David Nabarro: WHO's Next?
David Nabarro says the World Health Organization is in need of reform – and believes he’s the person to do it. But can he persuade 194 member states to hand him the top job?
David Nabarro is getting used to life without sleep. He has spent almost every night of the past few months on the road, snatching what little rest he can in hotel rooms around the world and cramped seats on aeroplanes crossing continents. A few weeks ago he even spent seven consecutive nights at 30,000 feet.
The day before we meet in Whitehall’s Richmond House, Nabarro jetted in from Bangladesh. After less than 48 hours in London he’ll be off to South Africa to continue his whistle-stop tour of the globe.
But in a few weeks he will find out if his ordeal has been worth it.
At the end of May, 194 countries will cast their votes in a secret ballot to decide the next director general of the World Health Organization, and Nabarro believes his efforts on this most gruelling of campaign trails could see him over the line.
The result is far from a foregone conclusion: the UK’s nominee – put forward with the full backing of the Department of Health and Dame Sally Davies, the Chief Medical Officer – faces stiff competition from his two rivals, former Ethiopian foreign and health minister Tedros Adhanom Ghebreyesus and Pakistani cardiologist Sania Nishtar.
But what sets him apart, he says as he sits down with The House, is his frontline experience. While the others have served as ministers in their respective home countries, Nabarro is the only candidate with a proven record of running an international response to a disease outbreak. In 2014, with the WHO coming under fire over its faltering response to the Ebola outbreak in west Africa, Nabarro was drafted in by UN secretary-general Ban Ki-moon to serve as Special Envoy on the crisis. He later chaired the advisory committee set up by the WHO’s outgoing DG, Margaret Chan, to consider changes to the body’s procedure on outbreaks.
Nabarro pushed through a series of reforms in response to concerns that the WHO was too slow to spot and respond to the crisis, including the establishment of a new health emergencies programme. But the damage to the WHOs reputation has been harder to shift. The election of a new leader, he believes, is a chance to show the organisation is serious about change.
“I’m finding when I speak to health ministers and foreign ministers, sometimes to presidents and prime ministers, that for them the issue of experience and credibility really matters,” he says. “The way I see it is: ‘who would you like to be in charge of the World Health Organization when the next big outbreak strikes?’”
He adds: “The organisation has taken a bit of a hit because of the problem with the Ebola outbreak, where it was considered to be slow and not to have been very effective at the beginning.
“I was told to find ways to assess the problem and to help find a much more effective response to that problem, and during that time I worked out what was wrong with the World Health Organization, in terms of its ability to deal with these types of diseases. What kinds of procedures need to be in place for picking up disease outbreaks early, for responding to them robustly, and ensuring that once you’ve done the response that you’ve also invested in the capacity of the country to take forward its own activities so that it’s better protected in the future. To do that you need a system with capacity at country-level, and capacity globally, backed up with proper laboratories with proper expertise.”
His most immediate change as DG, he says, will be to “reinforce our 150 country offices, and the six regional offices that support them, so that they have better protocol for dealing with disease outbreaks in an effective way”.
But Nabarro’s reform agenda doesn’t end with updating the WHO’s procedures on outbreaks of infectious diseases. He explains how he wants to continue to bolster the WHO’s work on tackling non-communicable diseases caused by obesity and changing lifestyles – including diabetes, high blood pressure and cancer – and to become “much more systematic” on advising countries on best health practice, “with a particular focus on women and children”.
But his bid idea is to engineer a shift in the organisation’s culture towards what he calls a “catalytic” approach. The WHO does not have the resources or the political power to achieve the sort of improvements in global health that are needed. But what the Organization can do, he explains, is set robust standards and “use our legitimacy and our position” to push for partnerships, support the spreading of effective practice and offer encouragement to “courageous political action” where needed, particularly on tackling those non-communicable lifestyle diseases.
He sums up his vision in eight words: “Less operational, more strategic. Less project, more policy.”
“Being catalytic means that you achieve your results not by doing your own small projects but by working through others who then amplify your standards,” he says.
“That gives you much greater impact than you would have if you’re operating in your own little territory on your own.
“For example – how are we going to deal with the diabetes epidemic? 20% of adults in a number of Gulf countries have got diabetes. It’s a huge and growing epidemic. The World Health Organization is not going to solve that. But by establishing standards and guidelines and working with national governments, and scientists and business and faith organisations, we will be able to provide the necessary energy to make inroads into that epidemic and many others.”
He adds: “This style of partnering for impact is something that I’ve done throughout my time at WHO, it’s what we did on malaria – we’ve transformed malaria in the last 15 years – but I’ve also done it in other areas like on nutrition and food. And I’m just going to make it the style and the culture of the World Health Organization in the future.”
This ‘catalytic’ approach is particularly important, he adds, at a time of tight finances. Ending the uncertainty over the WHO’s financial future will be towards the top of Nabarro’s in-tray should he land the job this summer. Some 70% of the body’s funding comes in the form of voluntary contributions, much of which is tightly earmarked for specific projects, and establishing more secure streams of funding, from national governments and elsewhere, will prove a challenge – not least at a time when the very idea of global, multi-lateral co-operation, is facing a crisis of confidence.
President Donald Trump has shown little enthusiasm for international organisations and treaties since his election, and reports suggest the president may slash US contributions to the United Nations and other bodies by as much as 40%.
Nabarro says he does not want to comment “on any one country”, but is clear that the WHO can only secure its financial future by proving its effectiveness and value for money.
“There’s a lot of discourse at the moment about multilateralism and whether or not global actions are to be supported by individual countries. There is a lot of conversation underway. But what matters – for the multilateral system as a whole and organisations like WHO in particular – is to demonstrate at all times our added value. And that will be my style,” he says.
Trust in the organisation will be rebuilt “automatically,” he adds. “Just because you exist doesn’t mean you get trusted. Earning trust means regularly demonstrating your transparency, regularly demonstrating your effectiveness, regularly demonstrating your impact to the people who pay the money and to the wider public.”
Whether Nabarro gets to be in charge of rebuilding that trust will be decided by 194 nations in Geneva this May.