Dr. Tedros Adhanom Ghebreyesus, the new WHO Director General-Elect
Picture: Russell Watkins/Department for International Development. Flickr
[Commentary]
The World Health Organization (WHO) was established by the United Nations in 1948 with a budget of $5 million. It has for the most part performed admirably. The elimination of small pox, the first disease ever to be wiped out is its most spectacular achievement. The proposed program budget for 2018-2019 is $4.4 billion; there are about 7,000 employees from 150 countries deployed in offices around the world.
Polio, whose elimination is imminent, is another success story. Over the years however WHO has grown to an unwieldy bureaucracy that is often accused of waste and mismanagement, not to mention the missteps in handling some major health concerns. AP wire services, citing an internal memo reported that WHO spent $200 million on travel by staff –business class, 5-star hotels– more than it spent on fighting global diseases such as HIV-AIDS, malaria and Tuberculosis. It has become too bloated and sclerotic to respond effectively and in a timely fashion in an emergency and has come under increasing criticism and calls for reform.
The challenges it faces have become more complex with a world population that has more than tripled since its inception, with new emerging deadly infectious diseases and climate change that is impacting the health and survival of the poor and vulnerable segments of the world population. Compounding these are armed conflicts, big and small, with the rising tide of refugees and the internally-displaced in Africa and the Middle East living in squalor in overcrowded camps where malnutrition and periodic outbreaks of cholera are not uncommon. Its resources are stretched thin and member countries’ contributions and corporate donations often fall far short of its needs.
When Ebola struck the Mano River Union nations in West Africa, the organization was caught flat-footed and sorely wanting; worse yet, it seemed tone deaf to the constant pleas from MSF on the ground for a robust urgent international response as early as March 2014. We in the African Diaspora communities were also mystified by the inaction of WHO and the world at large. We were among the first to hold a forum on Ebola at the UN on August 27, 2014 to raise awareness and underscore the seriousness of the rapidly developing pandemic. It took the loss of close to a 1,000 lives before WHO declared international health emergency in August 2014, five months after the signal from MSF.
The head of the World Bank, Dr. Jim Yong Kim, who happens to be a Physician and co-founder of Partners in Health took the leadership in the matter by immediately making available $400 million; the first $105 million of which was quickly dispatched to the affected countries within a record nine days, unheard of in World Bank transactions. He publicly chastised the WHO Director General Dr. Margaret Chan at a gathering of the world’s most influential health officials for her slow response and is said to have told her “you have the authority to act in this emergency, so why aren’t you doing it?”
It is the rapid response of tiny Cuba, in the early stages and later the U.S. and others and the formations of UN Mission for Ebola Emergency Response (UNMEER) as called for by the Diaspora Ebola Forum that eventually contained the pandemic which claimed more than 11,000 lives. It is against this brop that the election of new Director General has to be seen. There is a general consensus that the WHO is in need of deep structural reform.
One year shy of its 70th year anniversary, WHO made history on May 23 by electing its first African director general in the first competitive election in which all the member countries voted unlike previous practices when the Executive Board selected a candidate for approval by the Assembly. The previous directors-general were: three from Europe; three from Asia; and, one each from South America and North America. The search for the new DG was highly contested; at times, a bitter and protracted campaign.
Out of the original six candidates, all but two were from Europe (Italy, France, UK, and Hungary). A closed-door deliberation and voting in January this year whittled the number down to three finalist: Dr. Tedros Adhanom of Ethiopia; Dr. David Nabarro of the UK; and, Dr. Sania Nishtar of Pakistan. All three are well regarded public servants and highly skilled and experienced professionals. In the first ballot on May 23, Dr. Adhanom garnered more votes than the combined votes of the other two but was not enough to get him the required two-thirds majority. On the third and final ballot Dr. Tedros won handily with 133 votes in a head to head contest between him and Dr. Nabarro who managed 50 votes. Dr. Tedros will be installed in July as the 8th DG of WHO. He’s already declared: “All roads lead to universal health coverage. This will be my central priority.”
There was widespread Jubilation at the Geneva Headquarters when the results were announced. Jean-Marie Ehouzou, the African Union (AU) top envoy in Geneva expressed “happiness, happiness, happiness.” It’s not only a question of symbolism. “It shows when we are united, we can do everything,” he said. Thomas Frieden, director of the CDC in the Obama administration said: “Tedros is an excellent choice to lead WHO. He succeeded in Ethiopia, making remarkable health progress by rapidly reforming sclerotic bureaucracy and implementing effective community based services.”
Under his leadership as Ethiopia’s Minister of Health, the rate of new HIV infection at the time, one of the highest in Africa was reduced by 90% and death from AIDS dropped by 53% while treatment for HIV infection increased 150-fold. Maternal and infant mortality was drastically reduced in a short period of time thanks to his innovative approach ensuring access to health care by training some 40,000 women health extenders and establishing 4,000 health centers in remote rural areas of Ethiopia. It is this kind of result-oriented approach to health care challenges that makes him stand out as an original thinker and implementer of practical solutions, not constrained by prevailing conventional practices that dont work.
Dr. Tedros comes well prepared for the job. It helps that his PhD was in Community health. He is a top expert in malaria and has served as chair of Roll Back Malaria (RBM) Partnership as well as chair of the Global Fund to Fight AIDS Tuberculosis and Malaria. Commenting on his becoming Chair of the Global Fund in July 2009 for a two-year term, The Lancet wrote that Tedros was a “household name where his leadership was regularly cited at the Global Fund that resulted in Ethiopia to be named as an Exemplary high-performing country.”
He is a widely published author of several peer reviewed articles that appeared in some of the most prestigious medical and scientific journals such as Nature, Lancet, BMJ, Annals of Tropical Medicine to name a few. Saying that there was “real value in electing a leader who has worked in one of the toughest environments,” Dr. Tedros added he would “bring an angle the world has never seen before.”
He pledged he would work tirelessly to fulfill WHO’s promise of a universal health care. Acknowledging the challenging times for global health he goes on to say: “We will innovate and measure our progress by clearly defined outcomes.” UK Wired magazine listed him in 2012 among 50 who would change the world as did New African magazine who had him among its 100 most influential Africans for 2015. His election as head of the WHO ushers in a new era in this global institution and there is no doubt that in Dr. Tedros it has found a leader who is not only well-equipped to implement the badly needed structural reforms but also bring a new perspective and sensitivity to the job, a paradigm shift if you will, in making the promise of universal health care closer to reality.
He assumes his responsibilities in two months amidst a groundswell of support and well wishes from around the world. For WHO, Africa and the global health community this may be a game changer.
Mohammed A. Nurhussein MD is a retired physician in New York City and the Chairman of the United African Congress.
