As the cheers and applause washed over Tedros Adhanom Ghebreyesus, elected Tuesday to be the next director-general of the World Health Organization, a sobering sense of reality probably also set in.
Huge challenges face Tedros, as he is known, when he takes over the embattled global health agency’s top job on July 1.
Those problems don’t all boil down to inadequate funding — and threatened funding cuts from the WHO’s second largest donor, the US government. But the question of how to secure the cash the agency needs to do the job expected of it is pretty much top of the list, people familiar with the organization and its troubles said.
“It’s never a great thing to walk into an organization that’s broke. So that’s a problem,” said Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention, and an admirer of Tedros’s pioneering public health work in Ethiopia, where he was health minister from 2005 to 2012.
The job of filling the perennially cash-strapped organization’s coffers may be made that much more difficult by the belief that many of the WHO’s major donor countries supported another candidate in the race to be director-general: British physician David Nabarro, a veteran of the United Nations agencies system.
Tedros “won, and won soundly. And I think he’ll get a good fresh look and he’ll get a good hearing. But he obviously has to find a way to get the Western governments, who largely backed his opponent, to be enthusiastic about his leadership of WHO,” said Ron Klain, a Washington lawyer tapped by former President Barack Obama to serve as the US Ebola czar during the catastrophic West African outbreak in 2014.
“The challenge is that he has to show to the donor nations, the funding nations, that he’s dedicated to reform. And he’s going to fix the things that people don’t like about the WHO, and he can carry forward this reform agenda,” said Klain, who has been a sharp critic of the WHO.
Dr. David Heymann said he thinks Tedros has skills that will work to his advantage in this effort. For one, he has a background not only in health but in politics, said Heymann, who heads the Center for Global Health Security at Chatham House, a London-based think tank.
Indeed, Tedros served as Ethiopia’s foreign minister from 2012 to 2016.
On Wednesday, the 2017 World Health Assembly, the week-and-a-half-long annual meeting of the WHO’s 194 member countries, approved the agency’s budget for the next two years, agreeing to a 3 percent increase in the assessed contributions all countries must pay — the first increase in these dues in a over a decade. The increase in assessed contributions is surely welcome; in many budget cycles countries flatly turn down the WHO’s request for increases.
But outgoing Director-General Margaret Chan had planned to ask for a 10 percent increase, to make up some ground lost through years of zero growth. Her request was scaled back by the WHO’s executive board — a rotating committee of 34 member countries — when it met in January.
In a press conference Wednesday, Tedros was asked about threatened global health funding cuts outlined in the Trump administration’s 2018 budget blueprint that was released this week. He spoke of a plan to increase WHO’s fundraising efforts — and the size of its fundraising team — as well as a need to enlist more countries to make contributions.
The assessed contributions make up about 20 percent of the WHO’s budget; the majority of the rest of the agency’s budget is raised through voluntary contributions from countries or charitable sources.
“We need to expand the donor base,” Tedros acknowledged. By “expanding the donor base, we help, you know, the health financing to have a kind of shock absorber.”
There is a potential big shock heading the WHO’s way. The campaign to eradicate polio appears poised, after nearly 30 years, to end transmission of the paralyzing virus. There have been only five cases so far this year and there is hope that spread of the virus could be snuffed out in 2017 or early 2018.
The polio campaign will have several years of work left to do to ensure the virus is actually gone. But if all goes well, at some point early in the next decade, the Global Polio Eradication Initiative will start winding down — which could trigger a huge funding hit for the WHO.
Currently one out of every four dollars the WHO brings in is dedicated to the polio fight. In developing countries, a number of other programs piggyback off the polio money — for instance, routine childhood immunization efforts.
Chan said she hopes countries can be persuaded to “repurpose” their polio contributions. Some observers agree, though others say governments that have been asked again and again to pony up for polio may hope to see some savings when the eradication program — launched in 1988 — finally achieves its goal.
There are other challenges ahead for the incoming director-general. Frieden, the former CDC director, said staffing the WHO with the best people he can find should be the goal.
But sometimes top jobs there are filled with an eye to geography, with senior staff drawn from different parts of the world. That has resulted at times in people being responsible for programs they know little about, Frieden said.
Tedros will also have to decide what tasks the WHO should retain responsibility for, and which it can leave to other organizations, said Heymann. That idea of rationalizing the organization’s mandate was raised by a number of the reports that critiqued WHO’s response to the West African Ebola outbreak.
Klain suggested cutting overhead costs and reducing excessive travel costs must be on Tedros’s list of priorities.
And ensuring that the WHO is ready for the next disease crisis will be key to establishing confidence in the world’s capitals. Tedros “has got a lot of cleanup to do — and the clock is ticking,” said Klain.
“What we’ve seen over the past five years with an acceleration of outbreaks and epidemics of emerging and reemerging infectious diseases means that his do-or-die moment here on the world stage is coming,” Klain said. “Whether it’s coming in weeks or months or a year or two, it’s not off in the distant future. So whatever he’s going to do to make improvements in the WHO, reform the WHO, increase its capacity to respond to epidemics, he’s going to have to do very quickly.”