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EXPERT VIEWS-Challenges and priorities for WHO's new director general Tedros

by Astrid Zweynert | azweynert | Thomson Reuters Foundation
Tuesday, 23 May 2017 18:39 GMT

A Congolese health worker prepares to vaccinate a resident during an emergency campaign of vaccination against yellow fever in the Democratic of Congo's capital Kinshasa, July 20, 2016. REUTERS/Kenny Katombe/

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What lies ahead for the new head of the WHO?

LONDON, May 23 (Thomson Reuters Foundation) - Tedros Adhanom Ghebreyesus, a former health minister and foreign minister of Ethiopia, on Tuesday won the race to become the next director-general of the World Health Organisation.

Tedros becomes the first African to lead the U.N. agency.

The Thomson Reuters Foundation asked global health experts and charity leaders what the new director-general should prioritise.


The new director-general (DG) must be ready to put people at the centre and give local communities a seat at the global public health table to work together to build a stronger, more resilient and healthier world.

He will immediately be confronted by a range of urgent and long-term public health challenges such as the devastating health impact of food crises in Central and East Africa, protracted complex crises that have all but destroyed health systems in Syria, Yemen and parts of Afghanistan.

Other challenges include outbreaks of highly infectious diseases such as Ebola, cholera and yellow fever and a global rise in chronic diseases such as cancer, diabetes and heart disease, and also the impact of stress and hardship on mental health and wellbeing. And there are pockets of hard-to-reach communities still left behind despite inroads globally on immunisation, HIV, malaria, TB and maternal, adolescent and child health.

These challenges are a reminder the world has a long way to go before the WHO can claim success in achieving its mission of attaining the highest possible level of health for all people. One essential element will be for WHO to recognise the absolutely central role of local communities in preventing, detecting and responding to health challenges. WHO brings much needed technical knowledge, and expertise to the world and has the ability to mobilize international actors and resources.

To be a far-reaching emissary of global public health, the WHO must help bridge the divide between health systems nationally and globally, and the local communities that ultimately determine the course of an outbreak or health risk. Health challenges do indeed start and end in communities.


Amongst the variety of global health imperatives and complex organisational and administrative tasks the new DG must address, there are some key priorities to highlight.

1) He must restore strong confidence in the role of the WHO and its global credibility in being able to rapidly address, manage and contain emerging and re-emerging infectious diseases. It must have the capacity and structures, as well as expertise, to be rapidly responsive and effective. Through this the DG could then demonstrably and clearly negate the legacy of criticism regarding Ebola and other responses.

2) He must ensure there is international and national leadership regarding the major health threat of antimicrobial resistance and the management of drug resistant infections. There needs to be a whole healthcare economy approach to the challenge and cross-sectoral working with those working in agriculture, environment and industry. To support this objective the importance of infection prevention, sanitation and vaccination needs to be addressed to minimise preventable infectious diseases and further use of antibiotics. Sustainable and equitable access to effective treatment for infection must not be compromised.

3) The protection of healthcare workers needs to be made paramount. Their safety needs to be an overarching and constant aim, whether it is ensuring their protection from infection is optimal or ensuring their right to work safely and be protected in their place of work without fear of attack. This needs to be a core principle - an ethos that promotes and recognises the value and commitment of healthcare workers globally.

It must be recognised that for any DG to be able to deliver these priorities as well as the many others, and to continue to demonstrate the critical global role of the WHO, the underpinning necessary resources and administrative structures must be appropriate.


Nearly seven million more people are alive thanks to bold leadership and innovation, generous financial support and community-led efforts since 2000 to combat malaria. But we have much more work to do. Historic success is tempered by the fact that half the world's population remains at risk of this preventable and treatable disease and that a child still dies of malaria every two minutes.

The world is at an important crossroads in the fight against malaria. More than 20 countries are on track to eliminate malaria transmission by 2020, according to the WHO. Achievement of this goal would create undeniable momentum toward ending the disease globally. What happens in the next five years will determine whether we can put the world on a path to end malaria, or we risk opening the door to resurgence, drug- and insecticide-resistance, greater suffering and economic hardship.

We cannot afford to miss the opportunity to end malaria. Even in a world with so many pressing health challenges, malaria must remain a priority. Leadership by the next DG of the WHO could be decisive. We must continue to deliver on the basics to stop people dying needlessly from mosquito bites.

We are now able to target malaria interventions more efficiently and cost-effectively than ever before. Yet, to realize this potential and accelerate malaria elimination, countries must expand surveillance efforts and data-driven decision making with the WHO's guidance and support. By equipping countries to eliminate malaria, we also prepare them to tackle emerging health threats, thereby strengthening global health security for all.


Within the shifting geo-political and economic landscape one of the major challenges facing the new DG will be to expand and to broaden its funding base beyond the United States and Western Europe and engender support from countries such as China and India.

