BY MATTHEW PETTUS

The United Nations’ flag blows in the wind as we ponder the future of the World Health Organization. Source: Flickr.

Dr. Margaret Chan, Hong Kong-Canadian physician and Director-General of the World Health Organization (WHO), will be leaving her position this June, after a ten-year term. This means that the World Health Assembly must commence the search for a new Director-General, someone who can poignantly address the intersection between policy, global health, and economics. Historically, the role has had a large influence on the future of global health efforts in America, so, needless to say, this is an important decision with many implications for future disease prevention and proliferation.1

The Director-General of the World Health Organization is responsible for the arduous tasks of managing the finances for the WHO, spearheading the implementation of policy recommendations for all facets of global health (epidemiology, infrastructure, poverty, environmental health, etc.), and managing all of the departments within the WHO. In addition, the Director-General is responsible for leading the response to certain crises when they arise, such as the Ebola virus crisis.2

As the outgoing Director-General, Dr. Margaret Chan has ardently worked alongside the rest of the WHO for an entire decade. Her term began in 2007 and was extended after reelection in 2012. Chan has several notable accomplishments on her resume, including handling numerous viral outbreaks like Zika and Ebola, spearheading the response to the swine flu outbreak in 2009, and, as of late, increasing access to the meningitis vaccine in Africa by making it more affordable and eliminating infrastructural barriers.3 Going forward, she has said that her primary concern for the World Health Organization’s future is that “[Her] successor needs to continue to address the financing of the WHO. There’s no two ways about it.”3

How a new Director-General will manage the finances of the WHO is seen as one of the most important deciding factors for selection, in addition to whether he or she will be able to negotiate a better budget. Currently, the WHO relies on both member state dues, which are guaranteed, and voluntary donations, which are decreasing in size every day.4 The change in leadership this May has the power to fundamentally change the future trajectory of the WHO.

For such a complex and nuanced role, the election process for Director-General is surprisingly straightforward. Over the span of eight months, replacements are nominated, a forum is held for candidates to present their ideas to member states, WHO’s Executive Board narrows the list down to 5 candidates, the candidates are interviewed and further narrowed down to a list of three. Lastly, the final three move on to the World Health Assembly election in May where the new Director-General is elected.5

The headquarters of the United Nations, the World Health Organization’s governing body, in Geneva, Switzerland. Source: Falcon Photography, Flickr.

As of January 2017, the final five candidates were: Tedros Adhanom Ghebreyesus, 51, of Ethiopia; Dr. Sania Nishtar, 53, of Pakistan; Dr. David Nabarro, 67, of the United Kingdom; Dr. Flavia Bustreo, 55, of Italy; and Dr. Philippe Douste-Blazy, 65, of France. The initial favorite was Dr. Flavia Bustreo, as she is currently the Assistant Director-General of WHO and leads the Family, Women’s, and Children’s Health Department. The close second, Dr. Philippe Douste-Blazy, was a foreign affairs and health minister, who founded UNITAID, an organization that works to prevent, diagnose, and treat HIV. However, both candidates were eliminated after the interview round and did not advance to the final three.6 In February 2017, the pool of five candidates was narrowed down to three: Dr. Sania Nishtar, Tedros Ghebreyesus, and Dr. David Nabarro.

Dr. Sania Nishtar is a former Pakistani Health Minister and cardiologist. She has had extensive experience in the political realm, serving in the interim Pakistani Cabinet of 2013 and overseeing public health, education, and science in Pakistan. She is particularly knowledgeable in the field of public health, as demonstrated by her establishment of a health policy nonprofit, which has since been overtaken by the Clinton Global Initiative. In addition, what separates her from her competition is that she has diligently explored peacemaking as a discipline, and poignantly used her status to address the tense India-Pakistan and US-Pakistan relations. She has accomplished this through working with the Aman ki Asha Initiative, the Aspen Institute, the Global Advisory Council of the Pakistan American Foundation, and the US-Muslim Engagement Initiative.6, 7

Tedros Adhanom Ghebreyesus is an Ethiopian politician with much relevant knowledge in the field of public health. He served as the Minister of Health in Ethiopia for seven years, and as the Minister of Foreign Affairs for four years. Accomplishments and highlights from these positions include gaining immense ground on malaria research, increasing access to health services in impoverished communities, increasing the availability of medical doctors, and improving gender equality. He also managed West Africa’s response to the Ebola virus epidemic, and in doing so, augmented the International Health Regulations regarding disease outbreak and led the African Union Response Team. After his tenure as a board chair on the Global Fund to Fight AIDS, Tuberculosis, and Malaria, he was nominated to be the African Union’s candidate for the Director-General of the World Health Organization.6, 7

An unsanitary Nepalese delivery room demonstrates the current declining status of universal health care in the developing world. Source: Possible, Flickr.

