There is less than a week to go in the race to be the next Director-General of the World Health Organization. And given the WHO's recent mis-steps, especially with regard to Ebola, this is a crucial election. Unfortunately, the race just got terribly nasty with its own "dirty tricks."
The race has boiled down to a contest between Dr. Tedros Adhanom Ghebreyesus of Ethiopia and Dr. David Nabarro of Britain.
Tedros, as he is universally known, is the former minister of health and foreign minister of Ethiopia. Under his leadership, Ethiopia trained and deployed approximately 40,000 community health care workers to almost every village in the country focusing on basic primary care: diagnosing and treating malaria, providing basic prenatal care and moving women to facility-based deliveries, and improving childhood nutrition.
David Nabarro is a global health "old hand," working at the WHO since 1999. Over the years, he has coordinated or chaired numerous United Nations or WHO commissions, such as the Scale Up Nutrition effort and the Advisory Group to reform the WHO's responses to infectious outbreaks and emergencies. Nabarro he has been most associated with the WHO's responses to the cholera outbreak in Haiti, various influenza outbreaks, and from August 2014 to December 2015, the WHO's anemic response to the Ebola outbreak in west Africa.
(The third candidate is Dr. Sania Nishtar, a Pakistani physician with little global health experience, and no one gives her much of a chance of winning.)
The final vote is next Monday. This past weekend the Tedros-Nabarro contest had it very own "Comey moment." Larry Gostin of Georgetown Law School, a frequent WHO consultant and prominent global health scholar, released an unsubstantiated charge against Tedros. He claimed Tedros and the Ethiopian government covered up cholera outbreaks going back to 2006, calling them acute watery diarrhea.
Diarrhea is endemic to Ethiopia a country of over 100 million people where the vast majority of people live in rural communities. It has only one large city, Addis Ababa with a population less than 4 million. Unfortunately, in Ethiopia, about a third of children have diarrhea and it is the second leading cause of death in children under 5. As one report put it "Studies have shown that, in developing countries like Ethiopia, the occurrence of diarrheal disease among under-five children is complex" caused by many factors ― rotavirus, bacterial infections, contaminated food, lack of sanitary conditions. Often, especially in remote, rural communities, it is hard to make a laboratory confirmed determination of the precise cause of diarrhea and, consequently, most are classified descriptively as "acute watery diarrhea."
It is unclear why a decade-old charge was launched only in the waning days of the WHO campaign. Unfortunately, Gostin, normally a careful scholar (I have co-authored with him), provided no substantiating evidence — no official report and no scholarly papers — to support his charge against Tedros. But suspicions are high because Gostin is a Nabarro supporter, although he denies any coordination with the Nabarro campaign. This charge, more rumor and innuendo, is worrisome in its timing and, leaving no time for a response, borders on the unethical. The denial of coordination seems suspicious — like the plausible deniability of a government leak.
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Whatever the basis of Gostin's charge, all global health experts agree that because of the community health care workers and other programs initiated by Tedros, Ethiopia has made dramatic improvements in infant and maternal mortality, malaria mortality, immunization rates, and childhood nutrition. For instance, since 2005 infant mortality in Ethiopia has dropped by 23 percent and the number of malaria cases per year declined nearly in half from 3 million to 1.7 million. Indeed, unlike most sub-Saharan African countries, Ethiopia achieved all but one of the Millennium Development Goals in health.
We should not let rumor and political "dirty tricks" launched without time for careful consideration to sway such an important vote. It is finally time for an African — especially one of Tedros' tremendous achievements ― to head the WHO.
Ezekiel J. Emanuel, M.D., Ph.D., chairs the Department of Medical Ethics and Health Policy at the University of Pennsylvania. This piece was first published by the Huffington Post.
