FT Health: New WHO chief faces tough challenges

And the winner is . . . Tedros Adhanom Ghebreyesus. The new director-general of the World Health Organization, who was elected this week, takes office in July with a brimming inbox and a worryingly diminished cash box. The campaign lasted many months and proved unsparing, with concerns raised over the health and human rights record of his native Ethiopia. You can read our recent Q&A with him here.

But the outcome, after three rounds of secret ballots, sends a strong signal: Mr Adhanom is the first African to hold the post, and someone who has won considerable respect among his peers as a reforming health minister and past chair of two international infectious disease organisations. He will need all those skills and contacts in the years ahead.

His biggest challenge will be to boost the reputation of the WHO as a respected norm-setting agency and co-ordinator of pandemic response. Demonstrating its commitment to fulfil these functions well offers the best prospect of renewed donor support as the US turns in on itself.

His other focus will be his pledge on universal health coverage. It is an appealing notion, focused on equity and the need to respond to the rising pressure of non-communicable disease. But its vagueness and the need for individual countries to take the lead raises questions over the precise role of the WHO. With the latest White House budget estimated to leave 23m Americans uninsured, its objectives will prove difficult to achieve, in richer and poorer countries alike.

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Three Questions

Extracted from Mr Adhanom’s post-election briefing.

What is your view of universal health coverage?

Health is a [human] rights issue and a means to development. It’s not actually a waste — it’s the smartest thing to invest in. All roads should lead to universal health coverage. It’s addressing the financial barrier, the challenge we are facing with regard to access to drugs, the barriers to equality, quality of care and diagnosis. Some countries want to use private services to achieve universal health coverage. Others use public services only. Yet others use a mix of private and public. Some countries use general tax, others use insurance. Others use a mix. There is no one way or [single] means of achieving [it]. 

What will you do about the emergency response programme?

We have to implement it with a sense of urgency. It has to be geared towards implementing the international health regulations in full. We can do many of the things we’re doing now, like [rolling out] the global health security agenda . . . and identifying the gaps in implementing the [regulations]. Epidemics can strike at any time, but we have to be prepared.

How will you reform the WHO?

The reforms already started by the outgoing leadership should continue. And if there are new areas we need to consider, we should. But one thing that’s clear is that re-engineering the process is important. Do we have the same understanding? Do we have the same vision? And do we have concrete goals based on these priorities. Are we measuring on [a] regular basis? Do we have . . . motivated staff? For leaders, one main task should be to motivate, inspire and create [a good] work environment.

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Chartwatch 

More than half of adults and one in six children in OECD countries are overweight or obese, with the highest levels in the US and Mexico. People with a lower level of education or socio-economic status are more likely to be affected. (OECD) 

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News round-up

US cuts abroad . . . The White House flagged big reductions for global health programmes including a 26 per cent drop for the State Department and USAID, which represents the bulk of overseas health expenditure. Critics said this would severely damage the fight against HIV/Aids, malaria and polio as well as weakening global responses to Zika and Ebola. (Kaiser) 

. . . and at home Domestic health spending was also hit, with reductions for the FDA; Medicaid, the health programme for the poor; the National Institutes of Health, which fund research; and other public health projects. Separately, the US budget watchdog said the latest iteration of Republican healthcare reforms would leave 23m more uninsured. (NYT, Stat, FT)

Ebola hopes Authorities in Congo are preparing to use an experimental vaccine after a fourth death from the virus. The move is an important step towards regulatory approval for Merck’s vaccine — potentially the first for the disease. Hopes are rising that the outbreak may be smaller than first feared. (FT, Stat)

National health strategies A new handbook lays out guidance on consultation, operational planning, regulation and budgeting for national health systems. (WHO/Universal Health Coverage Partnership)

Drug approvals There has been a jump in approvals in the US and Europe as companies shift resources from mass-market products to more specialist medicines for rare diseases, cancer and infections that benefit from accelerated reviews. Potential big earners passed include Sanofi and Regeneron’s Dupixent (eczema), Roche’s Ocrevus (multiple sclerosis) and AstraZeneca’s durvalumab (cancer). (Reuters)

Cancer first Merck’s Keytruda became the first cancer drug approved by the US FDA to treat tumours with a specific genetic feature, rather than targeting the part of the body where it originated. Keytruda is a star performer among immunotherapy drugs, which work by releasing brakes on the immune system, allowing the body to attack tumour cells. (Reuters, FT)

