Category: Health (page 2 of 2)

Ladies and Gentlemen, Your Candidates for WHO Director-General

When I walk down the street, I don’t see signs saying “Tedros for WHO” or “Vote Szócska.” The television and radio airwaves don’t have endless campaign commercials ending with the tagline, “I’m Flavia Bustreo, and I approve this message.” Sania Nishtar does not hold large public rallies in sports stadiums to bolster her candidacy. Neither David Nabarro nor Philippe Douste-Blazy do phonebanking.

These facts don’t distract from the fact that there is a vigorous and hotly-contested electoral race for the Director-General of the World Health Organization. Think of the current period as the primaries, with the general election campaign beginning when the WHO Executive Committee forwards the names of the three finalists to the World Health Assembly in February.

When WHO reformed its processes for selecting a new Director-General (which I detailed here), they set themselves up for a new and largely unprecedented experiment. For better or worse, most international organizations select their leaders through fairly opaque processes, and the public gets little glimpse into the decisionmaking process. Even when we have seen multiple candidates competing for the top office, such as the 2012 race for the presidency of the World Bank, the formal campaigns have tended to be brief.

WHO’s election process is different. It is openly contested. It features some of the same trappings of other political campaigns. It requires a degree of public engagement not usually seen in international organizations. The United Nations’ search for a new Secretary-General was supposed to be more transparent, but the process came to a surprising early conclusion when the 15 members of the Security Council announced their unanimous support for former Portuguese prime minister António Guterres.

So far, the WHO DG election does not show signs of ending early. Part of that may be because of the procedures WHO established for the election, but it also reflects the keen interest in the job. When the nomination period closed on 23 September, WHO announced that there were six candidates:

The final list of six surprised a number of observers. Tedros (as he prefers to be called), Douste-Blazy, and Nishtar were not surprises, as all three had essentially been campaigning for months prior to the official nomination period. Bustreo, Nabarro, and Szócska, though, were not among the names being bandied about.

The candidates themselves are an interesting mix. Despite the fact that WHO has been criticized for only having had DGs from Europe or Asia since 1973, only one candidate comes from outside those two regions. Two candidates—Tedros and Douste-Blazy—have served as their country’s Foreign Minister. Bustreo is the only candidate who is currently employed by WHO, but Nabarro headed up one of WHO’s post-Ebola reform panels and previously worked in the Director-General’s office. Nishtar would be the first Muslim to lead the organization if she were selected. Three of the candidates come from traditional donor states to WHO. All but Tedros are medical doctors, while Tedros holds a PhD in community health.

As part of the campaign process, the candidates are reaching out to the voters/member-states. Four of the candidates—Tedros, Douste-Blazy, Nabarro, and Nishtar—have specific campaign websites, and Bustreo and Szócska are active on Twitter. and all six responded to a candidate survey from The Lancet. The African Union announced its support for Tedros’ candidacy (and the value of having an African in the top job) earlier this year. Given that African states are the largest single bloc within WHO, that could give him an early advantage—assuming all AU member-states vote in unison.

All of the candidates appear to meet the basic requirements for the position, so which factors are likely to make a difference in the election? Let me call attention to three issues that are likely to play a big role in the deliberations. First, WHO’s budget is a mess. More than 80 percent of its outlays come from voluntary contributions pledged for specific programs. As a result, WHO has little control over how it spends most of its money, and it lacks the financial flexibility to allow it to respond to an emergency like Ebola. That said, member-states have been reluctant to give WHO more money without seeing proof of WHO’s efficacy. A successful candidate will need to show an ability to simultaneously get WHO the resources it needs to carry out its mission and convince member-states that it can use those funds efficiently and responsibly. There may also be opportunities to develop new financing structures, like UNITAID’s airline ticket levy. (Incidentally, Douste-Blazy has been the chair of UNITAID since 2006.)

Second, WHO needs to restore its international credibility. To a large degree, that is likely to mean that member-states are going to want to know specifics from the candidates about what sorts of reforms WHO will introduce to function better. WHO cannot do everything, so the question is what direction the different candidates would go in their understanding of the organization’s scope. That will also touch on how much autonomy WHO should have: is it there simply to do the member-states’ bidding, or should it have control over its own agenda?

Finally, WHO’s leader will need to show an ability to play politics. Outgoing DG Margaret Chan has been criticized for not being an effective diplomat, especially in contrast to someone like former WHO DG Gro Harlem Brundtland. Like it or not, global health is an inherently political field; a focus on solely on the technical aspects simply will not work in this environment. Indeed, Josh Busby, Karen Grépin, and I argued earlier this year that the next WHO DG specifically needs political experience.

In many ways, the WHO DG election could provide a template for international organizations looking to elect their leaders publicly and transparently. As such, it is all the more important to keep an eye on it—and to pick up some sweet campaign swag.

So You Want to Be the Next Director-General of the World Health Organization…

It should come as no surprise to anyone that a political scientist like me gets really excited about elections and campaigns, and we’re currently in the thick of a doozy of a campaign season. Candidates have splashy websites and brochures, and they regularly meet with voters to pitch their candidacies. Whoever wins will take over an organization whose standing in the world is up in the air—and the winner will have a big job restoring the organization’s place in the larger global landscape.

Of course, I’m talking about the campaign for the next Director-General of the World Health Organization. What else would I be describing?

