[Ip-health] IP-Watch: WHO Director General Candidates Hold Colorful Meeting With The Press

Thiru Balasubramaniam thiru at keionline.org
Thu Jan 26 22:57:16 PST 2017


WHO Director General Candidates Hold Colorful Meeting With The Press


The three remaining candidates to be director general of the World Health
Organization today met at length with UN journalists in the WHO and
highlighted their plans for reform including finding new sources of funding
for the continually cash-strapped UN agency that now could face threats
from the US president to cut US funding.

The three candidates, to be decided amongst at the May World Health
Assembly, are (in order of votes received yesterday), [IPW, WHO, 25 January

Dr Tedros Adhanom Ghebreyesus (Ethiopia) [note: goes by “Dr. Tedros”]


Dr Sania Nishtar (Pakistan)


Dr David Nabarro (United Kingdom)


The candidates have been campaigning for many months, putting their jobs on
hold and conducting nearly 200 bilateral meetings and using other means to
interact with the global health community. Below are some key remarks from
today by the candidates in order of their appearance.


Sonia Nishtar addresses the WHO press today

Leading off, Nishtar said WHO’s role as “a lighthouse” has never been more
important as new concerns “threaten to wipe out the gains of the last

She pointed to three pillars of her plan: reclaiming WHO primacy, focus WHO
on its core mandate, and usher in a new paradigm especially with a “better
appreciation” of partnerships.

Nishtar raised concern about WHO’s reliance on a few donors, and said she
is putting forward a vision of a new resource mobilisation strategy, and
innovative financing.

She also highlighted a focus on emergencies, again pointing to
partnerships. She said she is aware that the next litmus test of the WHO
will be another emergency.

On relations with lobbyists and donors other than governments, Nishtar said
the normative work of WHO (policymaking) needs to have a “firewall” between
it and the partnerships. The private sector will come in at the
implementation stage.

Asked about access to medicines, she answered that there are major
advancements in oncology and hepatitis C, for example. She said WHO has a
clear role, referring to an access to medicines report that she said gave
WHO a mandate to set up a surveillance mechanism, which she said would be
helpful for industry to look at trends.

She mentioned other initiatives such as an independent task force, and an
agenda item on access to medicines at the annual World Health Assembly.

And Nishtar was the only one to mention the use of patent flexibilities in
the World Trade Organization Agreement on Trade-Related Aspects of
Intellectual Property Rights (TRIPS). She said it is “one of the ways to
address the price issue,” and that it has been used for hepatitis C.

But while she referred to price and intellectual property issues as “one
avenue” that can be considered, she highlighted also strengthening health
systems, with governments providing more assistance. And she mentioned the
need for vigilance, such as against “spurious” medicines.

She repeated the possibility of helping countries build their capacities
and to take advantage of the TRIPS Agreement, the Essential Medicines List,
and the orphan drug list.

She noted that in Pakistan some essential medicines are not available
because the price is so low as to make it not commercially viable.

She summarised by saying the WHO needs “different levers” at the global
level to address access to medicines, such as best practices, regulatory
norms and TRIPS flexibilities.

On reform, she said, “We require a culture change in WHO because
priority-setting in the past has only come up with a large wish list.” Now,
she said, member states will either prioritise, or delegate it to the WHO
to come up with priorities.


David Nabarro

Nabarro highlighted his deep experience within the UN and international
community as well as in the field as a medical doctor. But he stressed that
he would seek to be “catalytic” and be a strong force for change in the

“This is a job that I’ve been training for my entire life,” he said in the
press briefing, adding later, “I am an insider-outsider.”

He recognised that WHO is the only organisation that sets standards for
global health and enforces them. It is in effect the leader for every
person’s health on the planet, and global health is more of an issue now
than at any other time in history.

Among the many issues he talked about – such as noncommunicable diseases,
emergencies, women’s health, and antimicrobial resistance – he also
mentioned medicines prices.

“Access to medicines is becoming an issue everywhere,” he said. “We will be
working on prices.”

On Zika, he said WHO has handled it well, and is not the same as the
outbreaks of ebola and yellow fever. He acknowledged that “no organisation
is perfect,” and he has been asked to help work on some of the global
health issues that have needed extra help.

Nabarro was asked by Intellectual Property Watch about ideas to address the
long “impasse” at WHO on solving the problem of making new medicines
affordable for all.

In responding, he noted that he was answering as a candidate, so there are
things he cannot know and will know when he is actually director general.
He disagreed with the notion of an impasse, and highlighted several
instances where there have been successful agreements through discussions.

“Is there an impasse on medicines, or are we perceiving of it as an impasse
when actually there is quite a lot of agreement in our world today?” he
responded. “The situation is like this: it is always important to ensure
that medicines are available for people at a reasonable cost for people and
not to be in any way to be reaching a situation where people are being
denied access to life-saving or life-enriching care because somehow the
cost of the medicines are too expensive for them to be available, either
for purchase by the patient, or for purchase by the government on behalf of
patients or for purchase through some kind of insurance scheme.”

“I think there have been times when the issue of affordable medicines has
been presented as a controversial issue around, for example the way in
which intellectual property is handled, or around the way in which
medicines are priced by manufacturers,” he continued. “But I have noticed
so often that if the issue is put at the centre of the table, and if the
different parties come around that issue to focus on it, that solutions can
be found.

“If you want to find an impasse, then no doubt the impasse will be there,
but if you want to find a solution, then a solution can be found,” said
Nabarro. “We saw that for access to treatment for HIV/AIDS many years ago
when I was working here in the Office of the Director General. And the
price of AIDS care was reduced dramatically. We’ve seen it with access to
artesunate combination for malaria. We’ve seen with the way companies have
worked with governments on treatments for filariasus for oncocerosis, and
other neglected diseases.”