Condom deal A Chinese consortium is paying $600m for the condom and sexual health business of Australia’s Ansell to cater for growing domestic demand for higher quality contraceptives. China’s condom market will almost triple in value to $5bn by 2024 from 2015. (FT)

EMA tussle begins Brussels issued ground rules for member states to bid for the European Medicines Agency when it leaves the UK after Brexit. The EMA employs 900 specialists at its current London base and hosts 36,000 regulators and scientists each year. Some even believe Britain can cling on. (FT)

UK care crisis The general election campaign was dominated by a Conservative U-turn over social care plans, dubbed a “dementia tax” by opponents. Britain’s ageing population is increasing yet care home operators find it difficult to turn a profit. The number of older people needing care in England and Wales will rise by 25 per cent by 2025. (FT, The Lancet)

Depression test questioned Campaigners say doctors could be misdiagnosing depression by being too reliant on a questionnaire devised by Pfizer — a maker of antidepressant drugs. The PHQ-9 test has been widely used in UK GP surgeries for 20 years. (Telegraph)

Medical microbots Microscopic devices can move through the human body to diagnose conditions, carry drugs or even perform surgery, but two big hurdles remain before clinical trials: researchers must be able to monitor the devices more clearly and have greater control while they roam our insides. (Nature)

Status of mind How is the mental health of young people affected by social media, often cited as the cause of increased anxiety, depression and poor sleep? YouTube tops the table of positive influences with Instagram the most detrimental. (Royal Society for Public Health)

Surviving lightning Lightning strikes kill more than 4,000 people each year. The chances of surviving a surge of up to 200m volts are 90 per cent — but what are the lasting effects? (Mosaic)

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Best from the journals

Mapping Zika The Zika virus circulated in Brazil in 2014, more than a year before the disease was recognised, according to a large international study using genetics to track the spread of infection. Miami has a new battle plan for the mosquito season. (FT, Nature, Miami Herald)

Pandemic response The global response to pandemics needs to be overhauled. Public health capacity — including human and animal disease surveillance — must be improved, as well as global efforts to accelerate R&D of vaccines, drugs and diagnostics. (The Lancet)

Building resilience National health systems are the first line of defence against health crises. How can they become more resilient — withstanding shocks while maintaining routine functions? (BMJ)

Gene geniuses Scientists have identified certain genes linked to intelligence. Although less important a driver than factors such as environment, researchers say the find is a breakthrough in our understanding of the biological basis of reasoning. (Nature, NYT)

Health literacy A teaching programme for primary school children in Uganda and a podcast aimed at their parents have proved successful in teaching them how to evaluate health claims. Details at Informed Health Choices. (The Lancet)

Space sperm Hopes for humans reproducing in space came a little closer after mouse sperm stored on the International Space Station for nine months was successfully used to create offspring. (PNAS)

Breast cancer One in three cases of breast cancer could be prevented if women avoided alcohol, stayed a healthy weight and were physically active. The disease is the most common cancer among women across the world. (American Institute for Cancer Research)

Diabetes warning Type-1 and Type-2 diabetes significantly increased among younger people in the US between 2002 and 2012, particularly among minority racial and ethnic groups. (New England Journal of Medicine)

Coffee cancer link Drinking coffee is associated with a reduced risk of liver cancer, a rapidly increasing disease, especially in east and Southeast Asia. About 2.25bn cups of coffee are downed across the world daily. (BMJ)

Chagas challenge Deaths in Brazil from chagas — the disease spread by the triatomine beetle or “kissing bug” — may have been under-reported. Many infected people show no symptoms during the disease’s initial phases. (PLoS NTD, FT Guide to NTDs)

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Podcast of the week

A discussion with bite Richard Barnett, a medical historian from Cambridge university, discusses the history of dentistry, from “charlatans with big muscles” to the fad for “Waterloo teeth”. (NPR, 21m)

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In case you missed it

FT Health last issue: Trial transparency, UNFPA’s Babatunde Osotimehin, cyber fears.

Read previous editions and discuss the issues on our Facebook page. 

Latest news www.ft.com/health and @FT_Health.

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Final thought

Are the cuts in US foreign aid a prudent measure, forcing other countries to contribute their fair share to global health programmes? Or will they needlessly put lives at risk and damage US standing abroad? Share your thoughts with us on Twitter and Facebook.