Dr. David Nabarro is a British endocrinologist who currently serves as Special Adviser to the UN Secretary-General on the 2030 Agenda for Sustainable Development and Climate Change. Previously, he served as the Special Envoy to the Ebola crisis in Africa, and he is currently leading the response to the cholera outbreak in Haiti. He has prior experience with the World Health Organization, serving as Project Manager to eradicate malaria at the beginning of his career. He also cofounded the Global Fund to Fight AIDS, Tuberculosis, and Malaria. In addition, he has worked for the Food and Agriculture Organization, a subset of the United Nations. Nabarro’s work has been more focused on the environmental aspect of health than general public health, but this could potentially bring an underrepresented perspective to the position of Director-General.6, 7

An important part of the discussion is whom top media outlets have predicted as favorites to obtain the position. The media’s perspective is invaluable in this process, though not infallible. Dr. Flavia Bustreo of Italy was initially an overwhelming favorite due to her previous WHO experience, but she did not make it to the top three, which shows that perhaps the media’s views are not always the most didactic. Moreover, Ghebreyesus, of Ethiopia, offers two unique perspectives that have been often overlooked: a Director-General of the WHO has never been from Africa, nor lacked a medical doctorate degree. Some have said that the time is ripe to have a Director-General from Africa, seeing as he or she would be most accustomed to dealing with several of the most pressing disease outbreaks, many of which occur in Africa. However, the past eight Director-Generals, including Dr. Chan, were all medical doctors, and some argue that it is not possible to empathize with patients without having the experience of treating one’s own patients.7

A pedestrian bridge connects the old patient care building to the new research and education building at St. Michael’s Hospital in Toronto, Canada. Source: Paul Bica, Flickr.

In further analysis of the candidates, it is necessary to speak to how the three remaining candidates differ not only in background, but also in their current propositions and aims for leading the World Health Organization, arguably the most important aspect of this election. Dr. Nishtar’s focus is on human-health-climate interactions and countries achieving the Sustainable Development Goals, because weak infrastructure is a prominent obstacle to achieving universal health care and equitable health policy. His background in the Ebola crisis has informed Ghebreyesus’s priorities. He argues that improving response time to disease outbreaks is of the utmost importance but also seeks to determine a balance between international, national, and local health reforms and care. Lastly, Dr. Nabarro aims to further develop the International Health Regulations and the Sustainable Development Goals. He would also like to create a personalized system of health care and requests the help of all members of society to achieve this goal; after all, in his opinion, health care should be focused on the people.8

A great deal of analysis is required to choose between the final three candidates for Director-General, as, at this stage, all candidates are equally qualified. The Assembly must now base their decision on “soft” qualities, like the candidates’ personalities and who has the proper temperament and attitude to revive the WHO, in addition to their policy focuses. These sorts of elections can make or break an organization such as this, which is why this decision is of the utmost importance. As of now, the future of the WHO is extremely uncertain. What will become of the budget? Will their lack of financial donations eventually shut down the WHO? How will Trump’s administration impact the international status of health? We’ll just have to wait until May 31st to find out.

Matthew Pettus is a freshman in Saybrook College. He is a prospective Cognitive Science major. He can be contacted at matthew.pettus@yale.edu.

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References:

  1. Branswell, H. (2017). A guide to the selection of the new head of the World Health Organization. STAT. Retrieved from https://www.statnews.com/2017/01/23/who-director-general-selection/
  1. WHO Director-General’s Office. (2016). Election process for the WHO Director-General
  2. Retrieved from http://www.who.int/dg/election/en/
  3. Stowell, M. (2016). World Health Assembly: WHO Director Lists Accomplishments in Global Health This Year. Impact. Retrieved from http://psiimpact.com/2011/05/world-health-assembly-who-director-lists-accomplishments-in-global-health-this-year/
  1. Branswell, H. (2017). Can the WHO end its money crunch before it gets worse? Retrieved from https://www.statnews.com/2017/01/31/who-money-crunch/
  1. Whiting, E. (2017) Here’s how the next Director-General can rebuild the World Health Organization. STAT. Retrieved from https://www.statnews.com/2017/01/23/tip-next-director-general-rebuild-world-health-organization/
  1. Branswell, H. (2017). World Health Organization names nominees to lead global agency. STAT. Retrieved from https://www.statnews.com/2017/01/25/who-director-general-finalists/
  1. Gharib, M. (2016). Who will be the next leader of WHO? National Public Radio. Retrieved from http://www.npr.org/sections/goatsandsoda/2016/10/19/497939433/who-will-be-the-next-leader-of-who
  1. Horton, R., Samarasekera, U., (2016). WHO’s Director-General candidates: visions and priorities. The Lancet, 388 (10056), 2072-2095.
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