Philippe Douste-Blazy has focused his energy over the past decade on exploring alternative means to fund development causes. Now, he is making these efforts the centerpiece of his candidacy for the World Health Organization director-general.
Douste-Blazy was among the founding members of the Leading Group on Innovative Financing for Development, a group of countries and organizations working to identify and initiate financing mechanisms for development. Their efforts have led to such tools as the International Finance Facility for Immunization, which issues vaccine bonds on the international capital market to raise funds for Gavi, the Vaccine Alliance. Another example is the Advanced Market Commitments, under which pharmaceutical companies are encouraged to develop vaccines for neglected diseases following guarantees from donor governments or philanthropic institutions such as the Bill & Melinda Gates Foundation.
He also rallied behind the creation of UNITAID, which for the past 10 years — under his leadership as chair — has helped raised and provide funds for HIV and AIDS, tuberculosis and malaria diagnosis and prevention.
In 2010, Douste-Blazy helped set up the Medicines Patent Pool to lower prices for medicines like antiretroviral drugs for HIV and AIDS. And in 2015, he was involved in the launch of UNITLIFE, another financing mechanism that makes use of microlevies on the extractives industries to fight malnutrition.
Whoever wins among six candidates for the director-generalship of the World Health Organization will have a consequential impact on the future of agency and of global public health itself. Candidates are promising leadership and bold change. But any reform will have to contest with a WHO's fraught budget, demanding member states and a stultifying bureaucracy. Devex takes an exclusive look at the stakes behind the vote.
In a conversation with Devex, France’s candidate to lead WHO emphasized the crucial role “small microscopic solidarity contributions” can have in addressing the world’s most pressing global health issues. In those innovative mechanisms, he sees an opportunity for tackling WHO’s financial woes.
In this Q&A, Douste-Blazy speaks about his strategy for convincing member states to increase WHO’s budget, as well as his priorities for the organization and what he intends to do to restore member states’ full confidence in the institution he is hoping to lead. Our conversation has been lightly edited for length and clarity.
What’s your main platform/vision for running for the DG position?
I am professor of public health in Paris and also a visiting professor in Harvard. I believe in a strong WHO. Public health is a very important Sustainable Development Goal — SDG 3. If we want to achieve Sustainable Development Goal 3, we need a stronger WHO.
What does a stronger WHO mean in practical terms? Do you have specific priorities and policies you’d want to focus on if you are elected to the position?
During the last two decades, each time the international community had health issues, the international community created a new fund: The Global Fund against HIV and AIDS, TB and malaria, or Gavi for vaccinations, or UNITAID or Stop TB Partnership, or Roll Back Malaria. Each time, outside the WHO.
We need to push back the WHO at the heart of the global health policy.
About priorities. First of all, to strengthen the primary health care systems. If we want to achieve universal health coverage for each country in the world, we have to target the primary health care systems, particularly to continue to decrease the childhood mortality rate and the maternal mortality rate with midwives, etc.
The second thing is about implementation of the health emergencies program. It is linked with the first, because if you see the Ebola crisis, you can see that the three countries — Guinea, Sierra Leone and Liberia — which suffered a lot from Ebola didn’t have any primary health care systems. We need to implement this emergencies program to define accountability and responsibility for each level of the organization. Which accountability [goes] for headquarters, for regional, and for country offices. We have to define clear lines of accountability.
And third, [combatting] the noncommunicable disease, it is absolutely crucial. It is a purely factorial approach. It is compartmental, because in tobacco you have to sign the tobacco convention in each country in the world. It is also lifestyle, with not enough physical activity or too much salt or too much sugar in the soda, too much fat in food.
Read Q&A’s with other candidates:
The World Health Organization is a very good normative organization. But it also has to define norms in salt, sugar and fat intake the same in other countries. And we have to also target not only the ministers of health, but the ministers of education to explain to children under 10 that alcohol, tobacco, drugs, sugar, chocolate, fat intake and violences against women and violences against children are very important. …The Philippines is a very good example for that, because you work in this country against violence against women and children. I think that [the Philippines’] minister of health does a very good job.
And one of the most important things to do is the availability, accessibility and affordability of drugs, medicines, and health products. One third of the global world doesn’t have access to any essential medicines and essential vaccines. It’s a shame.
What are your specific strategies in terms of financing at WHO? Do you have any specific plans or actions going forward on financing?
Yes. If we have a big strategy — If we can convince heads of state that one strategy is very good, with a big vision, I do think that we can increase the member states’ budget [for WHO].
I think that global health is a political issue. It is not only a technical issue. So we have to speak not only to the ministers of health but also to the heads of state, saying that global health, public health, is not only a cost, but it is also an investment. If you can convince not only the minister of health, not only the minister of foreign affairs, but also the heads of state, you are going to have an increase for the budget for health.
You know, innovative financing could be also a key for the budget of WHO. When I was minister of foreign affairs in 2006, I had a small idea: add 1 euro or $ 1 per plane ticket. It is absolutely painless for the minister of budget, because it is not the state which is paying, it is not the airlines companies, it is the traveler [who] has to pay $1 more or 1 euro more. It is painless.
I convinced 12 countries to do that in the world. And we raised more than $2.5 billion in nine years. We used this money to fight against HIV and AIDS, tuberculosis and malaria in developing countries. It is crucial to understand that a small microscopic solidarity contribution like that can change things.
What about management and operations — what are your goals and plans? Particularly since the relevance of WHO is currently being questioned.
If we want to reinstall confidence between member states and WHO, we have to do three things: first, implement a strong audit function. It is absolutely crucial. Second, have a new human resource system with world class experts, independent and internationally respected. And third, we have to link budget to results.