Task before new WHO director-general

The World Health Organization’s 194 member states recently elected Ethiopia’s Tedros Adhanom Ghebreyesus as its new director-general at the 70th World Health Assembly in Geneva, Switzerland. He defeated Britain’s David Nabarro and Pakistan’s Sania Nishtar to become the eighth director-general of the WHO and the first African to head the global health agency in its 70-year history, thereby shattering the agency’s African-leadership glass ceiling. He will succeed Margaret Chan whose second term of office ends June 30.

Tedros holds a PhD in Community Health from the University of Nottingham and has for over three decades been a distinguished leader who has saved and improved lives in Africa and around the world. A globally recognised expert and author on health issues, including health workforce strengthening, emergency responses to epidemics, and malaria, he has been co-chair, Partnership for Maternal, Newborn and Child Health Board, chair, Roll Back Malaria Partnership Board, chair, Global Fund to Fights AIDS, Tuberculosis and Malaria Board, Ethiopia’s minister of health as well as minister of foreign affairs. His reforms as health minister are said to have transformed Ethiopia’s health system to expand quality care and access to tens of millions of Ethiopians, while in the global context he helped key global actors like The Global Fund and the Roll Back Malaria Partnership operate with greater efficiency and effectiveness.

Now that the mantle has fallen on him, it is time to face the arduous task ahead. The WHO has faced a barrage of criticisms recently, especially following its slow response to the massive outbreak of Ebola in West Africa in 2014. There have since been calls for an overhaul of the agency, with particular emphasis on its emergency response capacity.

Despite its remarkable achievements, the WHO today is not fulfilling its mission, isn’t adequately funded for it, and is failing in its current form, but the arrival of a new director-general offers an opportunity for reform that the agency must put to good use, reckons Ed Whiting, director of policy and chief of staff at Wellcome, an independent global charitable foundation.

“At a time when health budgets around the world are under increasing pressure, the new director-general must strengthen the case for investing in improving health outcomes. That includes encouraging greater investment in stronger national health systems and epidemic preparedness, and being fearless in calling out countries that fail to take action where it is needed,” says Whiting.

The WHO, he says, must also strengthen its unique role in alerting the world to health emergencies and coordinating the responses to them. And while the WHO’s new emergencies team has shown that it can mobilize resources and action at a pace never seen in the organization’s history, the new DG, he says, needs to convince national leaders that the world doesn’t yet have the capability to respond to cross-border emergencies, making sure the WHO clearly sees the existing gaps and the steps needed to close them.

“The new director-general should also be fearless in calling out global health risks, such as the growth of artemisinin-resistant malaria in Southeast Asia, particularly where national and regional authorities are not doing enough to combat such threats,” he says.

He adds that the WHO must also lead the fight for access to innovative health care for all. The new DG will need to work effectively with “the increasingly mixed economy of health care funders and providers” to ensure that the WHO has sufficient funds for its mission, as well as make a greater effort to better develop the WHO’s relationships with civic society and the private sector as every dollar invested by private companies reduces the burden on finance ministries and taxpayers and also delivers innovations and technical advances that can improve health.

Whiting advocates an ambitious internal reform programme that simplifies the WHO’s complex governance structures, and challenging poor-performing offices at the national, regional, and global levels, contending that key to that would be ensuring that staff are selected for posts based on their competence, not their politics.

“Clear, decisive leadership on all of the above will go a long way to restoring confidence in the WHO — a vital prerequisite to attracting the financial support the organization so desperately needs,” he writes.

As Tedros begins his five-year term on July 1, he must bear all these in mind. His words in his post-election briefing show he’s not unaware of the bumpy road ahead. Asked what he would do about the emergency response programme, he said, “We have to implement it with a sense of urgency. It has to be geared towards implementing the international health regulations in full. We can do many of the things we’re doing now, like [rolling out] the global health security agenda . . . and identifying the gaps in implementing the [regulations]. Epidemics can strike at any time, but we have to be prepared.”

This is the time for Tedros Adhanom Ghebreyesus to replicate the same magic that has earned him “considerable respect among his peers as a reforming health minister and past chair of two international infectious disease organisations”.