Global threats are rising. Rising inequity, rising discontent against political leaders, extremism, terrorism. As we grow more globalized, more inter-connected, so do we grow more vulnerable to each other's difficulties. For instance: difficulties in controlling aggressive epidemics in a few countries can now have immediate effects over the entire planet: people can panic, international travel and trade can plummet, and economies can stumble, with many ripple effects.
As the last decade's influenza, Ebola or Zika crises have shown, threats to public health will increasingly come from the global level. However, the good news for us all is that globalization also offers unique opportunities to improve our world health.
As a former Health Minister and Foreign Affairs Minister, I have seen with my own eyes where opportunities for a pro-health globalization lie. We are fortunate to already have a tool: our United Nations' agency for health, the World Health Organization, which stands at the core of those opportunities -- if we can reform it and focus it on its areas of highest impact. While everyone agrees on the need to reform WHO, the matter of how to reform has garnered few proposals. Below is the plan that I would respectfully like to propose to the global community on how achieve this.
READY FOR THE NEXT WAVE
In 2015, following the WHO's difficulties in responding to the Ebola epidemic, the world's governments took the excellent decision to formally set up within WHO a new, comprehensive Programme on Health Emergencies. This programme must now urgently be scaled up, empowered with clear lines of authority, transparent functional links with other parts of the organization, and a mechanism for independent assessment of the severity of disease outbreaks.
Rolling out the Health Emergencies Programme (HEP) and ensuring its delivery will be one of the highest priorities of the WHO's next leader. The first order of business will naturally be to secure proper long-term funding for the HEP, both by reallocating part of WHO's existing core funding, and by finding new external sources. For this purpose the WHO's Director-General should appoint one of their closest aides to support them full-time on this particular resource mobilization effort.
The HEP must be given authority to coordinate across all of WHO the essential function of truthfully mapping the country-level bottlenecks that prevent the implementation of the world's International Health Regulations - this well-known set of medical and non-medical precautions that, together, prevent diseases from spreading too fast. This authority vested in the HEP will in particular help mobilize the WHO's various departments that assist Member States in securing the resources they may need to implement their plans on health system strengthening and International Health Regulations rollout.
FIT FOR PURPOSE
In order for WHO to deliver stronger results for Member States, the latter should focus a greater share of the WHO's resources on achieving a smaller set of objectives, and agree a 15-year plan to deliver the health results that UN leaders adopted as part of the Sustainable Development Goals for 2030 (such as universal health coverage or ridding the world of the scourge of AIDS).
In order to ensure that Member States can achieve strong health results by 2030, WHO should concentrate strongly on its top 5 priorities over this entire period -- those being systemic priorities that can drive the greatest contribution to the agreed world targets. This sustained focus would be shown by devoting 50 percent of WHO's total resources to these top 5 priorities. The following top 15 priorities would receive 30 percent of WHO's resources, also sustained through a 15-year continuous effort. The remaining 20 percent of WHO's resources would be allocated by Member States to priorities that they will be re-set in 2020 and 2025.
Concerning resource mobilization for the WHO's core functions, I would like to contribute my experience in innovative financing for health (air ticket levy, extractive industry contribution) and establish a Task Force to examine how new approaches to financing for development could provide additional funding to WHO.
Like any large or aging organization, WHO faces the risk of becoming excessively bureaucratic. In order to limit this, we should set clearer lines of accountability between the Director-General, Regional Directors and country offices, and support them with explicit delivery agreements between the various levels of the organization. We should also reform human resources management so as to increase career rewards to executives who excel simultaneously at results delivery and organization-wide team spirit, including by facilitating for staff who wish to experience sabbaticals at outside health organizations to keep contributing to WHO's work while doing so. Finally, WHO must achieve full gender parity within the next 5 years.
Besides focusing a greater part of its energies on a smaller set of priorities, in order to guarantee it can deliver results, WHO must also select as priorities the areas where it can bring the most comparative advantage, drive the most change, and trigger the most real-life impact. Member States should select for WHO five areas that can most benefit from the agency's unique ability to convene, collaborate and promote collective action in global health. Below are the five top issues that I would respectfully bring to this conversation.
1. Outbreak response The overarching priority for WHO should be to ensure the aggressive scale-up of an effective and well-funded Health Emergencies Programme. Very concretely, the immediate priority for the HEP will be to strengthen outbreak risk analysis and mapping, to better predict the highest risk countries -- so that personnel, financial resources and capacity building can be targeted in a prioritized manner. This will require increasing WHO's frontline capacity at regional and country levels, including greater decentralization of budgets and staff to key regions and countries and a more flexible, globalized WHO workforce.
