When Health Ministers from around the world meet in Geneva next week, they will have two main jobs. One will be to elect the next person who will lead the World Health Organisation (WHO) for the next five years, possibly more. The second will be a listening brief of sorts, a 101 on the Ebola outbreak in the Democratic Republic of Congo (DRC). As someone who has written for many years about public health and journalism as public goods, I find the confluence of events interesting.
For a start, both are firsts. This is the first World Health Assembly (WHA) – the WHO’s apex body – where every country will have a vote to pick the next Director General (DG). This is a healthy departure from past practice where a small group of countries decided by rotation voted the DG. The next woman or man who will be the world's top public health diplomat, will have the power to call a global health emergency in addition to influencing health and health services to over six billion people on earth. As the world's only health policy setting organisation, the WHO sets standards for everything from vaccines to food, road safety to disease control. Health Ministers are in an unenviable position and in many cases, theirs is a thankless job. A look at the WHO website www.who.int sums up their challenges. From Dengue to Ebola, road traffic accidents to cancer, they are expected to deliver more with less.
This will also be the first time that a disease outbreak is in news as the WHA meets, making the conversation about diseases and their spread 'live and real' instead of an academic discussion over coffee and croissants. This is a good thing. It is about time the world looked at public health as a critical arm of development. More than ever and thanks in large measure to social media, we live in a world where news of an outbreak of a disease in one corner reaches the rest of the world in nano seconds. This places a huge responsibility on organisations working in public health as well as newsrooms around the world. One unverified piece of news is enough to set the world in panic. It requires public health communicators and media to be as agile and alert as public health officials. For that to happen, the world of public health has to look at the media as an ally. And for that to happen, there's a need for trust and confidence in each other. Trust is not a given. It has to be built every day. It is a lived and felt experience that must be nurtured to grow. The next DG of WHO must also be a good communicator, capable of speaking about epidemiology and economics, of raising the profile of the organisation in international affairs and settings and of speaking about public health in the high tables of the world.
A good example of what is necessary came last week when the world woke up to news of an Ebola outbreak. This time, the coordination between WHO and DRC was quick. In 2014, when large parts of the world first heard of Ebola, the DRC stood out for its ability to manage the outbreak and prevent it from spreading. The death toll was 49 in that country, compared to the thousands that perished in the surrounding countries that had less experience handling the disease. But that was not the case in Sierra Leone, Liberia and Guinea where more that 11, 300 people died. With little to no information, the media was full of stories about people dying on the streets or struggling to reach inadequately equipped health centres, blood and gore included. Frightened and isolated, people buried their dead in the darkness and silence of the night - Ebola is most contagious in the hours following a death. It was widely and wildly rumoured in the media that death squads were taking people to secret spots to administer a lethal injection.
A Ugandan journalist colleague Jennifer Bakayama who travelled to Sierra Leone and Liberia told me about unspeakable fear and suspicion - two of the worst things to happen during a health emergency. She said traditional burial rights were overlooked, community leaders were alienated and suspicion ruled the roost. Television screens around the world were replete with images of men in astronaut-like looking clothes spraying unknown stuff all around. The WHO had failed to rise to the challenge twice - firstly in controlling the disease and secondly in working with the media as an ally. Communication - the life-blood of trust - had failed.
Recognising their incapacity to cope with the 2014 outbreak, the WHO turned to the United Nations (UN) for help. The then Secretary General Ban Ki-moon deputed the British medical doctor Dr. David Nabarro as his special representative in August 2014 to assist the WHO. In the period between August 2014 and December 2015, Dr. Nabarro was part of the solution to the Ebola crisis in 2014.
Dr. Nabarro is one of the three candidates - the others are the medical doctor Dr. Sania Nishtar of Pakistan and politician and public health authority Dr. Tedros Adhanom Ghebreyesus of Ethiopia - in the fray to become WHO's DG at a time when Ebola and the need to be ready for outbreaks dominates public health discourse. A few days ago the WHO said outbreaks are inevitable and we have to learn to be ready to respond. I have no doubt this will be a subject of discussion and concern at the WHA. The importance of telling a comprehensive story that makes medical sense and upholds traditions and beliefs is succinctly summed up by the Ebola story. Whether or not Dr. Nabarro wins, his expertise and knowledge will be much sought after next week.
Full Disclosure: Subramaniam and Nabarro are former WHO colleagues. She is supporting his candidacy.