uh Sveta Ekaterina, Sofia, With Ceo
Prof. Gencho Nachev – Award For
Contribution To The Development Of
The Southeast European Medical Fo-
rum
Bulgaria, Sofia, 102 Bulgaria Blvd.,
tel./fax: +359 2 854 87 82
E-mail: bulgmed@gmail.com
Website: www.zdravenews.net
Southeast European Medical Forum
BACK TO CONTENTS
72
Bulgarian Medical Association
Office Bearers
President: Dr. Ventsislav Grozev
Vice Presidents: Prof. Dr. Ognyan
Hadzhiy­
ski, Dr. Galinka Pavlova
Secretary General: Dr. Stoyan Borisov
History in brief: Bulgarian Medical Asso-
ciation was established in 1901 which made
it the second professional medical associa-
tion in the world after the British one. At
first, its objectives were to protect the in-
terests of the medical profession, determine their fees, but later on
it began to organize the medical care across the country and deter-
mine the health policy of the state. During the communist regime
the Bulgarian Medical Association was put under a ban. It has been
restored after the democratic changes in 1990.
Membership: Adopted in 1999, the Act on the Professional Or-
ganizations of Physicians and Dentists legitimized the Bulgarian
Medical Association and the Bulgarian Dental Association as au-
tonomous statutory organizations. This law regulates the structure,
organization and activities of the professional organisations of phy-
sicians and dentists, the conditions for practising the medical and
dental professions and the liability for breaching of professional
ethics. The law stipulates that all practising physicians and dentists
shall be members of the Bulgarian Medical Association,respectively
the Bulgarian Dental Association.
Structure and major commitments: Bulgarian MA consists of 28
Regional Colleges. All the physicians with their full name, specialty,
work address, unique identity number and qualification degrees are
listed in the register of the respective Regional Medical College.
Every physician holds an electronic professional card.
The Association is committed to implementation of the following
major commitments (as stipulated in the Act on the Professional
Organizations of Physicians and Dentists):
1. to represent its members and protect their professional rights
and interests;
2. to represent its members as a party to the National Framework
Agreement under compulsory health insurance law;
3. to work out a Code of Professional Ethics of physicians and to
supervise the compliance therewith;
4. to adopt Rules of Good Medical Practice, to propose them for
approval to the Minister of Healthcare and to supervise the
compliance therewith;
5. to impose the penalties provided in the Act on the professional
organizations where necessary;
6. to establish and keep a national electronic register and regional
registers of its members;
7. to participate in the organization and delivery of continuing
professional development for physicians through the Accredita-
tion Council established at the Bulgarian Medical Association
and the Expert Medical Boards in all specialties;
8. to participate through representatives in the Supreme Medical
Council at the Ministry of Healthcare;
9. to give opinions on draft legislation in the field of health-
care;
10. to cooperate with other national and international organiza-
tions and institutions;
15, Akademik Ivan Geshov Blvd.,
1431 Sofia, Bulgaria
Ph.: +359-2-9541126;
Fax: +359-2-9541186
E-mail: blsus@mail.bg;
foreign.bls@gmail.com
Website: www.blsbg.com
Chinese Medical Association
Office Bearers:
President: Xiao-wei Ma
Vice President: Yu-pei Zhao, Ya-sen
Maimaiti, Ying-kang Shi, Yan-fei Liu,
Zhi Su, Qing-jie Li, Bao-feng Yang, Bo-li
Zhang, Sai-juan Chen, Da-peng Jin, Shu-
sen Zheng, Yang Ke, Ke-qin Rao, Fu-chu
He, Jian-guang Xu, Fu Gao
Secretary General: Keqin Rao
Membership: 506,000
Mission: The missions of the Association shall be to unite and or-
ganize professionals of medical science and technology, to abide by
the national Constitution, laws and regulations, and to implement
national policies for science and technology and healthcare. The
Association shall uphold medical ethics and advocate social integ-
rity. It shall operate with democratic principles, support freedom of
scholarship, and seek to raise the technical skills of the professionals
of medical science and technology. It shall promote the prosper-
ity and development of medical science and technology, and the
popularization of medical science and technology knowledge. It
shall promote the growth of work forces in medical science and
technology and the integration of medical science and technology
with China’s economic development. The Association shall provide
services for its members and for professionals of medical science and
Ventsislav Grozev
Xiao-wei Ma
NMA news
73
technology, for the health of the Chinese people, and for socialist
modernization in China.
Services provided:
1. To carry out medical exchange programs, to organize activities
for research priorities and investigations, and to promote rela-
tions and collaborations among scientific disciplines and learned
groups.
