Health needs to be looked at as a rights issue, says front-runner for post of WHO chief

This May, the World Health Organisation will get a new director general, after Dr Maragaret Chan resigns from the post. Among the top three contenders for the post is Dr Tedros Adhanom Ghebreyesus, who is currently special advisor to the prime minister of Ethiopia. He was the country’s health minister for seven years, from 2005 to 2012. He has also held top posts in international bodies like the Global Fund to Fight AIDS, Tuberculosis and Malaria and chaired the Roll Back Malaria programme.

The WHO’s role is to direct and coordinate international health efforts within the United Nations system and help countries tackle old and emerging health problems around the world, from rising pollution levels in major cities to seemingly intractable malnutrition in the poorest countries.

In recent years, however, the organisation has been criticised for its response to public health crises like Ebola, which claimed more than 10,000 lives in West Africa between 2014 and 2016. The organisation has also been weakened by concerns over funding. A bulk of its funds come from private organisations, which has also led to controversies about possible conflicts of interest.

In Delhi to campaign for the WHO elections, Ghebreyesus, who has a PhD in community health and a master’s in immunology of infectious diseases, spoke to Scroll.in about his vision for the organisation.

You mentioned in your presentation before WHO member states that you can bring a fresh perspective of a person from a developing nation. What do you think is lacking currently in the WHO’s approach?
The fresh perspective comes from my experience of working in a resource-constrained country which was also heavily burdened by diseases. In many of these countries, capacity is lacking. When we talk of health systems strengthening, primary health care is very important and also the focus on health promotion and prevention of diseases.

When I was health minister, I designed the reform of the Ethiopian system, implemented the reform and stayed as minister long enough to see the impact of the reform. The comprehensive reform we did was based on WHO guidelines which covers all the building blocks of the health system – service delivery, workforce, information system, pharmaceutical finance system, health financing, and emergency preparedness.

In Ethiopia, HIV and TB is declining. So, it is all about going back to the basics.

One of points you made in your presentation is that WHO needs to own itself. Only 20% of the funding comes from member states and the rest comes from voluntary donations. How will you ensure there is no undue financial influence?
There is a combination of things we can do. First of all, we need to add value for money. We can prioritise better and focus on areas where WHO has a better comparative advantage. By doing this you can use your money wisely and save money. If you do not have anything to save, you can at least focus your intervention and you will have resources for priority areas.

The second important thing to do would be to increase or expand the donor base. If you do that the influence gets less. A lot of funding comes from the United States, be it government bodies or private institutions. To some extent the United Kingdom and a few other countries contribute to WHO funding. We have to expand the donor base. Otherwise it will lead to donor fatigue.

The other important element is increasing the assessed contribution [contribution by member countries]. In the past it used to be more than 80%. Now it is not more than 20% and this is not good. We have to continue to make our case to member states to increase the assessed contribution.

Another thing we can do is to ensure that the funding we get from partners or donors are not earmarked. If it comes as basket funding [funding for agreed programmes], then it gives responsibility to use the money in a certain way.

We should consider those as a combination of measures that could reduce the influence of donors. The WHO funding should be predictable and flexible, wherever the money comes from. That will give WHO its freedom.

When we talk about health for all, many countries including India are looking at engaging with the private sector and providing insurance cover to citizens. In your speech, you mentioned that some countries like Sri Lanka have built a formidable public health system that covered even cancer care. Is it possible for all countries to build such strong public health systems?
It is possible to build such systems. Sri Lanka is not a rich country. Resources matter, of course. But it is more important to have political will.

For that you need to accept health as a rights issue. Investing in health is not a waste but actually a means to development. By having a healthy society, you develop as a society.

There are countries in several corners of the world who have already done it and benchmarking their practices is important. Some countries are afraid of the unknown. Health sector is really expensive. They may think ‘If we promise to give full coverage, then we may have difficulty covering it’. If that is their fear, it is good to start learning from others and see how those countries did it with less resources, learn from them and tailor it to their needs.

How do we ensure affordable medicines for all?
Access to medicines is an important part of Universal Health Coverage. Many people are dying because they cannot afford expensive drugs although there are drugs that can save their lives. It is immoral. When we have the means at hand and choose to see a human being dying, it is really unacceptable.

What we should do is the increase local production capacities of countries. But we have to combine that with ongoing negotiation with the TRIPS [Trade-Related Aspects of Intellectual Property Rights] agreement. Discussion of intellectual property rights should continue. WHO should really advocate this as a public health issue. This is also a political issue and member states should really be engaged in this with open minds. They should not strictly look at this issue with profit margins in mind.

We have to also see it from the pharmaceutical side. They have expenses. There are some difficulties they face. What can we do to understand their challenges? The United Nations recommendation on intellectual property rights from the high-level meeting last year in September is delinking research and development from the cost of the drug. We could consider that.

We need to strengthen regulatory capacity. Surveillance of prices of drugs is important. Some countries are capping the price of drugs so that more people will have access to drugs.

How should the WHO look at the problem of antimicrobial resistance?
On antimicrobial resistance I would say better late than never. We are late. If we can make it up now aggressively and with a sense of urgency, we can still make a difference.

The WHO should really be very active. It is not that active. Especially to ensure political involvement on the issue. This issue cannot be left to the health minister or to the health sector alone. It covers many sectors like agriculture, food production and so on.

There is a very good first step now. We had a resolution passed by the UN General Assembly to tackle antimicrobial resistance. But I sensed one problem during my visit to countries for my campaign. Countries need to own this issue at a national level and you do not see that level of awareness. You have a resolution at the top, but without a foundation it will fall apart. We also need to work with countries and sub-regional organisations.

This is not about manufacturing new drugs because we have superbugs, but it is also about the use of drugs and monitoring them. We have to see this in totality and we have to do this with a sense of urgency.