2018 WMA Annual Report Final

ANNUAL REPORT
2018
WORLD MEDICAL ASSOCIATION
209th WMA Council Session, April 2018 in Riga, Latvia – Photo: LMA Official photographer
  S O M E W M A A C T I V I T I E S I N I M A G E S
Dr. Ardis D. Hoven
Chairperson of Council, speaker at the « Health Security 100 years
after the Spanish flu pandemic » event
WMA Past President Dr. Yoshitake Yokokura and Dr. Tedros
Adhanom Ghebreyesus, WHO Director-General at the signing
of a Memorandum of Understanding to reaffirm and
consolidate co-operation between the two organisations.
Left: Dr. Osahon Enabulele, Nigeria
Right: Dr. Dr. Miguel R. Jorge, President-Elect, Brazil
Delegates of the WMA General Assembly, October 2018,
Reykjavik, Iceland – Photo: IMA Official photographer
MESSAGE FROM THE WMA PRESIDENT 
D R . L E O N I D E I D E L M A N
WMA President
P A G E 0 2   |
I am happy to present you the second
annual report of the WMA. It is not
supposed to be a full and comprehensive
overview of what the WMA does or has
done during last year, but rather to
provide some highlights that have been
important for our work. Joining forces
with WHO on important questions like
Universal Health Coverage, Health
Workforce, Social Determinants of Health
and emergency preparedness, as well as
our work on environmental health,
human rights, health and migration are
just some examples mentioned in this
report of our common engagement
during the year.
 
During 2018 other trends became clearer
and more relevant for us, as they have
been before. Although not new, but more
pressing then ever is the question of our
work environment. Confronted with a
steadily increasing work load and
complexity in medicine, pressures from
commercialization but also high patient
expectations, we have to note high rates
of burn out with physicians in many
countries. This scenario does necessarily
get friendlier with challenges and
opportunities coming up with
digitalization and Artificial or Augmented
Intelligence invading and changing
medicine and health care.
The WMA has decided to face the
challenges. In two conferences, one in
May in Israel and one in June in Tokyo, we
will discuss with experts, colleagues and
patients about the future of our
profession and the realization of Universal
Health Coverage. In times of uncertainty
guidance and common understanding of
what is right or wrong may be even more
important than before.
 
October last year we had the opportunity to
experience the launch of the Astana
Declaration. 40 Years after Alma-Ata, the
WHO, UNICEF and the government of
Kazakhstan invited to the „Global
Conference on Primary Health Care“. With
last year’s Astana Declaration[1], the WHO
takes a new approach to foster the
development of Primary Health Care.
Although the Astana Declaration does
neither contradict nor replace the Alma-Ata
Declaration[2] from 1978 it is far more
binding and tries to avoid
misinterpretations to what is Primary Health
Care. While after Alma-Ata donors and
government all too often retracted to a
minimum of Primary Care, the Astana
declaration demands completeness and
strives for a comprehensive approach in
health care reaching from health promotion
and prevention to curative care,
rehabilitation and palliative care. It remains
to be seen whether the donors who finance
the development of health care will share
the aspiration for comprehensiveness this
time.
 
The WMA will point to the role of physicians
especially family physicians, when it comes
to realise real Primary Health Care and not a
cheap substitute.
[1] https://www.who.int/primary-health/conference-
phc/declaration
[2] http://www.who.int/publications/almaata_declaration_en.pdf
E V E N T S                                       W M A 2 0 1 8 A N N U A L R E P O R T
At the invitation of the Icelandic Medical
Association, delegates from more than 58
National Medical Associations and
constituent member associations met at
the award-winning Harpa Convention
Centre, one of Reykjavik’s most
distinguished landmarks. The occasion
was the WMA’s 69th annual General
Assembly to coincide with the 100th
anniversary of the Icelandic Medical
Association.
For the first time, the General Assembly
was combined with a Medical Ethics
conference organized by the Icelandic
Medical Association partly in parallel with
our Council Session.