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National Security, Health, and Responding to Emergencies

Why don’t government officials respond to global health emergencies the same way that they respond to national security crises? This is the question Congresswoman Rosa DeLauro (D-CT) raised last week. She was speaking at the public launch of a new report by the Brenthurst Foundation on international society’s failure to respond to the Ebola outbreak in West Africa in a timely manner—but much of the conversation focused on the current response to Zika.

If military officials said they needed $1.9 billion to prevent a global crisis, she argued, Congress would not hesitate to approve the money. Unfortunately, health emergencies don’t receive the same level of attention. “Why aren’t we listening to the generals of public health?” she asked. Instead of making the long-term investments to strengthen health systems and improve detection and treatment capabilities, DeLauro noted, we lurch from one crisis to another.

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Global Health Governance Syllabi Open Thread

So, I noted in a post a few weeks ago during APSA that I thought the discipline doesn’t pay enough attention to global environmental politics. Part of this is a function of training. I didn’t have a global environmental politics course to take during graduate school, but I teach one now. I posted a few syllabi in the post and comments thread.

I think the same thing is true of global health. Politics abound with global health whether it be the Ebola virus, Zika, pharmaceutical prices, the on-going HIV/AIDS crisis, the rise of non-communicable disease, the challenges of health systems strengthening. And this stuff is important! Continue reading

What Am I Reading? Inaugural Feature on Global Health #1

I’m on leave this year so my regular blogging might be a little scant, but I thought I’d introduce a new feature which is a periodic series “What Am I Reading?” I’d like to flag what I’m  reading on different topics, namely health, the environment, and foreign policy. This first one is on health.

Zika

  • Last week I had a piece on the Monkey Cage in the Washington Post on the Zika virus, presenting some empirical work on what frames might generate public concern and, in turn, more impetus for Congressional funding for Zika control
  • My colleague Abigail Aiken finds a potential increase in demand for abortion in the Americas
  • There is growing pressure on Congress to fund efforts to combat Zika which have stalled
  • In addition to a state of emergency in Puerto Rico, there is now local transmission of Zika in Miami. CDC director Frieden suggests pregnant women stay away from Miami Beach and possibly Miami as well
  • Here a pregnant mother who lives in Miami pleads for action

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Chasing our tail: The Zika ‘emergency’ and stalled U.S. Congressional appropriations

On April 13th, the Centers for Disease Control reported 358 travel-associated Zika virus disease cases in the U.S. spanning 40 states and the District of Colombia. The U.S. territories of American Samoa, the U.S. Virgin Islands and Puerto Rico reported 471 locally acquired cases and 4 travel-associated cases. Since Zika is primarily transmitted by the Aedes species mosquito, the numbers of Zika virus disease cases are anticipated to rise once mosquito season is in full swing in the U.S. Yet, Congress has thus far refused to approve the $1.8 billion in emergency funding President Barack Obama requested in February. The House Appropriations Committee has instead asked the President to redirect funds previously designated for the fight against Ebola to the Zika outbreak.

It is puzzling why Zika has not garnered the same policy attention from Congress as the Ebola outbreak. Viewed through a security lens, the Zika outbreak more readily meets the attributes of a “threat” in its proximity to the U.S., in its pervasiveness, and in the fact that it poses a high risk for global transmission. Moreover, mobilization in response to humanitarian crises is generally more likely to occur when it strikes communities in close proximity to us (i.e. South America) or with whom we can identify (i.e. Americans).

Partisan politics might explain some of the Congressional stall tactics, though this would be a high stakes game to play.  So, what’s going on? I think the “emergency imaginary” has both enabled and constrained policy responses. First, because the Zika outbreak does not conform to conventional understandings of an “emergency,” policy action has been slow despite the demonstrated threats to the U.S. population. Second, because the Zika crisis is nonetheless viewed as an emergency, policymakers feel justified in diverting resources from other emergencies, even though it might produce mediocre results in both cases. Continue reading

Understanding the Emotional Impacts of Ebola: moving beyond crisis and stats to stories

This is a guest post by Dehunge Shiaka, researcher and gender expert in Freetown Sierra Leone

What are the emotional and psycho-social impacts of the Ebola epidemic in West Africa? With much of the media attention on the medical, international, and civil-military response to Ebola, this is a question that has largely been unaddressed. Yet it is inevitable that a virus that ravaged communities, halted economies, and killed thousands in a region would have multiple and lasting emotional impacts. Taking account of people’s extreme social and emotional reactions in emergency settings is vital to understanding the long-term impacts of Ebola. Moreover, a focused picture on emotion is necessary in trying to grasp the nature of the crisis and why resources should be dedicated not just to ‘eradicating’ the virus, but also to supporting communities struggling in a ‘post-Ebola’ era. This post provides a few examples of the emotional impact of Ebola and raises several questions about crisis, emotion, and the varying meanings of ‘impact,’ ‘virus free,’ and ‘security’ in relation to medical crises.

The first story takes place in Freetown, the capital, during the peak of the Ebola Virus Disease (EVD) outbreak in November 2014. It involved a one-week old baby who was found by the side of her dead mother. As part of the protocol at the time, the infant was driven in an ambulance to one of the holding centres for testing, but the baby was not immediately allowed in. Continue reading

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