{"id":58601,"date":"2018-01-12T06:00:49","date_gmt":"2018-01-12T06:00:49","guid":{"rendered":"http:\/\/www.bnreport.com\/worlds-doctor-gives-who-a-headache-3\/"},"modified":"2018-01-12T06:00:49","modified_gmt":"2018-01-12T06:00:49","slug":"worlds-doctor-gives-who-a-headache-3","status":"publish","type":"post","link":"https:\/\/www.bnreport.com\/en\/worlds-doctor-gives-who-a-headache-3\/","title":{"rendered":"World\u2019s doctor gives WHO a headache"},"content":{"rendered":"<p>Seven months into his tenure, the early moves of the WHO\u2019s <a href=\"https:\/\/www.politico.eu\/article\/new-world-health-organization-director-ethiopia-tedros-adhanom-ghebreyesus-overcomes-attacks-on-record-to-win-who-race\/\" rel=\"noreferrer\" target=\"_blank\">first African chief<\/a> are stoking a backlash.<\/p>\n<p>His supporters say Tedros Adhanom Ghebreyesus promised to shake the institution up. The critics, increasingly emboldened, say he\u2019s undermining the World Health Organization\u2019s effectiveness and putting its funding at risk.<\/p>\n<p>The former Ethiopian health minister turned heads with his appointment of Zimbabwean dictator Robert Mugabe as a goodwill ambassador in October. Meanwhile, behind the scenes, Tedros \u2014 as he prefers to be called by Ethiopian tradition \u2014 was eschewing the normal hiring process for U.N. agencies, looking to increase gender and geographical diversity as quickly as possible. That\u2019s unsettled some in the Geneva headquarters and the constellation of activists and researchers who work with WHO, who fear an overly political approach is bringing a culture change at the cost of credibility.<\/p>\n<p>The latest disruptive move is his appointment of a little-known Russian official to run the WHO\u2019s tuberculosis program, using a fast-track process, one month after <a href=\"http:\/\/en.kremlin.ru\/events\/president\/news\/56109\" rel=\"noreferrer\" target=\"_blank\">meeting with President Vladimir Putin<\/a> at a major gathering on the topic in Moscow.<\/p>\n<p>The Mugabe appointment \u201cwas stupid, but this is a disaster,\u201d said Mark Harrington, executive director of Treatment Action Group. Ahead of the appointment, TAG led an <a href=\"http:\/\/www.tbonline.info\/media\/uploads\/documents\/open_letter_re__need_for_transparent,_thoughtful_process_to_determine_the_next_who_global_tb_program_director.pdf?utm_source=POLITICO.EU&amp;utm_campaign=0f7650d096-EMAIL_CAMPAIGN_2017_12_19&amp;utm_medium=email&amp;utm_term=0_10959edeb5-0f7650d096-190018465\" rel=\"noreferrer\" target=\"_blank\">open letter<\/a> from more than 40 civil society groups asking Tedros to use a transparent, competitive process to choose the next director of the Global TB Program, tasked with fighting the <a href=\"http:\/\/www.who.int\/tb\/features_archive\/global_TB_report_2017\/en\/\" rel=\"noreferrer\" target=\"_blank\">top infectious killer worldwide<\/a>.<\/p>\n<h3>Reward for being retrograde<\/h3>\n<p>The December nomination of Tereza Kasaeva (an official at the Russian health ministry) prompted an <a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(18)30005-9\/fulltext?elsca1=etoc\" rel=\"noreferrer\" target=\"_blank\">editorial<\/a> in the medical journal the Lancet, which described it as triggering a \u201cpotentially disabling controversy.\u201d<\/p>\n<blockquote>\n<p>\u201cThe domestic situation there is horrible. It\u2019s probably one of the worst outside of Africa on TB infections\u201d \u2014<em> Eduardo G\u00f3mez, King\u2019s College London<\/em><\/p>\n<\/blockquote>\n<p>\u201cRussia has a poor record on TB and HIV,\u201d write the editors of the journal, which is widely seen as the voice of the global health establishment. \u201cHer appointment may be regarded as rewarding a country that does not deserve to be rewarded \u2026 WHO\u2019s reputation \u2014 indeed, its political leverage \u2014 depends on the agency\u2019s technical credibility.