President’s Report
The outgoing President, Dr. Yoshitake
Yokokura, gave a brief report on his
activities over the preceding six months,
when he had taken up the theme of
promoting Universal Health Coverage
through cooperation and collaboration
based on the Memorandum of
Understanding between the WMA and
the World Health Organisation. He had
spoken at many meetings, including the
High-Level United Nations meeting on
the prevention and control of non-
communicable diseases and the 18th
MASEAN Conference, the confederation
of medical associations from the South-
east Asian region consisting of 10 ASEAN
members. He had also attended
meetings of the German, Taiwan and
American Medical Associations. He said
he had been re-elected as President of
the Japan Medical Association for a
fourth term.
P A G E 0 3   |
General Assembly 2018 – Reykjavik
Chair’s Report
Dr. Hoven spoke about the success of the
previous day’s medical ethics conference
organised in conjunction with the
Icelandic Medical Association.
In her written report, she said she
continued to be outraged by the
atrocities imposed upon physician
colleagues throughout the world who,
when providing care for those in need,
were being injured, murdered or
imprisoned.
The WMA had partnered with the
International Committee of the Red Cross
in the global project “Healthcare in
Danger”, which was aimed at identifying
the extent of this problem and proposing
interventions to mitigate the damage
being done. It was imperative they
continued with this activity.
In addition, the medical profession had
been under growing pressure around the
world from governments intent on
undermining medical autonomy. In some
parts of the world, politicians appeared
determined to curtail the power of the
medical profession and exercise more
control over their representative
associations. The WMA strongly opposed
any attempt to stifle the voices of
physicians, because in the end it was
patients who suffered. Professional self-
governance was critical to the delivery of
healthcare across the world.
Late 2017, the WMA joined the working group
led by the IOM and WHO set up on an ad hoc
basis to provide a collective contribution
within the negotiation process of the Global
Compact for Migration, so that migrants
health needs are adequately addressed. The
working group agreed on a Proposed Health
Component, based on WHO Framework of
Priorities and Guiding Principles to promote
the health of Refugees and Migrants that the
70th World Health Assembly (May 2017) urged
Member States to promote at national level:
P A G E 0 4   |
Health and migration
“The framework seeks to contribute to improving global public health by addressing the health of
refugees and migrants in an inclusive, comprehensive manner and as part of holistic efforts to respond
to the health needs of the overall population in any given setting. It is designed to promote the right
to health, in accordance with international human rights obligations, including refugee law and
relevant international and regional instruments”[1].
[1] WHO Framework of priorities and guiding principles to promote the health of refugees and
migrants – B. Scope, p.1.
Since then and over 2018, in line with its
policies, the WMA has continued its
monitoring work aiming to ensure the
inclusion of health as an essential
constituent of good migration
governance. Last November, it
commented the 4th draft of the global
action plan on health of refugees and
migrants which will be submitted to the
next World Health Assembly.
E V E N T S                                       W M A 2 0 1 8 A N N U A L R E P O R T
Since 2017, the WMA has been contributing to the global debate on health and migration
with the valuable support of its membership, but also through WHO’s activities in its health
leadership role, and by developing close collaboration with the International Organisation for
Migration (IOM).
As a world health professionals
organisation, the WMA has to make its voice
heard, bringing its specific contribution
based on the field experiences and
expertise of physicians, not only to ensure
proper access to health care to migrants
and refugees but also to guarantee to
physicians and other health professionals
adequate working conditions safeguarding
the full respect of ethical principles of
healthcare.
All people are entitled without
discrimination to appropriate medical care
according to the international human
rights standards and medical ethics,
including the WMA Declaration of Lisbon
on the Rights of the Patient. In line with its
policies, the WMA advocates so that that
these fundamental premises are
implemented and protected in the
provision of health care to the migrant and
refugee population:
Migration, a matter of concern for physicians
Prioritization of the care of human beings above
any other consideration or interest – The right to
health should be guaranteed to all, regardless of
the civil, legal or political status of the individual.
This includes therefore encompassing the
provision of health care to undocumented
migrants.
Loyalty to their patients – The WMA has repeatedly
expressed concerns over the systemic difficulties
which physicians face when upholding guiding
ethical principles in environments hostile to the
provision of healthcare to migrants. Health
professionals must be granted adequate working
conditions so that they can provide care in the
best interest of their patients, well-being and
health being their first considerations. Their ability
to maintain loyalty to their patients requires
protection from any potential intrusion from their
employers in their relationship with the patient.
