Electing WHO’s New DG: Laurie Garrett Q&A, Part I

WHO Headquarters, Geneva, Switzerland
Image credit
The WHO’s new era began with a transparent election process that selected Tedros Adhanom Ghebreyesus. Image: Brian W. Simpson


GENEVA This year’s election of the new Director-General of the WHO was a victory not only for Tedros Adhanom Ghebreyesus but for transparency, says Laurie Garrett, senior fellow for global health with the Council on Foreign Relations. She has followed global health for more than 30 years as a journalist and an author (“The Coming Plague” and “Betrayal of Trust”), attending the World Health Assembly meetings since the 1980s. During a brief break the day after Tedros’s May 24 election, Garrett reflected on the DG election process as well as priorities and prospects for Tedros’s tenure.

Let’s start off with your reaction to the election of Tedros as the next director general. What do you think?
Well, first of all, I think it is really great that we had an election, and that the whole process went quite smoothly—better than most people thought it would.

Because this one was more transparent than those in the past?
Well, it’s the first time ever. And there isn’t anything to compare it to, because in the past, everything was closed-door, with a small group of the Executive Board. And they might have multiple rounds of voting. I believe 1 went 10 rounds before they reached a conclusion. But it’s a total of, like, 34 voters representing the wealthy countries, plus a rotating pool of the rest of the membership. So it was never an inclusive process. And that also meant that all the campaigning just focused on those 34 voting countries. So, you went to Washington, you went to London, you went to Paris, and then Tokyo, and maybe 10 other places.

What we’ve seen is, 3 main candidates—and even more in the original pool—have spent a year traveling all over the world, to some of the smallest countries in the world, as well as large [ones], to poor and rich. Listening, as Tedros put it. And because the process was so transparent, I don’t believe that there was any bribery this time.

Really? I remember you had noted hearing something in the past—
—Oh, yeah.

—that you had a great story about that.
Yeah, I mean, bribery was rampant. When you had the closed process and a finite number of voters, and an even finiter, if you will, number that came from poor countries—it wouldn’t take a lot to win their vote. You’d just say, “Look, I’ll give your son-in-law a job in Geneva, put your kids through Geneva private school, and we’ll build a clinic named after your president in the capital,” and so on. So, your country was doing the bribery. You know, it’s not the candidate directly, although the candidates made promises.

One very, very prominent former candidate, who came very close to winning, about 3 elections ago, told me an example of a Minister of Health, who was one of the Executive Board voters, who sat right next to him at lunch, and said, “Tell me what job you’re going to give me in your administration, and how much you’ll subsidize my family, my large family, and their lifestyle in Geneva, or there’s no point in talking further.”

Wow.
Just no interest in policy, nothing. It was all, just blatant.

And you think that really changed this time?
I do.

Just because of the scale of the election, having all of the member states eligible to vote?
Well, first of all, 2 out of the 3 candidates came from countries that couldn’t give away anything. Pakistan doesn’t have money to throw around, and certainly Ethiopia doesn’t. The second thing is, in terms of making promises of jobs they would give, well, we won’t know what promises Tedros may have made, until we see who is on his transition team, and who he ends up appointing in top posts. I would hazard to predict that he will put more Africans in positions. But I don’t think that’s because he got their votes.

Let’s move to your thoughts on prospects for his tenure as Director-General.
Well, his number one challenge is going to be money, money, money, money, money. And that would be true, regardless of who won. [David] Nabarro’s promise, as a candidate, to voters was, “Look, I’ve been really good at raising money in the US system,” which is true. He has. And so, you know, “I’ll be able to ease this pain more effectively and more rapidly than my opponents.” And it was a reasonable case for him to make, given his track record. However, the problem is that, his final run has weakened as much as everybody else’s. I mean, we’re so far behind in fundraising for Haiti, it’s ridiculous. They need billions, and it’s, you know, tens of millions have come. So, money would be a problem for all of them. In Tedros’s case, the timing—the other big problem that all of them are going to face is this anti-globalization spirit in the United States and Britain, and in some other key parts of the world. Of course, it’s not a universal thing. I mean. China is embracing globalization, and so is Japan, and most of Africa has benefitted from globalization and loves it. So, I think he’s going to face this challenge that the anti-globalists are into retrenching resources. They don’t believe in soft power. They don’t believe, writ large, that it’s the role of a wealthy government to support the basic human needs of people in poorer countries.

And do you think the proposal by the Trump administration for the next year’s budget—do you see that that scale of those cuts would be likely to go through?
No. Well, reading the tea leaves on the Republican Party is turning out to be awfully difficult. (Laughs.) You know, the House—I think we’re seeing a bigger and bigger divide between the House and the Senate. And the most rational Republicans are all in the Senate. On the House side, it’s the Tea Party, what’s left of it, and the Freedom Caucus that are really calling the shots. I mean, I think everybody was shocked about the first round of Trumpcare, to see how much clout, basically, about 15 guys calling themselves the Freedom Caucus had. And on the Senate side, you know, I don’t think that many of us thought that all the hopes and aspirations of the world would end up resting on Lindsay Graham’s shoulders.

There’s always plenty of surprises out there. (Laughs.)
Well, one last thing about America, you know, it’s well known by [US Health and Human Services Secretary Tom] Price’s folks that Tedros was really Obama’s candidate. And the Obama administration supported him very strongly. So, I don't know how the US ultimately voted. But he was not their first choice. So, he has to win over the global health team inside of the Trump administration before he can really start working the Hill, and so on, for money. They have to be, at the very least, not blocking him.

 

Read Part II of Brian Simpson's interview with Laurie Garrett here.

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1 comment

Dr Elvira Beracochea
May 31, 2017

I agree that money is going to be a challenge to Dr Tedros. And, showing that WHO is investing its resources efficiently and transparently is going to be a challenge. WHO lacks a global health strategy that demonstrates how it will help at least a limited number of the most needy countries to achieve SDG3 by 2030. WHO seems to have abandoned the Primary Health Care Strategy it so much developed in the last 40 years and what it said in its 2008 World Health Report of "Primary Health Care, now more than ever." What we, global health professions, see now is a fragmented and unfocused strategy towards universal health coverage that hopes to somehow to work out. It is time to really take the WHO's constitution into the 21st century and progressively demonstrate that countries are actually covering more people with quality services. Dr Tedros will need all our help and support to make it happen.

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