Behind the buzz of the election of Tedros Adhanom Ghebreyesus as director-general of the World Health Organization, two important themes emerged from its marathon annual assembly which closed this week.
The first was the diversity of the more than 80 items on the agenda. This included rising concern about non-communicable diseases (NCDs), which are becoming a growing burden on governments in poorer as well as richer countries.
A resolution on the public health response to dementia stressed that of the 50m people diagnosed around the world, over half were in poorer nations. Yet fewer than 30 countries even have a national plan to respond. With no cure in sight, focus is needed on prevention including improved diet and exercise — as for so many other NCDs.
The second theme was resources. The WHO’s proposed 2018-19 budget, at $4.4bn, is up 3 per cent on the previous year. The organisation still allocates more than twice as much for communicable as non-communicable diseases although such divisions are becoming increasingly arbitrary.
The planned contribution by member countries includes 22 per cent from the US alone. Whether that will be paid remains to be seen. If Mr Tedros can refocus the agency and bring in the pledged funding, he will easily justify his starting base salary of $241,276.
We spoke to Mark Dybul, who this week finished more than four years as executive director of the Global Fund to fight Aids, TB and Malaria. His replacement is due to be selected by November.
What were your greatest achievements at the fund?
They are collective achievements. We shifted the focus back to the country as the place where things need to happen. We repositioned the secretariat as servants to the people in the countries: government, civil society, the private sector. We also introduced a new funding model and focused on how to use data to drive decision-making for greater impact. When you shift the focus and impact into the country, they have the responsibility.
What were your biggest frustrations?
Leaving without a successor. There is a vulnerability that goes with that. This is a challenging time in the world, which is very unfortunate. We are also not as far along in embedding as much of the changes in culture and processes as I would have hoped. We are way too process-heavy, too risk-averse, not adaptable or flexible enough. I’m still frustrated we have not taken the adolescent and young person epidemic in HIV anyway near seriously enough. We are not making the progress in TB we should, and there is a risk of backsliding in malaria.
What are the challenges for your successor?
It’s understanding how global health fits within development and the world. It’s a very different place than 15 years ago: the socio-economic and political shifts, the rapid flow of ideas and people, movement and uncertainty. We continue to operate in a model that is 75 years old. We need to finance health in a fundamentally different way and understand how to respond to vulnerability and inequality. We need a shift from scaling up the response to ending epidemics. And fund governance is complex. Our board needs to understand that having a blocking minority is an issue.
No smoke without ire A number of studies marked World No Tobacco Day on Wednesday, including a report on the industry’s environmental impact, and research showing most young smokers want to quit. There were also calls to increase tobacco prices and extend plain packaging. Tobacco kills more than 7m people a year. (CDC, World Bank, WHO, PLoS)
Climate change and health As the US walks away from international commitments on climate change, here are reminders of how global warming can spread epidemics and how environmental challenges could undermine health advances of recent decades. Climate change is already making us sick, doctors say. (Washington Post, BMJ, NBC)
Zika fears Health authorities have welcomed a drop in Zika cases but debate is raging in India about an alleged cover-up.Researchers have separate worries about the collection of data on the disease while the Trump administration is coming under more pressure over its deal with Sanofi to develop a vaccine. (The Hindu, Nature, Boston Globe)
Cholera in Yemen The WHO flew 67 tonnes of cholera response supplies to Yemen, the Arab world’s poorest nation which is expected to have 130,000 cases within weeks. The UN Security Council was told that the civil war, cholera outbreak and widespread hunger could lead to the collapse of the country. (WHO, FT, WHO, Deutsche Welle)
US drug prices The debate over the cost of medicines in the US is heating up as drugmakers, pharmacists, politicians and middlemen fight over who is to blame. Big pharma spent a record $58m in political lobbying in 2016. Older people are most affected. (NYT, Kaiser, WSJ)
Cancer update The American Society of Clinical Oncology meeting this weekend is a key event for scientists and drugmakers alike. Can Roche’s Herceptin franchise endure? Will the location of a tumour become less important? Can combination therapy extend the benefits of immunotherapy? Can AstraZeneca build an oncology powerhouse? (FT)
