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  • A time of challenge and opportunity for the WHO


The new head of the World Health Organization, Margaret Chan, must balance both political and scientific pressures if she is to succeed at improving global health efforts.

As votes were cast last week for a new director-general of the World Health Organization (WHO), the agency was engaged in a sharp exchange with the Chinese government over whether a new strain of bird flu had emerged in China.

This controversy epitomises current challenges facing the United Nations health agency — the need to steer a robust course embracing both science and politics.

The timing was ironic. Not only is the winning candidate, Margaret Chan, China's candidate for the post. But she owes her success partly to her commitment both to open communication and to her achievements firstly as the Department of Health's director in Hong Kong — where she led campaigns against SARS and bird flu — and more recently as head of the WHO's own efforts in this field.

What remains to be seen, however, is the extent to which Chan can balance her enthusiasm for getting messages out with an equal eagerness for ensuring that these ideas are scientifically sound.

Checking the facts

Chan has identified a need for evidence-based approaches to decision making on health issues. She has promised to establish a 'global health observatory' that will collect and collate data on key health problems to help inform health policy.

She has also pledged to "promote national and global mechanisms to apply knowledge and technology, and increase local capacity to conduct research".

Both commitments fit well with the emerging role that many expect from the WHO. As national governments and private foundations like the Bill and Melinda Gates Foundation increasingly support the practical aspects of improving healthcare in developing countries, the WHO should turn towards strategic interventions, playing an advocacy role in promoting new policy initiatives.

These initiatives, however, will only succeed if they are thoroughly grounded in sound scientific conclusions. If the WHO wants to influence government policy, it must take care that its arguments have a rigorous scientific basis, particularly when these are likely to be widely reported (see 'Bird flu: the role of science journalists').

Getting research out of the lab

The agency must also increase its efforts to ensure that research results are applied in the field — supporting and promoting science should not be restricted to laboratory research. This is particularly true for 'neglected diseases' that affect people in the developing world, who hold little attraction as potential customers to pharmaceutical companies.

Chan has promised to integrate the WHO activities across the health research spectrum, "to promote health and prevent disease". In practice, this means it will need to increase emphasis on technology transfer — getting research out of the laboratory — and innovations in health delivery.

Hopefully Chan's stress on effective action will extend to active support for moves in the WHO to engage more deeply in the entire spectrum of health systems research, as recommended by the World Health Assembly.

A balancing act

But without a significant increase in funding, which seems unlikely at the moment, there will be uncomfortable trade-offs to be made.

For example, following a review earlier this year, The Special Programme for Research and Training in Tropical Diseases — the main vehicle set up to ensure research is put to good use — is set to focus future research and development efforts on the most neglected diseases, as well as fields where others are not adequately working.

Such a strategy could result in reduced WHO funding for other areas (such as malaria research) that remain scientifically productive, on the grounds that they are obtaining increased support from other sources.

The net gain, however, will be an approach that — as with any increase in support for health systems research — both focuses on areas in which the agency can be most effective within the new funding environment, and places all research within the wider context of health systems innovation.

All this points to a growing — and welcome — recognition within the WHO that while science provides an essential component of effective health systems, other inputs, from government innovation policies to patent legislation, are equally important.

Chan herself is aware of the need to take the broader context into account. "Not all of the problems faced by the WHO in its efforts to improve world health are subject to scientific scrutiny, or yield their secrets under a microscope," she said soon after her appointment. "Lack of resources and too little political commitment. These are often the true killers."

If this political commitment can be appropriately channelled into improving health systems in a way that is both operationally effective and scientifically robust, the world's health can only improve.

The danger is when the political commitment is allowed to overpower the science. Chan's success will be largely measured by her ability to balance the two.

David Dickson, Director

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