Do no harm – The WMA is opposed to the
participation of physicians to any non-medically
justified examination or treatment – such as
sedatives to facilitate easy deportation from the
country or relocation, or bone examination to
determine the age of a migrant declaring to be a
minor. These practices constitute a diversion of
medically justified measures for police or judicial
purposes. As such, it contravenes to medical
ethics. But worst, some of these practices can
potentially have a harmful impact on health.
P A G E 0 5   |
Rights to confidentiality, privacy and autonomy –
The WMA Declaration of Taipei on ethical
considerations regarding health databases and
biobanks lays down essential ethical principles in
collecting and using health data, including the
required informed consent for the collection,
storage and use of data of the individuals
concerned as well as the rights to confidentiality,
privacy and autonomy, which entitle individuals
“to exercise control over the use of their personal
data and biological material”[1]. All measures
should be taken so that these ethical principles
are fully respected, and any possible misuses be
prevented in health data collection of the
migrant’s and refugee’s population.
E V E N T S                                       W M A 2 0 1 8 A N N U A L R E P O R T
The Global Compact for Migration (GCM)
Some highlights on the health component
 
The GCM was adopted on 18 December in
Marrakesh. It is a voluntary, non-legally
binding global agreement for safe, orderly and
regular migration. Based on cross-cutting
guiding principles and 23 objectives, the
compact recognizes the need for interregional
and international cooperation and
responsibility sharing among countries in
addressing migration. It rests on the purposes
and principles of the Charter of the United
Nations, international human rights standards
and other relevant international
instruments[1].
 
Out of the 23 objectives, 7 objectives include
references to health, the main one being the
objective 15 “Provide access to basic services
for migrants” which refers to WHO Framework
of Priorities and Guiding Principles to promote
the health of Refugees and Migrants. Although
the inclusion of such a health component
constitutes a positive step in acknowledging
the need to foster the rights to health for the
migrant’s and refugee’s populations, the
compact fails to address the complex
situation of health professionals, in particular
physicians, in the provision of health care to
this particular population. The recognition of
the ethical challenges they might face and the
consequent need for adequate working
conditions, would have helped clarifying the
healthcare framework, preventing conflicts of
interests and fostering trustworthy patient-
physicians relationship indispensable for the
provision of quality care.
 
Under objective 1, the GCM specifies that data
collection should be operated “while
upholding the right to privacy under
international human rights law and protecting
personal data”[2]. Although this should be
welcome, the blurred formulation of this
international agreement does not guarantee
the full protection of the dignity, autonomy
and privacy of the individuals in line with
medical ethics, including the requirement of
informed consent for the collection, storage
and use of data, as firmly stated in WMA
Declaration of Taipei.
 
Global Compact for Migration:
https://refugeesmigrants.un.org/migration-
compact
[1] Global Compact for Migration, parag. 1 & 2
[2] GCM Parag. 17
[1] Declaration of Taipei, paragraph 9
Over 2018, WMA continued its advocacy work to promote health within relevant global
environment debates. Under the initiatives of WMA Environment Caucus co-chaired by Dr. Lujain
Alqodmani (Kuwait Medical Association) and Dr. Peter Orris (Associate Member), and through
cooperation with WHO or the Global Climate and Health Alliance, 2018 offered key opportunities
to voice physicians’ concerns.
In addition to its ongoing work on chemicals and its impact on health, the main areas of WMA
actions related to air pollution and climate change.
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      Health and environment
Dr Lujain Al-Qodmani was one of the keynote
speakers of WHO’s First Global Conference on
Air Pollution and Health (30 October to 1
November, Geneva) and contributed to a WHO
discussion paper on air pollution and child
health. The event was the experience of lively
and engaged discussions about air pollution, its
health effects, how to tackle this global crisis
and related health, climate and economic
benefits.  