\u201d<\/p>\n<p>Russia is widely regarded as retrograde in its approach to treating the infectious disease, having developed a raging outbreak after the breakdown of the Soviet Union. Since 2000 or so, <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK62453\/\" rel=\"noreferrer\" target=\"_blank\">overall incidences are down and survival rates are up<\/a>, but Russia is still a world leader on the proportion of infections that don\u2019t respond to antibiotics; <a href=\"http:\/\/www.sciencemag.org\/news\/2017\/05\/drug-resistant-tuberculosis-strains-gain-foothold-russia\" rel=\"noreferrer\" target=\"_blank\">a recent study<\/a> predicted one in three cases would be antibiotic resistant by 2040.<\/p>\n<p>Kasaeva replaces Mario Raviglione, a leading TB expert with more than 25 years of experience fighting the bacterial infection.<\/p>\n<p>Tedros says he\u2019s just keeping a campaign promise to overhaul the agency in the wake of its high-profile failure to respond quickly to the 2014 Ebola crisis in West Africa. He is the first African to run the WHO \u2014 and the first director general chosen with a vote open to all member countries in May, overcoming what he called a \u201c<a href=\"https:\/\/www.nytimes.com\/2017\/05\/13\/health\/candidate-who-director-general-ethiopia-cholera-outbreaks.html?_r=0\" rel=\"noreferrer\" target=\"_blank\">colonial mindset<\/a>\u201d among backers of his British rival.<\/p>\n<p>Tedros\u2019 advisers have <a href=\"https:\/\/twitter.com\/DrSenait\/status\/921751781985660928\" rel=\"noreferrer\" target=\"_blank\">defended<\/a> his decision to name Mugabe a goodwill ambassador for noncommunicable diseases less than four months into the job as just a misguided effort to build bridges with a regional giant who, despite human rights violations and a long embrace of the tobacco industry, recently expressed openness to new commitments on health.<\/p>\n<p>The offer was <a href=\"http:\/\/www.who.int\/mediacentre\/news\/statements\/2017\/goodwill-ambassador-rescinded\/en\/\" rel=\"noreferrer\" target=\"_blank\">quickly retracted<\/a>, but not before it triggered international condemnation. An opinion piece in the Washington Post even <a href=\"https:\/\/www.washingtonpost.com\/news\/democracy-post\/wp\/2017\/10\/25\/another-week-another-scandal-at-the-united-nations\/\" rel=\"noreferrer\" target=\"_blank\">speculated<\/a> that it was payback to Mugabe for securing the African Union\u2019s support in the WHO election, or to China for its backing.<\/p>\n<p>Tedros\u2019 <a href=\"http:\/\/www.politico.eu\/pro\/new-who-chief-names-leadership-team\/\" rel=\"noreferrer\" target=\"_blank\">first appointments<\/a> have already transformed the gender and geographic balance within the top ranks, even as they have raised concerns about a closed selection that downplays conventional expertise.<\/p>\n<p>Of <a href=\"https:\/\/twitter.com\/womeninGH\/status\/943493981022965760\" rel=\"noreferrer\" target=\"_blank\">eight new directors<\/a> chosen largely through a fast-track process, including Kasaeva, all but one are women.<\/p>\n<p>Tedros is trying change the recruitment system to eliminate \u201cunconscious biases that make it unfavorable for women to get the positions,\u201d a top Tedros adviser, Senait Fisseha, said in an email. Until that can be accomplished, she said, he had made \u201climited appointments of diverse and highly qualified women\u201d to move his vision forward.<\/p>\n<p>That\u2019s music to the ears of those who see an endless game of musical chairs that circulates people from one U.N. or international development agency to another. Often that means wealthy Western countries dictating to poorer countries how to deal with their problems in order to receive aid.<\/p>\n<h3>Vlad in Geneva<\/h3>\n<p>Diversity is a worthy goal, said Global Coalition of TB Activists CEO Blessina Kumar. But it shouldn\u2019t come \u201cat the cost of effectiveness and competency. You can\u2019t trade one for the other,\u201d she said.