How next director-general can rebuild the WHO
Opinion / Published: 23 January 2017
Ed Whiting, our director of policy and chief of staff, says a new director-general of the World Health Organization offers an opportunity for reform that it must put to good use. This article originally appeared in STAT.
Nearly nine months have passed since the last Ebola patient was declared free of the disease in West Africa. Yet one body – the World Health Organization – is still ailing, stung by criticism that it responded slowly to that local and global emergency.
Despite encouraging signs that it learned valuable lessons from the Ebola outbreak, faith in the WHO hasn’t yet fully returned. The organization has been chronically underfunded for years, and its outdated structure has resisted reform over many decades. This has led to a vicious spiral of underachievement.
The WHO needs to lead on global health – and its member states must allow it to do so. But its problems are undermining its position as the global leader responsible for moving the world toward a better, healthier future.
This week, the WHO will announce the finalists for the director-general post. He or she will take over its public health, strategic, and political leadership on July 1, 2017. This offers the organization a real chance to resolve these issues and return to working effectively toward improving global health.
My foundation, Wellcome, which often partners with the WHO on research and advocacy for our shared interests, such as tackling drug-resistant infection worldwide and vaccine development, won’t be endorsing any of the candidates. But we will be looking carefully at their platforms.
Here are several qualities we believe the new director-general needs to have, along with several actions the WHO should take to recapture the world’s confidence.
First and foremost, the WHO needs more effective political leadership to regain trust. It is the only organization charged exclusively with speaking for public health and for health care workers around the world, with a mandate that trumps the interests of individual countries. 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. Movement in this direction has begun, notably the joint evaluation exercise on epidemics, support for universal health coverage, and the naming and shaming of countries not meeting air pollution standards. But the new director-general must go further.
The WHO must also strengthen its unique role in alerting the world to health emergencies and coordinating the responses to them. While the WHO’s new emergencies team has shown that it can mobilize resources and action at a pace unprecedented in the organization’s history, the new director-general needs to convince national leaders that the world doesn’t yet have the capability to respond to cross-border emergencies. He or she must also make sure the WHO clearly sees the gaps that exist 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.
The next director-general can expect greater pressure on the WHO to ensure access to health care, drugs, and services at prices that countries and citizens can afford. He or she is also likely to see new arguments about access to innovative therapies as medicines become more personalized and expensive. The WHO should lead the fight for access to innovative health care for all.
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. Other essential steps to rebuilding trust should include an ambitious internal reform program that simplifies the WHO’s complex governance structures, and challenging poor-performing offices at the national, regional, and global levels. Key to that would be ensuring that staff are selected for posts based on their competence, not their politics.
To fully ensure that the WHO has sufficient funds for its mission, the new director-general will need to work effectively with the increasingly mixed economy of health care funders and providers. We’ve already seen encouraging signs of this in the research and development blueprint for epidemics, where Wellcome is working with the UK’s Department for International Development, the Gates Foundation, and other global funders to improve the research pipeline for epidemic disease risks. In exchange, all of WHO’s funders must be transparent about their expectations and be held accountable for their activities.
The next director-general should also make a greater effort to better develop the WHO’s relationships with civic society and the private sector – every dollar invested by private companies not only reduces the burden on finance ministries and taxpayers, but also delivers innovations and technical advances that can improve health.
While noting the challenges the WHO currently faces, we must not lose sight of its remarkable achievements, from eradicating smallpox to the near-eradication of polio and vastly reducing deaths from malaria. No organization can speak for the improvement of global public health as powerfully as the WHO, and such a role is vital in uncertain and volatile times. At the same time, we mustn’t mince words: today the WHO is not fulfilling its mission and isn’t adequately funded for it. In its current form, it is failing.
The arrival of a new director-general in a few months offers an opportunity for reform that the WHO must put to good use.
Preparing the WHO for the next outbreak by Wellcome Director Jeremy Farrar