E V E N T S                                       W M A 2 0 1 8 A N N U A L R E P O R T
Air pollution and children’s health : a
global health emergency
WHO publication, Air Pollution
Conference, November 2018
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In view of the Katowice Climate Change
Conference (COP24, 3-14 December 2018,
Poland), WHO issued a special report on
health and climate change, written at the
request of the President of the 23rd
Climate Summit (COP23). This report – to
which WMA provided input – is a
contribution from the public health
community to support the global
negotiations. See illustration below
Early December, an article from WMA
President Dr. Eidelman was published in
the US magazine ‘Fortune’ emphasizing
the ethical duty of physicians to protect
their patients from the adverse effects of
climate change.
The WMA was represented at the Katowice
Summit by the two WMA Caucus co-
chairs. In parallel to these negotiations, the
Climate and Health Summit organised by
HEAL and the Global Climate and Health
Alliance, was a key opportunity for
advancing health-focused action,
engagement and collaboration to address
climate change. The Summit focused on
the call to Action on Climate and Health
which outlines a set of priority policy
actions for health leadership. Dr. Lujain
Alqodmani participated in the closing
session dedicated to WHO special report
and health and climate change.
The international political response to climate
change began with the 1992 adoption of the
UN Framework Convention on Climate
Change (UNFCCC), which entered into force
on 21 March 1994, has 197 parties.
The Kyoto Protocol, entered into force on 16
February 2005, commits industrialized
countries, and countries in transition to a
market economy, to achieve quantified
emissions reduction targets for six Green
House Gasses (GHGs).  In December 2015,
parties adopted the Paris Agreement, under
which all countries should submit Nationally
Determined Contributions every five years.
The Agreement includes the goal of limiting
the global average temperature increase to
well below 2°C above pre-industrial levels, and
pursuing efforts to limit it to 1.5°C.
COP24 outcome.
P A G E 0 7   |
   Background features on UN Negotiations on climate change
The 2018 Katowice Summit was declared a
success though the negotiations were
painfully slow to bring all countries
participating along in the consensus. 
Negotiators from 196 countries and the
European Union worked for two weeks on the
« Katowice Rulebook », implementing the Paris
Agreement. More than a dozen intense
meetings enabled negotiations to be
successful on different topics regarding
principles aimed at implementing the Paris
Agreement. Katowice has become, after
Kyoto and Paris, another milestone on the
way towards a sustainable global climate
policy. In the Katowice Rulebook, different
parties adopted a path that will be followed
by each of them when it comes to stepping
up actions for climate protection.
E V E N T S                                       W M A 2 0 1 8 A N N U A L R E P O R T
WHO publication: « BreatheLife »
Prior to the UN General Assembly a High Level
Meeting on NCD was organised on 27
September 2018 in New York with the theme
‘Scaling up multi-stakeholder and
multisectoral responses for the prevention
and control of NCDs in the context of the
2030 Agenda for Sustainable Development’.
Following the long engagement of WMA with
the WHO GCM secretariat,
WHO appointed Dr Yokokura, WMA president,
to be a member of the WHO Civil Society
Workgroup to advise the Director General on
the planning and advocacy of the High Level
meeting on NCDs and on the mobilization of
civil society.
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NCD activities
At the Global Dialogue on Partnerships for
Sustainable Financing of NCD Prevention and
Control in Copenhagen, Denmark from 9-11
April 2018 a pre-meeting for the High Level
meeting on NCDs, WMA organised a session
on ‘A vital investment: Scaling up health
workforce for NCDs’.
Furthermore Dr Yokokura was invited to be a
panel speaker at the High Level Meeting
during the plenary session. The WMA was
closely involved in the preparation process of
the High Level Meeting and commented on
the conference outcome document.
E V E N T S                                       W M A 2 0 1 8 A N N U A L R E P O R T
The aim of this session was to highlight the
importance of the health workforce in the
fight against NCDs and the investment needs
and roles of various stakeholders in
strengthening countries’ capacities to develop
HRH policies and plans in line with national
health strategies to achieve UHC and SDG3.4.
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The WMA supported the launch of the
publication of a new speaking book for
children with cancer. Previously, along with
other partners, the WMA has supported the
publication of speaking books on high blood
pressure, tobacco use cessation, kids in
hospital and clinical trials.
The purpose of speaking books is to provide
accessible information on clinical research for
illiterate populations
Each 16 page book is illustrated , with easy-to-
read text and/or voice on command.
