Offline: A unique opportunity for WHO

Abstract

2017 marks the tenth anniversary of the Institute for Health Metrics and Evaluation (IHME) and the 20th anniversary of the Global Burden of Disease. The success of IHME was not assured. An attempt to launch a centre for generating global health data in 2005 failed when the donor, Larry Ellison, quixotically withdrew his US$115 million gift to Harvard University. The Bill & Melinda Gates Foundation stepped in to fill the void, and IHME, led by Chris Murray, was established as a self-governing research organisation within the University of Washington in 2007. Last week, IHME's Board—including Julio Frenk (President, University of Miami), Sally Davies (Chief Medical Officer for England), and Victor Dzau (President, US National Academy of Medicine)—met to review the Institute's achievements and challenges. They did so in the wake of the Gates Foundation's recent award of a further $279 million to IHME. The success of the Institute has depended on its mission-driven ethos, ownership and critical engagement by over 2400 collaborators, scientific innovation and rigour, and an industrial capacity for data gathering and processing. Nature recently noted that IHME is a GPS for global health, developing “cutting-edge approaches to complex modelling”, and becoming “regarded as a go-to source for health information”. WHO is the world's leading global health agency and is the only legitimate multilateral mechanism for advancing the health of nations. But in recent years WHO has struggled to find resources to invest in the production of global health data. It has found the retention and recruitment of a new generation of health metricians difficult. And the ability of WHO to maintain its independence has been compromised. WHO's requirement to have country data pre-approved by member states before release has led to political interference that has undermined the agency's reputation for impartiality. The scale of what it now takes to produce comprehensive global health information has surpassed WHO's capabilities. By 2018, IHME will have 361 staff, over half of whom will be dedicated to producing the Global Burden of Disease. WHO is unable to compete with IHME's critical mass of health metrics scientists, let alone the massive computational capital needed to produce data for mortality, morbidity, and risk factors across 194 nations. Add to that the work of IHME on financing health, measuring health system performance, assessing progress on meeting the Sustainable Development Goals, evaluating the impact of global health initiatives (such as GAVI and the Global Fund), and monitoring specific concerns around, for example, air pollution and obesity. In 2016, IHME published 150 papers in 77 scientific journals, and its data were used by 156 governments. IHME has achieved its objective of producing trusted, timely, reliable, and actionable global health data. Here is the unique opportunity that is now available to WHO. With a new Director-General of WHO—Tedros Adhanom Ghebreyesus—to take office on July 1, 2017, and with an entirely new leadership team to be appointed across the agency in the coming months, now is a good moment to reassess the relationship between WHO and IHME. For much of the past decade, WHO officials have been understandably suspicious of IHME's work and intentions. They have seen IHME as a competitor to WHO. They have frequently been reluctant to use data published by IHME scientists. But WHO has misread IHME's goal. IHME seeks to produce information that is a global public good for nations. WHO's new leadership should see IHME not as a rival but as a partner in its mission to deliver healthy lives for all. The advantage of such a positive reset in their relationship is clear: adopting IHME global health data as WHO's official world health statistics would propel WHO into a position of leadership in global health monitoring. Some critics may say that the sacrifice is too great. Would accepting that WHO cannot keep pace with the science of health metrics further damage the agency's reputation? But IHME does not seek to harm WHO. On the contrary, IHME seeks to strengthen the agency's mandate and ability to advance health. Partnering with IHME would not be a capitulation by WHO. Instead, an alliance between the two organisations would secure and strengthen the agency's capacity and ability to speak with authority on global health. Such an alliance is an opportunity to be seized by WHO's new Director-General.