World Health Organisation director-general Margaret Chan warns of an antibiotic dead-end, wishes health policies were sexier and talks about her envy of our free health system.
In between running the World Health Organisation and managing its $5 billion annual budget, WHO director-general Margaret Chan can climb three flights of stairs without panting.
People have to change their eating habits
“I used to do more, but guess how old I am? I’m probably twice your age!” Dr Chan, 65, jokes.
The light-heartedness might belie her job title, but the charm and playfulness are just two facets to a woman who rarely minces her words.
“Big tobacco is using dirty tricks to discourage governments from pursuing the right public health policies,” she whispers, having just noted that the 2005 Framework Convention on Tobacco Control has yet to take root.
“No other binding convention has been ratified by as many countries. But the pace of implementation hasn’t been as fast as I’d like to see.”
The dirty tricks, she says, include legally bullying smaller countries into submission. “They’re taking governments to court. Would you allow a private sector industry to come here, sell its products, kill your people and even sue your government? Of course not. We need to step up the fight.”
Australia has already started doing so, with plans to replace tobacco branding with plain packaging having received the legal green light.
Dr Chan believes that if the measure is a success, other countries – including the EU bloc – will follow suit.
“[European Health Commissioner] John Dalli and I have been speaking about tobacco control for some time. He understands it, and he got it right.”
In the meantime, smoking rates among Maltese women weighed on Dr Chan’s mind. “I’ve been told in Malta it’s often the mother who stays home and cares for the children. That means children end up being regularly exposed to second-hand smoke.”
With Malta having the dubious honour of being both Europe’s fattest and least exercise-prone nation, obesity is also a major concern.
“The problem with obesity is the complications it brings, like diabetes,” Dr Chan acknowledges.
“But addressing it is very difficult because it requires behavioural change. How many Maltese have moved away from a Mediterranean diet to fast foods? People have to change their eating habits.”
Those eating habits often tend to involve significant quantities of meat – meat which often contains antibiotic residues. “We use more antibiotics in animals than in humans,” Dr Chan points out, “otherwise they die.”
Antibiotic-loaded livestock is believed to be a key contributor to antimicrobial resistance, as bacteria become immune to the drugs. Husbandry reforms could work, she argues. “Look at Denmark. Meat there is antibiotic-free, and as a result it fetches a premium price.”
Antimicrobial resistance has reached crisis proportions in malaria treatment, with patients in many parts of the world only responding to artemisinin-combination therapies, or ACTs.
“We don’t have any antibiotics in the pipeline. If malaria bacteria were to adapt to resist that, we have nothing else,” Dr Chan sighs.
And while she’s eager for prescription-happy doctors and antibiotic-demanding patients to curb their zeal for the precious drugs, Dr Chan also feels a trade-related difficulty isn’t helping matters.
“There’s little financial initiative for pharmaceutical companies to develop new antibiotics. If they come up with a new blockbuster drug, it makes money for a while, and then it gets copied.”
That meant other players, such as governments, needed to step in.
“That’s what the EU is doing – entering into co-financing agreements with private businesses researching new drugs.”
But don’t campaigns discouraging the over-prescription of antibiotics risk antagonising pharmaceutical companies, their shareholders, and the governments who hosted them?
Dr Chan laughs. “I don’t think so. They’re ethical people too, and remember we’re talking about misuse, not use, of antibiotics. There has got to be a moral compass somewhere.”
In 1977, WHO set itself the target of ensuring every man, woman and child lived a healthy life by the year 2000. Twelve years after that date, a billion people still live in poor health.
“That’s the dilemma in healthcare public policy,” Dr Chan admits. “Having a target date galvanises people and motivates them to achieve more. But having deadlines also sets you up for failure in the public eye.”
Dr Chan has spoken openly about directing many of WHO’s efforts towards improving the health of two groups – women and those on the African continent.
So it is ironic that just as it is starting to register some significant gains, with drops in malaria and TB levels, WHO is experiencing a credit squeeze.
Without health, everything else fails
According to Dr Chan, most of WHO’s financial difficulties are down to exchange rate variances.
“Seventy per cent of our income comes in US dollars, with a big chunk in euros. And we’re based in Geneva, spending Swiss francs. We’ve lost a lot of purchasing power because of the weakness of those two currencies,” Dr Chan says in between sips of water.
And although Dr Chan insists WHO is not in competition with massive fundraising operations such as the Gates Foundation – which also gives money to the organisation – she candidly admits a measure of threat.
“Donors want to be able to show something tangible for the money they put in. And a million doses of vaccine are tangible. But if you give WHO $1 million, what do you get? Training, system development, examples of best practice. Those,” Dr Chan says with a smile, “aren’t sexy”.
WHO’s aim of achieving worldwide universal health coverage remains a distant target for many countries – but not for Malta.
Malta’s health sector was praised last week by one of Dr Chan’s colleagues, the director of WHO’s regional committee for Europe, Zsuzsanna Jakab.
Dr Jakab’s admiration is shared by Dr Chan. “I agree with her. National health systems must be seen within a context, and my context is the 193 member states of WHO. The European region, as a whole, is in much better health context than most other regions of the world. And you have universal health coverage as well as free education. I envy you.”
She continued: “Keeping those requires economic growth. And Malta seems to be doing relatively well. Whatever you’re doing, you’re doing right.”
Her visit to Malta had led her to reminisce about her native Hong Kong, Dr Chan says.
“There are similarities. Hong Kong was a fishing village, without any natural resources and forced to import everything. But it invested in two things: education and healthcare.
“We need to learn more – innovation will propel us forward. But without health, those gains cannot be sustained. Without health, everything else fails.”