By Craig Moran
In a historic development, Dr. Tedros Adhanom Ghebreyesus, former minister of health of Ethiopia, has been elected the next director general of the World Health Organization. When Tedros succeeds the current director general, Dr. Margaret Chan, on July 1, he will be the first African ever to lead the global health body.
The change in leadership comes at a critical time for the WHO. Tedros’ first major challenge will be to tackle the unprecedented health and humanitarian crisis developing in war-torn Yemen. Fresh water shortages, rampant malnutrition, and the destruction of the country’s infrastructure have culminated in a new outbreak of cholera, with UNICEF saying that cases could quadruple to reach 300,000 in the next month. Cholera has already played a major role in Tedros’ public health career, though not a positive one. During the WHO elections, Laurence Gostin, an informal advisor to a rival candidate and the director of the O’Neill Institute for National and Global Health Law, accused him of covering up three cholera outbreaks in Ethiopia while he was health minister. Tedros said that outbreaks that took place in 2006, 2009, and 2011 were only “acute watery diarrhea” in places where lab testing “is difficult,” despite the fact that testing for the presence of Vibrio cholerae bacteria is easy and takes less than two days.
Although Tedros overcame these allegations to win the election, he must now face the WHO’s broader crisis of credibility. The agency recently suffered the latest in a string of blows to its legitimacy following allegations that it spends approximately $200 million per year on travel expenses, nearly $10 million more than the combined amount of money spent combatting AIDS, hepatitis, malaria, and tuberculosis. According to documents obtained by the AP, during a trip to Guinea to celebrate the world’s first Ebola vaccine in May, Chan stayed in the presidential suite of a luxury hotel with a list price of more than $1,000 per night.
The news of the expansive travel expenditures came at a critical time for the global health body, just as the U.S.—the WHO’s biggest sovereign donor—has been proposing funding cuts. President Donald Trump’s 2018 federal budget proposal has called for huge reductions to global health and humanitarian aid, scientific research, and disease prevention agencies and programs—many of which channel funding to the WHO. Overall, the reductions would amount to a drop of $2.2 billion in global health spending. If the WHO wants to continue anything beyond its most basic operations, saving the agency’s reputation and financial base will be a critical early task for Tedros.
The new director general will also need to reform how the WHO responds to epidemics to ensure deadly mistakes are not repeated. Following the devastating Ebola epidemic that began in West Africa in 2014, the WHO was widely panned for its lack of foresight and lethargic response to the crisis, which ended up killing more than 11,000 people. Now, more than three years after the initial epidemic erupted, the deadly virus has resurfaced in the Democratic Republic of the Congo. Unfortunately, the agency continues to be haunted by its fumbled response to the outbreak of 2014.
Last December, the WHO’s advisory group on immunization recommended that a new vaccine developed by Merck be used quickly if another outbreak were to occur. In April, however, the U.S. National Academy of Medicine challenged the methodology of the trial, saying that the vaccine was likely much less effective than initially thought. This raises suspicions about the WHO’s capacity to successfully evaluate the safety of new vaccinations, which will be a crucial tool to stem the latest outbreak.
Questions also remain about the extent to which the WHO will be able to coordinate an organized response to the crisis in DRC. During the last epidemic, the WHO’s sluggish response prompted many of its partners, as well as other parties, to bear the brunt of the counterattack. For instance, charities like Doctors Without Borders (MSF) and Oxfam handled the crisis response on the ground in hard-hit countries like Liberia and Sierra Leone. In March 2015, MSF charged in a report that “months were wasted and lives were lost” because the WHO, whose mission is to lead on global health emergencies, failed to act rapidly. The WHO’s hesitation forced MSF to carry out most of the work in the early months—far too large of a burden for an organization with only 40 staff who had experience with Ebola. Private companies, too, were forced to take measures into their own hands. For example, Moscow-based aluminum giant RUSAL funded and built an epidemiology center to coordinate patient treatment and research the effectiveness of experimental antiviral drugs.
The onus on both nonprofit and private actors to fill the void left by the WHO is a sign of a worrying trend. As the WHO proves increasingly ineffective in the face of the very sorts of crises that fall into its realm of responsibility, other organizations are forced to try to take over many of its key functions. Yet neither charity groups nor corporations have the right tools to fulfill the WHO’s role completely, such as assuming leadership during international health crises or articulating global medical health policies. If the WHO is going to have any chance of staying relevant during the next global health emergency—whether it be cholera in Yemen, Ebola in the DRC, or some unknown new disease—Tedros is going to have to live up to his campaign pledges and reform the agency’s credibility, accountability, and disaster response mechanisms. This will be the only way to make Trump and other donors think twice about completely cutting off the WHO’s lifeline.
Craig Moran is an independent geopolitical consultant. He has experience in energy and natural resources planning, assessing and advising on political and security risks, and handling constitutional and legislative issues across multiple territories.
[Photo courtesy of Wikimedia Commons]