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The Seventieth World Health Assembly takes place in Geneva, Switzerland, during the final week of May.
This annual Assembly is the decision-making body of the World Health Organisation (WHO).
As delegates from 194 member states prepare to gather under the shadow of Mont Blanc, they are facing an important choice over who should lead the organisation for the next half-decade.
Dr Margaret Chan, the outgoing Director-General, is stepping down after completing two five-year terms.
The process to replace Dr Chan is already months’ old. It began in November last year when six candidates spoke at a forum for all WHO member states; and then a meeting of the WHO Executive Board last month whittled the candidates down to just three.
The final shortlist covers a significant geographical range, encompassing three continents, with Ethiopian Dr Tedros Adhanom Ghebreyesus, (51), Dr Sania Nishtar (54) of Pakistan and Dr David Nabarro (67) of Britain.
All three now go before the upcoming Assembly, where an election will take place. The victorious candidate takes office in July.
Dr Tedros Adhanom Ghebreyesus
Although the results from last month’s WHO Executive Board vote were not made public, media reports indicated that Mr Adhanom Ghebreyesus came out on top with Dr Nishtar and Dr Nabarro following in that order.
However, this tally may not have any bearing on the election at the Assembly, where nation states will vote. Observers of the WHO say it is difficult to predict how the vote will transpire, as states tend not to make any public announcements regarding their voting intentions.
Dr David Nabarro
This is also the case in Ireland where a spokesperson for the Department of Health remained tight-lipped on how Ireland would vote.
However, the Medical Independent (MI) understands that, prior to the Assembly in May, there is expected to be consultation at ministerial and official level between the Department of Health and the Department of Foreign Affairs and Trade regarding Ireland’s vote.
Dr Sania Nishtar
“The Election of the Director-General of the WHO is by secret ballot,” a Department of Health spokesperson told MI last week.
“This facilitates the conduct and management of sensitive international relationships. It is not normal practice to publicly indicate who Ireland will vote for or has voted for in United Nations/WHO elections.
“The Executive Board of the WHO, of which Ireland is not a member, voted in January 2017 to reduce the field of candidates for the post of Director-General to three.”
Following consultation between Hawkins House and Iveagh House, it will be Minister for Health Simon Harris who will make the final call on how Ireland will cast its vote.
“Following consultation with the Department of Foreign Affairs and Trade, the Minister for Health decides who Ireland votes for in this process,” the spokesperson confirmed.
“Ireland’s vote will be deployed with a view to maximising our international influence and our capacity to represent and advance the values and concerns of our people.
“We would want to see a strong and effective candidate capable of building a fit-for-purpose WHO.”
The spokesperson added that the Department of Health will be represented at the World Health Assembly in May.
Ireland’s financial contribution to the WHO is not insignificant. In July last year, this newspaper reported that the Department of Health provided funding of over €3.8 million to the WHO from 2014 to June 2016. The Department of Foreign Affairs and Trade provided funding of €5.35 million to the WHO during the same time period.
It is the Department of Health that leads on the management of this country’s overall relationship with the Organisation.
The WHO Director-General is not only the most public face of the Organisation but also the technical and administrative officer that oversees WHO’s international health work.
A specialised agency of the UN that is concerned with international public health, the WHO has more than 7,000 people working in 150 country offices.
Given this size it’s not surprising that some critics have raised issues regarding unwieldy bureaucracy within the WHO.
In this context the only female candidate, Dr Nishtar, puts particular focus on needed structural reform of the WHO in her campaign literature.
The Pakistani cardiologist says that, under her leadership, the WHO will adopt an accountability framework that is straightforward to enforce and is guided by independent voices. “As a starting point I will voluntarily make my own electoral campaign financing a matter of public record.”
Her campaign has a 10-point plan, at least four of which are targeted at changing the structure of how the WHO does its business.
She promises that her reforming agenda will evolve the WHO “into an effective, well managed, transparent, accountable and cohesive organisation, which achieves value for money”.
The other huge issue that hangs over the upcoming election is the WHO’s response to the Ebola crisis of 2014. The Organisation has been criticised by some for its slow response and failure to declare the outbreak as a Public Health Emergency of International Concern (PHEIC) in ample time.
One of the candidates, Dr Nabarro, who is a public health expert, was appointed in August 2014 as the UN Secretary-General’s Special Envoy on Ebola.
Dr Nabarro also subsequently chaired the Advisory Group on the Reform of the WHO’s Work in Outbreaks and Emergencies.
“He is committed to completing the work needed to solidify the WHO’s capacity to respond to outbreaks and health emergencies,” according to his campaign literature.
But in his general pitch to the international electorate, Dr Nabarro list a number of wider global public health challenges, namely “changing climate, violent conflict, persistent poverty and mass migration”.
In particular he focuses on the social and economic causes of public health disparity
“The benefits of globalisation and new technologies remain unequally shared. As a result, people face an ever-growing avalanche of threats to their health. I have worked on such issues for over 40 years. As I see it, the need for a robust, reliable and responsive WHO has never been more urgent.”
Dr Nabarro is currently the special adviser to the UN Secretary-General on sustainable development and climate change.
Dr Tedros Adhanom Ghebreyesus is the only non-medical doctor among the final three candidates. The Ethiopian has a PhD in Community Health and boasts experience in governmental positions, being both former foreign affairs minister and health minister in Ethiopia.
“Climate and environmental change pose new threats,” Dr Tedros says in his vision statement.
“Unhealthy lifestyles are giving rise to non-communicable diseases that imperil public health. Globalisation has made it easy for infectious disease pathogens to spark pandemics that threaten lives and economic security.
“Antimicrobial resistance is threatening our ability to effectively treat common diseases and infections, and widespread population movements, global trade and inequities in access to basic healthcare and social protection are leading to complex global health challenges.”
The Government of Ethiopia has submitted the nomination of Dr Tedros Adhanom Ghebreyesus. He is a former minister of foreign affairs and minister of health in Ethiopia. In January last year, the Assembly of the African Union endorsed his candidature, thus most likely guaranteeing him votes from over 50 African countries in May’s election.
He has a PhD in Community Health from the University of Nottingham and his doctoral thesis was entitled: The effects of dams on malaria transmission in Tigray Region, northern Ethiopia, and appropriate control measures.
He also has a Master of Science in Immunology of Infectious Diseases and is an expert and author on health issues including health workforce strengthening, emergency responses to epidemics, and malaria.
Campaign website www.drtedros.com.
The Government of the United Kingdom of Great Britain and Northern Ireland submitted the nomination of Dr David Nabarro. Born in London, Dr Nabarro is currently the special adviser to the UN Secretary-General on sustainable development and climate change. He played a leadership role in the UN’s response to the cholera epidemic in Haiti and has also served as the UN Secretary-General’s Special Envoy on Ebola.
He has over 40 years of experience in international public health as a community-based practitioner, educator, public servant, director and diplomat.
Campaign website www.davidnabarro.info.
Dr Sania Nishtar is the founder and President of Heartfile, which began in Pakistan in 1999 as a health information-focused NGO and evolved into a think tank on health policy issues.
Dr Nishtar co-chairs the WHO Commission on Ending Childhood Obesity and also serves on the board of the United Nations University’s Institute for Global Health.
A cardiologist by training, she served in Pakistan during the 2013 caretaker government as minister for science and technology. During her time in government she also played a role in the establishment of the current Pakistani Ministry of National Health Services, Regulation and Coordination.
She sits on the international advisory board of The Lancet Global Health journal.
Campaign website www.sanianishtar.info.