<\/p>\n<p>\u201cMerit was the first criteria for all appointments, while secondary consideration was given to gender and geographical diversity,\u201d WHO spokesman Gregory Hartl said. \u201cDr. Tedros also sought to appoint qualified people with country-level experience, as a vital complement to the technical expertise that already exists within WHO. This will help to accelerate progress at the country level.\u201d<\/p>\n<p> <img decoding=\"async\" src=\"https:\/\/www.politico.eu\/wp-content\/uploads\/2018\/01\/GettyImages-899204276-714x476.jpg\"\/><\/p>\n<p>Russian President Vladimir Putin met Tedros last year | Kirill Kudryavtsev\/AFP via Getty Images<\/p>\n<p>Kasaeva\u2019s appointment has proved politically volatile both for Russia\u2019s speckled track record in combatting TB, and because it\u2019s seen as playing into Putin\u2019s hands, helping the Russian president project power on the global health stage while he neglects patients back home.<\/p>\n<p>\u201cThe domestic situation there is horrible. It\u2019s probably one of the worst outside of Africa on TB infections,\u201d said King\u2019s College London\u2019s Eduardo G\u00f3mez, the author of \u201cGeopolitics in Health: Confronting Obesity, AIDS, and Tuberculosis in the Emerging BRICS Economies.\u201d<\/p>\n<p>In 2012, Russia <a href=\"http:\/\/www.aidspan.org\/gfo_article\/global-fund-rescinds-approval-round-10-tb-proposal-russian-federation\" rel=\"noreferrer\" target=\"_blank\">rejected a $127 million<\/a> grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, stifling many of the groups on the ground. On top of that, the federal government cut domestic TB funding in recent years, according to G\u00f3mez.<\/p>\n<p>Nonetheless, in mid-November, Russia <a href=\"http:\/\/tass.com\/society\/976024?utm_source=POLITICO.EU&amp;utm_campaign=562d721334-EMAIL_CAMPAIGN_2017_11_19&amp;utm_medium=email&amp;utm_term=0_10959edeb5-562d721334-190018465\" rel=\"noreferrer\" target=\"_blank\">pledged<\/a> $15 million toward fighting TB worldwide during a major U.N. TB conference in Moscow. The foreign aid is a typical Putin move, said Gomez. \u201cThis is an opportunity to reassert Russia\u2019s dominance in global health.\u201d<\/p>\n<p><a href=\"http:\/\/en.kremlin.ru\/events\/president\/news\/56107\" rel=\"noreferrer\" target=\"_blank\">Putin addressed the gathering<\/a> and met with Tedros. A month later, on December 15, Tedros announced Kasaeva\u2019s appointment in an internal WHO email.<\/p>\n<p>\u201cI can\u2019t see what the upside is other than political payback,\u201d Harrington said.<\/p>\n<h3>Backlash on Tedros<\/h3>\n<p>Defenders say Russia\u2019s TB program is improving \u2014 driven in part by Kasaeva \u2014 and that she may be the best hope for getting the country to change.<\/p>\n<p>Vadim Testov, a former WHO official now working on Russia\u2019s TB program, said he\u2019s seen the government\u2019s commitment increase over time, and that it\u2019s \u201cready to provide\u201d financing to make Russia\u2019s domestic TB fight successful. He noted that new regulations from Kasaeva\u2019s team have led to a sharper decrease in TB cases over the last five years.<\/p>\n<p>Kasaeva \u201cwill have influence on Russian officials\u201d in her WHO position, Testov predicted.<\/p>\n<blockquote>\n<p>Many aren\u2019t sold on Tedros\u2019 new approach and fear that global health will suffer \u2014 especially if the WHO\u2019s biggest donors get spooked.<\/p>\n<\/blockquote>\n<p>The backlash shows the risks from Tedros\u2019 effort to upend the status quo. Defenders say the same-old same-old at the U.N. hasn\u2019t served patients on Ebola, TB or a range of other issues.<\/p>\n<p>\u201cWhatever we\u2019ve been doing for the last quarter century isn\u2019t working that well,\u201d said Salmaan Keshavjee, a Harvard TB expert who has worked on the ground in Russia with Partners in Health.<\/p>\n<p>He argued that WHO recommendations have in the past been ill-suited to Russia\u2019s circumstances and that homegrown experts from emerging, populous economies may be in a better position to solve their own problems and bring a new perspective to the global effort.