WHO Director-General outlines demands on organization, goals for future

The World Health Organization has been “strikingly effective,” making significant inroads in recent years in the areas of vaccine development and distribution and tropical disease medication distribution, but the organization is over-extended, and may be in need of a change in scope, according to WHO Director-General Margaret Chan.

“The level of WHO engagement should not be governed by the size of a health problem. Instead, it should be governed by the extent to which WHO can have an impact on the problem,” Chan said. “Others may be positioned to do a better job.”

Chan made these comments earlier today during an address to WHO’s executive board, which is reviewing their budget for 2010-2011.

WHO mirrors many organizations in global health, like the Global Fund and the Global Alliance for Vaccines and Immunization (GAVI) Alliance, which face serious funding shortfalls. The current financial crisis, coupled with records of extreme weather events like flooding in Australia, Brazil and Sri Lanka and the mega-disasters of the January earthquake in Haiti and the August floods in Pakistan have stretched relief efforts, according to Chan. Using an example, she said that Rwanda had to report to various donors on 890 health indicators during 2009 alone.

Although she did not make direct recommendations on which areas should be cut, or where services should be directed, Chan said there have been areas where WHO has been “strikingly effective,” and noted that there are other areas where WHO’s efforts may overlap with other organizations, such as charities and donor governments.

Success stories

One area where Chan noted WHO has been effective is the launch of a new meningitis vaccine “that has the potential to end devastating epidemics in Africa’s meningitis belt.” She said this vaccine, which was coordinated by WHO and PATH, developed by an international consortium of academics and scientists, and funded in part by the Bill and Melinda Gates Foundation, provides a “ground-breaking new model for product innovation driven by public health needs, and not by market forces.”

Chan said that countrywide vaccination campaigns recently launched in Burkina Faso are being followed by similar campaigns in Mali and Niger.

“The vaccine was developed, from start to finish, in less than a decade, in record time, and at about one-tenth of the cost usually needed to bring a product through development to the market,” Chan said. But even with this cost savings, she said, funding shortfalls jeopardize much-needed meningitis campaigns elsewhere in the Meningitis Belt.

“This situation raises a question that recurred throughout the year and continues today. How much will the financial crisis and economic downturn affect public health, both internationally and within individual countries,” Chan said. “Will progress stall? Will powerful innovations, like the meningitis vaccine, fall short of reaching their potential?”

Moving forward

To prevent progress stalling, Chan reaffirmed WHO’s current emphasis on building fundamental health capacities.

“Doing so increases resilience and self-reliance. It also provides the foundation for equitable and sustainable improvements in health outcomes,” Chan said.

She cited several WHO-authored reports that cited weaknesses in immunization, malaria prevention and HIV/AIDS prevention programs as hindrances to fighting these illnesses. She also pointed to the H1N1 pandemic influenza as one area where public distrust also hindered prevention efforts.

“We may need to accept the fact that public perceptions about vaccine safety can be permanently changed by unfounded fears, to an extent that no amount of evidence can change the public’s mind,” Chan said. “This is a worrisome new trend that needs to be addressed.”

Chan also called for continued support from the pharmaceutical industry for donations of needed medications and research on tropical diseases. She also called for continued emphasis on women’s and children’s health, including incorporating health policies that address these issues into government policy.

“The objective of incorporating health concerns in all government policies, especially for controlling noncommunicable diseases, faces some tough opponents,” Chan said. “But this must be done. The rise of these diseases clearly contributes to the rise of health care costs.”

In the meantime, she said, the demands of international public health continue.

“Treated bednets need to be replaced. Antiretroviral therapy for AIDS is a lifeline, for a life time. Case-finding and treatment for tuberculosis are a constant undertaking that needs to intensify. Every new generation of babies must be protected from vaccine-preventable diseases. Last year, we launched an aggressive new strategy for polio eradication,” Chan said. “Does the international community have the stamina, and the resources, to reach these milestones?”

Reading what Dr. Chan had to say in her comments to the WHO Executive Board confirms my belief that she is one of the most capable Director-Generals that the WHO has ever had. She kept a firm and steady hand on the helm during the H1N1 influenza pandemic, especially so as the pandemic was waning and she was being accused of collusion with the pharmaceutical industry, and other absurd malfeasances without a shred of evidence to support them. During all this, she kept her cool, while admitting that, in retrospect, some things could have been done better. The example of a collaborative effort that worked well is both apt and very meaningful to me. One of the major figures in bringing all this about was Marc LaForce, MD, a good personal friend and former Editorial Board member. I heard in vivid detail from LaForce of the false steps and the eventual success of developing a monovalent Group A meningococcal polysaccharide vaccine, convincing a pharmaceutical company to produce it and bring it to the market for literally pennies per dose, making it affordable to the sub-Saharan African countries where epidemic Group A meningococcal disease is an annual scourge. Marc has never received the recognition he deserves for this feat, but has still derived a great deal of personal satisfaction, as well as many thanks from the people in these countries. It was an excellent example for Dr. Chan to use to illustrate her points.

–Theodore C. Eickhoff, MD

Infectious Disease News Editor Emeritus

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