Today the World Health Organization (WHO) voted in a new director-general, Tedros Adhanom Ghebreyesus of Ethiopia, in a contentious and unprecedented election. But yesterday, in her final speech to the World Health Assembly, outgoing Director-General Margaret Chan chose to address the political unrest beyond Geneva that has many questioning the relevance and future of the WHO.
“As I speak to you, the political and economic outlook is much less optimistic than it was when I took office in 2007,” Chan told the 3,500 delegates from 194 member states. “That was before the 2008 financial crisis changed the economic outlook from prosperity to austerity almost overnight, with effects on economies and health budgets that are still being felt.”
Against the backdrop of security fears, rising inequality, protectionist policies in the West and assaults on civil society globally, Chan charged delegates to make reducing inequalities a “guiding ethical principle,” to listen to civil society – “society’s conscience” – and to uphold scientific evidence.
“Protect it,” she said. “No one knows whether evidence will retain its persuasive power in what many now describe as a post-truth world.”
The resurgence of measles in Europe and North America because of vaccine refusals is an obvious example of what happens when people reject scientific evidence, according to Chan.
“[It] should never have happened,” she said.
She also challenged the organization to strengthen accountability systems, “safeguard” the WHO’s integrity and pursue innovation. All these values, she said, will “shape the future of this organization,” especially as critics begin to wonder whether the underfunded, understaffed, hulking bureaucracy has a role in global health anymore.
The WHO’s handling of the 2014 Ebola crisis in particular marred not only the agency’s reputation but Chan’s as well. In her speech, Chan acknowledged that the WHO was unprepared for the virus to behave differently from before.
“This happened on my watch, and I am personally accountable,” she said.
However, she also noted that the agency made “quick course corrections,” controlled the three outbreaks and helped develop the world’s first Ebola vaccine that offers “substantial protection.” Last week, the Democratic Republic of the Congo confirmed its eighth outbreak of the virus, which so far has caused 29 suspected cases and three deaths.
“The world is better prepared but not nearly well enough,” according to Chan, and the WHO still has critical contributions to offer – both seen and unseen.
For example, Chan noted that when many countries won’t introduce a new vaccine until the WHO has officially approved it or when the WHO endorses a new product and partners find ways to fund it, the agency’s relevance is “readily apparent.” Though it’s taken a decade, the WHO also managed to bring down the price of HIV antiretroviral drugs during her tenure. The cost of new hepatitis C treatments fell much faster in just two years.
Chan also celebrated record progress toward soon eliminating many neglected tropical diseases, as well as polio and guinea worm.
Less visible, but just as relevant has been “the way WHO has built a safety net that encircles the globe in the form of thousands of laboratories specialized in the surveillance and diagnosis of priority pathogens, hundreds of collaborating centers, and a vast network of scientific boards and strategic advisory groups,” Chan said.
But these successes largely depend on the WHO to maintain the trust of its member states, civil society partners and all other stakeholders to work as a cohesive network. In the current global environment, and especially after a politically fraught election, will the new Director-General Tedros be able to maintain already diminishing trust?
Tedros won a five-year term as head of the WHO today in a first-ever secret ballot election in which each member state held an equal vote regardless of population. He will enter office on July 1 with controversy nipping at his heels. As Ethiopia’s former minister of health, he has been accused of human rights abuses, improper distribution of food supplies during famine and intentionally covering up cholera outbreaks that may caused thousands of people to die.
Some think that politics – China and India – denied another contender, Pakistan’s former minister of health Sania Nishtar, a fair go at the position, despite vowing to serve only one term and running on a platform of transparency, reform and collaboration with civil society and humanitarian organizations.
Geopolitics presumably also shut Taiwan out of the World Health Assembly this week, since China believes other countries and international organizations should not treat the “renegade province” as a separate country. Chan, who hails from Hong Kong, had the right as director-general to invite Taiwan as an observer.
Just before the vote took place, the WHO was also accused of spending more on travel than on AIDS, hepatitis, malaria and tuberculosis. Although the agency does spend more than double its $200 million travel expenses on polio, the optics are being heavily criticized.
Meanwhile, U.S. President Donald Trump continues to propose major cuts to global health funding.
Therefore, even if it does take Chan’s advice to heart, the WHO’s future may be rocky.