The WMA was invited by Ms Françoise
Grossetête, Member of the European
Parliament, and Prof. Thomas Szucs to be a
member of the steering group to develop an
EU Manifesto on Influenza Vaccination, which
aims to help shift the agenda at European
and national level in support of influenza
vaccination. The Manifesto confirms the need
for stronger policy-driven actions to reduce
the burden of influenza and emphasises the
importance of the health workforce in this
topic. The digital launch was on 6 March 2018,
followed by the physical launch later that
month.
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Influenza
In May, the WMA restarted its communication
campaign to increase influenza immunisation
uptake. The emphasis of this year’s campaign
is on asthmatic patients. People with asthma
are at high risk of severe complications from
influenza – even if their asthma is mild. With
their influenza more likely to develop into
bronchitis or even pneumonia, asthma
patients are more likely than others to end up
in hospital with influenza. Additionally,
influenza is also a trigger for asthma and vice-
versa, when people with asthma get influenza,
the virus can worsen asthma’s chronic
irritation of the bronchial mucosa.
E V E N T S                                       W M A 2 0 1 8 A N N U A L R E P O R T
The second part of the social media
campaign started in autumn when the
immunisation season for the northern
hemisphere starts. The communication
campaign achieved  1,2 million social
media impressions ( 612.000 from twitter
and 595.000 from facebook) and in total
nearly 700.000 engagements. The
geographical focus of this global
campaign was on India and Eastern
European countries..
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On the occasion of the 40th Anniversary of
the Declaration of Alma-Ata, the Second
International Conference on Primary Health
Care was hosted by the President of
Kazakhstan, with the World Health
Organization and the United Nations
Children’s Fund (UNICEF) in Astana,
Kazakhstan from 25-26 October 2018.  The
Conference aimed to strengthen Primary
Health Care as the foundation for UHC,
building on lessons learnt over the past four
decades.
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Primary Health Care
Health professional regulation faces many
challenges in a world characterised by
political, social, economic and technological
change. Widespread reform of health
professional regulation reflects policy
initiatives by many governments to ensure
sustainable, efficient and effective health
service delivery. But what are the implications
of these challenges, and how do we ensure
the public’s best interests are met?
Running over one-and-a-half days
immediately before the World Health
Assembly in May 2018, the 6th World Health
Professions Regulation Conference (WHPRC)
provided participants with insights,
perspectives and discussion on current
challenges in health professional regulation.
Three main themes were addressed during
the conference:
E V E N T S                                       W M A 2 0 1 8 A N N U A L R E P O R T
Dr Otmar Kloiber, Secretary General, is a
member of the International Advisory
Committee for the preparation of the
Primary Health Care Conference. The
WMA participated in the development of
the conference declaration (Astana
Declaration) and commented on the
technical background papers.
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1. A call to set the right standards in regulation
Topics included: setting the right standards,
who is regulating the regulators, ethics and
professional autonomy, barriers to
implementation, and reimbursement.
2. Safety, quality and compliance: Benefiting
patients, communities and populations
Topics included: best practice guidelines, the
role of regulation in sustainable prevention,
facilitation of migration, the cost of
maintaining licenses, use of big data and case
studies of outcome-oriented models.
3. Supporting the quality of lifelong learning
Topics included: continuing professional
development (CPD) and a discussion on the
need for global standards, fostering
innovation, improving patient treatment, the
shift in CPD to assessment vs independence,
and regulation of specialization.
World Health Professions Alliance
                    W M A 2 0 1 8 A N N U A L R E P O R T
WMA has issued an important number of press releases in support of its members and
each time a human rights violation from the health sector was brought to its attention. .
The press releases are available on the WMA website and have been communicated on
the WMA social media channels and newsletter.
