The health challenges in today’s world, particularly for developing countries, demand bold new leadership to ensure that those issues are treated with the urgency they require. The World Health Organisation (WHO) on April 22, began the process for the selection of its new leader. Since its inception in 1973, leaders of the organisation have either being of European or Asian origin, hence the recent push for the next leader to be either from Africa or Latin America. Candidates for the election will have to be nominated by one or more member countries
The election of a new leader next month presents an opportunity for member states to make a decisive impact on global health. The election comes at a time when the demand for a strong, responsive, and efficient international health agency is growing louder each day. The decision that all 194 countries will take will likely affect the health and wellbeing of millions of people around the world particularly those in the African Continent. Some of those whose names have come up so far include Michel Sidibé, the executive director of the Joint UN Programme on HIV and AIDS and Awa Coll Seck, Senegalese minister of health and executive director of the Roll Back Malaria Partnership. Others with both expertise and credibility include Agnes Binagwaho, Rwanda’s minister of health; and Graça Machel, chair of the Partnership for Maternal, Newborn and Child Health, and a past chair of the GAVI Alliance Board. Tederos Adhanom Ghebreyesus, foreign minister of Ethiopia and a former health minister — who has chaired both the Global Fund and the Roll Back Malaria Partnership — is a candidate. Phillipe Douste-Blazy, the chair of the board of Unitaid and a former French minister of foreign affairs and of health, has also been nominated and is said to have the support of the French government. Sania Nishtar, Pakistan’s former minister of health, is also interested in the post. The WHO executive board will interview a short list of the top-five candidates and present the top-three candidates for a vote by secret ballot at the May 2017 World Health Assembly.
This election is different in the sense that candidates will take part in a public process to elucidate their vision for the WHO as well as answer questions from member states. With the active involvement of member states, this election will avail them the opportunity to decide the best person to head the global health body. This election is attracting a lot of attention and this is understandable. WHO has suffered waning influence especially since the coming on board of players and sources of funding such as the Gates Foundation, which have created a more diffuse global health landscape. Available statistics show that spending on global health increased dramatically since 2000, but much of the funds were channeled through new entities such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, not the WHO. The organisational and leadership shortcomings of the Ebola response, reportedly further diminished the WHO’s reputation and this has been further compounded by weak finances and the global body’s inability to pay sufficient attention to strengthening of health systems.
In our view, at this critical time, there are five issues that will define the tenure of the next Director-general and on which their success would be measured. The Ebola outbreak was a painful reminder that being prepared to respond to epidemics is vital to the health of our people and the strength of our economies. In 2015, the Ebola virus ravaged West Africa and put the whole world on alert. International mobilisation was not timely, but in spite of coming belatedly, it combined with the actions of some locals, some of who died in the process, to avert a wider global crisis but by which time 28,000 people were infected and more than 11,000 died. The WHO was severely criticised at that time for poor handling of the health emergency and this continues to haunt the organisation even as it makes efforts to tackle other health emergencies.
We also learned that being prepared to respond to such epidemics requires a holistic approach that includes smart foresight (i.e. placing a priority on strong health systems before an epidemic strikes), decisive leadership, and effective communication – all characteristics that the new WHO leader will need to embody. Rich and poor countries alike are now grappling with a growing burden of non-communicable diseases. Cancer, diabetes, and heart disease are among the leading causes of premature mortality globally. They are skyrocketing particularly in the developing world. Their rise is worrying, particularly in settings with a sizeable burden of infectious diseases – the so called double burden of disease. How the WHO responds to this growing challenge will affect millions of lives.The global political and economic landscape is changing. There are now unprecedented opportunities for countries in Africa to engage with countries in South America and Asia to share innovative and adaptable solutions to address their health and development challenges. The history of the AIDS epidemic in Africa was changed by the introduction of cheap generics from the global South and the emergence of global health partnerships. The global South must look to build local capacity to ensure medicines reach the people who need them most. Climate change is already having a devastating impact on health around the world. Five countries in Africa are now struggling to respond to one of the worst food shortages we have seen in decades. Communities, many of which are already vulnerable to poor health, will also have to deal with changing water levels, extreme heat events, and infectious diseases. The WHO needs a leader who acknowledges climate change as a threat to health and will fight to mitigate and prevent it. WHO must undertake a number of key reforms. These include adopting new priority setting mechanisms, changing management structures, and adopting an accountability framework that can improve organisational performance. The new leader of the WHO will be tasked with reestablishing the organisation’s primacy as the global authority of health. These reforms will be central to this effort.
To be seen as an inclusive global organisation, candidates from regions that have never had a representative in the top position at WHO should be given a fair chance. We believe it is time for change, but this is not about regional representation, gender, or religion. We also believe that the most qualified candidate to lead the WHO at this pivotal time must be able to articulate the mission and vision of the WHO. Such a leader must also be able to face these challenges and accelerate the reforms needed within the WHO. He/she must be a visionary leader with an impeccable reputation of transparency, effectiveness, and fair yet forceful governance. The time for such a leader to emerge is now. The WHO director-general will need to regain the confidence of the organisation’s stakeholders, particularly its donors. The new leader will have to boost funding for core functions that only a global organisation really can perform, such as coordination of disease surveillance and early-warning efforts. Moreover, the next director-general will have to mobilise more resources for health-systems strengthening for countries that lack capacity, lest we see a repeat of the Ebola and similar health crises.