Like many people around the world, I was dismayed last month by the appointment of Robert Mugabe, the embattled president of Zimbabwe, as a World Health Organization goodwill ambassador. While I believe it is important for the WHO to work with political leaders of every variety, Mugabe’s record in Zimbabwe, which has led to incredible pressure for him to step down, made him profoundly unsuitable for such a role. That wasn’t the only reason this decision seemed so extraordinary to me: It stands as an outlier amid many very sound judgments made by Tedros Adhanom Ghebreyesus, WHO’s newly elected director-general.
In his first 100 days in office, Tedros, as he is known, has assembled an able and extremely diverse senior leadership team. He has also engaged meaningfully and constructively with critics — not least by quickly reversing the Mugabe appointment and without equivocation. He acknowledged a misstep and, I believe, deserves our support because his leadership is a critical opportunity to rebuild the WHO into the force it should be in global health.
Tedros’s election has given him a mandate that no other head of a United Nations agency can claim. His election was the first of its kind in terms of transparency and openness, complete with manifestos, an election platform, and a vote among all WHO member states. His legitimacy, coupled with focused minds at WHO after the failures of Ebola, means he can do what the global health community has been asking the WHO director-general to do for decades: lead its member states with an ambitious program of effective and measurable work, rather than simply reacting passively to their diverse wishes.
This will mean reforming the organization so it’s more effective, focusing on a small number of priorities that only the WHO can deliver, and fixing the relationship between the WHO headquarters in Geneva, the six powerful but highly variable regional offices, and the 193 national offices.
This week, the WHO executive board meets in a special session to decide its strategy and program of work. What matters is that the organization doesn’t attempt to focus on too much. The WHO is an institution with limited financial resources and limited political capital. To accrue more of each, it needs to show real results for a few things it prioritizes and be willing to be held accountable for making tangible progress.
One of these priorities will be universal health coverage. Tedros made it the central plank of his candidacy and, as the first African director-general of the WHO, it is key to his personal story and commitment to social justice. But it’s also a tough challenge that will be achieved only over the long term. The WHO can advocate, but it doesn’t control the levers of change essential for achieving progress, such as economic prosperity, governmental prioritization for health, and financing. So while universal health coverage is very important, Tedros needs to pick a few other programs of work where it has the capacity to achieve more, and quickly.
I would make the case for two priorities. First, make tangible progress on the health elements of the U.N.’s sustainable development goals. This could touch many different areas, but the prominent ones should include antimicrobial resistance, deadly global infectious diseases, and the emerging effects of climate change and air pollution on health, particularly via their impact on noncommunicable diseases.
Second, build a world that’s better prepared for emerging infectious diseases. In the aftermath of Ebola, we have made some progress, particularly through the WHO research and development blueprint, to fast-track the development of vaccines and treatments. But more is falling by the wayside. The WHO can and should make the case for strengthened health systems in vulnerable countries, improve global surveillance of emerging diseases, enforce data sharing among countries and researchers, and champion and facilitate research into prevention and treatment.
Of course, the WHO cannot solve those issues on its own. By working with new partners with different strengths, it can move forward and alleviate some of its funding difficulties. It’s hard to see a leap forward on these issues without WHO leadership — and that can happen only if Tedros inspires existing funders and welcomes with open arms new partners that have complementary strengths.
Take on these priorities, and show real measurable impact, and the WHO can rebuild its reputation as an organization that is a force for change, not one that papers over failures. The prize of a resulting increase in confidence in the WHO will be substantial: nothing less than restoring faith in multilateral partnerships at a time when there is a real danger of returning to more nationalistic and isolationist agendas. What’s more, the bigger prize of improved health for all wherever they live — including Zimbabwe — will be in sight.
Jeremy Farrar, M.D., is the director of the Wellcome Trust, a global charitable foundation, and chairs the Scientific Advisory Group for the WHO’s R&D Blueprint.
Gg