5.02.2019 | Attack on hospital denounced by global health leaders
01.02.2019 | Message of solidarity sent to health workers in Venezuela
25.01.2019 | WMA condemns use of lethal force against sudanese physicians and protesters
20.12.2018 | WMA expresses shock at turkish physician leaders’ prison sentences
08.11.2018 | WMA condemns ‘shameful’ move to ban doctors from working
22.10.2018 | Physician leaders protest over conditions of detention and death sentences
06.10.2018 | Criminalisation of Doctors is Condemned by World Medical Association
27.09.2018 | World Medical Association supports health personnel on trial
07.09.2018 | Global physician leaders express revulsion about torture reports from Uganda
10.08.2018 | Turkish president urged to end campaign against physician
30.07.2018 | World Medical Association condemns killing of medic
16.07.2018 | WMA condemns complicity of doctors in Iranian executions
15.06.2018 | Collapse of health system condemned by World Medical Association
23.05.2018 | Physician Leaders Echo Call for Vigorous Response to New Ebola Outbreak
30.04.2018 | Physician Leaders Urge All States to Sign Nuclear Weapons Treaty
10.04.2018 | World Medical Association Council meeting
26.02.2018 | International community criticised over Syria bombing
13.02.2018 | WMA appeals for immediate release of jailed physician
Human Rights
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Constituent Membership
The physicians of this world are typically
represented by national and territorial medical
associations of their own regions.
Such associations are broadly representative of
the physicians of their country by virtue of
their membership, with their voting
membership being limited to physicians and
medical students. They are not subject or
directed by any office or agency of
government.
Advantages
1. Recognition and acceptance as a member
of an international organization such as the
WMA lends the power of a global community
to a National Medical Association (NMA). This
underlines the importance and relevance of
the NMA.
2. The WMA is in official relations with United
Nations agencies such as the World Health
Organization, which gives NMAs and Associate
Members access to these international bodies.
3. By participating in debates with colleagues
from all over the world, NMAs and Associate
Members have the opportunity to collaborate
on ethical guidance and leadership in health
care.
4. Information and knowledge can be sourced
from the WMA, which can contribute to the
optimal efficacy of NMAs and individual
physicians.
5. NMAs and Associate Members can make
use of the WMA’s products and services.
WMA currently has a total of  112 members as of October 2018. Detailed list on the WMA website.
M E M B E R S H I P                               W M A 2 0 1 8 A N N U A L R E P O R T
Associate Membership Advantages
Associate membership is limited to physicians
(as defined in the WMA Bylaws) and medical
students who are properly enrolled in a
recognised medical school, who have applied
for such membership and who have paid the
amount of dues prescribed for such members.
Associate membership is available to such
individual physicians and medical students
whether or not their National Medical
Association is a Constituent Member of the
World Medical Association.
1. The privilege of attending and participating
in WMA annual assemblies.
2. Introductions to professional leaders in your
field and opportunities to visit medical and
health institutions abroad.
3. Information on medical meetings abroad.
4. A service department which will assist you
in meeting your colleagues both at home and
abroad. 
5. A membership certificate for display,
6. WMA secretariat consultation, service and
small meeting center. 
7. Preferred access to the WMA Education
Portal for Continuing Medical Education and
Continuing Professional Development.
8. Publications of the World Medical
Association.
9. Access to the internal discussion
documents on policy development.  
WMA currently has more than 1000 active
Associate Members as of October 2018.
The registration page is available on the
WMA website.
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BALANCE SHEET AT 31 DECEMBER
FOR THE YEARS 2017 AND 2016
F I N A N C I A L R E P O R T                   W M A 2 0 1 8 A N N U A L R E P O R T
 INCOME STATEMENT FOR THE
YEARS 2017 AND 2016
WMA SECRETARIAT
Dr. Leonid EIDELMAN
President
Israel
Dr. Miguel R. Jorge
President-Elect
Brazil
Dr. Yoshitake YOKOKURA
Immediate Past President
Japan
Dr. Ardis D. HOVEN
Chairperson of Council
United States
Dr. René HÉMAN
Chairperson of the Finance
and Planning Committee
until December 2018
Netherlands
Dr. Miguel Roberto JORGE
Chairperson of the Socio-
Medical Affairs Committee
until October 2018
Brazil
Dr. Joseph HEYMAN
Chairperson of the Associate
Members
United States
      W H O W E A R E                   W M A 2 0 1 8 A N N U A L R E P O R T
Dr. Otmar KLOIBER
Secretary-General
Germany
Dr. Frank Ulrich
MONTGOMERY
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