A Healthier and Safer World: An Interview with Dr. David Nabarro

Imagine a safer and healthier world. A place where diseases did not fester for months or years until public outcry demanded action. A world without pandemics, and one with thriving, healthy children. And, a time when we take a global view of health rather than hoping that political borders were enough to protect us. In the reality of today's world, everyone's health is intertwined.

Governments and international bodies such as the World Health Organization are needed for leadership and support, but we all have a stake in this vision and we all have a part to play.

This week I had the opportunity to query Dr. David Nabarro on his thoughts about a healthier future for our world. In the past 12 years, successive Secretaries-General of the United Nations have entrusted Dr. Nabarro to lead action on some of the most pressing and complex challenges of this century - responding to influenza and other pandemics, promoting food security, ending malnutrition, and advancing efforts relating to climate change.

WBK: Balancing expectations with possibilities underpins every effort. How would you put this concept into the context of global health?

DN: There can be few achievements that better demonstrate the power of collective human effort than the end of a disease. Thirty-five years ago the world saw the last case of smallpox. I am hopeful that during the coming five years the world will succeed in eradicating two more diseases and making substantial progress on three others. With the ongoing engagement of multiple trusted partners, the last remaining countries that suffer from polio should be able to stop the transmission of this crippling disease by the end of 2017. The symbol of medicine includes the Rod of Asclepius (a snake wrapped around a staff). Some believe it represents the Guinea worm, a parasite that causes significant pain and disability. Like polio, the disease has been dramatically reduced and within five years WHO could - once again - be the force that catalyzed the eradication of a terrible disease - this time, ending the scourge of Guinea worm.

The peak of the HIV/AIDS epidemic has passed but a redoubled global effort will be needed to achieve the Sustainable Development Goal of ending the epidemic by 2030. This will require a relentless focus on people, continuous innovation, and sufficient funding.

Malaria is one of the greatest killers known to humankind. The number of deaths from malaria is down by about 60% since the year 2000. The experts tell us that malaria can be eradicated within a generation. Even though large-scale and widespread challenges stand in the way, this is an opportunity the world must seize.

There has also been exciting progress to combat Tuberculosis (TB), but too many people are still in danger because they have drug-resistant TB. Like HIV/AIDS, this problem needs concerted effort - innovation, energy, finance and partnering.

WBK: Speaking of drug resistant infections - or superbugs as many people know them - the issue seems to be a hugely under-appreciated problem. They affect both people and animals and their impact can range from preventing routine surgery to food production systems.

DN: Yes, Antimicrobial Resistance (AMR) is one of the critical global public health priorities of our time. While projections vary widely, it is clear that the lives of many people will be in danger if there is not determined action now. Here is one prediction: by 2050 around 10 million will die of Antimicrobial Resistance every year- more than of cancer.

Why is this? On the one hand, antibiotics are low-cost medicines. Overuse and misuse in humans and animals is substantial. This leads to microbes becoming resistant. On the other hand, there have been few new antimicrobial medicines in the last 2-3 decades and there are also too few being developed. This lack of innovation is largely a problem of incentives, and not one of insurmountable scientific hurdles.

It is possible to address these challenges, but it will take time and we therefore have to start now. As you mentioned, it is not only a human health issue but involves animal health, agriculture and food production as well as the environment at large. The water in some rivers has higher concentrations of drugs than are found in the human body when someone is taking a course of treatment. The use in animals is necessary for humane reasons, and agricultural productivity is absolutely critical for the development of many countries and ensuring human nutrition. But, sound approaches need to be agreed upon and implemented.

It is important that the whole of society is involved, not just the experts who put the issue onto the global agenda. The world is responding to HIV and climate change because governments have been encouraged by their people who - through civil society, businesses, and parliamentarians - are pushing hard for action.

WBK: What about diseases that are not infectious or contagious?

DN: Non-communicable diseases (NCDs) are the leading cause of mortality and morbidity worldwide. NCDs are responsible for 7 out of 10 deaths globally - or 38 million a year. WHO and its Member States have helped dispel the belief that NCDs are primarily a concern of high-income countries. The burden of NCDs is truly global: almost 75% of deaths occur in low to middle income countries. Almost half of the NCD burden is due to cardiovascular disease, with cancer and chronic lung disease accounting for much of the rest. The rise of NCDs has been primarily driven by four major risk factors: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets.

The focus must constantly be on 'how' as well as 'what'. The area that needs the greatest attention is the prevention of NCDs through increased attention to the risk factors. Prevention consistently receives less attention than it deserves and I know from discussions with Health Ministers and senior officials, experts and activists, that this is an area on which there is increasing consensus throughout the world. The challenge is to ensure that the setting of priorities and allocation of resources across different sectors of government and society - not only the health sector - reflects this priority.

WBK: Your leadership has been called upon repeatedly to tackle big disease issues that have required immense teamwork among professionals and coordination among organizations, businesses and government. What's the secret to success?

DN: I will point to a number of factors that have allowed me to resolve complex problems by bringing people and organizations together.

First, it's essential to see the bigger picture. When handed an issue, like a health crisis, I immediately place it into context. Health underpins global security. Keeping this mantra in mind, and in the minds of my team and partners, allows successful cooperation on the route to solving an issue.

Second, An inclusive and accountable style of leadership is essential. I have never overlooked the importance of having a strong, geographic and gender representative management team. I provide my team with space to fulfill their mandates, whilst providing strategic direction. I simultaneously apply this attitude outside of my team, to working with, as in the case of the UN, Member States. Taking account of the interests and needs of each Member State, and then engaging additional actors in principled and transparent ways, is key to success.

Lastly, I am truly results-driven. Looking forward, success for the WHO should be judged by the extent to which the organization is able to catalyze those actions which ultimately have a substantive impact on health outcomes.

WBK: Thank you for sharing your thoughts with us Dr. Nabarro. I know that you have recently been honored to be one of a select few nominated for consideration as the next Director-General of the World Health Organization. Given your experience and vision, I can only say that we all will be in good hands if you are elected for the post in May.

Postscript:

While it's fair to describe many of our colleagues as a "consummate professional," Dr. Nabarro far exceeds that definition and has served as a beacon of light to those of us working to making our countries, our people, and the world a healthier and safer place. In fact, he enlisted me along with many colleagues from around the world to form a broad multi-disciplinary volunteer network of scientists, government authorities and private sector leaders called Towards a Safer World. His ability to grasp complexity, to listen and really hear what people are saying and synthesize that information into actionable next steps is exceptionally remarkable - something we all hope for in the person to take the helm of leadership at WHO.