IP-Watch – by Peter Kenny
It has been a gruelling campaign for the three final candidates for the post of director general of the World Health Organization and their latest public foray was dubbed a “moderated discussion.”
The event was organised on 6 March by the Global Health Centre at Geneva’s Graduate Institute, in cooperation with the Centre on Global Health Security at Chatham House, The Rockefeller Foundation and the United Nations Foundation.
Each of the three remaining candidates: Tedros Adhanom Ghebreyesus (Ethiopia), Sania Nishtar (Pakistan) and David Nabarro (United Kingdom) have had to take time off their normal jobs to campaign in front of their peers and the public. The candidates all have the backing of their national governments.
Prior to the event, there had been an open call for questions. The questions were grouped and made available to the moderators who chose them in discussion with the organisers and they were offered to the candidates in an equitable manner. There were no questions from the floor.
The organisers said their interests are focussed on political leadership and diplomacy and they would like to see how the candidates approach issues of power, competing interests of stakeholders, processes of consensus-building, representation and the like.
Each candidate began with a three-minute outline of their political leadership vision for running the world health body. In many instances, each of the three supported the same points and it is clear that for three exceptionally qualified candidates the choice may largely come down to management style.
The moderators were Andrew Jack, head of curated content at the Financial Times, and Diah Saminarsih, special adviser to Indonesia’s Minister of Health.
Dr. Sania Nishtar
Dr. Sania Nishtar is a qualified medical doctor with experience in civil society serving on the boards of the likes of Gavi and the Chal Foundation, along with public sector experience, having served as a federal minister in Pakistan. She gave the most detailed responses, but sometimes ran over time in her answers.
She began by saying, “The global political landscape has changed and so has our understanding of health…. WHO must readapt and reconfigure. WHO has a clear rear mandate to lead on some complex transnational threats.” Among examples she cited were different types of infections, antimicrobial diseases and non-communicable diseases.
She also said WHO must exercise “effective public health diplomacy.” Up till now, said Nishtar, WHO has engaged with ministries of health.
“But in the new era of [United Nations] Sustainable Development Goals, we know that many sectors other than health deeply impact health standard decisions,” while noting that decisions such as universal health coverage are not taken by ministers of health but by heads of state.
Nishtar said the WHO therefore needs to effectively forge multi-sectoral partnerships to become a force multiplier by playing “its unique normative role.”
She noted a modern paradox of increased expectations from WHO but also the prevalence of financial uncertainty, so the next director general will need to be able to communicate an effective investment case to get the necessary financial support.
WHO has a fine-balancing act in its role seeking to effect policy and must “stand by evidence-based positions” even if these have political implications in order for the secretariat to be effective.
Nishtar asserted that the director general has a very important political role to play internally within the organisation, in order to break silos, bring reforms to fruition and overcome blockages within the membership when they occur.
“WHO has to very careful to firewall its normative work from the many non-state actors which have to be and must be engaged in order to work on the Sustainable Development Goals,” said the Pakistani candidate who ended by saying she believes she has the experience for the job.
Each candidate answered the same question moderated by Jack and Saminarsih, and hundreds of twitter questions were received.
Dr. Tedros Adhanom Ghebreyesus
Dr. Tedros Adhanom Ghebreyesus (“Tedros”) is Ethiopia’s minster of foreign affairs, has a PhD in community health and a master’s in immunology of infectious diseases, having also worked as a co-chair of the Roll Back Malaria campaign. He tends to speak more in headlines with points pushing his case anecdotally on his successes in reform while he was Ethiopia’s health minister from 2005 to 2012. He sees national health organisations at country level as key.
He noted people have been advocating health for all since 1947, so it is a given that they continue to do so.
“My first priority is universal health coverage and the second is emergency preparedness. The third focus is on women and children and adolescents; fourth climate change and environmental change; and the fifth is we need to transform the WHO to achieve the four priorities.
“I believe all roads should lead to universal health coverage, breaking the financial barriers, breaking access to quality and services and breaking the barrier to medicine., he said. Universal health care should then be used to address communicable and non-communicable diseases.
“On emergency preparedness, the world is waking up now and we need to be moving” with a sense of urgency. “We are sure there will be an attack by pandemics…We must prepare,” said Tedros.
Turning to the pharmaceutical industry he urged delinking research from drug costs and said, “Continuing to negotiate on TRIPS (the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights) is very important.”
Marginalising woman and children is dangerous, and regarding climate change it is a matter of whether “we are in or out on this” and have to make WHO more effective in doing the right things with effective independent assessment.
“This is my life and this is my passion. I believe in this organization and that it is still relevant” in the multilateral system and of course it has many challenges. He said it was especially important to “focus on building country capacity and building WHO capacity at the frontline which is the country offices.”
Dr. David Nabarro
Dr. David Nabarro is the insider of the candidates and is Special Adviser to the United Nations Secretary-General on the 2030 Agenda for Sustainable Development and Climate Change. A trained medical doctor, he has often been likened to a troubleshooter for the WHO, for example during the West African Ebola crisis that started in 2014.
“Politics is about looking at the way in which power influences people and it is about using power to change their situation,” he said. “The good use of politics is using power to make sure people are healthier.
“We must always be skilled at engaging with politician of all kinds to ensure that in the process they use their power for the political good,” said Nabarro who joked with Tedros a number of times.
Nabarro said it is known that people without power or limited power are less able to ensure their health and to access health care as well as say accessing clean water and food.
“We know that health workers who lack power are unable to defend the interests and rights of the people who they seek to benefit,” he said.
Nabarro noted, “We know that UN organisations are used to ensure that power is used for the common good and that is what the Sustainable Development Goals are all about.” The same applies for the primary health care movement.
The WHO is right at the centre of this health movement and is at the centre of sustainable development, Nabarro asserted.
“The director general of the WHO has a unique role, because although the organisation is bounded by its member states and they exercise political control over what it does, the director general is empowered by the member states to act for the best interests of people,” he said.
“The role of the member states on May 25,” Nabarro continued, “is to identify the director general whose track record and value system shows that she or he is able to harness political power for the good of everyone” at every level, in regions, sub-regions and everywhere.
Image Credits: Peter Kenny