FT Health: The WHO’s screeching U-turn on Mugabe

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Robert Mugabe may be a posterboy for political and personal longevity, but outraged international reaction meant his World Health Organization title of “goodwill ambassador for non-communicable diseases” had rather a shorter lifespan. The question is whether the man behind the fastest U-turn in public health history, Tedros Adhanom Ghebreyesus, can just as swiftly recover his reputation for judgment and governance as head of the WHO.

Mr Tedros’s decision within four days to anoint and rescind the nomination of the 93-year-old leader of Zimbabwe, who has been in power since 1980, sparked a Twitterstorm of public criticism and many irate high-level private conversations. Mr Mugabe’s abuses of democratic and human rights are coupled with oversight of a collapsing economy and once-strong health system, despite commitments on paper to universal health coverage. No surprise that he travels to Singapore for treatment.  

His brief appointment was likely less linked to health leadership than to political and personal connections: he was president of the African Union when it put its weight behind Mr Tedros’ candidacy to run the UN agency; and he was one of the few heads of state to attend a WHO meeting in Uruguay last week, putting President Tabaré Vázquez on the spot as host.

Mr Tedros won widespread support to run the WHO thanks to his record as health minister of Ethiopia, but also because he had greater political experience than most of his rivals or predecessors. Yet his decision on Mr Mugabe was made without consulting senior WHO staff. It suggests a curious insensitivity to how the appointment would be viewed by others, including many African leaders and officials, not to mention western policymakers who dominate funding of the WHO.

His decision without consultation may owe something to Ethiopia’s own authoritarian political culture, and does not show the sensitivity to a wider range of international opinions he will need to respect to succeed in his new job. Mr Tedros has demonstrated one useful but far from ubiquitous political characteristic: a thick skin. Many believe his ability to judge and listen to others needs to go rather deeper. 

Three questions

Derek Yach, one of the architects of the World Health Organization’s Framework Convention on Tobacco Control, has been appointed head of the Foundation for a Smoke-Free World, with $1bn in funding over 12 years from Philip Morris International [PMI]. Mr Yach, who is from South Africa, argues he can work freely for “harm reduction” with a shift away from cigarettes; critics suggest taking money from “Big Tobacco” is counter-productive.

How do you respond to the criticism of you for taking charge of the foundation?

I’ve brought tobacco control back to life. Shouldn’t I get some credit for getting the debate going after a decade of bureaucratic inertia? I was surprised with the efforts to close down discussion in the face of a world trend which is trying to open it up. For every critique, I get requests from quality scientists, suggesting there has been a pent-up demand for innovation not just for reduced risk but in smoking cessation. When you look at the pipeline, for the last 20 years there have been very few new products.

Can the foundation be truly independent of PMI?

It’s equivalent to people asking me during apartheid in South Africa how could I be taken seriously while the government still had people in prison. The two are completely de-linked. The foundation is truly independent, and we don’t have to explain continued bad behaviour. We have to monitor it, report on it and evaluate new products as a way out. We should do the same for all tobacco companies.

Are you willing to criticise Philip Morris for its tobacco marketing and lobbying activities?

I’m willing to criticise any practice that doesn’t meet the Framework Convention on Tobacco Control, especially marketing to children. I’m also realistic. This needs to be done in an industry-wide way . . . If your main competitor is not [pulling back from marketing], it’s simply unilateral disarmament. [PMI] should be abiding by the convention. But in some areas they are lobbying in the public interest and are opposed by the public health [community], such as for a ban on ecigarettes. That is telling a smoker to continue [smoking].

Chartwatch

Polio progress This animated chart marking World Polio Day shows the disease's gradual reduction from 1980 to 2016. There are still hopes of eradication by the end of this year. A new film, Breathe, portrays the life of a polio survivor and wheelchair-use pioneer in the pre-vaccine era. (Our World in Data, WHO, Huff Post, The Conversation)

News round-up

Pandemic planning Progress on diseases such as Ebola and Zika could be seriously jeopardised by US aid cuts, says the "Healthier World, Safer America" report. The World Bank is rehearsing for a pandemic "sooner than we expect" but some virologists think it is impossible to predict. (Cidrap, Path, Washington Post, The Atlantic)

Measuring measles Global measles deaths dipped below 100,000 for the first time last year but elimination is far off — almost 21m children are missing out on vaccination. Trouble spots are Nigeria, India, Pakistan, Indonesia, Ethiopia and Congo. (Reuters, Measles & Rubella Initiative)