<\/p>\n<p>\u201cIf you want to hold the BRICS countries\u2019 feet to the fire, they have to be involved in health architecture,\u201d Keshavjee said.<\/p>\n<h3>Budget strings<\/h3>\n<p>But many aren\u2019t sold on Tedros\u2019 new approach and fear that global health will suffer \u2014 especially if the WHO\u2019s biggest donors get spooked.<\/p>\n<p>Though <a href=\"http:\/\/foreignpolicy.com\/2017\/09\/07\/congress-rejects-trump-plan-for-cutting-foreign-assistance-state-department-redesign-diplomacy-senate-appropriations\/\" rel=\"noreferrer\" target=\"_blank\">ultimately blocked<\/a>, U.S. President Donald Trump\u2019s proposal to cut back on foreign aid \u2014 <a href=\"https:\/\/www.washingtonpost.com\/world\/national-security\/foreign-aid-under-the-ax-in-state-department-budget-proposal\/2017\/05\/23\/55bc0600-3f15-11e7-adba-394ee67a7582_story.html?utm_term=.362fbd305b90\" rel=\"noreferrer\" target=\"_blank\">announced on May 23<\/a>, the same day Tedros was elected to lead the WHO \u2014 has alarmed many in the organization. The recent controversies drive some worry that other large donors like the U.K. or Germany might be tempted to draw the purse strings tighter.<\/p>\n<p> <img decoding=\"async\" src=\"https:\/\/www.politico.eu\/wp-content\/uploads\/2018\/01\/GettyImages-687376702-714x467.jpg\"\/><\/p>\n<p>WHO Director General Ethiopia\u2019s Tedros Adhanom Ghebreyesus delivers his speech after his election in Geneva in 2017 | Fabrice Coffrini\/AFP via Getty Images<\/p>\n<p>The U.S. contributes almost a quarter of the WHO\u2019s $4 billion-plus <a href=\"http:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA70\/A70_7-en.pdf\" rel=\"noreferrer\" target=\"_blank\">annual budget<\/a>.<\/p>\n<p>Tedros\u2019 doctorate is in community health, and he served as Ethiopia\u2019s health minister for seven years \u2014 winning wide praise for strides in expanding contraception, fighting malaria and, yes, controlling TB.<\/p>\n<p>But it may be his experience as Ethiopia\u2019s top diplomat from 2012 to 2016 that seems most apposite now. During that period, he kept his country in the West\u2019s good graces (and the aid money flowing) despite growing concerns about the regime\u2019s human rights violations, by stressing Ethiopia\u2019s position as a stable, strategic partner in the war on terror.<\/p>\n<p><a href=\"http:\/\/www.who.int\/dg\/leadership-team\/en\/?utm_source=POLITICO.EU&amp;utm_campaign=2f2da98ee1-EMAIL_CAMPAIGN_2017_10_03&amp;utm_medium=email&amp;utm_term=0_10959edeb5-2f2da98ee1-190018465\" rel=\"noreferrer\" target=\"_blank\">Tedros\u2019 team<\/a> includes plenty of conventional choices; Jane Ellison, a Brit, served as something of an olive branch to the WHO\u2019s No. 2 state donor after the U.K. strongly backed its own candidate in a campaign that turned nasty. Tedros also named a German to a long-sought top post after Berlin stepped up donations and <a href=\"https:\/\/www.politico.eu\/pro\/germany-confronts-america-first-on-global-health\/\" rel=\"noreferrer\" target=\"_blank\">raised Tedros\u2019 profile<\/a> by inviting him to the G20 summit.<\/p>\n<p><a href=\"https:\/\/www.politico.eu\/article\/tedros-adhanom-ghebreyesus-gives-who-a-headache\/?utm_source=RSS_Feed&amp;utm_medium=RSS&amp;utm_campaign=RSS_Syndication\" rel=\"noreferrer\" target=\"_blank\">Original Article<\/a><\/p>\n<p>[contf]<br \/>\n[contfnew]<br \/>\n        <img decoding=\"async\" src=\"https:\/\/encrypted-tbn0.gstatic.com\/images?q=tbn:ANd9GcRMd3Tz2gX9xSa6CJyaOj2dokBVcrdaT4yY3R3RI7YmL18vCLZZ\"\/><\/p>\n<h5>Politico<\/h5>\n<p>[contfnewc]<br \/>\n[contfnewc]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Seven months into his tenure, the early moves of the WHO\u2019s first African chief are stoking a backlas..<\/p>\n","protected":false},"author":1,"featured_media":58602,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[48],"tags":[],"class_list":["post-58601","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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