tag:theconversation.com,2011:/us/topics/tedros-ghebreyesus-adhanom-39074/articlesTedros Ghebreyesus Adhanom – The Conversation2019-07-19T13:36:30Ztag:theconversation.com,2011:article/1206162019-07-19T13:36:30Z2019-07-19T13:36:30ZEbola epidemic officially declared a global health emergency<p>On July 17, the World Health Organisation (WHO) declared Ebola in the Democratic Republic of the Congo a <a href="https://www.who.int/ihr/procedures/statement-emergency-committee-ebola-drc-july-2019.pdf">public health emergency of international concern</a> (PHEIC). A PHEIC is the highest level of alert for an infectious disease. WHO director-general, Tedros Adhanom Ghebreyesus (known as Dr Tedros), declared Ebola a PHEIC on the advice of a group of independent experts known as the emergency committee. At the three previous meetings of the emergency committee on Ebola in the DRC, they advised against declaring a PHEIC. </p>
<p>Since the emergency committee last met in June, new Ebola cases have continued unabated (now at 2,500), the death toll has continued to rise (now at 1,700) and, most troubling of all, the disease has spread to Goma, a city of 2m people. So, for many, the PHEIC designation is welcome news. Indeed, some experts have <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30243-0/fulltext?utm_campaign=lancet&utm_content=84187900&utm_medium=social&utm_source=twitter&hss_channel=tw-27013292#articleInformation">been arguing</a> that the criteria to declare a PHEIC have been met since the beginning of 2019.</p>
<h2>What the PHEIC is and what it does</h2>
<p>The International Health Regulations is a treaty intended to “prevent, protect against, control and provide a public health response to the international spread of disease”. It gives the director-general of WHO the power to declare a PHEIC and sets the criteria for doing so. To date, there had been four PHEICs declared: the 2009 H1N1 influenza, 2014 polio, 2014 Ebola, and 2016 Zika virus. When determining whether an event is a PHEIC, the director-general must consider several factors, including the risk to human health, the risk of international spread and the advice of the emergency committee.</p>
<p>The PHEIC declaration does not give WHO access to additional funding, but it can act as a call to the international community. This can mobilise political, financial and technical support, which is just as well as the next phase of the response will cost <a href="https://www.who.int/dg/speeches/detail/ihr-emergency-committee-on-evd-drc-north-kivu">hundreds of millions of dollars</a>, according to Dr Tedros. </p>
<p>Given the complex security and political matters affecting the response in the DRC, this declaration may motivate countries to bring the matter to other international forums. While not a requirement for action in UN bodies, the declaration of a PHEIC would be a clear signal from the world’s global health body that immediate and significant support is needed.</p>
<p>The international community must now step up and provide WHO with the resources it needs to bring this outbreak under control as soon as possible. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/284954/original/file-20190719-116590-1yq7x3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284954/original/file-20190719-116590-1yq7x3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284954/original/file-20190719-116590-1yq7x3s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284954/original/file-20190719-116590-1yq7x3s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284954/original/file-20190719-116590-1yq7x3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284954/original/file-20190719-116590-1yq7x3s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284954/original/file-20190719-116590-1yq7x3s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">WHO chief, Tedros Adhanom Ghebreyesus, declares Ebola a public health emergency of international concern.</span>
<span class="attribution"><a class="source" href="http://www.epa.eu/health-photos/health-organisations-photos/72nd-world-health-assembly-photos-55208821">Salvatori Di Nolfi/EPA</a></span>
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<h2>Trade and travel restrictions</h2>
<p>A PHEIC also empowers the director-general to make temporary, non-binding recommendations. These attempt to minimise trade and travel restrictions on the affected states. Yet during previous PHEICs, countries have not consistently complied with these recommendations despite the risk such action poses to international, and their own, global health security. </p>
<p>During the 2014–16 Ebola outbreak in West Africa, many countries imposed restrictions on the affected area. This is despite the director-general issuing recommendations against such measures, which are ineffective and detrimental. </p>
<p>In declaring the PHEIC Dr Tedros said: “No country should close its borders or place any restrictions on travel and trade.” It is important that members respect this. Imposing trade and travel restrictions on the DRC might be a breach of international law and only serves to be counterproductive to the global response.</p>