2. To edit and publish journals, books and materials and pro-
duce electronic audiovisual products of medical sciences, tech-
niques, information, and popularization of medical science
knowledge.
3. To provide continuing medical education and to organize its
members and professionals of medical science and technology
to upgrade their knowledge and raise their professional levels in
medical science and technology.
4. To organize medical and health knowledge popularization and
health promotion activities through various channels and in dif-
ferent forms to improve public health knowledge and increase
the ability of the public to care for their own health.
5. Tobeinvolvedinthetrainingandexaminationofmedicalspecialists.
6. To organize technical assessments of medical malpractices.
7. To organize assessment and appraisal of projects of medical sci-
ence and technology, evaluations of new clinical technologies,
and reviews and evaluations of decisions concerning medical
science and technology, and to put forward medical, pharma-
ceutical and technological suggestions for evidence-based deci-
sion-making for the government.
8. To develop relations with foreign groups and professionals of
medical science and technology and carry out international and
Taiwan, Hong Kong, and Macao regional exchange and coop-
erative programs.
9. To provide consulting services on medical, pharmaceutical and
health science and technology and organize exhibitions to facili-
tate transfer and application of medical research results.
10. To select and award outstanding achievements in medical sci-
ence and technology including scientific papers and popular sci-
ence writings, etc. and organize the assessment and award of the
China Medical Award.
11. To find, recommend and train outstanding talents of medical
science and technology;
12. To promote and award medical professionals for their medi-
cal ethics and skills, and to commend and award Association
members who make outstanding contributions to the activi-
ties of medical science and technology and Association staff
members who make remarkable achievements for the Asso-
ciation.
13. To serve its members by keeping the Party and the government
informed of the views and aspirations of the professionals of
medical science and technology and by protecting their legal
rights and interests. And to organize programs and activities for
its members.
14. To undertake tasks entrusted by relevant governmental depart-
ments.
42 Dongsi Xidajie, Beijing, China, 100710
E-mail: intl@cma.org.cn
Website: www.cma.org.cn
Finnish Medical Association
Office Bearers:
President: Dr. Marjo Parkkila-Harju
Vice-presidents: Dr. Antti Tamminen,
Dr. Arto Virtanen
Chief Executive Officer: Dr. Heikki Pälve
Vice-CEO: Dr. Hannu Halila
Health Policy Adviser, International Af-
fairs: Mervi Kattelus
Office and Membership:
The Finnish Medical Association, estab-
lished in 1910, is a professional organization of which almost all
(94 %) doctors practicing in Finland are members. Membership is
voluntary and available for all physicians practicing in Finland. In
the beginning of 2016 the number of members was around 25 000.
The FMA binds its members together to support common values
(advancement of medical expertise, humanity, ethics, and collegial-
ity), and represents their common professional, social and economic
interests. The FMA employs approximately 65 people (including
Finnish Medical Journal).
Services provided:
Member services include a patient injury and liability insurance,
legal advice, membership in unemployment fund, CPD/CME-
training, network of trusted physicians, Finnish Medical Network
(Fimnet) Internet portal, and grants for training, research and for
international co-operation. Members are also offered certain prod-
ucts, discounts and social activities. In addition they receive Finnish
Medical Journal that is published in paper form weekly, and can
read the electronic version as well.
Activities:
• We involve our members at regional and local level to participate
policy-making of the association.
• We negotiate the salaries of the physicians working in the public
sector.
• We foster medical ethics in several ways: Medical Ethics Com-
mittee that involves representatives also from other physician´s
Marjo Parkkila-Harju
NMA news
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74
organizations, Medical Ethics book (available also online), Medi-
cal Ethics Day once a year, seminars on timely ethical topics with
other professional organizations etc.
• We follow actively health policy issues in the society and do ad-
vocacy work towards and together with the ministries in order to
develop health and health care system and patient´s rights in the
country.
• We provide official and reliable data concerning physician work
force both to the governmental agencies as well as to the media.
• The views of the FMA are frequently quoted in the media.
• The FMA is a member of the Confederation of Unions for Pro-
fessional and Managerial Staff in Finland (AKAVA).
Vision:
Finnish Medical Association is a professional organization and a
trade union of a unified medical profession. It benefits its members
as well as key stakeholders.
International cooperation:
FMA is a member of several international physician´s organizations
i.e. globally the WMA and in Europe Standing Committee of Eu-
ropean Doctors (CPME), European Union of Medical Specialists
(UEMS), European Union of General Practitioners/Family Physi-
cians (UEMO), and European Junior Doctors (EJD). We have also
active cooperation with other Nordic countries. In addition, we are
involved with some development cooperation projects.
