A critical question for the global health community
By Genevie Fernandes
The World Health Organization is hiring its next Director General who will replace Dr. Margaret Chan in May 2017.
Six candidates have been nominated by their governments to succeed Chan: (1) Tedros Adhanom Ghebreyesus, Ethiopia’s foreign minister and former health minister (2) Flavia Bustreo of Italy, Assistant Director-General for Family, Women’s and Children’s Health at WHO (3) Phillipe Douste-Blazy, a French former minister of health and currently a UN special advisor on innovative funding for development (4) David Nabarro, a veteran in the UN system and currently a sustainable development advisor to the UN secretary general (5) Sania Nishtar, Pakistan’s first female cardiologist, former health minister and founder of the NGO ‘Heartfile’ (6) Miklós Szócska from Hungary, a professor and former health minister.
As a PhD fellow of the Global Health Governance programme based in the University of Edinburgh, I have been following the WHO Director General (DG) elections and was thrilled to attend the first ever public engagement event with the DG candidates held at Chatham House in London.
The Royal Institute of International Affairs, commonly known as Chatham House, is one of the most influential think tanks in global health and it was only fitting for such a high profile event be held here. So, after a scenic early morning train ride from Edinburgh to London, I walked into Chatham House, located in this beautiful 18th century property in St. James Square, that was also formerly occupied by three British Prime Ministers.
I entered a room packed with academics, researchers, health reporters from leading newspapers, a few students, and of course, an entire line of camera crew who would be recording and live streaming this event. I slowly began to identify the faces around me, and within minutes, I saw the moderator Richard Horton, and the co-chairs David Heymann and Suerie Moon. It was quite a celebrity moment for me to see so many seasoned global health experts all under one roof. As the five candidates began taking their seats on the stage, I thought about how the outcome of this election is going to be critical and consequential not just for the WHO but also for the global health community.
The WHO came out battered and bruised after the 2014 Ebola epidemic with several experts raising questions about its credibility, capacity and responsiveness, and urging for reforms. As the world was settling from the Ebola shock, Zika happened. In a time when the world is faced with an increasing risk of infectious disease outbreaks and rising burden of non-communicable diseases, the WHO remains severely underfunded and troubled with governance issues. Moreover, WHO is not the only player in this game of improving global health; there are multiple actors who are younger, nimbler, more dynamic, better-funded, efficient, and credible. With new political leaders being elected in the US and across Europe, uncertainty around global health priorities and funding has been looming. The next DG will therefore have a difficult if not an impossible role in restoring trust in the WHO and leading the organization in this rapidly changing political climate.
Five of the total six candidates fielded tough questions from the moderator Richard Horton, on what was their vision for the WHO and why they were the perfect candidates for the job. The sixth candidate – Tedros Adhanom Ghebreyesus, a former foreign minister, was absent owing to a transition of the cabinet in his home country.
Sitting on this panel must have definitely been nerve-wrecking for all the candidates despite their solid experience. Imagine being interviewed for a job live in front of representatives of the 194 member states in Geneva, followed by an open public questioning time with an electric Richard Horton in London. However, each of the five candidates came prepared with their vision for the new WHO under their leadership.
Having spent nearly two decades at WHO, Flavia Bustreo is an insider. She has been credited for her work on the Partnership for Maternal, Newborn & Child Health and as a vice-chair of the Board of GAVI. Bustreo said that she had the character, capacity and courage to restore trust in the WHO and spoke about reaching out to a large list of small funding partners for sustainable financing. As Bustreo spoke, I wondered if she will replace Margaret Chan, who is an insider herself having worked at the WHO before becoming director general or will the member states choose an outsider this time around given the new and seemingly transparent nature of the elections.
Phillipe Douste-Blazy, stressed that the world needed the authority and efficiency of the WHO now more than ever. Douste-Blazy played up his achievements at UNITAID, an innovative financing mechanism mostly funded by a tax levied on airline tickets, that negotiates lower prices for drugs and diagnostics. With a French national already running an international organization (Christine Lagarde at the IMF), it would be interesting to examine if geopolitics could affect Douste-Blazy’s chances at leading the WHO.
David Nabarro emphasised on framing health within global security and on building strong partnerships. While good health as a global security goal is important, this kind of framing however, is problematic as it lends itself more to an agenda aligned with priorities of the North rather than being an inclusive approach. In a career spanning four decades, Nabarro has worked as a clinical doctor in communities in Iraq and Nepal, held leadership roles at DfID, and led several high-level UN taskforces. Becoming the DG, he said, would be like coming full circle from where he started as a medical student.
Sania Nishtar advocated for governance-related reforms within the WHO for accountability, efficiency and effectiveness. Nishtar’s responses although technical at times and longer than the rest of the candidates, showed an astute understanding of the WHO policies and existing challenges. It is important to note that last year, Nishtar was also in the running for the job of the high commissioner of the UNHCR, having lost of Filippo Grandi.
While Miklós Szócska has been credited for implementing a full ban on smoking in public places and raising food tax that contributed to increasing salaries of public health employees, his overall exposure and experience in managing global health is relatively less, and this was evident in his responses, many of which were rather too simplistic.
I was disappointed on learning that Tedros Adhanom Ghebreyesus would not be present at the Chatham House meeting. Ghebreyesus is the only candidate without a clinical background; he is politically well connected, shares a strong rapport with the donor community, and is credited with improving health infrastructure and workforce in Ethiopia. He is also backed by the African Union. However, as a foreign minister, Ghebreyesus has been linked with the detention of British leader of an Ethiopian rebel group, Andargachew Tsege and during his tenure as a health minister, Ethiopia faced major cuts in finance for HIV programs questioning the performance of his office.
Who would I vote for?
It is hard to say yet, as all the candidates presented all the right ideas in their vision statements. However, what bothered me to some extent was that while all the candidates spoke about what needs to done, nobody shared any detail on how this has to be done. To be fair, all the candidates were given a strict time limit of 1-2 minutes for their responses and in such a tight frame it is hard to tease out an actual action plan. But I would have been happy with some steps and so would the rest of the audience at Chatham House.
Whoever is elected as the next DG needs to be in the words of David Heymann, ‘A jack of all trades but also a master of one’, and as Suerie Moon interestingly put, a person who is able to lead a 70-year old ship, reform and maintain it, and steward the other ships (regional offices, partners and stakeholders) in extremely choppy waters.
The next DG will have to work hard in restoring trust in the WHO, expanding the core budget through innovative and sustainable financing mechanisms, reform and focus on the core mandates and strengths of the WHO, improve regional coordination and accountability, reach out to vulnerable groups, and most importantly stay committed to social justice and health for all.
However, will the 194 member states consider these critical criteria when they come together in May 2017 to cast their secret ballot and elect the new leader of one of the most important organisations in global health?
I really hope and pray that they do.