Global Fund candidates The Global Fund to Fight AIDS, Tuberculosis and Malaria announced its shortlist for executive director following an aborted attempt in February. The candidates are Simon Bland of UNAIDS; Frannie Leautier of the African Development Bank; Peter Sands from Harvard; and Anil Sohi from Mylan, the pharma company. (Devex, FT Health)

Africa plea The continent needs 11m more health professionals to stave off a "social and economic" disaster because of its booming population, the UN says. (Reuters)

Opioid action President Trump declared the US opioid epidemic a "public health emergency". The US experience is worse than other countries because of over-prescription, TV advertising, promotion from doctors, poor training and a strong culture of medication. (FT, BBC)

Diabetes danger The head of Novo Nordisk, the world's leading insulin maker, warned the annual bill for diabetes-related illnesses could hit $1tn by 2045 — a figure "not sustainable to societies" — and overwhelm governments' healthcare budgets. (FT)

Cyber lessons The cyber attack that hit the UK's NHS in May was more extensive than thought — and could have been prevented if IT warnings had been heeded. More than one in three hospital trusts were affected and 19,000 appointments cancelled. (FT)

An "Airbnb for patients" . . . A scheme to tackle hospital bed shortages by putting recuperating patients in private houses has been attacked for safety reasons. The lack of beds is estimated to result in as many as 8,000 deaths each year. (Guardian)

. . . and an "Uber for contraception" A US contraceptive-ordering app is encountering resistance in conservative states and prompting new debates about the role of telemedicine. US anti-abortion groups are targeting Latin America and the Caribbean. (Stat, Guardian)

Avoiding antibiotic apocalypse A new campaign by NHS England emphasises rest as an alternative to antibiotics and says a fifth of all such prescriptions are unnecessary. England's chief medical officer has warned of a "post-antibiotic apocalypse". But patients should not shoulder all the blame. (BBC, Guardian)

Mental health at work UK workers with long-term mental health problems are leaving the workforce much more rapidly than those with physical problems. Sickness absence has fallen by up to 20 per cent since 2009, but absence for mental health reasons has risen by about 5 per cent. (FT)

Body brokers The pitch? Get a free cremation for donating your loved one's body "to advance medical studies". A series on the grisly and unregulated US trade in body parts. (Reuters)

Genetic dilemmas Genetic testing of embryos is becoming more readily available but what if patients trying to get pregnant select one with DNA that could lead to a disease or disability? (Stat)

Bed-head Sleep rhythms of teenagers can lag an adult by two to three hours. Letting them sleep later can have real benefits — from improved academic performance and road safety to lower risks of obesity and suicide. (FT)

Best from the journals

Career advice Mortality rates across Britain differ significantly depending on occupation. An analysis of 20 years of data suggests, for example, that the least risky jobs in England and Wales are health professionals, with construction workers at the bottom of the table. (The Lancet)

The imperative of vaccination  Making vaccination mandatory, albeit temporarily, should not be seen as an infringement of personal rights. Thousands of lives in poorer countries could be saved if children got the same vaccines as in rich countries. (The Lancet, National Geographic)

Investing in adolescents There has been an analysis of the impact of interventions targeting the health and wellbeing of those aged 10-19. Action will also generate high economic returns, especially in low-income countries. (The Lancet)

Cell mapping  Scientists have be gun work on the Human Cell Atlas — a project to map all the cells in the human body. As well as aiding treatment it will also give biologists a better understanding of human evolution. (Nature)

Ecigarette debate Teenagers trying ecigarettes with higher nicotine are more likely to progress to heavy vaping or traditional smoking. New York is banning vaping anywhere that cigarettes are prohibited while UK MPs have launched an inquiry into whether it "re-normalises" smoking. (Jama Pediatrics, NYT, Telegraph)

Surgery and the body clock Surgery involving the heart is better done in the afternoon when the body clock means it is stronger. (The Lancet)

Walking works More evidence that regular walking helps you live longer, even if you don't meet exercise targets. (American Journal of Preventive Medicine)

Podcast of the week

Breaking bad news How should doctors tell someone that they’re seriously ill or dying? (Mosaic, 21m)

Coming up

Join us at FT headquarters in London on November 21 for an evening of discussion, drinks and networking on HIV treatments and the future of medicine. Guests include Deborah Waterhouse of ViiV Healthcare and Yusef Azad of the National Aids Trust.

In case you missed it

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Final thought

Obesity: whose fault? Are we putting too much blame on individuals when the average person is "upsold" food and drink more than 100 times — amounting to 17,000 extra calories — a year? (BMJ)