The Search for the Next Global Health Chief and the Challenges Ahead
This year the World Health Organization will elect a new director-general, who will be charged with moving past the WHO’s widely criticized reaction to West Africa’s Ebola outbreak two years ago and guiding a global organization that is low on budget and high on bureaucracy. The WHO executive board has trimmed down the list of candidates for the top position in the organization to three candidates:
Dr Tedros Adhanom Ghebreyesus, 51, a long-time senior Ethiopian government official and a member of the country’s most powerful political party. Widely respected as a malaria researcher, he has a significant social media presence. He is also backed by a number of African governments, who have joined forces to help fund his WHO candidacy.
Dr David Nabarro, 67, a British doctor with decades of experience working abroad in child health and nutrition programmes in South Asia, East Africa and Iraq. His postings have included stints at the DfID, the WHO and universities; the BBC even made a documentary about his volunteer work during his gap year.
Dr Sania Nishtar, 53, a former federal minister in the Pakistan government and co-chair of the WHO’s commission on ending childhood obesity. She is the founder and president of Heartfile, a health thinktank, and the only candidate with a website devoted exclusively to her bid.
Of the three, Nishtar was the only surprise, displacing Dr Philippe Douste-Blazy, 64, a French drug affordability and universal health care advocate, lauded for his work in promoting the millennium development goals and raising money for Unitaid to fight HIV, malaria and tuberculosis, whom some had considered a likely finalist. Others knocked out from the race were Dr Flavia Bustreo, 55, of Italy, a WHO assistant director-general, and Dr Miklós Szócska, 56, of Hungary, the first health minister to manage a full four years in office and who has implemented a wide range of public health regulations, from banning smoking in public to adding a tax on food and beverages with added salt and sugar.
The current Director-General of the WHO, Dr Margaret Chan, was first appointed by the World Health Assembly in November 2006 and was given a second five-year term in May 2012. Prior to joining the WHO, she was Director of Health in Hong Kong where she led the health ministry in containing the first human outbreak of H5N1 avian influenza in 1997 and the severe acute respiratory syndrome (SARS) in Hong Kong in 2003.
For the past few years, the WHO’s critics have supported its focus and emphasis on disease prevention and eradication, yet many argue that success has been elusive because the WHO is too bureaucratic and centralized and not nimble enough to be effective or efficient enough in prioritizing projects and managing resources. In 2009, the WHO declared a pandemic involving the H1N1 influenza virus but critics claimed the WHO had exaggerated the danger, spreading “fear and confusion” rather than “immediate information”. In 2014 and 2015, the WHO was heavily criticized because of the slow response to the Ebola virus epidemic in West Africa.
The next WHO chief will face a tough task in proving to the international community that the WHO is still competent as an agency delivering global health. These are some of the global health issues to watch in 2017:
- Emerging diseases and waning threats: Polio and HIV are two of the most devastating diseases of our time — but they’re waning or, in the case of polio, on the verge of eradication while these diseases as most likely to cause a global epidemic in the future: (1) Middle East respiratory syndrome (MERS)-CoV, (2) Lassa virus, (3) Nipah virus.
- Chronic diseases have been projected to account for almost three-quarters of all deaths worldwide: Almost ¾ of deaths due to ischemic heart disease (IHD) and almost ¾ deaths due to diabetes will occur in developing countries. Obesity is a significant factor in the development of a number of chronic diseases, including diabetes, heart disease, hypertension, and cancer. Obesity is now dramatically on the rise in low- and middle-income countries, particularly in urban settings.
- One Health: The idea of One Health is to bring awareness to the idea that the health of humans is connected to the health of animals and the health of the environment. This collaborative approach connects health experts all over the world in an effort to control and prevent the spread of disease and streamlining the flow of information so that threats can be identified earlier and responded to in a more rapid and effective manner.
- Pharmaceutical Outsourcing and Quality: Pharmaceutical outsourcing makes drugs more affordable; that is an undisputed fact. However, the concern is that the quality of these drugs continues to be an issue.
Global health issues are not limited to infectious disease outbreaks; they can be disease awareness, prevention, or global efforts to combat insidious killers like drug addiction and obesity. The one common thread is that these global health issues represent challenges; the future is in the solutions. Other important issues include the following:
- Air pollution and climate change: A recent study linked air pollution to 6 million deaths per year in China. Last month, Beijing issued its first red alert for smog. And smoking, which contributes to poor air quality, continues to rise in China, where it may cause about 20 percent of all adult male deaths during this decade. In addition, air pollution contributes to deaths from other diseases such as heart disease, stroke, COPD, lung cancer, and respiratory infections in children. On the climate front, more extreme weather and rising sea levels, temperatures, and carbon dioxide levels could usher in a wide array of human health effects, from asthma to dengue and chikungunya to mental illness.
- Reversal in the health worker shortage: According to the World Health Organization, there’s a global shortage of 7.2 million doctors, nurses and midwives. With the Sustainable Development Goals, more countries will be working toward universal health coverage and to meet their health-related targets through stronger, more equitably distributed health workforces that include community health workers, widespread access to technology and a health team approach to bringing care to those in need.
- Global Refugee Crisis: It is important to note that there is no systematic association between refugee migration and the importation of infectious diseases and no significant outbreaks of infectious disease linked to the hundreds of thousands of refugees that have arrived in Europe since the start of the crisis. However, this is an opportunity for the global health community to address the broader issues of inequality driving the crisis.
WHO has been strapped for cash for a while now and the next Director-General needs to address the financing of the agency. The dues paid by member states, which make up less than a quarter of the annual budget, have been frozen for over 10 years now. Lack of funds has hampered WHO’s ability to properly and effectively do its job but its shortcomings make member states hesitant to give more. The future of global health and international aid is uncertain. With the recent developments in the US, we do not know yet how the Trump administration will carry on the country’s traditional commitments to global health aid. The US contributes more than any other country in the world to global health and international aid.
This May, for the first time, the election has expanded beyond the executive board. This coming election has major implications for the future of an organization that has faltered in the face of health crises and for the entire global health architecture.
