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Influenza A (H1N1): "Lessons Learned and Preparing for the Future"

High-level Meeting on Influenza A (H1N1)

Cancun, Quintana Roo, Mexico.
3 July 2009.

PAHO Director closing remarks
*Dr. Mirta Roses Periago.

First, I would like to thank the Governor, the Quintana Roo Secretary of Health, and the Prefect for their excellent arrangements, hospitality, kindness, and courtesies. I am speaking, of course, on behalf of Dr. Margaret Chan and her entire team and that of the Pan American Health Organization. I am also taking the liberty of speaking on behalf of all the participants who perhaps have not have the opportunity to do so.

We thank the Ministry of Foreign Affairs' Chief of International Cooperation for the arrangements his department made for the many participants who came from abroad. We know that facilitating the presence of all the delegates here in Mexico has been a big job and we know that the hope is that many more will come and even more will continue to come.

I would like to express my very special thanks to Mexico's Secretary of Health, Dr. Córdova Villalobos, who, really, has not only been an extraordinary host in the field of public health, but also the driving force behind this meeting. There was so little time to organize this remarkable meeting, to hold this event, which has received a marvelous response from all the countries from the Region and around the world, represented here by their highest authorities. We know that the majority of our authorities are torn. Some wanted to be here, others have to spearhead the response in each country and, as a result, have made a very special effort to be here or to send their most senior officials.

The Secretary has accustomed us to bold decisions quickly taken, such as this meeting and Mexico's response since the virus made its appearance. I believe that all the countries have been able to share information at this meeting, especially the affected countries or those that are now entering the mitigation phase, and that the emphasis of this entire meeting has been on how to move from the initial containment phase to the mitigation phase as we prepare to deal with the gradual spread of the virus in every country. Above all, this meeting has been marked by a spirit of solidarity and great interest and trust among all the countries, who have not only shared their successes but their mistakes and even their uncertainties.

Even though we are leaving this meeting with a great deal of knowledge, the beginning of wisdom is knowing how much we don't know. What we don't know about the evolution of this virus is considerable, but the support, trust, and solidarity that we have observed among the three countries primarily affected, Mexico, Canada, and the United States, are something to behold. I believe that we can thank Mexico, because, as the saying goes, the first one on the dance floor is the one who doesn't know the steps very well, and I believe that we should be thankful that they logically, and I don't mean to minimize their political courage, were primarily thinking about their own population. However, their solidarity, openness, and generosity permit me to say that, almost at the same time and to the same degree, they were concerned about health worldwide, and for this, we should all give Mexico a special round of applause.

In fact, I believe that we are reaping the fruits of years of planning and preparation, which have been very important and, since 2007, have put most of the countries on a rather similar and equitable plane in terms of their ability to participate and implement the International Health Regulations. This obliges all of us to develop new working relationships in the countries--of course, with the primary mission and vision being to protect the health and lives of the population, and recognizing the need to try to minimize the impact on the free movement of people and goods. Actually, a globalized world, migration, the constant movement of people and goods, and trade are new phenomena that pose a major dilemma for all of us public health leaders who are present here, and I believe that the spirit of the new International Health Regulations is what has truly guided many of our actions.

We know that on this path, this event has enabled us to discuss very important matters, which were studied in great depth in each technical panel, as well as in the high-level panel, which I would like to commend for its very new, very creative, and very innovative dynamic. On behalf of the senior officials who participated and interacted with Dr. Chan and me, I would like to say that it has been a really beautiful and unique experience to have engaged in a dialogue on scientific, technical, and political issues and actually made it possible to develop trusting interpersonal relations, laying the foundation for us to forge ahead in learning how to protect health throughout the world.

There is undoubtedly concern over what our policy will be once the initial phase that we mentioned has concluded, and there is also concern over the virus' South-to-North cycle in terms of what new problems will have to be addressed. I believe that critical issues were identified, among them the protection and security of health workers, occupational measures, data that Mexico presented on the vulnerability of housewives, which, actually, is simply recognizing that they are the ones who take care of the sick.

A very important issue here in Mexico but also in the first three affected countries, which are federal nations, is the political and necessary reality of decentralization in the health services structure and how political negotiation and effective coordination between levels and sectors are needed; it was very instructive, I believe, and a very good example for the world to see the President of Mexico at the forefront of the action with all of his cabinet, with every member of the cabinet having a role to play and a responsibility to shoulder in the response. I believe that we are going to experience this in small or unitary countries, because the reality of decentralized services, which the Organization recommends to bring services closer to the people, conduct surveillance, and implement the response, demands this type of joint action.

The issue of risk communication was a constant theme. I believe that this dichotomy and the balance needed to avoid a reaction based on fear, which breeds selfishness and isolationism, and create a positive, open, equitable, collective reaction is the real challenge of risk communication. We know that we must engage the population, consult it at all times, make it a participant, listen to its concerns; and talking about the community, we mean all sectors, including the private sector, the public sector, and civil society organizations that represent the communities themselves.

There have been important discussions, and I believe that in essence they have been about the serious questions that we all have. This means that we must make this dialogue ongoing, and the Organization is available to help tackle the great uncertainties still before us with respect to vaccines- the development of vaccines and equitable access to them.

I believe that considerable progress was made on general principles, on how we are going to handle this issue, and also on commitments during the high-level dialogue with the Director-General on the need to clearly define the points at issue and resolve them little by little with the collaboration of all.

And finally, the importance of continuing and sharing research. I repeat, there are many more uncertainties than certainties in the evolution and behavior of this virus, in its potential to mutate, change, and recombine, and I believe that, as Dr. Chan stated, we cannot lower our guard but must have a large dose of humility to deal with this virus and recognize that it may still be full of surprises. One thing is certain, however, and that is that with courage, often taking the greatest political risks given the lack of more scientific and technical information (this is the real political challenge, always bearing in mind the fundamental principles of protecting the population, solidarity, and equity, and above all trust among peoples and among authorities), we will move forward. That is the example that the countries present have given us.

Thank you very much.

Event photogallery.

More information:

- (PDF) Director's closing remarks
- Video - Director's closing remarks [only Spanish version]
- Video - Mexico Influenza A H1N1 [only Spanish version]
Pandemic H1N1 in Mexico. 20 minutes video produced by the PAHO's Communications and Public Information Area which emphasizes the close collaboration developed between PAHO/WHO and the Mexican health's authorities during the first weeks of the epidemic. The video includes fragments from the speeches delivered by Dr. Chan, WHO Director-General and Dr. Roses, PAHO Director during the High-level Meeting on Influenza A (H1N1)that took place in Cancun, Mexico.

- PAHO Director's Newsletter Issue No. 13. July 02, 2009

PAHO Press Release / Nota de Prensa de la OPS

- Aspectos destacados de la reunión de alto nivel de Cancún sobre Influenza A (H1N1)
- Highlights from the High-Level Cancun Meeting on Influenza A (H1N1)

For more information, please contact Diaz, Eng. Katia (WDC), Director's Office Webmaster.