P.O. Box 49 (Mäkelänkatu 2 A)
FI-00510 Helsinki, Finland
E-mail: international@laakariliitto.fi
Website: www.laakariliitto.fi
Malaysian Medical Association
MMA Executive committee (2015–2016)
President: Dr. Ashok Zachariah Phillip
Immediate Past president: Dr. H Krishna
Kumar
President Elect: Dr. John Chew Chee Ming
Honorary General Secretary: Dr. Ravin-
dran Naidu
Honorary General Treasurer: Dr. Guna-
sagaran Ramanathan
Honorary Deputy Secretary: Dr. Rajan
John
Honorary Deputy Secretary: Dr. Ganabaskaran Nadason
Chairman Schomos: Dr. Vasu Pillai
Chairman PPS: Dr. Muruga Raj
Membership:
• Currently there are over 41,715 registered medical practitioners
in Malaysia.
• Almost 20 percent of them are MMA members.
• MMA also has a separate wing for the student members.
Objectives:
• To promote and maintain the honour and interest of the profes-
sion of medicine in all its branches and in every one of its seg-
ments and help to sustain the professional standards of medical
ethics.
• To serve as the vehicle of the integrated voice of the whole pro-
fession and all or each of its segments both in relation to its own
special problems and in relation to educating and directing public
opinion on the problems of public health as affecting the com-
munity at large.
• To participate in the conduct of medical education, as may be
appropriate.
• To promote social, cultural and charitable activities in building a
united Malaysian nation.
• To carry on any business, trade, joint venture, commercial ar-
rangement, transaction or any enterprise whatsoever which may
in the option of the Association be advantageous to the Associa-
tion or calculated directly or indirectly to enhance any of the As-
sociation’s assets, properties or rights.
Sections, Societies and Committees Of Mma
• Sections
–
– Section Concerning House Officers, Medical Officers & Spe-
cialists (SCHOMOS)
–
– Private Practitioners Section (PPS)
• Societies
–
– Society of Occupational & Environmental Medicine (SOEM)
–
– Society of Medical Students (SMMAMS)
–
– Society of Public Health
–
– Society of Sports Medicine
–
– 20 MMA Committees
–
– 29 MMA Representatives for External Organization, GOVT
& NGO committees
Section Concerning House Officers, Medical Officers & Spe-
cialists (Schomos)
• Its objective is to identify, address and seek the cooperation of
the government to resolve issues relating to the welfare, pay, and
allowances and working conditions of all grades of doctors in gov-
ernment service.
• SCHOMOS over the years has evolved into a powerful Section
of the MMA which conducts periodic meetings with the Direc-
tor General and other top Ministry of Health officers and has
achieved many notable successes in its ventures.
Ashok Philip
NMA news
75
• The issues discussed periodically includes: clinical allowance for
medical officers, review of specialist allowance, overtime pay,
­
promotion prospects for medical officers and specialists, house-
men issues, etc.
The Private Practitioners Section (PPS)
Private Practitioners Section of MMA was established to look after
the needs of the private practitioners
PPS continues to be the negotiating arm of the Association in all
matters relating to private practitioners. Currently, the PPS is con-
cerned on issues related to:
• Pharmacy Bill-
• FOMEMA
• Third Party Administrator (TPA)/Managed Care Organization
(MCO)
• National Health Financing Scheme
4th Floor MMA House, No. 124 Jalan Pahang,
53000 Kuala Lumpur, Malaysia
E-mail: info@mma.org.my
Website: www.mma.org.my
Myanmar Medical Association
Office Bearers
President: Prof. Rai Mra
Hon. Secretary: Prof. Saw Win
Membership: Myanmar Medical As-
sociation (NMA) is the biggest asso-
ciation of medical doctors in Myanmar.
It was established in 1949, a year after
Myanmar (formerly known as Burma)
got her independence from British colo-
nial rule. It is a non-governmental, non-
political professional association with permanent members of
more than 12000 and more than 1000 pro-members. There are
15 branches in 15 States and Divisions of Myanmar and 37 spe-
cialist societies and 3 special interest groups under it’s umbrella.
MMA is governed by 20 members elected Executive Committee.
MMA is an active member of World Medical Association
(WMA), Confederation of Medical Association of Asia and Oce-
ania (CMAAO) and Medical Associations of ASEAN countries
(MASEAN).
Services provided: The main mission of MMA is to improve the
professional and ethical standards of medical doctors so as to have
better health care of the people. MMA also plays advisory role
in various health issues to Ministry of Health of Myanmar. MMA
provide heath education and advocacy in various health problems
of the country.