<p>There has been a good deal of criticism of WHO for not declaring a PHEIC when the criteria <a href="https://secure.jbs.elsevierhealth.com/action/getSharedSiteSession?redirect=https%3A%2F%2Fwww.thelancet.com%2Fjournals%2Flancet%2Farticle%2FPIIS0140-6736%2819%2930243-0%2Ffulltext%3Futm_campaign%3Dlancet%26utm_content%3D84187900%26utm_medium%3Dsocial%26utm_source%3Dtwitter%26hss_channel%3Dtw-27013292&rc=0">were met</a> and for not following the process laid down in <a href="https://gh.bmj.com/content/4/2/e001618">international law when doing so</a>. Now that a declaration has been made, it is important that member states respond appropriately. This means giving WHO the resources it needs to bring the outbreak under control and respecting the recommendations Dr Tedros has put in place.</p><img src="https://counter.theconversation.com/content/120616/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Eccleston-Turner consults for the World Health Organization, on unrelated matters. </span></em></p>Ebola has now now spread to Goma – a city of 2m people.Mark Eccleston-Turner, Lecturer of Law, Global Health, Keele UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/808982017-07-16T10:20:56Z2017-07-16T10:20:56ZAfrican academics set out what Dr Tedros needs in his toolbox to tackle health ills<figure><img src="https://images.theconversation.com/files/178244/original/file-20170714-3488-1i1rcen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New World Health Organisation Director-General De Tedros Adhanom Ghebreyesus. </span> <span class="attribution"><span class="source">Reuters/Denis Balibouse</span></span></figcaption></figure><p>Africa has the highest burden of HIV/Aids and malaria with escalating rates of non-communicable diseases. How will the World Health Organisation’s Director-General Dr Tedros Ghebreyesus deal with the mounting challenges? The Conversation Africa asked academics across the continent what impact his appointment will have, and for advice on what he needs to do, to manage the challenges.</p>
<hr>
<p><strong>What is the significance of his appointment?</strong></p>
<p><em><strong>Dr Thumbi Mwangi, Washington State University, Kenya Medical Research Institute:</strong></em> It’s two fold. As an African he has been closely involved in the battle against <a href="https://parasitesandvectors.biomedcentral.com/articles/10.1186/1756-3305-5-240">neglected tropical diseases</a> like rabies, trachoma, guinea worm and others which affect <a href="http://www.who.int/mediacentre/news/releases/2017/ntd-report/en/">1 billion</a> people. He was <a href="http://www.reuters.com/article/us-health-who-idUSKBN18J278">health minister</a> in Ethiopia where neglected tropical diseases are common. He needs no lectures on why the WHO must remain at the forefront of fighting them.</p>
<p>Secondly, his ownership of the agenda as set out in his campaign <a href="http://www.drtedros.com/">manifesto</a> – to work towards “a world where everyone can lead healthy and productive lives, regardless of where they are or where they live” – should be seen and felt.</p>
<p><em><strong>Dr Andrew Githeko, Kenya Medical Research Institute:</strong></em> Dr Tedros
brings a <a href="http://www.who.int/dg/tedros/en/">wealth of experience</a> and skills in governance, diplomacy, advocacy and resource mobilisation.</p>
<p>His efforts as <a href="https://www.usaid.gov/news-information/frontlines/child-survival-ethiopia-edition/interview-dr-tedros-adhanom-ghebreyesus">health minister</a> in Ethiopia produced measurable and significant outcomes. He’s familiar with addressing infectious diseases like malaria as well as non infectious diseases.</p>
<p>He also led <a href="http://www.drtedros.com/publications/">research</a> into effective ways of controlling malaria and greatly improved the ways in which it’s prevented and controlled.</p>
<p>On top of this, he played a momentous role in bilateral and multilateral malaria initiatives including those supported by <a href="http://www.rollbackmalaria.org/">The Roll Back Malaria Partnership</a> and the <a href="https://www.theglobalfund.org/en/">Global Fund</a>. </p>
<p>As a researcher he will be sympathetic to the plight of researchers from developing countries.</p>
<p><em><strong>Dr Karen Daniels, South African Medical Research Council:</strong></em> Dr Tedros comes from The Horn of Africa which remains a politically fragile setting, vulnerable to the impact of conflict and natural disasters. What this means is that he’s been in the health care trenches, like many of us who live and work in health settings across the continent. This is precisely where it’s been shown that Africa can find African solutions to African problems. </p>
<p>A leader like this is needed at the helm of the WHO. Dr Tedros will understand that Africans can be included in partnerships rather than dominated in the quest to find solutions to the unique challenges that the continent faces. </p>
<p>From an African health policy and systems research perspective, there are many reasons to laud his appointment. He brings the combined perspective of having been a researcher, a health systems manager, minister of health for Ethiopia, and a policymaker. </p>
