[Ip-health] Politico Europe: Africa eyes WHO opening

Thiru Balasubramaniam thiru at keionline.org
Wed Jun 15 13:44:27 PDT 2016


Africa eyes WHO opening

Three candidates are in an intense and unpredictable race to lead UN health



6/1/16, 6:07 AM CET

GENEVA — Want to run a 8,000-person global health agency tasked with
preventing the next epidemic, tackling the spread of superbugs and stamping
out the health ravages from tobacco use?

It may help if you’re African.

That was the buzz at the World Health Organization’s annual gathering here,
where the race to take over the director-general spot began in earnest.

Still reeling from the Ebola epidemic that killed some 11,000 people,
Africa carries the highest burden of disease, yet it has never had one of
its own leading the U.N. body to understand its problems from the ground,
the argument goes.

“If you bring someone with fresh experience from Africa, it can bring you a
fresh view,” Tedros Adhanom Ghebreyesus, a former Ethiopian health minister
and current foreign minister said, kicking off his candidacy officially.

At stake is leadership of the body set up after World War II as part of the
United Nations to set global health policy. The agency has the power to
declare public health emergencies, jumpstart urgent drug development and
pressure governments to fund essential medicines. It also spearheaded the
first global treaty on tobacco control.

The race this year takes on a new intensity and unpredictability. It’s the
first time all 194 member states will get to choose, by secret electronic
ballot, between three candidates shortlisted by the 34-member executive
board. In the past, the board essentially chose a candidate for countries
to back or not.

Under the U.N.’s one-country, one-vote rule, Niue, a Pacific island country
with a population of less than 1,200, will have the same sway as
1.3-billion strong China, making the outcome hard to predict.

“It will be a nail-biter,” said Suerie Moon, a research director at Harvard
Global Health Institute and a fellow of London’s Chatham House.

At the organization’s annual meeting in Geneva in late May, it wasn’t just
Tedros talking up the benefits of an African perspective to run the agency.

Philippe Douste-Blazy, a former health and foreign minister from France, is
making perhaps the boldest pitch, referencing his work on the Continent and
calling steep drug prices a “scandal.”

Half of the WHO’s world regions had never had their turn running the agency.

“It’s like at the time of the apartheid,”  Douste-Blazy told POLITICO in
Geneva. “It took one man to say: that’s not acceptable… and I’m saying: if
the WHO doesn’t tackle this issue, who will?”

The third candidate, Sania Nishtar of Pakistan, has heard the chorus on

“There are three regions that haven’t had a candidate. It’s also time for
Eastern Mediterranean and Southeast Asia,” she said in an interview. “If
the geographical factor is considered, then all three are equal.”

Current chief Hong-Kong born Margaret Chan pointed out recently that half
of the WHO’s world regions had never had their turn running the agency.
Eight chiefs have come from just three regions: Europe, the Americas and
the Western Pacific, which includes China and Japan.

The African candidate?

The three declared candidates made the rounds in Geneva, which included
speed-dating with representatives from 15 Pacific island countries, where
each candidate had 15 minutes to make their case and answer questions.

But delegates from Africa were among the candidates’ hottest targets. With
54 states, the continent will account for close to 28 percent of votes.

“If Africa supports you, you’re pretty sure to win,” said one diplomat from
a large English-speaking African nation. “It’s a big deal, so it’s natural
that they’re canvassing support.”

Tedros has been Ethiopia’s foreign affairs minister for the past four
years, after serving as a health minister between 2005 and 2012. He has a
Ph.D. in community health and a masters in immunology, though is not a
medical doctor, which would be the first for a leader of the agency.

“He is Africa’s candidate and we estimate that he is legitimate to ask for
this job, knowing that it was never occupied by an African,” said the
Algerian Health Minister Abdelmalek Boudiaf.

But his candidacy, which has been officially endorsed by the African Union,
is not without opposition.

Several groups of Ethiopians living abroad are protesting loudly, pointing
for example to his refusal to declare a cholera epidemic as health
minister, which they say led to thousands of deaths.

Tedros defended himself in an interview, saying that the cases of acute
watery diarrhea recorded could have many causes, not only cholera. However,
a reportinto the outbreak said laboratory checks had proven they were
caused by cholera.

The Ethiopian groups also point to an audit of Ethiopia during Tedros’s
tenure, which found funds awarded to fight HIV were misspent on subpar
health centers, many of which lacked access to water.

That audit was led by the inspector general of the Global Fund, a financing
group of governments, NGOs and industry, where Tedros was for a time board
chairman. It demanded $6 million be returned.

“It’s not true that the money was misappropriated,” Tedros told POLITICO.
He said the funds were returned only because they were used after the
deadline had passed.