Activities: We are conducting regular CME courses for Family
Physicians, ad-hoc CME activities and regular Annual meeting and
Conference, which will be 63rd
time in coming 2017. We are pub-
lishing Myanmar Medical Journal ( MMJ) quarterly,which was first
published in 1953 We also publish monthly newsletter.
As social activities we have Support Group for Elderly Doctors
(SGED) and Health Care Volunteers groups. We had conducted
rapid disasters rescue and help in various disasters of Myanmar and
neighbouring countries.
There are 10 public health projects conducting in collaboration with
UN organizations and other NGOs in areas of Malaria,Tuberculo-
sis, Reproductive Health and Youth Development.
249, Theinbyu Road,
Mingalar taungnyunt township, Yangon.
Phone: +951 394141
E-mails: mmacorg@gmail.com;
drsawwin@gmail.com; drkyawlynn@gmail.com
Official facebook page: MMA CME
Website: www.mmacentral.org
Rwanda Medical Association
Office bearers
President: Dr. Kayitesi Kayitenkore
Vice-President: Dr. Joseph Ryarasa
Nkurunziza
Treasurer: Dr. Louise Kalisa
Head of Scientific& Research Committee:
Dr. Brenda Asiimwe-Kateera
Head of Ethics Committee:
Dr. Emmanuel Nkeramihigo
Secretary General: Dr. Felix Cyamatare
Rwabukwisi
Executive Secretary: Mr. Rwabukwisi A. Eddy
Description and History:
Founded in 1997; the Rwanda Medical Association (RMA) is reg-
istered as a non-profit, a Non-Government-Organization (NGO)
that advocates on behalf of its members and the public for access to
high quality healthcare, and provides leadership, guidance to physi-
cians for Continuous Professional Development. RMA also strives
for the welfare; professional protection as well as medical ethics and
conduct among its members.
Rai Mra
Kayitesi Kayitenkore
NMA news
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76
RMA is committed to being at the fore front of healthcare man-
agement by enhancing and integrating professionalism among its
members; integrating members into policy negotiation, formulation
and implementation and building alliances with other health pro-
fessional association and regulatory bodies to meet the health needs
and expectations of Rwandans.
Vision: “To be a world class community of motivated medical doctors
with the highest ethical and professional standards”
Mission: “The trusted and unified voice of medical doctors in promoting
both professional excellence and welfare of medical doctors in Rwanda
Objectives:
• To represent medical doctors with authority and credibility.
• To advise the Government, other medical bodies and the general
public on matters related to health.
• To promote the integrity and collegiality in medical profession.
• To contribute to the capacity building of doctors for providing
excellent health care.
• To contribute to the research and development in the Rwandan
health system.
• To develop partnerships with other national and foreign associa-
tions/organizations for opening opportunities to RMA.
• To promote the welfare of medical doctors through RMA UMU-
GANGA (MD) Saving And Credit Cooperative Society Ltd.
Guiding principles:
• Our members are our number one priority in all the work we do.
We seek to build and maintain an association that is inclusive,
collaborative, and accountable to physicians. We have an uncom-
promising commitment to serve them well, protect their interests,
and contribute to their overall health and well-being.
• We are committed to be in the forefront of building a stronger,
higher quality health-care system for our patients, and ensuring
valued and effective roles for physicians in that system.
Core values: “Integrity, Professionalism, Collegiality and Empathy.”
Collaborations:
1.National collaborations
Within Rwanda, the association seeks to harmonize efforts with
similar organization in order to efficiently advocate for its members.
The collaboration covers technical support from specialized orga-
nization and financial and policy support with public system. We
collaborate with:
–
– Rwanda Ministry of Health
–
– Rwanda Medical and Dental Professionals
–
– Rwanda Health Care Federation
–
– Professional associations of specialist doctors in Rwanda
2.International Collaboration
The RMA is a member of different International Medical Organi-
zation or Association such as:
–
– World Medical Association (WMA) www.wma.net
–
– Confederation of African Medical Associations and Societies
(CAMAS)
–
– East African Medical Association (EAMA).
Core and Routine activities
With its members: RMA organizes Continuous Professional De-
velopment (CPD) workshops for its members across the country, in
different regions every quarter.The aim is to ensure RMA members
have up to date medical information on relevant topics and targeted
knowledge gaps in order to improve the quality of service provided
by our members. Particular attention has been made to medical eth-
ics which has been included in all our CPD activities. These ac-
tivities are supported by the contribution paid by our members and
local partner organizations.
RMA organizes an annual scientific conference each year which
aims to bring together scientific innovation; political leaders and
implementers to discuss key topics according to the context of med-
ical practice in Rwanda. This has been an opportunity to keep the
debate alive especially on issues that affect on one hand our mem-
bers’ daily work and efficiency, on the other hand the healthcare
system as a whole.