Tackling opioid addiction Last year more than 52,000 Americans died of drug overdoses, mostly from opioids such as heroin and fentanyl. West Virginia has the highest overdose rate in the country and Ohio is accusing drugmakers of fuelling the epidemic. The US National Institutes of Health is working with private partners to tackle overdoses and find alternative, non-addictive treatments for chronic pain. (Telegraph, The New Yorker, FT, NEJM)
Medical tourism Half a million Chinese went abroad for medical treatment in 2016, a fivefold increase from the previous year, as the rich bypass an overburdened domestic system for treatment of conditions such as cancer. (New York Times)
Measuring healthcare With little research to compare quality of healthcare, the WHO calls for an improvement in data collection, measurements and presentation. A separate study of US healthcare providers found that measuring a diverse range of indicators including patient experience led to better safety records — and bigger profits. (WHO, Harvard Business Review)
Brussels Brexit blast Medicines made in Britain will be treated as imports by the EU if no deal is reached in Brexit negotiations and UK life sciences will face new regulations, the European Commission warned. Brexit could also cost the NHS £500m if expats returned for treatment once EU reciprocal arrangements end. A campaign is urging the EU to take up the role of global health leader. (FT, Deutsche Stiftung Weltbevölkerung)
Paraguay paragon About 30m people in Latin America do not have access to safe water and 100m lack sanitation, despite the region's freshwater resources. One country stands out: Paraguay — with 94 per cent of its rural population now enjoying clean water. (The Guardian)
Air pollution UK campaigners launched a court action over the government’s "flawed" air pollution proposals as campaigners claimed the premature death toll from dirty London air this year hit 1,000. (Evening Standard)
Wales blazes trail Not only has Wales led the rest of the UK on public health provisions such as smoking bans, obesity and reforming pharmacy services, but it is the first country in the world to introduce statutory health impact assessments of the effect of public actions on citizens’ health. (The Conversation)
Native wisdom Can traditional healing practices be integrated into modern healthcare? The Nuka integrated system of care for the Alaska native community has become an international model of reform. (Stanford Social Innovation Review)
The peanut problem Can science crack the peanut allergy? Amid the rise in food allergies, two new treatments are on the verge of approval. Here is how they work and a look at why our food has turned against us. (FT)
Zombie time Scientists are planning to inject stem cells into someone declared clinically brain-dead to see if they can be brought back to life. The subjects are also injected with proteins, given electrical nerve stimulation and laser brain therapy. “Of course, many folks are asking the ‘what comes next?’ question,” said the chief executive of the company running the trial . . . (Stat)
Best from the journals
Vector control A new push is needed to target mosquitoes, flies, ticks, bugs and other vectors that transmit pathogens, a method proven to be the best way to prevent the spread of infectious disease. (The Lancet)
Diarrhoea deaths Half a million children under five still die from diarrhoea each year although the global figure fell by a third between 2005-15. It is the fourth leading cause of death. (The Lancet)
Older mothers The average age of new mothers continues to rise in richer countries. A new study lays out the complications facing women who delay childbirth past 40. (PLoS Medicine)
US healthcare How will the Senate treat the reform proposals passed by the House on issues such as Medicaid, subsidies for the private insurance market, tax cuts, and funding for Planned Parenthood? (NEJM)
Brain stimulation Scientists hope a new method of electrically stimulating neurons tested on mice could be applied to humans suffering from brain disease. (Cell)
Thought for food A look at how your brains, digestive system and energy needs conspire to determine your appetite. (PLoS)
Podcast of the week
A discussion on the state of the American Health Care Act and what it means for the politics of healthcare in the US. (The Lancet, 18 minutes)
Applications are invited by the end of June for outstanding ideas to revolutionise healthcare at the World Health Summit in October. Young researchers can also apply to submit presentations to the New Voices section of the conference.
In case you missed it
FT Health last issue: Tough challenges for new WHO chief
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A study has showed that only about 40 per cent of doctors and other healthcare providers complied with hand washing rules in US hospitals and on any given day, one in 25 patients suffers from an infection acquired while in hospital. Could a handshake-free zone be the answer? (Kaiser)
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