Candidates for WHO director-general discuss challenges, priorities
With the World Health Organization (WHO) set to name a new director-general in May 2017, the editors of The Lancet sat down with the six candidates running to replace Margaret Chan, MD, MPH, as the head of the world's only multilateral health agency.
The new director-general will face several challenges, among them rebuilding the WHO's reputation in the wake of its much-criticized handling of the recent Ebola crisis. Here are some of the highlights of the interviews, in which the candidates were asked to list the three biggest global health threats and the priorities they would focus on as director-general:
Tedros Adhanom Ghebreyesus, PhD (Ethiopia): Adhanom listed unequal access to health coverage, antimicrobial resistance and health emergencies (including infectious disease outbreaks), and the health impacts of climate change as the world's biggest health challenges, and said two of his main priorities would be transforming the WHO into a more effective and accountable agency and advancing universal health coverage. "We need a WHO that belongs to all of us equally, puts people first, and ensures health is at the centre of sustainable development efforts," Adhanom said.
Flavia Bustreo, MD (Italy): Bustreo said epidemics and humanitarian emergencies, the slow response to the negative health effects of climate change, and the demands of aging populations are the biggest health threats the world faces. As director-general, she added, she would prioritize expanding universal health coverage, reforming WHO so that it can more effectively help member states respond to health crises, and addressing health impacts of climate change. "We must maximise efforts to achieve equity using a human-rights-based approach in health and sustainable development," Bustreo said.
Philippe Douste-Blazy, MD (France): Douste-Blazy listed the persistent risk of emerging epidemics, the increasing prevalence of non-communicable diseases, and diminishing attention to health as a public good as the three biggest health threats facing the world. He said ensuring the WHO responds effectively to emerging (and re-emerging) infectious disease would be among his top priorities as director-general. "Under my leadership, WHO will demonstrate a strong culture of responsiveness, especially with regard to health emergencies, drawing upon the difficult lessons of Ebola and other recent health crises," he told The Lancet.
David Nabarro, MD (England): Nabarro said poverty, inequality, and weak governance; existing and emerging infections, and nations viewing health and healthcare as a low priority are the three biggest global challenges to health. As director-general, he would focus on aligning the WHO with the United Nations' Sustainable Development Goals, transforming the agency to better respond to health emergencies and outbreaks, and advancing people-centered health policies. "As I see it, the need for a robust, reliable, and responsive WHO has never been more urgent," Nabarro said.
Sania Nishtar, MD (Pakistan): Nishtar listed infectious disease outbreaks, antimicrobial resistance, and the "silent pandemic" of non-communicable diseases as the world's leading health threats. She said making the WHO more transparent, accountable, and prepared for outbreaks and health emergencies would be her top priorities. "In a world brimming with unprecedented opportunity for health improvement, WHO faces structural limitations and reputational damage," Nishtar told The Lancet. "The new Director-General must usher in an era of renewal."
Miklos Szocska, MD (Hungary): Szocska said the health impacts of climate change, irresponsible individual and social behavior that leads to health problems, and the emergence of big data in health and genomics are the most pressing priorities. As director-general, he said managing pandemics, ensuring sustainable funding, and fostering development of new antibiotics would be among his top priorities. "The world needs WHO as a leading international change agent for health, an agile global agency to deal with the extremes and the unexpected," Szocska said.
Oct 13 Lancet special report
Monkeypox outbreak reported in Central African Republic
The WHO yesterday reported more than two dozen cases of monkeypox in the Central African Republic.
According to a WHO news release, 26 patients with suspected monkeypox were admitted to the Ira Banda health center in the Haute-Kotto health district between Sep 4 and Oct 7. Three of the cases have been laboratory confirmed. The index case became sick on August 17 and died before specimens could be collected for lab testing.
Monkeypox is transmitted to humans through contact with an infected animal or through infected animal bites, and person-to-person transmission can occur through close contact with an infected individual. While small-scale outbreaks regularly occur in tropical Africa, the WHO says monkeypox transmission cannot be sustained through person-to-person contact alone.
The WHO says it is responding by strengthening surveillance for possible cases, increasing public awareness, and training healthcare workers to use personal protective equipment. Because the outbreak occurred in a remote and sparsely populated area, the risk of international spread is considered to be low.
Oct 13 WHO news release
Laos reports H5N1 avian flu on small poultry farm
Laos has had an outbreak of H5N1 avian flu on a small poultry farm in the northern part of the country, its first involving that strain in more than 6 years, according to a report today from the World Organization for Animal Health (OIE).
The affected farm is in Luang Prabang province, and the outbreak began Sep 28. Of 130 chickens on the farm, 47 contracted the disease and died. The remaining 83 chickens and 20 ducks on the farm were destroyed to contain the outbreak.
Tests from a national lab came back positive for H5N1 on Oct 5. Officials have taken steps such as curtailing poultry movement, disinfecting the premises, and establishing a surveillance zone around the farm.
Laos had not reported an H5N1 outbreak since May 2010. Its most recent outbreak of highly pathogenic avian flu was a bit over a year ago and involved the H5N6 strain.
Oct 14 OIE report
On 70th CDC anniversary, Frieden talks progress, future goals
In an interview yesterday in JAMA to mark the 70th anniversary of the US Centers for Disease Control and Prevention (CDC) this year, Director Tom Frieden, MD, MPH, highlighted several of the agency's successes—such as helping nations worldwide establish rapid disease-detection systems—while outlining what he still hopes to see, such as curtailing the spread of HIV.
Frieden said the West Africa Ebola outbreak of 2014 through this year provided many public health lessons. "First, countries around the world need to get better at finding, stopping, and preventing health threats [by] improving laboratory systems, disease detection systems, rapid response systems, surveillance and monitoring systems. At CDC we've helped more than 40 countries develop their own systems for rapid detection and control, but we also know that the world has to be ready to surge in when a country is overwhelmed."
Another success Frieden noted is the Advanced Molecular Detection Initiative. "This is a $30-million-a-year initiative, now in year 3 of 5. This uses new powerful pathogen detection techniques to find outbreaks sooner and respond faster. In the Zika virus response, we've been able to use the molecular detection infrastructure to type the recently emerging virus, to help establish a diagnostic test, and to validate that test with partners around the world in weeks, when something previously would've taken 3 to 4 months."
In response to his greatest goal for what is yet to accomplish, Frieden said, "Ending polio forever, preventing a million heart attacks and strokes through the Million Hearts initiative, turning the tide on the opioid epidemic, beginning to get an even better handle on the HIV epidemic, reducing teen pregnancy and motor vehicle crashes, turning the obesity epidemic around, achieving, as we have, the lowest proportion of US smokers in US history.
"We've seen progress on many of those specific efforts, but the more general issue is ensuring that the CDC continues for the long term as a scientifically rigorous, independent technical agency that has operational excellence on the ground throughout the US and throughout the world."
Oct 13 JAMA interview