Each HEP priority country should receive from WHO "surge support" for developing a plan to roll out full implementation of the anti-epidemic precautions known as "International Health Regulations", and a plan to improve its health emergency preparedness. WHO must provide stronger assistance to countries to raise the financing needed to then implement those plans. An effective accountability mechanism must be set up at global level to ensure that countries report regularly on their compliance with the International Health Regulations. Country preparedness must be measured more rigorously, eg via regular emergency response drills.
2. Cancer, heart disease and other NCDs The situation of Non-Communicable Diseases (NCDs) is a looming disaster. If we fail to act soon, NCDs will reach such levels in low-and middle-income countries as to cost upwards of US$ 7 trillion in cumulative economic losses across the period 2011-2025. The WHO must rise to this historic challenge.
We will not make progress on NCDs until we tackle tobacco, alcohol and junk food. WHO's role starts with highlighting evidence and developing evidence-based normative guidance, encompassing prevention, treatment and support. WHO should engage in a pragmatic manner with non-health actors that exercise a strong influence on NCD risks and outcomes, including industry, patients, provider advocates and non-health ministries. WHO's leadership can help identify innovative funding mechanisms that would assist Finance Ministries in gradually transitioning government income derived from "sin taxes" into income from healthier industries.
In addition to environmental drivers of NCDs, WHO must also assist Member States in stopping the neglect that has plagued health systems' response to mental disorders. Mankind loses as many "quality-adjusted life-years" to mental disorders and self-harm as to cancer. Much progress has been made in psychiatry over recent decades, but still very few have access to it ! This neglect must stop, and WHO can lead the change.
3. Universal health coverage As a former Minister of both Health and Foreign Affairs, I have seen how WHO's 1978 Alma-Ata Declaration on primary healthcare has been the foundation of our world health system. WHO should therefore seize the occasion of the Declaration's fortieth anniversary in 2018 to work with Member States to help countries recommit at the highest level to deliver on healthcare for our global constituents.
Globally, the proportion of health budgets dedicated to mid-to-long term public health or prevention approaches remains unacceptably low. The Director-General must contribute personally in promoting the economic case for investing in public health, at the highest levels of government.
It's in the only possibility to continue to decrease childhood and maternal mortality. WHO should work to ensure that contributions to health system finance have more to do with individuals' longer-term capacity, and less with their immediate health needs - and that funding sources are stable enough to withstand economic fluctuations.
WHO and UN Women should increase their collaboration to support country efforts aimed at equipping the health workforce with the skills and resources necessary to help prevent and respond effectively to gender-based violence.
Geostrategic forecasts point to an acceleration of migrant and refugee flows in the coming decade. Already, migrants face a disproportionate risk of exposure to such problems as tuberculosis, HIV or mental disorders. WHO must play its part in attending to these dire needs, and should convene a Global Inter-Agency Task Force for Migrant and Refugee Health.
4. Access to lifesaving medicines The medical revolution of the twentieth century is hinged on medicines and vaccines. Sadly, the diseases of the poor offer no commercial incentive for private pharmaceutical research, and those medicinal advances coming from research are sometimes priced at levels that few patients can effort.
Following after public-private partnerships like the Medicines Patent Pool or Drugs for Neglected Diseases, WHO must develop innovative initiatives to: (a) lower drug prices; (b) improve medicine regulation to ensure safety without hampering access, eg on biosimilars; (c) spur the development of missing essential medicines and diagnostics for diseases that offer limited commercial prospect; and (b) pilot alternative schemes to share the global burden of funding pharmaceutical R&D.
5. Saving antibiotics from resistance No major new class of antibiotics has been introduced since 1987, and there are currently too few potential new classes of antibiotics in pharmaceutical development to assure the world that new ones will become available before current ones are worn out. The world cannot afford to slide back to its pre-antibiotics era. At the same time, huge quantities of antimicrobials are wasted on patients and animals who do not need them, while those who do need them do not have access. WHO must assist countries in implementing stronger controls on antimicrobial wastage and rational use of medicines, and -- building on existing multilateral and bilateral arrangements -- lead in the establishment of a Global Innovation Fund to fund early-stage and non-commercial research on promising new antimicrobials.
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