“So I’m not prepared to come into the issue of costs of medicines by
defining it as an ‘impasse’, your words,” he said. “I define it as a
problem to be solved together, and each individual problem to be solved in
specific ways, whether it’s hepatitis C, or whether it’s HIV/AIDS, or
malaria, or the development of new medicines to cope with antimicrobial
resistance. The story is to be continued.”

Asked if he is a “hands-on” kind of leader, Nabarro said, “You could say
I’m hands-on and I wouldn’t mind that. But I’m somebody who wants others to
get their hands on as well because I really believe if you’re not engaged
in issues, then it’s very hard indeed to have impact.” That’s why he
emphasises his “catalytic” role, he wants to bring out the best in others,
like “pumping up the amplifier” on music at a festival.

On the threat of loss of financial support to the UN from the United States
(IPW, WHO, 26 January 2017), he said those threatening seem to be clear
that there are purposes for international bodies, and they want to be sure
that the purpose for which international bodies are working is absolutely
clear, is in line with their national objectives, and the organisation is
working for impact in the most effective, efficient and transparent way.

“I don’t think if we do that that we’ll be cut off from money,” he said.
“After all, dealing with health security and health threats matters
whatever country you’re in, and indeed the United States has been an
amazing supporter of work on emergencies and outbreaks, as well as on
different health systems within the WHO over the years.”

“So I’m not sitting here thinking that the noises that are coming from not
the actual new administration, but from a number of people in the
legislature, I’m not actually thinking that these are going to lead to
terminal problems for WHO in the coming weeks or months. Instead, I think
they’re an invitation to dialogue, and an invitation to openness, and I am
totally up for that.”

Nabarro also spoke at length about Zika virus when asked a question about
it, saying it is a really important question that exposes complexities. In
his view the WHO, the governments, and other agencies have handled it well,
and it is not the same as outbreaks such as ebola and yellow fever.


Dr. Tedros Adhanom Ghebreyesus

Tedros said he believes he is the best candidate because of his mix of
international and national experience. He said he instituted reform in
Ethiopia, listing achievements such dramatically cutting mortality related
to a range of diseases. He stressed his experience also with international
organisations, such as being Board Chair of the Global Fund for AIDS,
Tuberculosis and Malaria, and as a leader in the 2015 Financing for
Development conference in Addis Ababa.

His top priority is universal health coverage, which he attributed largely
to a lack of political commitment. Second on his list is health emergency

“There will be another round of pandemic and we need to prepare right
away,” he said, adding that he would put at the centre national capacity to
respond as well as WHO capacity, all harmonised with other UN agencies.

His plan to reform WHO finances is to increase assessments, expanding the
donor base, making voluntary donations more flexible, and creating more
value for money. He also emphasised partnerships, mentioning UNICEF, the
Global Fund and GAVI for example, and suggesting WHO would lead.

This was also his answer to the question of any concern about President
Trump cutting US funding to the UN. Expanding the donor base is important
because the organisation “should have predictable funding.”

“When you put all eggs in one basket that’s when the problems arise,” he
said, adding that if WHO can show results that show it is relevant,
“everybody will come.”

On avoiding conflicts of interest at the organisation, he said the WHO
Framework of Engagement with Non-State Actors (FENSA) – such as private
entities, foundations, academia, and civil society – should be implemented.

When expanding the donor base, he like Nishtar said normative functions
should be “firewalled” and that any conflicts of interest should be
avoided. If there is any supplier that supports that, “they are welcome,”
he said.

Asked about decentralisation of the organisation, he said what went wrong
with ebola, for which the WHO was criticised for not responding quickly
enough, was that countries such as Guinea with weak national capacity saw
it go out of control, while countries such as Nigeria immediately put into
effect its polio mechanism and stopped it. “Use what is at hand,” he said.

He acknowledged that WHO is “overstretched and underfunded,” but dodged a
question on priorities, saying he would prefer once in office to sit down
with staff and partners and “through an inclusive process” choose what has
to be deprioritised. Then they have to be decisive, he said.

Tedros also talked about when political mobilisation is done at the top in
New York and Geneva, that there is no “buy-in.” Rather, he would use a
“grassroots” approach in a case like antimicrobial resistance (AMR) and
start at the subregional level such as the Association of South-East Asian
Nations (ASEAN) or the African Union (which has endorsed his candidacy).

With AMR, despite the highest level declaration at the UN last September,
he has seen the buy-in is “not enough” at the regional level.

Finally, he was the only candidate asked about an issue in his personal
background, as questions of human rights violations in Ethiopia during his
time as a government leader have been swirling during his candidacy.

He answered by saying “my record speaks volumes on that,” first pointing to
his success in overseeing great gains in health in the country with meagre
resources. As well, they have focused on advancing women’s health in the
country, which brings economic power which brings political power.

But on “general human rights” and democracy, he said the country “believes
democracy is the alpha and omega of our existence. We are committed to it,”
as it has no option as a highly diverse country.

But the criticism is welcome, he said, because the democracy is a nascent
democracy, so we have more challenges than other countries that have more
experience in democracy. It’s a process, we can build it overnight. It
needs cultural change.” It needs things like increasing literacy rates.

When it matures, it gets better, “the country goes from one level to the
other,” he said.

“Bring me any country that has not gone through this process,” he said.
“Even those countries who claim to have the best democracy and human rights
record, believe me, they still have a serious problem themselves. So it’s a
relative status.”

Tedros was the only candidate not available for follow-up questions after
the briefing.

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