RMA has started advocating for the professional indemnity insur-
ance, professional consulting fees etc. for its members.
With Partners: RMA actively participates in debates and work-
shops organized in the country in order to keep the voice of our
members represented in all circles that are impacting our work and
welfare. We represent our members to the Ministry of Health; re-
gional discussion affecting the practice of medicine; legal and trade
policy discussion.We also reach out to seek for financial and techni-
cal collaboration in order to increase the capacity of the association
to serve its members.
KG5 Avenue, Kigali-City,
Gasabo District, Kacyiru Sector,
B.O.P: 458 Kigali-Rwanda,
Cell: +250 788381486 or +250 788561597
E-mail: rmasecretariat@gmail.com
Website: www.rma.rw
NMA news
77
Slovak Medical Association
President: Prof. MUDr. Ján Breza,
General provisions
Slovak Medical Association (SkMA) is a
voluntary, non-governmental, politically in-
dependent non-profit association compris-
ing professional associations and societies
acting in the sphere of medicine, the mem-
bers of which participate in development of
medical branches and health care.
SkMA is a legal person and civil association
in accordance with the Act No. 83/1990, Collection, on Association
of Citizens as amended. It was registered in 1969. SkMA has the
organisational units comprising professional societies, physicians’
guilds and pharmacists’ guilds and societies of intermediate health
care workers.
As of December 31, 2015 it registers 98 professional asso-
ciations, 16  of these are collective members. Altogether it unites
16 457 members: 14 622 physicians, pharmacists and 1795 other
health care workers. SkMA publishes a journal entitled Monitor
medicíny SLS/ Medicine Monitor by SkMA.
Presidium of SkMA is a statutory body and has 15 members.SkMA
and its professional societies and guilds can be the members of the
other national and international non-governmental organisations
(associations, guilds) having a similar scope of interest (EFMA,
WMA, WHO, UEMS, CIOMS, CPME).
Mission and objectives of SkMA
SkMA shall:
• initiate and mediate transfer of the latest scientific professional
medical, diagnostic and therapeutic information into practice in
the form of continuous – further systematic education,
• assert a decisive role of the professional societies mainly as expert
guarantors in continuous – further systematic medical education
of physicians, pharmacists and other medical workers,
• initiate, submit, enforce and publish the opinions on
a)
the issues connected with expertise and scientifically based
knowledge of medical sciences within individual medical
branches;
b)
the issues connected with possibilities to apply top, diagnostic
and therapeutic methods in medical practice;
c) the issues of ethic of physicians and medical workers;
d) the issues of existing and being prepared legislative standards in
health care;
e) the issues of specialised scopes of a further education system;
f)
nomination of the experts as members of various commit-
tees,
–
– represent its professional societies and guilds outwards with the
aim to protect their justified requests and interests in relation
to other subjects.
Scope of SkMA activities (the Tasks)
15. Within the scope of further education of medical workers it
shall organise, ensure and guarantee the expertise of intrastate
and international professional and scientific educational events
(congresses, meetings, symposiums, conferences, lectures, semi-
nars, courses, training courses etc), accompanying exhibitions
and symposiums of medical and pharmaceutical societies.
16. It shall support participation of its members in professional and
scientific events at home and abroad.
17. It shall issue and support issuing of professional medical jour-
nals, collections, bulletins, publications and other information
materials.
18. It shall annually draw up and edit the Calendar of Professional
and Scientific Events.
19. For the members of SkMA, it shall ensure methodical guid-
ance connected with meeting the objectives, mission and scope
of activities of SkMA.
20. It shall inform members and other medical workers about the
latest medical and pharmaceutical products.
21. It shall establish contacts and cooperate with international non-
governmental, scientific and professional organisations acting
within the health care sphere at home and abroad.
22. It shall conclude agreements on cooperation and reciprocal ex-
change of experts (members of SkMA) and employees of SkMA
with partner international organisations.
23. It shall organise competitions and award prizes and honours.
24. Through delegated representatives it shall participate in selec-
tion, competition, attestation, accreditation and similar actions.
25. Through delegated representatives it shall participate in the ac-
tivities of consultative bodies of parliament of the Slovak Re-
public, Ministry of Health Care of the Slovak Republic, Slovak
Medical Chamber, Slovak Pharmacists’ Chamber and other
chambers and professional institutions dealing with issues of
health care and public health.
26. To secure the mission, objectives and scope of activities it shall
pursue additional economic activities (e. g. publishing and edi-
torial activities, advertising, lease, mailing services etc.).