<p><em><strong>Professor Bob Mash, Stellenbosch University:</strong></em> Dr Tedros is the first WHO director-general to have firsthand knowledge of the challenges facing African countries and health systems. One of his priority areas is “health for all” and providing universal health coverage. This implies a commitment to the strengthening of health systems, particularly primary health care. </p>
<p>This should stimulate research on disease orientated programmes as well as cross cutting systematic issues like the primary care workforce, access to care, patient-centredness, community orientated primary care as well as continuity, coordination and comprehensiveness of care. </p>
<p>But his experience in Ethiopia may not have sensitised him as much to the global problem of non-communicable diseases that’s also becoming a problem on the African continent. One of my concerns is whether he will give sufficient attention to the epidemic of diseases such as hypertension and diabetes.</p>
<p><strong>What are three biggest challenges facing him? What should he tackle first?</strong></p>
<p><em><strong>Dr Mwangi, Washington State University, Kenya Medical Research Institute :</strong></em> The WHO has faced <a href="http://www.who.int/topics/financial_crisis/financialcrisis_report_200902.pdf">financial constraints</a> addressing global health challenges including outbreaks of emerging infections.</p>
<p>Countries that are adversely affected by <a href="http://www.who.int/neglected_diseases/diseases/en/">neglected tropical diseases</a> need his voice and the diplomacy of his organisation to keep these diseases high on the global agenda, as well as top priority in affected countries.</p>
<p>Dr Tedros needs to make three focused commitments while he’s at the helm. </p>
<p>The first is domestic financing: for a long time countries affected by neglected tropical diseases have relied mainly on external funds. He needs to urge them to commit their own budgets to these diseases. Domestic budgets can help significantly. We need relatively low cost solutions such as drug tablets that are out of patent, improved hygiene for the affected populations and existence of effective vaccines.</p>
<p>Dr Tedros should also encourage partners to keep their commitments.</p>
<p>Secondly, there should be a deliberate effort to integrate the detection, surveillance and treatment of these diseases into the health system. Countries stand a much better chance of reducing and finally eliminating neglected tropical diseases if the interventions are embedded in primary health care systems.</p>
<p>The <a href="http://apps.who.int/iris/bitstream/10665/43485/1/9789241594301_eng.pdf">One Health</a> concept that brings together the human and animal health perspectives should also be practised. Dr Tedros supports this <a href="http://www.sciencedirect.com/science/article/pii/S0140673610614651">concept</a>. His challenge will be how to break the current silos in individual sectors. </p>
<p>Innovations offer important toolkits to consider. This includes <a href="http://www.sciencedirect.com/science/article/pii/S0277953613006485">mobile phones</a> to diagnose and report diseases as well as attempts such as use of <a href="http://www.gavi.org/library/news/gavi-features/2016/rwanda-launches-world-s-first-national-drone-delivery-service-powered-by-zipline/">drones</a> to supply emergency medical care and use of <a href="https://news.wsu.edu/2016/10/24/rabies-vaccine-effective-warm/">rabies vaccine</a> that needs little refrigeration that can be delivered by community health workers.</p>
<p><em><strong>Dr Githeko, Kenya Medical Research Institute:</strong></em> When it comes to malaria his greatest challenge will be to sustain – and increase – resources to the various control programmes, particularly in sub Saharan Africa.</p>
<p><a href="http://www.who.int/malaria/areas/drug_resistance/overview/en/">Resistance</a> to malaria medicines is a global health threat. Dr Tedros should support malaria endemic countries to expand and accelerate national efforts to control and eliminate malaria.</p>
<p>The WHO should urge member states to improve the training of health workers so that they closely follow the protocols in the treatment and management of malaria. This will save more lives.</p>
<p>The infrastructure in health facilities should also be improved to test for malaria, and to treat it more efficiently. This can only be achieved through concerted efforts and commitments by WHO member states.</p>
<p>The research wings in various countries need to be supported to encourage novel research of drug and insecticide resistance. Support for research will be critical to address scientific, behavioural, and socioeconomic factors that affect malaria control.</p>
<p><em><strong>Dr Karen Daniels, South African Medical Research Council:</strong></em> There is a vicious cycle in which the burden of increased communicable and non-communicable diseases weaken health systems. Dr Tedros has the challenge of strengthening these systems, something he’s already committed to. </p>
