At this year’s World Health Assembly, member states voted by secret ballot to elect Dr. Tedros Adhanom, from three shortlisted candidates including Dr. David Nabarro and Dr. Sania Nishtar – as the current Director-General Margaret Chan’s successor. Dr. Tedros will assume the DG position on July 1st. This election represented a significant departure from previous DG selection processes in which the WHO’s Executive Board would determine the presumptive DG. While the World Health Assembly still had to approve the DG, it never voted down a candidate recommended by the Executive Board. A more democratic process has also lead to a more expensive one – each of the candidates actively campaigned around the globe, supported by their respective governments.
It’s now almost trite to point out that global health entities have grown in number and scope over the past couple of decades. Yet, this acknowledged proliferation of initiatives and the commensurate surge in resources for global health can obscure the unique position that the World Health Organization (WHO) continues to occupy. It remains the only global health agency able to create international law and binding regulations across countries. Even in the aftermath of Ebola, despite multiple reports on its failings to respond effectively, it is still the institution the world looks to in a public health crisis to respond, to manage, to control, to help heal; we saw this most recently when Zika struck in 2015-2016 and all eyes turned again to WHO.
Indeed, the Director-General (DG) of the WHO is an incredibly important position. Additionally, the WHO DG uniquely possesses a legitimacy derived from WHO’s member states to help set WHO’s priorities, get these funded and convene member states in an independent forum to solve pressing challenges. The next DG must focus then on what the WHO should be doing in standard-setting, global public goods production, targeted technical assistance and pandemic preparedness – and, as a corollary, what the WHO should not be doing, because other entities possess sufficient capabilities and competencies to do so, or simply because WHO does not.
We believe the newly elected DG must move quickly to outline his vision for the organization. Such an articulation has a few constituent parts.
First, Dr. Tedros must lead an expeditious process to determine WHO’s priorities. We believe such a list must include health emergency preparedness and response, continued technical assistance in key areas (e.g., TB and malaria) and how it will help advance the sustainable development goals agenda, particularly as it relates to universal healthcare coverage and climate change. Part of such a detailing must also include what WHO will not focus on and how it will support other actors – state, intergovernmental, non-governmental, foundation – who are already tackling those issues.
Second, partly in response to an organization committed to defining a more focused mission, member states should support either an increased in membership dues (frozen for more than thirty-five years) or provide voluntary contributions to support the new DG’s work on defining priorities and then any resulting reforms required. One possibility is for the BRIC countries (which Chatham House analysis currently estimates contribute roughly 1% of voluntary contributions to the WHO) to provide funds to help the DG define WHO’s future. Because of what we’ve seen in other organizations and at the WHO itself, increased contributions would also likely increase the BRIC countries’ voice in the organizational work to define future priorities and then work toward their realization.
Third, WHO under the new DG must adopt a clear open information policy and commit to greater transparency about its work and the impact of that work around the world. Dr. Tedros’ experience as Chair of the Board of the Global Fund to Fight HIV/AIDS, TB and Malaria will be valuable here given the great strides made by the Global Fund in this regard.
Fourth, and a point which relates to the work required to define priorities, WHO must have clearer policies around how and when non-member states can engage in dialogue with it and be part of work it is coordinating or actively engaged in.
Finally, a big test for both DG Chan’s legacy and the next DG will be whether the reformed health emergency program will actually work in the next outbreak and whether WHO will perform its coordinating and response roles better than it did with the 2014 Ebola Outbreak. Currently, at least donor countries do not seem to have much faith in the organization given that they barely funded the WHO’s emergency request for Zika. This anecdote underscores the need for the next DG who can be respected for a leader – not only because of his past leadership experience and achievements but even more for his ability to lead the organization into a clearer, even if more narrowly defined, future.
Political analysis will be conducted over why Dr. Tedros was elected over the other 2 candidates. What is clear as is generally true in UN elections, the result was a product of member states’ assessment of the candidates skills, liabilities, regional context and their interpretation of the global political zeitgeist.
We hope now that the candidate is selected, he will have the unified support from all member states to start work immediately. Viruses, bacteria, protozoa aren’t waiting and health inequities do not improve on their own. We have no time to waste.
Chelsea Clinton and Devi Sridhar are co-authors of ‘Governing Global Health: Who Runs the World and Why?’