70th World Health Assembly: Election of New Director General During Uncertain Times

The Power of Change.  From May 22- 31, 2017, NTI participated in the 70th World Health Assembly (WHA) as it met in Geneva to debate and decide on topics ranging from continued implementation of much-needed World Health Organization (WHO) reform in the wake of the 2014-2016 Ebola epidemic to the growing need for creative solutions to build and sustain country financing for outbreak preparedness and response. The most significant outcome of the 70th WHA was the election of a new Director General – Dr. Tedros Ghebreyesus of Ethiopia.  The election of Dr. Tedros, who previously served as both the Minister of Health and the Minister of Foreign Affairs in his home country, encompasses many firsts. Among them: He is the first person elected WHO Director General under new and open election proceedings in which the health minsters of 186 countries voted by secret ballot, and he is the first Director General from Africa.  Dr. Tedros will take on his new role when Dr. Margaret Chan, who has served two consecutive 5-year terms in the WHO Director General post, steps down on June 30.  He will inherit a WHO beleaguered by the slow response to Ebola in 2014, a large bureaucracy, and an ongoing major reform effort. With the ongoing calls for WHO to “reform,” Director General-elect Tedros also will need to heed to the call for WHO to “perform” – and perform efficiently – which will require funding and staffing focused on WHO’s core activities, such as the global response to outbreaks of international import.  

Amid controversy, some consensus.  Despite usual debates during the WHA on issues that often separate low-, middle-, and high-income countries – such as access to medicines, assessed contributions, and the relative importance of different types of health threats facing different regions of the world – one growing consensus emerged. Last week, during focused meetings of the Global Health Security Agenda (GHSA) Steering Group and the Joint External Evaluation Alliance, like-minded countries agreed to focus more attention on next steps to convene Ministers of Finance, as well as health and development funders and private sector representatives, to sustainably finance coordinated, measurable, cross-sectoral plans for national preparedness. An unsung achievement of this year’s WHA, 42 countries have now undergone transparent Joint External Evaluations (JEE) – peer reviews of national capacity to prevent, detect, and respond to epidemic threats – and more than 20 additional countries have signed up. The measurable targets outlined in the JEE grew out of the GHSA, a community of nearly 60 countries launched in 2014 under the leadership of President Obama and dedicated to accelerating national, regional, and global capacity to prevent, detect, and rapidly respond to infectious disease threats.  Such success in country transparency and cooperation is unprecedented in the life of the International Health Regulations and will only continue if countries are able to quickly develop and finance corresponding national plans to fill identified gaps. Assigning further urgency to this issue, on May 25, the World Bank rolled out ambitious, long-awaited recommendations to achieve pandemic preparedness financing – in strong support of all countries undergoing JEE and financing national plans for preparedness, and the development of health security indices and other tools to incentivize new commitments and hold countries accountable for those commitments already made. To bolster these vital efforts, NTI is developing a Global Health Security Index, in partnership with the Johns Hopkins University Center for Health Security and the Economist Intelligence Unit. This October, when Ministers meet in Kampala, Uganda for the fourth-annual GHSA High Level Event, they should call on all countries to publish priced out, financed, multi-sectoral national plans for pandemic preparedness within 2 years’ time.


Paradox: U.S. Commitments to Global Health Security.  During the WHA, the United States firmly announced its continued support for the GHSA and its commitment to advancing that agenda. However, while supportive statements from Secretary Tom Price and other U.S. officials were well-received by partner countries concerned about waning U.S. leadership, President Trump’s Fiscal Year 2018 budget proposes to significantly slash the very appropriations that advance health security, save lives, reduce the threat of bioterrorism, and keep America – and the rest of the world – safe and secure from biological threats. For example, the proposed budget would cut core global health security programs at the U.S. Centers for Disease Control and Prevention and the U.S. Agency for International Development, including funding for deployed disease detectives focused on finding and stopping outbreaks at the source. Much like other elements of our national defense, our national biodefense relies on experts in the field, who can assist host nations in quickly identifying and snuffing out outbreaks – before they flare into epidemics that spread and threaten lives at home and abroad. These are the forward-deployed “smoke detectors” of our national disease surveillance system, and if these experts are called home in 2018, we will be inarguably less safe.  We also need to maintain key U.S. efforts to bolster biosecurity and biosurveillance, including the Department of Defense Cooperative Threat Reduction, Cooperative Biological Engagement Program and the State Department Biosecurity Engagement Program. These U.S. efforts work together toward common targets to help prevent bioterrorism, detect threats early, and respond quickly and effectively. Similarly, these investments cost a fraction of the billions we invest for outbreak response when a disease threat is not rapidly detected. Finally, countries with weak health systems, subjected to major outbreaks, are at risk of political collapse – inviting further instability for regions already battling terrorism and fighting to maintain democratic institutions. 

Toward Greater Accountability for Stopping Outbreaks at the Source. While progress has been made, the WHA showed that much work remains to cement lessons learned from Ebola and to ultimately achieve the GHSA’s vision of a world safe and secure from infectious disease threats. One starting place is for global leaders to recognize that we are less safe and secure when we cycle through moments of sustained funding (“panic”) and severe cuts (“neglect”). Instead, policymakers should aspire to achieve a state of constant vigilance, where health security and biosecurity are consistently treated as a national, regional, and global security priority on par with other transnational threats like cybersecurity, counterterrorism, and climate change. Similarly, we must hold ourselves and our partners accountable for the commitments made to assist others.  The United States has made major commitments to the GHSA, including $1 billion in Ebola emergency resources and an agreement to assist 31 countries and the Caribbean Community to achieve specific, measurable targets. This commitment must continue, and core funding for the U.S. Government budgets that support this work must be sustained and grown. Additionally, other partners, including the G-7 leaders and some G-20 and Nordic countries, have also made major commitments to assist at-risk countries, and these commitments should be more specifically outlined, tracked, and delivered.  Such commitment accountability is not only important, it’s essential – not only for donors, but also for host countries, the private sector, the World Bank, and the public. In this fight, we literally cannot afford to fail.  


June 2, 2017
Elizabeth Cameron, PhD
Elizabeth Cameron, PhD

Vice President, Global Biological Policy and Programs

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