Georgetown University Law Center Scholarship @ GEORGETOWN LAW 2017 Reimagining WHO: Leadership and Action for a New Director- General Lawrence O. Gostin Georgetown University Law Center, [email protected] Eric A. Friedman Georgetown University Law Center, [email protected] This paper can be downloaded free of charge from: https://scholarship.law.georgetown.edu/facpub/1941 https://ssrn.com/abstract=2910022 Lancet Online (Jan. 27, 2017) This open-access article is brought to you by the Georgetown Law Library. Posted with permission of the author. Follow this and additional works at: https://scholarship.law.georgetown.edu/facpub Part of the Health Law and Policy Commons Health Policy Reimagining WHO: leadership and action for a new Director-General Lawrence O Gostin, Eric A Friedman Three candidates to be the next WHO Director-General remain: Tedros Adhanom Ghebreyesus, David Nabarro, and Published Online Sania Nishtar. The World Health Assembly’s ultimate choice will lead an organisation facing daunting internal and January 26, 2017 http://dx.doi.org/10.1016/ external challenges, from its own funding shortfalls to antimicrobial resistance and immense health inequities. The S0140-6736(17)30203-9 new Director-General must transform WHO into a 21st century institution guided by the right to health. Topping the O’Neill Institute for National incoming Director-General’s agenda will be a host of growing threats—risks to global health security, antimicrobial and Global Health Law, resistance, non-communicable diseases, and climate change—but also the transformative potential of the Sustainable Georgetown University, Development Goals, including their universal health coverage target. Throughout, the next Director-General should Washington, DC, USA (Prof L O Gostin JD, emphasise equality, including through national health equity strategies and, more boldly still, advancing the E A Friedman JD) Framework Convention on Global Health. Success in these areas will require a reinvigorated WHO, with sustainable Correspondence to: financing, greater multisector engagement, enhanced accountability and transparency, and strengthened normative Prof L O Gostin, O’Neill Institute leadership. WHO must also evolve its governance to become far more welcoming of civil society and communities. for National and Global Health To create the foundation for these transformative changes, the Director-General will need to focus first on gaining Law, Georgetown University, political support. This entails improving accountability and transparency to gain member state trust, and enabling Washington, DC, USA [email protected] meaningful civil society participation in WHO’s governance and standing up for the right to health to gain civil society support. Ultimately, in the face of a global environment marked by heightened nationalism and xenophobia, member states must empower the next Director-General to enable WHO to be a bulwark for health and human rights, serving as an inspiring contra-example to today’s destructive politics, demonstrating that the community of nations are indeed stronger together. Introduction Global health security The WHO Executive Board has narrowed the field for Global health security will probably top WHO’s agenda. Director-General to three candidates (table, appendix The new Director-General must convince states to fund See Online for appendix p 2). Electing an empowered global health leader has WHO emergency operations, build core capacities, and never been more important. The world faces daunting comply with International Health Regulations norms. health challenges, but WHO’s weak response to Ebola Global health security extends to antimicrobial resistance, undermined trust, and its governance model remains already taking 700 000 lives every year.3 WHO’s response stuck in the last century. International cooperation and requires cooperation among complementary regimes4 investment are sorely needed, but nationalistic populism and innovative financing, including the Global Antibiotic hostile to globalisation is taking hold in many of the Research and Development Facility, to stimulate world’s most powerful countries. Yet with peril there is research.5 With USD$16 billion every 10 years, market promise. Global health is rising to the highest political entry reward systems could support 15 new drugs—a levels, from UN summits on non-communicable modest security dividend for a pipeline of effective diseases, antimicrobial resistance, and HIV/AIDS to the therapeutic countermeasures.3 Sustainable Development Goals’ crowning promise of universal health coverage. Universal health coverage The new Director-General must transform WHO into Health system strengthening is integral across priorities the 21st century institution