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Professor Dame Sally C Davies

Professor Dame Sally C Davies

Chief Medical Officer, UK Department of Health, endorses Dr David Nabarro as next Director-General of the World Health Organization.

View Sally Davies' endorsement in The Lancet (PDF)

At the World Health Assembly this month, the health ministers of the world will elect the next Director-General (DG) of WHO.

This is a vitally important job, as WHO is central to global health, security, and development. The organisation, working in response to the directives of its member states, acts as the directing and coordinating authority within the international system for all health matters, setting standards and monitoring their implementation. It also convenes a myriad of UN bodies, government agencies, civil society groups, and others as these standards are applied in response to specific health issues identified by member states—particularly those with global impact. WHO needs a strong DG to make this happen.

In January, 2016, I wrote a Comment in The Lancet setting out the essential criteria that I thought the future DG would need. This was coauthored by global health leaders from Brazil, Thailand, Japan, and South Africa.

As coauthors we agreed with WHO's established criteria for the role and added others. We wrote that WHO needed a leader who would engage confidently with science and evidence; who would communicate dynamically and effectively with both the people of the world and their political leaders; who would build on the post-Ebola reforms of current DG Margaret Chan and deliver real organisational change; and, most crucially, would be someone who cared about the health of everyone everywhere and brought unimpeachable character to the role.

Much has changed since January, 2016. The election of the DG is now just a few weeks away, and the six candidates who put themselves forward have been whittled down to three: David Nabarro (UK); Sania Nishtar (Pakistan); and Tedros Adhanom Ghebreyesus (Ethiopia).

The criteria set out in the Comment have stood the test of time, and I believe they are still the yardstick against which candidates for the DG role should be measured. When they were written, I did not know that Nabarro would be one of the candidates, but it is now clear that, measured against these criteria, he is the best person to become WHO DG.

Nabarro works with science and evidence, identifying the key issue at the heart of complex problems and communicating this widely and effectively with audiences ranging from the public to heads of state. As a medical doctor with decades of experience on the front line in over 50 countries and working at the highest levels of the international system, he has a track record of delivery. In 2005, for example, as fears of a human influenza pandemic were growing, it was Nabarro who was trusted to become the coordinator of the international system response. He translated the complex science of influenza and vaccination for health ministers, and galvanised action around the world.

Nabarro also understands the importance of the reform work started by DG Chan, and will keep up the momentum to deliver an organisation fit for the complexities and challenges of the modern world. Following the Ebola crisis, he was the Chair of the Advisory Group on the Reform of HO's Work in Outbreaks and Emergencies with Health and Humanitarian Consequences. Here he saw first-hand where the fault lines lay and has since articulated a strong vision for how WHO needs to change. He will bring clear lines of accountability into the organisation, while respecting and channelling the powerful role of the regional offices. His experience as Executive Director of the WHO DG Office under Gro Harlem Brundtland leaves him under no illusions of the scale of the challenges he will face, and also prepares him uniquely for overcoming them.

Above all else, Nabarro is passionate about WHO. At various points in his long career in global health he has worked within it, alongside it, and also challenging it-so he understands how the organisation operates and cares deeply about its staff and its mission. I do not know anyone who cares more than Nabarro about building a better, healthier future for people all over the world. His work within the UN system delivering the Sustainable Development Goals, and his commitment to universal health coverage, stands testament to this.

No one could doubt that the other two candidates are committed to global health. The very act of running for the DG role demonstrates this, as it is a gruelling process with the only reward being the possibility of an incredibly difficult job at the end of it. For myself and the UK Government, however, it comes down to two questions: experience and transparency.

Nabarro is the only candidate with real sleeves-rolled-up experience of delivering health on the ground. It is very different to lobby for change from a non-governmental organisation than it is to be responsible for making change happen in the complex international system. It is very different to survey progress from a national office than it is to work on the front line managing the response to a health emergency. It is very different to deliver from the comfort of a board room chair than it is to have difficult conversations with staff and stakeholders to drive programmes forward. Nabarro's real-world experience is broad and deep, and this is a time when we need experience at the head of WHO.

Many people talk the talk on transparency, but often as if it is an end in itself rather than a necessary tool. It should be remembered that transparency is valued because it makes for stronger organisations and, in turn, better outcomes for the people of the world. In the UK National Health Service, we have seen how transparency can transform patient outcomes and accountability, with public scrutiny driving improvements. The same can be true in WHO; member states will only give funds if they are confident they can hold WHO to account, and they can only hold it to account if they know what is going on.

Nabarro is exemplary in this regard, having been the first of the candidates to publish his full campaign expenses on the WHO website in line with the election code of conduct. This makes clear where he has been, and what his sources of funding are. Such transparency has been slow in coming from other candidates.

It is therefore important to be clear: these three candidates are not the same. Nabarro is widely regarded as the most competent and the most experienced, and I ask governments around the world to put politics aside and carefully scrutinise all the candidates on their own terms. I believe that WHO is too important to have anyone other than the best person at its head: this is Nabarro. For all our sakes, I hope that health ministers will bear this in mind when their nations cast their votes at the World Health Assembly in May.

Professor Dame Sally C Davies
Chief Medical Officer, UK Department of Health

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