27. To pursue additional economic activities and provision of pub-
licly useful services, it may establish the non-profit organisa-
tions, foundations, funds, business and other companies, or be
their associate.
Cukrova 3, 813 22 Bratislava 1
Slovak Republic
Tel: +421 903 650 978
E-mail: irina.sebova@pe.unb.sk
Website: www.sls.sk
Ján Breza
NMA news
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78
Swedish Medical Association
Office Bearers:
President: Dr. Heidi Stensmyren
CEO: Hans Dahlgren
Membership: I am not sure I understand
membership but it is voluntary and you pay
a monthly fee, high number of members as
we are the only union for doctors in Sweden
8 out of 10 doctors are members.
Services provided: We provide Advice
and support in matters relating to your salary, contract, and general
working conditions, insurance and pensions as well as support on
how to get your foreign licence to practice recognised.
Help with salary negotiations, and up-to-date salary statistics.
Legal assistance on disciplinary matters, such as negligence claims
or probation, and on general matters of healthcare.
However we also work with political issues and have a key role to
play in influencing the development of healthcare in Sweden. The
Swedish Medical Association enters into collective agreements on
behalf of its members in areas such as general employment con-
ditions, which includes salaries, working hours, holidays, sick and
parental leave and pensions.
Vision one association for all doctors through their whole career.
Activities, do you mean current activates besides our union work
with helping members , doing collective bargaining. We also moni-
tor and work with healthcare politics on national, European and
International level.
International collaboration,
The Swedish Medical Association is an Active member of the
UEMS, CPME on a European level as well as an active member
of the WMA.
Box 5610, Villagatan 5
114 86 Stockholm
Phone: 00468 – 790 3303
mob: 004670 – 790 3303
E-mail: info@slf.se
Website: www.lakarforbundet.se
http://www.slf.se/Info-in-English
Swiss Medical Association (SMA)
Office Bearers:
President: Dr. med. Jacques de Haller
General Secretary: Anne-Geneviève
Bütikofer
The Foederatio Medicorum Helvetico-
rum (FMH) or Swiss Medical Association
(SMA) is the politically and economically
independent umbrella organisation for
more than 70 core and specialised medical
organisations. The main objectives of the
SMA are:
• to ensure the high quality of medical care in Switzerland
• to promote further training and continued education for doctors
• to play an active role in shaping the health policy framework so that
doctors can work efficiently and in the full interests of patient welfare
The SMA consists of the medical associations which bring together
the 200 delegates of their member societies to create the “physicians’
parliament”,and of the 7-strong Central Committee which acts as a
“government”, representing the interests and implementing the de-
cisions of the medical associations. The Central Committee acts in
an advisory capacity to the 33-member Delegates General Meeting.
The SMA offers its members services such as the personal Health
Professional Card (HPC) and provides support and assistance in
issues relating to the law, tariffs and business matters. External part-
ners, media and the general public also benefit from SMA services
such as statistics on physicians, media releases or the popular ad-
vance directive (living will).
Major challenges facing the SMA are
• the rising volume of administrative demands made on the medi-
cal profession
• the substitution of medical services by other healthcare profes-
sions and the resultant risk of healthcare fragmentation
• the insufficient number of places for medical students and the
resultant scarcity of doctors
The SMA is able to pursue its objectives vigorously thanks to its
members, whose interests it is committed to advocating. As such, it
is regarded by partners in the healthcare sector, politicians and the
community as a highly effective mouthpiece for doctors in Swit-
zerland.
FMH Swiss Medical Association
Elfenstrasse 18, Postfach 300, 3000 Bern 15
E-mail:info@fmh.ch
Website: www.fmh.ch
Heidi Stensmyren Jacques de Haller
NMA news
79
Medical Association of Thailand
(MAT)
Office Bearers (2016–2017)
President: Prof. Dr. Saranatra Waikakul
President Elect: Prof.Dr. Ronnachai Kong-
sakon
Vice-President: Group Captain Dr. Paisal
Chantarapitak
Secretary General: Dr. Sawat Takerngdej
Deputy Secretary: Prof.Dr.  Prakitpunthu
Tomtitchong
Treasurer: Assoc. Prof. Dr. Juvady Leopairut
House Master: Major Dr. Chanrit Lawthaweesawat
Scientific: Prof. Dr. Wachira Kochakarn
Publication: Prof. Dr. Amorn Leelarasamee
International Relations: Major. Gen. Assist. Prof. Dr.  Kidaphol
Wadhanakul
Medical Education: Assoc. Prof. Dr. Yothin Benjawung
Ethics: Assoc.Prof. Dr.Orawan Kiriwat
Public Relations: Dr. Sakda Arj-ong Vallipakorn
Registration: Dr. Komgrib Pukrittayakamee
Welfare: Dr. Nithiwat Gijsriurai
Special Affairs: Prof.Dr.Apichat Asavamongkolkul
Chief Executive Officer: Prof. Dr. Somsri Pausawasdi
Membersof Committee: Pol.Gen. Dr. Chumsak Pruksapong
Dr. Pinit Hirunyachote
Assoc.Prof.Dr.Thanya Subhadrabandhu
Dr.Rungsima Saenghirunvattana
Dr. Somchai Thepcharoennirund (Regional Rept.)
