As embattled WHO faces ‘existential crisis’, finalists to replace Hong Kong’s Margaret Chan at helm are named

PUBLISHED : Thursday, 26 January, 2017, 9:38am
UPDATED : Thursday, 26 January, 2017, 9:48pm

The list of candidates to replace Margaret Chan Fung Fu-chun as leader of the World Health Organisation (WHO) and rebuild its battered reputation has been whittled down to three, with a final choice due in May.

The high-stakes choice comes as the powerful agency faces what has been described as an “existential crisis”, after 10 years with Chan, the former Hong Kong health director, at the reins. The agency has come under fire for the agency’s sluggish reaction to the African Ebola epidemic, which spread across one of the world’s poorest regions, killing thousands of people.

Chan’s second five-year term ends on June 30.

After a day of interviews with the WHO executive board in Geneva on Wednesday, those left in the running were Ethiopian Foreign Minister Tedros Adhanom Ghebreyesus, medical doctor David Nabarro who served as UN envoy on Ebola, and Sania Nishtar, the Pakistani founder of a health think tank Heartfelt who served one year as a federal minister.

The final choice is to be made by the World Health Assembly, the annual ministerial gathering of WHO’s 194 member states held from May 22-31.

Some public health policy experts called for a leader with political experience to revive the WHO’s international standing and bring in funding for flagship programmes.

“International organisations like WHO have lost lots of lustre,” Lawrence Gostin, professor of global health law at Georgetown University Law School, told Reuters. “WHO was wounded very badly with Ebola and now even with its new emergencies programme is under-funded. It should be easy to fund.”

“That is why somebody who has a lot of political stature has to direct it,” he said.

France’s former foreign minister Philippe Douste-Blazy and Italy’s Flavia Bustreo, a current WHO deputy chief, were eliminated from the running on Wednesday.

“This is an enormously important election,” said the director of Harvard University’s Global Health Institute, Ashish Jha.

“It really is an existential crisis for WHO,” added Jha, co-author of a 2015 report calling for sweeping agency reform.

WHO may be the United Nations’ most influential body, coordinating responses to pandemics like Ebola and Zika, but also setting standards for national healthcare systems including in advanced Western countries.

Chan was hired on the strength of her role as Hong Kong health director, during which she handled crises including the 2003 Sars outbreak and the 1997 H5N1 avian flu outbreak.

But her WHO tenure, which began in 2006, has suffered from accusations of inadequate transparency and accountability.

Those complaints boiled over with the 2014 Ebola epidemic in west Africa, when WHO was found to have missed glaring warning signs about the severity of the crisis that ultimately killed more than 11,000 people.

“When you look at the debacle of the Ebola response, no one in Geneva lost their job over that,” further fuelling concerns over accountability, said Jha.

WHO officials often lament their funding constraints, but the Harvard professor said financing problems are caused by the fact that “donors don’t fundamentally trust WHO to do a great job”.

Among the criticisms of the Ebola response was that WHO deferred to governments in the region, notably Guinea, as they initially sought to downplay the dangers of the outbreak.

The editor of The Lancet medical journal, Richard Horton,said the election was “make-or-break time” for the Geneva-based WHO, especially after the failures linked to Ebola.

“We need a director-general who has got courage, who is independent and who puts people before governments”, he said.

Nabarro, 67, is an Oxford-educated doctor who has held a series of high-level WHO posts. With the Ebola crisis raging in August 2014, Nabarro was tapped to take over the botched UN response and won praise for helping contain the outbreak.

Among the top priorities listed on his campaign website is aligning WHO to respond to outbreaks and emergencies.

Nishtar, the only woman in the group, has high-level experience within the UN but also founded and has led Heartfile, a respected non-profit focused on healthcare in Pakistan, possibly giving her the outsider credential that some say the agency needs.

The senior fellow for global health at the Council on Foreign Relations, Yanzhong Huang, said the 53-year-old Nishtar has impressed by voicing a clear commitment to shaking up WHO’s internal governance.

Tedros, a former foreign and health minister, is also a renowned malaria researcher, applauded for expanding access to healthcare in Ethiopia.

He is being strongly backed by the African Union and, if elected, would be the first African to lead the global health body.

While experts urged WHO members to pick the most qualified candidate, they conceded that the lobbying ahead of the May poll will inevitably be highly politicised.

“Voting... will likely be driven more by foreign policy concerns than by health goals,” said Huang, warning over the prospect of “vote buying and deal striking” among member states.