<p>This has to be supported by sound health policy and systems research, to help find solutions to the continent’s health challenges. But better home grown solutions need more investment in national and Pan African centres of excellence. Dr Tedros could help by enabling greater WHO investment in health policy and systems research. These centres of excellence should be founded on close collaboration between researchers, health systems managers, health systems policymakers, as well as communities and civil society organisations. </p>
<p>Centres of excellence could facilitate closer collaboration between health policy, the research community and the WHO. This could help ensure that research is more closely aligned to the real challenges faced in our own countries. We will hopefully begin to reduce the “know-do gap” where research evidence exists, but isn’t taken up in implementation.</p>
<p><em><strong>Professor Mash, Stellenbosch University:</strong></em> One of his greatest challenges will be strengthening health systems at primary health care level. Governments need to be convinced to invest in primary health care as the hub and not the marginalised periphery where poorly trained and low level health care workers offer fragmented and poor quality care. Strong multidisciplinary teams should include a family physician.</p>
<p>Strong primary health care is a prerequisite for providing universal health coverage. Ideally this should be through a national health insurance or systems that – at the very least – don’t impoverish people or increase inequality.</p><img src="https://counter.theconversation.com/content/80898/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bob Mash receives funding from European Union to strengthen primary health care through primary care doctors and family physicians in South Africa.</span></em></p><p class="fine-print"><em><span>Karen Daniels is a Specialist Scientist for the Health Systems Research Unit of the South African Medical Research Council, and a member of the Health Systems Global Board. The opinions expressed here are based on her own independent thoughts and views.</span></em></p><p class="fine-print"><em><span>Thumbi Mwangi receives funding from Wellcome Trust, GAVI and World Health Organisation.</span></em></p><p class="fine-print"><em><span>Andrew Githeko does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>How will the World Health Organisation’s Director-General Dr Tedros Ghebreyesus deal with the mounting challenges? Africa’s academics have some tips.Andrew Githeko, Chief Research Officer, Kenya Medical Research InstituteBob Mash, Division of Family Medicine and Primary Care, Stellenbosch UniversityKaren Daniels, Specialist Scientist, Health Systems Research Unit, South African Medical Research CouncilThumbi Mwangi, Clinical assistant professor, Washington State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/784122017-05-26T10:04:28Z2017-05-26T10:04:28ZThree ideas on how the new WHO DG can build health systems from the bottom up<figure><img src="https://images.theconversation.com/files/171111/original/file-20170526-23230-mof293.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tedros Adhanom Ghebreyesus, the new Director-General of the World Health Organisation </span> <span class="attribution"><span class="source">Reuters/Denis Balibouse</span></span></figcaption></figure><p>Dr Tedros Ghebreyesus Adhanom is <a href="http://www.who.int/mediacentre/news/releases/2017/director-general-elect/en/">the first African</a> to become the director-general of the World Health Organisation (WHO). He is also the first non-physician to head up the United Nations’ body.</p>
<p>He has big challenges ahead of him.</p>
<p>He will be expected use his formidable talents – including diplomacy – to boost the WHO’s image and finances, protect it against the whimsical policies of superpowers, and keep the organisation free of <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31146-7/fulltext">commercial influences</a>. </p>
<p>Dr Tedros has already prioritised improving <a href="http://www.bbc.co.uk/news/amp/40010522">universal health coverage</a>. As he put it:</p>
<blockquote>
<p>All roads should lead to universal health coverage. I will not rest until we have met this.</p>
</blockquote>
<p>To achieve this, he will need <a href="http://www.healthsystemsglobal.org/vision/">to strengthen health systems</a>. But the challenge he faces is that the responsibility for strengthening health systems is different in different contexts, and it seldom falls directly to the WHO. </p>
<p>Such efforts are often driven by funders’ priorities. And for countries that don’t rely on external resources, such as China and India, investments in health systems tend to reflect domestic social sector policy and priorities. </p>
<p>It’s therefore worth asking: what can the WHO, or more specifically the DG, do to advance the health systems agenda? Here are three ideas that could be usefully pursued to achieve the outcome the DG desires.</p>
<h2>Span boundaries</h2>
<p>Much of global health activity is still organised into disease-specific silos. This can be insidious: it privileges narrow disease-specific solutions, when in reality more holistic systemic or political solutions may be in order. </p>