the global health system as diverse as HIV/AIDS, child and maternal mortality, sorely needs, reimagining the organisation as agile, non-communicable diseases, and domestic violence. To open, and accountable throughout its operations. achieve International Health Regulations capacities, Success will require credibility with civil society, WHO created the joint external evaluation tool.6 To build diplomatic skills to engage other sectors and secure human resources, it published a global strategy.7 Its compromises from states with diverging national framework on integrated, people-centred health interests, political acumen to persuade governments to services8,9 extends matrices of health system effectiveness act as stakeholders in WHO’s success, and scientific to empowerment, equity, participation, accountability, expertise to ensure high quality technical advice and cross-sector collaboration. The task now is to ensure (appendix p 3). these norms catalyse action. WHO’s own capacity to support national health systems Action agenda remains weak despite their centrality, with most resources The new Director-General should set an action agenda, earmarked for specific diseases or programmes. with clear benchmarks, ongoing monitoring, and International health assistance and domestic funding rigorous evaluation of progress (appendix p 4). often follow similar patterns. WHO’s leader must www.thelancet.com Published online January 26, 2017 http://dx.doi.org/10.1016/S0140-6736(17)30203-9 1 Health Policy Tedros Adhanom Ghebreyesus David Nabarro Sania Nishtar Nomination country Ethiopia UK Pakistan Current position Minister of Foreign Affairs, Ethiopia Special Adviser to UN Secretary-General on • Founder and President, Heartfile the 2030 Agenda for Sustainable • Co-Chair, WHO Commission on Ending Development and Climate Change Childhood Obesity Selected previous • Chair, Global Fund to Fight AIDS, • Assistant Secretary-General, UN system • Federal Minister, Education and Training, positions TB and Malaria senior coordinator for Avian and Human Science and Technology, Information • Minister of Health, Ethiopia Influenza Technology and Telecom, Pakistan • Executive Director, WHO Roll Back Malaria • Chair, GAVI’s Independent Evaluation •Special Envoy of UN Secretary-General on Committee Ebola Strengths • Successful fund-raising and experience • Experience working with • Combination of leadership experiences mobilising support non-government organisations and across government, civil society, and • Political and diplomatic leadership communities international organisations, along with • Health governance experience from a • Familiarity with UN agencies technical expertise developing country • Expertise on SDGs and global health • Sensitivity to cultural, social, religious, and security political differences Priorities • Increasing WHO’s accountability and • Aligning health with the SDGs • Accelerating WHO reforms on encouraging partnerships with • Enhancing WHO’s outbreak and health accountability, transparency, stakeholders emergencies capacities and effectiveness • Mobilising domestic resources for • Engaging multi-stakeholders to create • Strengthening WHO work on climate- universal health coverage trust and cooperation health interaction • Strengthening WHO’s response to • Advancing people-centered health • Effectively supporting member states to emerging health threats policies achieve SDGs • Placing vulnerable populations at the • Strengthening actions on global public centre of WHO’s work goods in health Action highlights • Establishing an Inter-Ministerial Advisory • Using the 2030 Agenda for Sustainable • Ensuring value-for-money through Commission to include experts and Development as the instrument to efficient and cost-effective working, and politicians from multiple sectors to develop transform health for all sufficient budget through innovative innovative financing solutions • Mobilising stakeholders to achieve each financing, assessed contributions, and • Open-door policy to encourage priority solidarity financing transparency, communication, and • Enabling WHO staff to develop collective • Breaking silos between headquarters and collaboration capabilities to serve as technical leaders regional and country offices • Supporting the Global Health Crisis that contribute to better lives for all • Initiating WHO-wide independent Taskforce and Health Emergencies • Increasing attention to community evaluation and institutionalising capacity Programme caregivers for forecasting emerging threats • Forging strategic partnerships to overcome health sector corruption • Augmenting WHO capacity to provide health system stewardship PMNCH=Partnership for Maternal, Newborn and Child Health. SDG=Sustainable Development