On invitation by the hosts of the high-level Round Table discussion at the 8th World Salt Symposium in May 2000, leading international organizations actively involved in supporting the global elimination of iodine deficiency convened in Paris on 10th January 2001. This 1st Summit of Leaders reviewed the tremendous global progress in universal salt iodization, and considered the recommendations made by a small Interim Working Group to establish a more formal collaborative structure with a work plan of mutually supportive work for addressing the challenges of the future. Representatives from 16 key international organizations from the broad field of required expertise attended.

The Summit was presided by the President of ESPA, Dr Jan van Ingen and the Executive Director of MI, Mr M.G. Venkatesh Mannar. The Summit participants unanimously concurred with the proposals of the Interim Working Group. The Summit decided that the new Partnership should be composed of a Summit of Leaders, meeting once every 2-3 years, and an Advisory Board meeting regularly, and be supported from a small, permanent Secretariat. A constitutive Board was formed with UNICEF, WHO, ESPA, Salt Institute, Chinese National Salt Industry Corp., Kiwanis International, MI, ICCIDD and PAMM as members. The Board met immediately following the Summit. Below is a summary of presentation, discussion and agreements of the Summit meeting.

CONDUCT OF THE MEETING

The Chairperson of the Interim Working Group (IWG), Dr Justus de Jong, presented the IWG's considerations in recommending the new Partnership. The proposal lays out essential details but it leaves choices for the Summit to consider. These choices are related to: Legal status; Size and location of the Secretariat; Purpose, role and schedule of a Summit; Authority and composition of the Board; and Financial matters. Seven Partner organizations (UNICEF, WHO, Salt Institute, ESPA, Kiwanis International, MI and International Council for Control of Iodine Deficiency Disorders) had been invited to prepare their nominations for a Board. The IWG recommended thata constitutive Board meeting be held immediately following the Summit.

The Global State of Universal Salt Iodization was presented by the IWG Coordinator, Dr Frits van der Haar. By end 1999, 70% of households in IDD-affected countries of the world had access to iodized salt. Out of ±140 million newborns entering the world in 2000, approximately 85 million were given protection of their developing brain by the additional iodine from iodized salt consumed by their mothers. Areas and large populations seen to be lagging in the global progress include South Asia, East Asia, the Horn of Africa, the Independent States and Central Asia, and French-speaking West Africa. In a sizable number of countries, including the West, data collection is not systematic. Information from this "Score Card" was used by the IWG to develop guidelines for the constitutive Board to devise a Partnership work plan.

Participants from the 13 international organizations present at the Summit commented upon the need and rationale of a new Partnership, its structure and functions, and the formation of an Advisory Board. A meeting of a constitutive Advisory Board was held to plan for next steps.

NEED AND RATIONALE FOR A PARTNERSHIP

Participants at the Summit concurred that the realization of the global goal -sustained elimination of iodine deficiency disorders- is a national responsibility. Support from international organizations is best positioned to buttress national coalitions in pursuing the national responsibility and sustaining its success, once achieved. The need for strengthening broad public, private and civic participation in national coalitions was emphasized. Ensuring that the success of elimination endures implies that the Partnership supports national coalitions in their permanent progress.

Experience from the past decade demonstrates that successful progress occurs most effectively from blended contributions of multiple sectors and professional expertise. The agreed-upon strategy, universal salt iodization, uniquely involves talents from the productive, civic and administrative elements of society. The tasks ahead are sizable and complex. The essential strategy should become embedded in the fabric of society. This calls for new collaborative leadership.

ROLES AND RESPONSIBILITIES OF PARTNERS

In historical perspective, the global elimination effort increased from the 1990 Summit for Children, mostly represented by public leadership, and it culminated at the World Salt Symposium in 2000 with salt industry as host. A sea-change has occurred where an initially public health perceived problem now is being tackled as a national development priority with civic, private and public Partners involved. Salt industry has in the past participated largely on an ad-hoc basis. The point was made that salt producers do not make extra profit from iodization, nor is it the aim to make people consume more salt. The salt industry joins the Partnership to make their unique contribution in meeting the global and national development imperatives.

UN and bilateral agency participants stressed the need to plan for future tasks: (1) Achieve the goal in countries lagging, and (2) Sustain the successes nationally. A Partnership is essential to meet such new challenges. It may serve as a model for similar coalitions to address other global public nutrition problems. A Special Session at the United Nations Assembly in September 2001 is being planned with UNICEF in a lead role. The Special Session sets out to reaffirm the stated goals, and to see to it that the tasks of sustaining the effort and making it endure will be addressed. The support of national coalitions in their challenges ahead requires that all Partner organizations at the table make contributions.

STRUCTURE OF THE PARTNERSHIP

Participants at the Summit emphasized that the new set-up should be small in size, not create a large overhead, and avoid unwarranted bureaucracy. The structure chosen should serve to provide critical linkages among the organizations already active. The Partnership should work with and through existing and ongoing bilateral arrangements. Each Partner organization maintains its own networks, procedures and mandates.

The Summit participants unanimously concurred with the proposals made by the IWG. It was agreed that a Summit of Leaders should meet perhaps once every 2-3 years to provide oversight, promote advocacy and publicity, and ensure continued global commitment. In agreeing on the formation of a Board of Directors, it was emphasized that the Board should be advisory to Partnership members. Interests of developing countries should be ensured in the Board's decisions, perhaps by co-opting eminent individuals as Board Advisor. The Board should be inclusive of interests of all members. The Summit recommended a small Secretariat, 2-3 people perhaps, with an emphasis on strong communications among Partners and with national coalitions. The first need in most countries is for information and exchange of experience.

CONSENSUS OF THE SUMMIT

Participants at the Summit agreed to form an international Partnership (Partnership for Sustained Elimination of Iodine Deficiency) to tackle tasks beyond the ongoing agendas of each Partner. The focus of the Partnership will be on global strategy, support to national coalitions, analysis of national problems, collaborative responses to clear national needs, monitoring of global progress, information exchange, and networking among members.

The Summit agreed that a Summit of Leaders be held once every 2-3 years to sustain the global priority, ensure permanent progress and promote global publicity. A meeting of Partnering organizations could be organized once a year if required. A formal Advisory Board was agreed upon for guiding the Partnership's work. The Board shall meet 2-3 times each year, complemented by teleconference if needed.

Nominations for Board membership were accepted of UNICEF, WHO, Salt Institute, ESPA, Kiwanis International, MI and ICCIDD. The China National Salt Industry Corporation, and the Program Against Micronutrient Malnutrition (at Emory University and CDC, Atlanta) were accepted as Board members. Support for the Partnership will be provided by a small permanent Secretariat, housed in the office of one of the members if feasible.

The Summit asked for a detailed package, including a draft Constitution, Work Plan and Financial Plan to be prepared and submitted to the Partnership by end June 2001.