Dr. Varaphan Unachak (Regional Rept.)
Dr. Suraphan Loiha (Regional Rept.)
Dr. Banjerd Sukapipatpanont (Regional Rept.)
Membership: Any Thai medical doctor can join the MAT as a
regular member.
Services provided: The main services provided by the MAT to their
membership are activities for our members’ safety and wellbeing, the
Annual Academic Meeting as well as news and scientific publica-
tions, representation of their interests in national and international
forums and participating as a member of World Medical Association.
Activities (some examples)
• With Members: Receiving lifelong access to Journals of the Med-
ical Association of Thailand
• With the Public: Through Medical Knowledge program for Thai
People as FAQs decease problem TNN TV Channel monthly by
the Famous MAT speakers
• With the Governments: As a Medical Counselor to support the
Ministry of Health for adoption of a medical career in the public
services. NMA news
• With the Media: Press releases related to health issues of public
interest,promotion of debates related to health policies,education
on health related issues.
• With international organization: WMA, MASEAN, CMAAO
and oversea medical organizations
• WithStrategic Partners: special research aiming to promote
health information to the public as well as to provide happiness
working and safety to Thai physicians.
4th
Floor, Royal Golden Jubilee Building 2, soi Soonvijai
Newpetchbri Rd. Huay Kwang Bangkapi Bangkok 10310
E-mail: math@loxinfo.co.th
Website: www.mat-thailand.org
Zambia Medical Association
Office Bearers (2015– 2017)
President: Dr. Aaron Mujajati
Vice President: Dr. Abidan Chansa
Secretary General: Dr. Jonathan Sitali
Treasurer: Dr. Matthe w Manoj
Chairman of Medical Education Board:
Dr. Mutinta Muyuni
Chairman of Public Health Board:
Dr. Wilbroad Mutale
Representative to Health Professions Coun-
cil: Dr. Kaunda Mwansa
President of Resident Doctors Association: Dr. Francis Mupeta
Background
The Zambia Medical Association (ZMA) is a membership orga-
nization of Doctors in Zambia. Founded in 1964, the association
has been providing support services to its members by represent-
ing their professional interests in the public domain, speaking on
behalf of the Zambian people on issues of health that affect them,
and influencing health policy in Zambia. ZMA began as a small
association for doctors based in Lusaka, the capital city of Zambia,
with only a handful of members.ZMA now boasts of a membership
of just under 1000 doctors with representatives in all 10 provinces
of the country. ZMA therefore has undergone significant growth
since its inception. It now has a secretariat in Lusaka from which its
activities are coordinated and has been decentralized to provincial
level with a representative in each of the 10 provinces of Zambia.
In 2014, ZMA established its international relations by becoming a
member of the World Medical Association. It also has a represen-
Saranatra Waikakul
Aaron Mujajati
NMA news
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80
tative of Zambian doctors in the diaspora with a chairman based
in Geneva, Switzerland. ZMA also has regional representatives in
China coordinating the Asia region, in the USA for the Americas
and in New Zealand for Oceania.
Activities of ZMA
Continuous Medical Education
One of the key objectives of ZMA is to further the development
of the medical profession as an instrument of social development
and as an essential element for growth of society. In this regard we
seek to maintain a high standard of medical practice by providing
continuous medical education activities (CMEs) to our members.
With an executive committee member in-charge of CME’s in place,
ZMA holds CMEs across the country throughout the year.
Reports/Presentations to Parliament
ZMA is an important stakeholder in the country in the area of
health. The Zambian parliament has recognized this and has in the
last year invited ZMA to make presentations to the select com-
mittee on health on key health issues affecting the country. In this
regard presentations on the HIV national response, maternal mor-
tality and on social health insurance and the healthcare system in
general were made during the last year.
Representation on Various Boards and Committees
Still in keeping with the ZMA’s mandate of remaining relevant to
the public and aiming to influence national policy in the arena of
health, ZMA is represented on various boards and committees in
the country. In particular, we have an executive committee member
who sits on the board for the health professions council and another
on the Zambia Medicines Regulatory Authority board. We also
have representation on committees at the National AIDS Council
and at the Ministry of Health. These are important links to ZMA
because it is through these links that we get to influence national
policies.
