Can David Nabarro heal the WHO and put it back on track?

Merit is overwhelmingly in his favour.
Can David Nabarro heal the WHO and put it back on track?
Can David Nabarro heal the WHO and put it back on track?

In national and international circles where public health is discussed, David Nabarro is a well-known name. A medical doctor by training, he packs the power of science and good sense drawing from over four decades of service in different countries and complex settings around the world.  Currently he is Special Adviser of the Secretary General of the United Nations (UN) on the 2030 Agenda for Sustainable Development and Climate Change.  The government of the United Kingdom (UK) has proposed his name to become Director General of the World Health Organisation (WHO). A WHO committee this week narrowed the search for the world’s top public health diplomat to three people out of an initial six. Nabarro made the cut and is now competing with candidates from Ethiopia and Pakistan to clinch the job. On merit alone, he is widely seen as a frontrunner. Diplomats and public health observers say Nabarro has a fine understanding of the global disease burden, especially how outbreaks are linked to socio-political realities, and that he fully appreciates the need for science-based responses that engage a range of sectors and disciplines. The time he has spent with the UN family has honed his skills as a sharp and steady negotiator, who can see the pitfalls of multilateralism as well as its successes. 

“The WHO has extraordinary power to bring about change where it matters the most. I am passionate about my work and I am ready to lead the WHO,” he tells me in an interview hours before the vote this week. “In my career, I have worked in some 50 countries and I have learnt how health is inextricably linked to wealth, food security, education and access to clean water…I have always been ready to tackle inequalities in health and well being.” Justice, inequality, compassion, humility, commitment, transparency and accountability form the grammar of Nabarro’s approach to public health and he keeps it straight and simple. “I am painfully aware that millions of those who are sick do not benefit from access to the kinds of services that make a difference…this does not seem right. It is wrong that people continue to die across the world from illnesses that can be prevented and treated.” 

Nabarro’s passion for public health is contagious and he tells a comprehensive story drawing from his vast experience. In 1999, he worked in scaling up efforts for malaria control. For almost ten years beginning 2005, he was tackling avian influenza and in 2009, the focus was on an influenza epidemic. Two years ago, he was ending the Ebola outbreak in West Africa and last year, he was working in Haiti, coordinating responses to the Cholera outbreak. “In each case, I worked with many actors, encouraging a people-centred and whole-of-society effort,” says Nabarro. If he gets to lead the WHO, he plans to engage robustly with scientists, civil society, media and business leaders from the word go.

I first met Nabarro in Oslo when we were part of Dr. Gro Harlem Brundtland’s transition team (1998) preparing for her to take over as the Director General of the WHO. In a stirring presentation, he argued that public servants, especially those working in public health, have to earn the right to lead with every action they undertake and sitting on past laurels was inexcusable. Then, as now, he speaks of the importance of learning from evidence and experience. Then, as now, Nabarro says the critical path from data to decisions is an opportunity the WHO must harness however difficult that challenge may be. Then, as now, he believes the building blocks of public health revolve around trust, confidence-building and tangible results. People trust people and according to him, a “faithful public servant serves as a bridge between those who have the power to bring about change and those who do not...and the WHO must serve as a catalyst, building bridges between people and communities.” 

What the WHO needs urgently is root and branch changes and not incremental dabbling here and there. Over the years, the world's only policy-setting organisation has been criticised for having frittered away much of the goodwill it once enjoyed. It was absent when its strategic direction was critical, especially where work involved engagement with multiple actors. The way it handled the Ebola outbreak showed up glaring gaps in the system. Reducing interaction with the media to an occasional press release is not a sign of good health, considering it is accountable to tax payers and public health is a public good. Trust in its actions is low and anyone who gets to turn this ship around will need determination and compassion in equal measure. “I plan to link the underlying causes of ill health to the outcomes we seek as people working in the field of public health…I want to be in a position to help people feel better, achieve more and make the most of their lives. That is why I work for the better health of people, communities and nations,” says Nabarro.

How does he plan to deal with sticky dossiers relating to WHO’s interaction with the pharmaceutical and food industries? Nabarro is unequivocal here and cuts to the bone. He is looking forward to plunging into this debate with what he calls a “leap of faith” and goodwill. “I will be totally transparent in my dealings…over time I have learned how to stimulate movements for a better world and to encourage transformation within institutions of all kinds,” he says, adding that good faith and trust go a long way in bringing all actors to the negotiating table. Nabarro is not overly concerned about budgetary issues and frames WHO's task as a "precious" ally and not a funding organisation as it is sometimes viewed. 

The job for the next WHO head is well laid out. Chronic or non-communicable diseases (NCDs) account for the greatest number of deaths worldwide and given that most are preventable or treatable, there is urgent need for action.  Nabarro says the resistance of microbes to antibiotics (AMR) will become a major threat in the coming decades and climate change and air pollution are potential health threats that need a careful watch. Enabling science to speak to policy needs a creative thinker and an innovator. Is the WHO ready to elect a leader who has worked as a community worker, a clinician, educator, project manager, coordinator, adviser and envoy across geographies? Anything short of that will mean the organisation has short-changed itself. 

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