<p>The global response to the 2014 Ebola outbreaks provides a useful example to illustrate the problem. The outbreaks evoked fear of a global epidemic as thousands died in West Africa. As a result significant external resources were diverted to contain the epidemic, until it emerged that there were key missing links to the response – <a href="https://academic.oup.com/afraf/article-pdf/114/454/136/6645026/adu080.pdf">engaging local communities and strengthening local health systems</a>.</p>
<p>The Ebola case highlighted the fact that there is never one silver bullet when addressing health issues, even in a crisis. Similarly, health gains depend heavily on action across a range of development sectors such as the environment, food, urban development and gender equality. To maximise gains coordination across all of them is vital. </p>
<p>An example of how this can work is well illustrated in <a href="http://www.tandfonline.com/doi/pdf/10.1080/23288604.2016.1148802">Chhattisgarh, rural India</a> where the demands of marginalised tribal communities for better health care were part of a larger movement for access to water and conservation of forest resources. Community health workers frequently engaged in supporting people’s needs beyond the health sector.</p>
<p>Breaking the silos and promoting <a href="http://gh.bmj.com/content/1/1/e000058">boundary-spanning</a>, across disease programmes and between development sectors, is key to making the health sector more effective. The <a href="http://www.un.org/sustainabledevelopment/sustainable-development-goals/">Sustainable Development Goals</a> offer ample opportunity to broker alliances with other global agencies, but also for the WHO to help mainstream intersectoral action as part of health systems strengthening efforts at national and local levels.</p>
<h2>Diversify engagement with countries</h2>
<p>As the first DG from a member state that is also a major recipient of global aid, Dr Tedros will be acutely aware of the boundaries between support to a country, and respect for its self-determination. </p>
<p>It will be interesting to see how the WHO will help developing countries balance the results orientation of donors, with institution-building initiatives that are necessary yet might not yield short-term gains.</p>
<p>The WHO is a member state organisation. But it can’t neglect the fact that states don’t necessarily represent the interests of all their people. Ultimately the WHO has a responsibility to promote democratic values and to help people’s voices be heard, especially those of the most vulnerable. </p>
<p>People all over the world are concerned about governance, including the governance of health systems. The desire to be freed of corruption and exploitation, to have basic rights and entitlements, and to be able to have a say in their own future are universal. These issues must be addressed by the WHO. </p>
<p>The emerging <a href="https://t.co/NU4LSGb71x">Health Systems Governance Collaborative</a> at the WHO seeks to promote practical solutions and learning to improve governance at local and national levels. It is an interesting experiment that could extend WHO’s focus beyond the narrow domain of technical support, into complex real world health systems. But more such experiments are called for.</p>
<h2>Make global health about care, not fear</h2>
<p>A health system is, or should be, the institutionalisation of the basic human impulse to care. Its performance is a reflection of society’s will for caring. The WHO should manifest the global community’s collective commitment to caring – which translates practically into helping build caring institutions across the world. </p>
<p>The WHO can do more to support bottom-up practices: listening to voices of health system builders on the ground (particularly those engaged in caring for the poor), learning from and supporting them, and putting what they learn into practice and policy. </p>
<p>This change must be led by the DG as part of the organisational accountability reforms <a href="http://www.bbc.co.uk/news/amp/40010522">he has prioritised</a>.</p>
<p>Global health is often described as a lexicon of threats, whether from antimicrobial resistance, climate change or epidemics. Safety and security are certainly critical elements of the health systems agenda. But if the rhetoric of fear overcomes that of care, the best-resourced health system will be ineffective in delivering good health equitably. The dream of universal health coverage will be elusive.</p>
<p>The WHO has a key role in ensuring that questions of global health security are never divorced from inclusivity.</p><img src="https://counter.theconversation.com/content/78412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kabir Sheikh is the chair of Health Systems Global and a member of WHO’s Health Systems Governance Collaborative.</span></em></p>The new director-general of the World Health Organisation has set universal health coverage as a priority. There are several ways to make headway with this goal.Kabir Sheikh, Joint Director, Research and Policy, Public Health Foundation of IndiaLicensed as Creative Commons – attribution, no derivatives.