The World Health Organization (WHO) is the United Nations agency responsible for international public health. As the COVID-19 pandemic has demonstrated, the WHO plays a crucial leadership role in coordinating the global response to international health emergencies. However, the WHO has faced criticism in recent years regarding its independence, transparency, and effectiveness in fulfilling its mandate. These concerns have sparked debate as to whether the WHO needs significant reform and change in leadership to remain fit for purpose in the 21st century.
Criticisms of the Current WHO Leadership
The Director-General of the WHO is Dr. Tedros Adhanom Ghebreyesus, who was elected to a five-year term beginning in 2017. While Dr. Tedros has been widely praised for his handling of the COVID-19 pandemic, providing steady leadership at WHO news conferences and coordinating vaccine distribution through the COVAX initiative, his leadership has also come under fire in several respects:
– Slow response to COVID-19: Critics argue Dr. Tedros was too deferential to China in the early stages of the COVID-19 outbreak, praising China’s transparency despite evidence it suppressed information about the virus. This delayed the WHO’s declaration of a Public Health Emergency of International Concern.
– Politicization: Dr. Tedros has been accused of politicizing the WHO and neglecting its core functions like disease surveillance and response. For example, he appointed Zimbabwean dictator Robert Mugabe as a WHO Goodwill Ambassador in 2017 before reversing the decision after an international outcry.
– Ethiopian connections: Dr. Tedros served in senior roles in the Ethiopian government before leading the WHO. Some allege this political connection impedes the WHO’s ability to effectively address health crises in Ethiopia.
– Mismanagement: Internal audits and media investigations have revealed wasteful spending, abusive behavior by senior leaders, and mismanagement under Dr. Tedros’ watch. There are concerns these organizational issues are undermining the WHO’s efficacy.
The Case for New WHO Leadership
Given these controversies, is it time for new leadership at the WHO helm as Dr. Tedros’ first term winds down in 2022? Those advocating for change make the following arguments:
– Restore scientific integrity: The WHO needs a Director-General devoted to science and health expertise, not politics. New leadership could reinforce the WHO’s reputation as an impartial, trusted source of health guidance.
– Increase transparency: Rebuilding public and donor trust requires increased transparency regarding the WHO’s decision-making processes and funding sources. This will enhance accountability.
– Improve crisis response: Learning from missteps in the early COVID-19 response, new leadership could implement organizational reforms enabling the WHO to more nimbly and effectively respond to fast-moving pandemic threats.
– Boost funding: Given widening global health needs, the WHO requires an effective fundraising advocate as Director-General to persuade donors to increase their voluntary contributions.
– Strengthen ethics: Following damaging internal scandals, new leadership with impeccable integrity could reinforce ethical practices across the WHO and restore its reputation.
The Case for Dr. Tedros’ Re-Election
However, there are also strong arguments for Dr. Tedros retaining his position for a second term:
– Steady hand during COVID-19: Keeping consistent leadership during the pandemic has enabled Dr. Tedros to develop valuable crisis management experience and relationships with global stakeholders.
– International cooperation: Dr. Tedros has drawn praise for uniting countries behind a science-driven pandemic response, promoting multilateral solutions like COVAX and ACT-Accelerator amid geopolitical tensions.
– Improving diversity: As the first African Director-General, Dr. Tedros brings valuable regional and cultural perspectives to this traditionally Eurocentric institution. His re-election could support ongoing diversity efforts.
– Institutional memory: Through his first term reforms, Dr. Tedros has gained extensive knowledge of the WHO’s complex organizational dynamics. His continuity would support ongoing change initiatives.
– Global health progress: Under Dr. Tedros, the WHO has recorded successes in malaria reduction, polio eradication in Africa, and universal health coverage advocacy. Change risks disrupting this progress.
Potential Alternatives to Dr. Tedros
If member states do elect a new WHO Director-General in 2022, who are the leading contenders to replace Dr. Tedros? Several names stand out:
– Dr. Sania Nishtar (Pakistan): Cardiologist who co-chaired the WHO’s high-level commission on noncommunicable diseases and runs a large NGO.Finished second in 2017 election.
– Dr. David Nabarro (UK):Veteran WHO executive who led the UN’s COVID-19 response and has called for WHO reforms. Strong communicator.
– Dr. Michel Kazatchkine (France): HIV/AIDS expert and diplomat who leads the Global Fund to Fight AIDS, Tuberculosis and Malaria. Well-connected with donors.
– Dr. Philippe Douste-Blazy (France): Former health and foreign minister, led UNITAID and innovative financing for global health. Knows politics and business.
– Dr. Agnès Buzyn (France): Former health minister, haematologist who treated HIV and leukaemia patients. Handled French COVID-19 response early on.
– Dr. Mariângela Simão (Brazil): WHO assistant director-general with three decades of experience. Led vaccine, health systems, HIV/AIDS programs.
The 2022 Election
Under WHO election rules, the Director-General is appointed by the World Health Assembly, with member states nominating candidates. To be nominated, candidates must receive support from their home countries.
The election process itself is based on exhaustive secret balloting. If no candidate achieves a two-thirds majority on the first ballot, further rounds of voting are used to build consensus. Campaigning and debate between candidates on global health issues can play a key role in shaping member state voting.
How Could New Leadership Reshape the WHO?
If member states do opt for new WHO leadership in 2022, what might change under an incoming Director-General? While maintaining continuity on ongoing programs, we could potentially see moves in several key directions:
– Enhanced pandemic preparedness: Increased powers and funding for WHO teams focused on health emergencies and disease surveillance. More proactive risk assessment.
– Transparency mechanisms: Stronger whistleblower policies, external audits, information disclosures to boost accountability and tackle corruption.
– Member state consensus-building: Proactive engagement with member states to shape global health strategy, rebuild trust. Sideline polarization.
– Organizational streamlining: Review bloated bureaucracy and administration costs. Invest savings in technical programs and country support.
– Ethics enforcement: Strict policies on conflicts of interest, probes of misconduct, protection for internal dissenters. Lead by example.
– Science-led decision making: Ensure expert guidance and evidence shapes health policy not politics. Publish analysis behind major decisions.
Conclusion
The challenges facing the WHO leadership are immense, and there are reasonable arguments on both sides of the debate around Dr. Tedros’ future. Much may depend on the COVID-19 situation approaching the 2022 election. If the pandemic recedes, member states may have appetite for change. However, if we remain in a crisis footing, stability could trump reform.
The key is ensuring that, whoever occupies the Director-General’s chair in 2023, they have the qualifications, character, and vision to lead the WHO through the monumental global health challenges ahead. This historic institution’s mission has never been more important.