To deliver on its mandate of ensuring that people around the world have the highest possible standard of health, the WHO must “constantly transform” itself, says WHO DG candidate David Nabarro. Leading that kind of change will be a challenge for anyone taking the reins of the organization that’s been accused of being dysfunctional, hidebound, and hobbled by bureaucracy and an unwieldy system of regional offices.
Yet Nabarro, a longtime veteran of WHO and UN work, argues that he can drive the necessary transformation. In this second part the GHN Q&A series, Nabarro reflects on lessons he learned by heading up reforms to WHO’s outbreak and emergency response following the Ebola outbreak. He also shares insights into the changes he would prioritize for WHO.
You led the advisory group on reforming WHO’s outbreak and emergency response in 2015 and 2016. What’s the most important thing you learned about WHO’s shortcomings through that experience?
Successive UN Secretaries–General have asked me to lead the response to outbreaks such as avian and pandemic influenza, Ebola and cholera so I know what is required.
First of all, WHO’s work on outbreaks must at all times be impartial, focusing on the collation of reliable information about the extent to which people are suffering with suspected or confirmed illness. This requires trusting relationships between national authorities and WHO, with nations prepared to share sensitive information with WHO, and WHO handling this information in confidence while agreeing with the nation on the degree to which the information should be communicated to the wider public. It is the responsibility of the Director-General to ensure that the interests of public health are served at all times.
Second, to ensure that the system for responding to outbreaks is predictable and dependable, it should be implemented through a single cross-WHO program with a single workforce and budget, one set of performance standards and clear lines of responsibility. The WHO’s Global Policy Group and the World Health Assembly have agreed on these changes.
Third, WHO must be agile in convening surveillance, monitoring and the capacity to alert nations when worrisome patterns are emerging. This should be done without convening a formal expert group to declare a Public Health Emergency of International Concern.
Fourth, there should be regular simulations to test WHO systems and the interaction between WHO and the Member States.
But the most important element of the response system must be the capacity of communities and nations to themselves detect threats, to react promptly and to prevent their escalation. This calls for national action and international support, with partners being convened and guided by WHO, in line with the International Health Regulations. If such elements had been in place before Ebola hit West Africa in 2013–2014, the affected nations would have not have lost so many of their people.
In times of health outbreak and emergency, the WHO must be able to provide strategic direction to all involved. I have worked on emergency responses throughout my career and have myself seen some of the challenges of ensuring adequate local capacity for effective responses. I have also instituted the action needed to improve capability and will ensure that the whole of WHO is properly prepared to respond to the full range of outbreaks and hazards wherever they might occur.
What would you change about WHO?
Enabling all people, everywhere, to achieve the highest possible standard of health is WHO’s constitutional mandate. I believe the organization must constantly transform so that it delivers on this mandate.
WHO must draw on its position as the global standard setter for people’s health. This means being a catalyst, working in support of national governments and partners, enabling them to achieve priority impacts. This also means diminishing the number of small projects for which WHO acts as an implementation agency and relying on others to implement wherever possible. I will ensure WHO scales up a dynamic approach to disease outbreaks, working through governments, NGOs and other actors. It must be first on the scene in any global health emergency and offer strategic direction for responses.
Noncommunicable diseases (NCDs) are the cause of most deaths in today’s world. Many NCDs (such as diabetes and cardiovascular disease) can be prevented at low cost. Others can effectively be treated if diagnosed early. I would like WHO to support national authorities as they seek ways to prevent NCDs and to implement early detection and effective treatment. All these issues require WHO to work with countries as they establish health systems accessible to all, especially women and children. The needs are particularly great in the least developed countries, in communities affected by violent conflict and among societies that are vulnerable in the face of adverse climate events.
WHO must be transparent about all its activities and demonstrate clearly the value gained as a result of all investments made. I have the experience from working within communities and as a leader, as well as within multilateral organizations. I am ready to deliver the changes that WHO needs.
What’s more important to a DG: global health experience or political skills?
You need the perfect balance of the two – you are working with politicians so you need to know how to negotiate with influence and integrity, as well as maneuver large organizations which requires astute judgment.
But you also must command the respect of medical professionals the world over, and make decisions that each and every one of them—so having clinical experience is absolutely vital. The WHO is the standard bearer across the world for medicine and you need to have the experience of delivering the care you are encouraging others to take up. When it comes to health and clinical decisions knowing the theory is not enough.
I believe through my experience in the field, and working in senior leadership position in multilateral organizations, that I have the skills for this job.
This interview has been edited for clarity and length.
Read other installments of Global Health NOW’s 4-part Q&A with David Nabarro here.
See the recent GHN Q&A series with DG candidate Sania Nishtar here.
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