ZMA Work with the First Lady of Zambia
ZMA has recognized the unique role that the First Lady of the
Republic Mrs.Esther Lungu,plays in the area of health through her
charity work. She has had a lot of impact on various health issues
especially relating to women and children. In recognition of this
work and the impact her work has on those that are disadvantaged,
she was a joint recipient of the prestigious 2015 ZMA President’s
award. Since the award, ZMA has worked closely with her office to
support her work. In line with this, an executive committee member
has since been appointed as ZMA liaison to the First Lady’s office.
Workshops with Religious, Traditional and Civic Leaders
In our quest to impact the nation, ZMA has engaged national lead-
ers at various levels on several issues of interest to the association in
public interest. One area has been the issue of maternal mortality
and the significant contribution made by unsafe abortions. In this
regard,a series of separate workshops were organized in the last year
with religious leaders, traditional leaders and members of parlia-
ment to raise awareness about this problem and to highlight how
workshop participants could use their positions to make a change in
their communities.
Public Health Media Work
As a way of engaging the public and ensuring our goals receive media
coverage, ZMA supports public health programs on national radio
and television. These are weekly programs meant to highlight key
public health issues.These programs serve as a conduit through which
ZMA can reach the public.In line with this,we have a weekly column
in one of the national dailies dubbed the “Public Health corner.”Ar-
ticles from this weekly column are also placed on our website.
Upcoming Events
The 2016 ZMA Annual Scientific Conference and AGM will be held
from 28th to the 30th of July 2016 at Chrismar Hotel in Living-
stone.The theme for this year’s meeting is “Public Health Solutions
for Sustainable Development Goals.”
Monitoring of the Zambia Presidential and General Elections and Ref‑
erendum by ZMA: On 11th August, 2016, Zambia goes to the polls
in a Presidential and General election and Referendum. ZMA will
be involved as elections monitors.This is in keeping with the ZMA
goal to ensure we remain relevant to our time and influence national
policy. ZMA is nonpartisan and we are engaged in these elections
in an advisory capacity to the various stakeholders to ensure elec-
tions are held in a free and fair manner.We are especially alive to the
various public health concerns that may arise during an election and
that may negatively affect the voting. It is to these that we want to
especially address and ensure the relevant authorities address these
issues amicably.
The 2016 ZMA Annual Ball and Awards Gala will be held on 10th
December, 2016 in Lusaka. The venue is yet to be confirmed. Last
year’s event was held at Hotel intercontinental and the Republican
President, His Excellency Edgar Lungu was the guest of honor.
The 2017 World Medical Association Council meeting will be held in
Livingstone, Zambia in April of 2017. The meeting will be hosted
by ZMA at a pleasure resort on the banks of the Zambezi River just
next to the Mighty Victoria falls. This is an area in a Game Park.
Guests to this meeting can plan for a holiday and experience a true
safari in one of the most beautiful places in the world. Special pack-
ages in this regard will be advertised in due course.
Unit 2, Brentwood court. Stand Number 6458,
Los Angeles Boulevard, Longacres, P.O. Box 50693, Lusaka.
E-mail: zambiamedicalassociation@gmail.com
Website: www.zambiamedicalassociation.org.zm
NMA news
III
Save the date
2nd
GLOBAL CONFERENCE ON ONE HEALTH
10th
– 11th
November 2016
Kitakyushu City, Fukuoka Prefecture, Japan
Moving forward from One Health Concept to
One Health Approach
Following the successful Global Conference on One Health (GCOH) that was held in Madrid in May 2015, the WVA and
WMA in close collaboration with the Japan Medical Association (JMA) and the Japan Veterinary Medical Association
(JVMA) are preparing the 2nd
GCOH to be held on 10t-11th
November in Kitakyushu City, Fukuoka Prefecture,
Japan.
The 2nd
GCOH aims to bring together Veterinarians, Physicians, Students, Public Health Officers, Animal Health Officers,
NGOs and other interested parties from the different world regions to learn, discuss and to address critical aspects of
the ‘One Health’ Concept.
The main objectives of the conference are to strengthen the links and communications and to achieve closer
collaboration between Physicians, Veterinarians and all appropriate stakeholders to improve the different aspects of
health and welfare of humans, animals and the environment.
The main conference sessions will focus on the issues of:
• Zoonotic diseases
• Foodborne diseases
• Antimicrobial resistance
• Environmental hazards exposure to humans and animals
More details regarding the conference and registrations will be
published soon on WVA and WMA websites
www.worldvet.org www.wma.net
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IV