[Ip-health] Governance Now - The challenges and expectations in heading WHO

Thiru Balasubramaniam thiru at keionline.org
Thu Nov 17 04:45:56 PST 2016

The challenges and expectations in heading WHO

Transparency, financial crunch and economic divide are key issues the
next WHO chief would need to address

Shreerupa Mitra-Jha | November 17, 2016 | Geneva

- See more at: http://www.governancenow.com/news/regular-story/the-challenges-expectations-in-heading-who#sthash.CbfguQBl.dpuf

The process for selecting the chief of the world’s biggest
multilateral health organisation is underway. The next
director-general (DG) of the World Health Organisation (WHO) will be
elected at the world health assembly (WHA) in May as the current DG
Margaret Chan steps down in June after ten years. Much has changed in
the global health landscape during the past decade as new threats have
emerged and old ones have quietened down.

The process of selection unfolds thus: nominees of the governments
were announced on September 23. The following month, the candidates
interacted with member states through a web forum. For the first time,
a live forum was held at the WHO headquarters in Geneva in November
where the candidates presented their vision to the governments. The
member states asked them questions during the 90 minutes allotted to
each candidate. This is part of the UN secretary-general’s plan to
bring in transparency in top appointments in the global body. Finally,
the executive board will interview five of the six candidates in
January and short-list the three whose names will be sent to the WHA.
For the final selection, each candidate would have to make a short
speech before the WHA. Member states would elect the next DG in a
secret ballot and on a ‘one government, one vote’ basis. The new DG
assumes office on July 1, 2017.

Currently, there are six candidates in the race: Tedros Adhanom
Ghebreyesus (Ethiopia), Flavia Bustreo (Italy), Philippe Douste-Blazy
(France), David Nabarro (UK), Sania Nishtar (Pakistan) and Miklós
Szócska (Hungary).

Ghebreyesus, who has been endorsed by the African Union, is a former
health and foreign minister of Ethiopia. Though he is not a WHO
insider, Ghebreyesus, presumably, has much experience in dealing with
failing health systems, and has also served in important positions in
Gavi: The Vaccine Alliance and UNAIDS.

Bustreo is currently the assistant DG at the WHO for family, women’s
and children’s health for six years. She has been the deputy director
of Child Survival Partnership for UNICEF, incharge for India and
Pakistan among other countries.

Douste-Blazy is a former university professor in medicine specialising
in public health, epidemiology and preventive medicine and held key
positions in the French politics. He is a former minister of culture
and communication, health and social protection, and foreign affairs.

Notably, he was the chair of the executive board of UNITAID and
brought prices of antiretrovirals down to $1 a day through successful
partnerships. He is currently the under-secretary-general of the UN
and special adviser to the SG on innovative financing for development.
Because of his work on lowering drug prices and experience of working
within the UN system, Douste-Blazy is a favourite of many health

Nabarro too has vast experience in negotiating the WHO system. He has
been special adviser to the SG on the 2030 sustainable development
agenda and climate change, special representative of the SG for food
security and nutrition, former chair of the advisory group for WHO’s
reform in emergencies work, former special envoy of the SG on Ebola,
former assistant SG for avian and human influenza, former head of
WHO’s health emergencies group and the former executive director of
the office of the DG. Nabarro has the backing of some developed
countries and is a strong candidate.

Pakistani candidate Nishtar does not have as much experience within
the UN’s health agency as Douste-Blazy and Nabarro but she has been a
part of working groups and expert groups of the WHO. She has served as
member of the DG’s working group on R&D and financing and DG’s
high-level task force on health systems. The articulate cardiologist
apparently enjoys support of some Islamic countries and started her
campaign much earlier in the year. Pakistan had also nominated her for
the post of the head of the UN’s refugee agency that was bagged by the
Italian diplomat Filippo Grandi.

Hungarian doctor Szócska is a former minister of state for health and
currently the director of a health management training centre in a
university. He seems to have the least experience within the WHO


Health is political and therefore could sometimes be an aggressively
contentious terrain, sometimes. These issues, as is the case in other
multilateral forums, are aligned along the North-South divide though
the world we live in is much more multipolar than it used to be. So
while the funds flow in from the North into the WHO coffers, majority
of the poor and the diseased live in the South. Also, it is generally
understood that the health security agenda is advanced on a war
footing only when it threatens the West. Negotiating these fractures
is a tall task for any DG. These were some of the issues thrown at the

“Notwithstanding your claim to be a candidate from a developing
country, in my view, you have espoused an agenda that is very much
aligned with the priorities of the North such as approaching global
health through a security lens, treating universality through a
concept of coverage not of a universal health system. You see WHO as
an implementer of international health regulations, not as a
standard-setting body. You focus on fragile states, hard-to-reach
settings, but with very little clarity on WHO’s mission with respect
to the development agenda. So, how can we translate your views in
terms of a development candidate?” Brazil asked Ghebreyesus at the

This North-South divide is most visible, for instance, in the
discussion around SG’s UN High-Level Panel (HLP) on Access to
Medicines report published on September 14. While the northern
countries, especially the US, and pharmaceutical companies have
strongly criticised the formation of the panel and its report, the
lower and middle-income countries have been pushing for more strong
action by the UN for enhancing access to cheaper drugs and vaccines
and having an R&D convention.


In fact, a recent request by India to the forthcoming WHO Executive
Board (EB) in 2017 to include a discussion on the UNHLP was rejected.
(India, along with Brazil, China and South Africa requested WTO’s
TRIPS Council to hold a dedicated session of the report on November 8
and 9, which was accepted by WTO.)

“Despite the great strides achieved in the prevention, diagnostics and
treatment of diseases, developing countries are still excluded from
many of the benefits of modern science. What concrete proposals do you
have to address this issue and public health, innovation, intellectual
property and trade involving WHO, WTO and WIPO?” Colombia asked
Nishtar at the WHO forum. At this point, the US ambassador to the UN
Pamela Hamamoto (a classmate of president Barack Obama) took her
earpiece to listen to Colombia’s question. Leaked documents had
revealed that the Colombian officials feared that the US funding for
the Colombian peace process might suffer if Colombia side-steps a
patent on Novartis’s cancer drug.


While British candidate Nabarro did not touch much upon the UNHLP on
access to medicines during the discussions at WHO, he answered a
question from the audience in the Chatham House discussion that he
would address North-South issues from a “moral and ethical” position,
and that changes in intellectual property rules alone are not enough –
a lot more has to be done.

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