With the increased frequency of global epidemics such as MERS, ZIKA, and Ebola it is vital that WHO continues to develop procedures for dealing with new epidemics. The response to Ebola showed the importance of good crisis management teams being able to respond effectively to emergencies – and the lessons learnt must be put into practice for future events.

It also identified the need to be better able to speedily evaluate new therapies/vaccines for potential use in such situations. Advances in technology and the use of open access data bases need to be embraced more effectively by the WHO to provide international leadership in both monitoring disease morbidity and mortality.

One of the ambitious challenges the WHO has set is the control and elimination of neglected tropical diseases. The WHO has had great success in working with philanthropists such as Bill and Melinda Gates in developing a road map for this. A clear task is to deliver on this roadmap in the coming decade. These relationships with aid agencies and philanthropists need to be maintained and were possible expanded to face up to many new threats such as that of antibiotic resistance by regulating the use and production of sub-standard or fake medicines.

The WHO needs to be able to call on new ideas and innovations if it is to effectively meet the numerous challenges facing it. To do this the new director may want to institutionalise meritocracy by defining tenure periods for post holders in Geneva and regional offices thereby ensuring a constant flow of new talent.


Dr Tedros takes the helm of the WHO in the face of significant and complex challenges to global health and security. Chief among these will be to ensure the WHO and member states act on the lessons of the devastating recent Ebola epidemic in West Africa and the current outbreak in the Democratic Republic of the Congo, so that the global community is better prepared to respond swiftly to future outbreaks before they spiral out of control.

The WHO has a tremendous opportunity to accelerate recent advances in global health. PATH urges the new DG to prioritise the necessary policies and investments to promote innovation through health research and development, increase global access to lifesaving medicines and technologies, and continue global progress toward ending HIV, malaria, tuberculosis, polio and preventable maternal and child deaths.

Additionally, it will be important to facilitate the multisector collaboration needed to achieve such goals Dr Tedros must set forth and execute a plan to address these challenges and opportunities amid budget crises, challenging political climates, and the continuing need for institutional reforms. PATH looks forward to seeing him spearhead a highly effective, efficient, and forward-thinking WHO that embraces innovation, to achieve a world where affordable, quality health care is within reach of everyone.


WHO is a key partner of the Global Fund in our work together to end epidemics and to create strong systems for health that contribute to greater global health security. Dr Tedros is already a distinguished leader in global health, and he can do great things at WHO. His leadership will be crucial as the world seeks to accelerate efforts to end HIV, tuberculosis and malaria as epidemics as well as address emerging health threats to global health security like antimicrobial resistance.

His pledge to transform WHO and focus on universal health coverage, health security, women, children and adolescents, and the health impacts of climate and environmental change highlights comprehensive but urgent themes that will be transformative to global health.


The WHO has provided outstanding leadership in the fight against neglected tropical diseases. This diverse group of treatable and preventable infectious diseases have a devastating impact on individuals and communities, causing severe disfigurement and disability.

They affect the poorest and most marginalised communities in the world, placing a heavy burden on over one billion people. They impact on life expectancy, education and economic opportunities of affected individuals, costing developing economies billions of dollars each year.

They are cost-effective to treat and are often known as a "best buy in public health", costing as little as half a dollar per treatment. In 2016, the WHO reported on the delivery of almost one billion treatments. We urge the new DG to continue this momentum, to eliminate these diseases that trap communities in poverty and deprive them of the opportunity to fulfil their potential.


Inequality is one of the main challenges for health. Bringing quality health services to the most disadvantaged, especially women and children, is a priority for public institutions and the new director of the WHO.

Did you know that in Central America only one of every two pregnant women in the poorest 20 percent gives birth assisted by skilled personnel and that twice as many children under five in the poor population die compared to the regional average?

In Latin American and the Caribbean maternal mortality is the leading cause of death among 15-19 year-olds and 90 percent of maternal deaths are from preventable causes.

Measurement, decision-making based on scientific evidence, result-based financing, policy dialogue with countries, public-private partnership and, above all, innovation are the most useful tools to break health gaps and these factors should be high up on the new DG's agenda.


As the world faces increasingly complex health challenges, including aging populations, an epidemic of non-communicable diseases and health risks due to environmental issues, the ability of women to thrive and strengthen communities and economies has never been more crucial, and yet it is still not a realistic possibility for so many around the world.

Health challenges are not the same across geographies and genders. From natural factors such as climate to systemic issues linked to finances and workforce training, health issues vary considerably between geographic regions. And from complications related to childbirth to inequitable access to care due to their gender, women face different health issues and risks than men.

The world's most powerful health agency needs a leader who advocates for gender equality and sexual and reproductive health and rights as a net positive for all. He must consistently prioritise girls and women as powerful agents of change and drivers of development.

Equally important, he must strengthen the WHO's gender balance and engagement with young people and civil society not just because it's the right thing to do, but the sound thing to do.

(Editing by Astrid Zweynert @azweynert.; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights, climate change and resilience. Visit http://news.trust.org)

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