“We would love for Africa to be represented and some may argue that it’s
Africa’s turn,” said Zelealem Tessema, a board member of the Ethiopian
Advocacy Network, who opposes Tedros. “What we are saying is that this is
not the right person and the right regime to represent it and someone who
we can trust the health of the globe with.”

The Global Fund now says that the East African country’s health programs
are well administered and have achieved “great success.” Between 2005 and
2015, Ethiopia saw a 50 percent reduction in the incidence rate of HIV,
while AIDS-related deaths fell from 82,000 to 23,000, a spokesman said.

Tedros touted Ethiopia’s double-digit economic growth and health
achievements, also noting the government’s rapid response to the current
drought. Ethiopia has shed its image as a malnourished country, having
successfully avoided famine, he argued.

He said his experience revamping his country’s health system and the Global
Fund’s finances would be an asset.

“There is a consensus now that the WHO should be reformed; this consensus
is an opportunity that’s motivating me,” he said.

The rabble rouser

Former French health minister Douste-Blazy, meanwhile, is courting
controversy and focusing his campaign on universal health care and drug

“We need to strike a dialogue with drug developers to say ‘wait, you can’t
be killing people,’ because not letting people access medicines is killing
them,” he said in an interview.

During his stint as foreign minister in 2005-2007, French media derided
Douste-Blazy’s blunders — such as mixing up Taiwan and Thailand — and his
poor command of any foreign language. Today he speaks English (with a heavy
French accent) and hands out business cards from Harvard University, where
he is a visiting professor.

A trained cardiologist, he has also played up his achievements over the
past decade atUNITAID, an agency housed within the WHO that helps poorer
countries purchase medicines through innovative financing such as a levy on
airline tickets.

One big political hurdle that may emerge is that there’s already a French
national at the helm of a global institution: the International Monetary
Fund’s Christine Lagarde.

But Douste-Blazy thinks the geopolitics are overhyped. “People want to know
who has the strongest political leadership to be a manager. Whether he’s
Indian or French is totally irrelevant.”

Boosting his confidence, two delegates from former French colonies of West
Africa voiced preference for him over their continent’s official candidate.

Both told POLITICO they backed Douste-Blazy’s vision and said he spoke
about Africa’s concerns — in their language, too: while Tedros answered in
English the questions of some Francophone delegates, Douste-Blazy promised
to bring more French into the Geneva headquarters.

“The Ethiopian came and imposed himself, as if he was Africa’s natural
candidate … He didn’t even give a chance to others,” one West African
official said, arguing Senegal’s Health Minister Awa Marie Coll-Seck would
have made a promising candidate if she had been given more time to contend.

Coll-Seck admitted to POLITICO last March she hadn’t seen Tedros’ candidacy
coming, but that he had been endorsed by the African Union and that she
would not go into “dissidence,” because the continent needed unity.

A more subtle candidacy

While Douste-Blazy and Tedros both held briefings to tout their agendas in
Geneva, the former health minister of Pakistan, Nishtar, has laid lower,
with no campaign manifesto yet or formal press conferences.

The Pakistani government did hold a reception for her in Geneva. Dressed in
the same deep green as her nation’s flag, Nishtar told some 60 attendees
she was deeply committed to reforming the WHO’s governance and would give
her very best to this “amazing organization.”

Sania Nishtar speaks during a session at the Annual Meeting 2013 of the
World Economic Forum in Davos, Switzerland in January, 2013 |
WEF/Swiss-image.ch/Mirko Ries via Flickr Creative Commons

And she agreed to talk to POLITICO, arguing her experience in government
and founding civil society groups “from scratch” makes her the best

“I was the first woman cardiologist properly trained in Pakistan,” she
said. “I could have sought a very lucrative career, but I left that career
to strive for improvements for health for the disadvantaged, to campaign
for the right outcomes in health and wellbeing.”

She also co-chairs a WHO committee on childhood obesity and is chair of the
U.N. secretary general’s independent accountability panel on women and
children’s health.

In April, the Organization of Islamic Cooperation, which has 57 member
states and aims to serve as the collective voice for Muslims, “welcomed”
Nishtar’s candidacy.

Seth Berkley, CEO of the GAVI vaccine alliance, which buys vaccines in bulk
for poor countries, called Nishtar “a very strong woman leader, who is
constantly trying to innovate,” in a promotional video for her, though he
later clarified that was not an official endorsement.

Under WHO rules, member countries can propose candidates until September
22. Then begins a higher level courting period during which the executive
board shortlists a handful of candidates, submitting up to three names for
a vote next May.

“It’s a year-long campaign and you can’t exhaust everything in one go,”
Nishtar said.

Helen Collis contributed reporting

This story has been changed to note the name of the NGO is the Ethiopian
Advocacy Network

More information about the Ip-health mailing list