Historic opportunity for WHO to re-assert leadership.

When countries gather for WHO’s Executive Board meeting next month, to appoint a new DirectorGeneral, they must select a candidate with the courage and political leadership necessary to address the most critical challenges the UN agency is facing today. The recent appearance of extensively drug-resistant tuberculosis illustrates the scale of the work ahead. The health threat posed by this microbe in settings with a high prevalence of HIV highlights the urgent need for action for WHO to set the agenda for the fast-tracked development of new drugs and better and easier-to-use tests to diagnose tuberculosis and detect drug resistance, to replace today’s increasingly ineff ective tools. WHO will need to lead a process involving health ministries, regulatory agencies, drug companies, productdevelopment partnerships, funding bodies, and non-govern mental organisations, and it will need to deliver. HIV/AIDS is another immediate issue. With the end of the 3 by 5 programme, WHO today lacks any strategic plan for the coming years, despite ambitiously calling for universal access to AIDS treatment. Now that newer compounds are increasingly needed to deal with resistance, the cost of treating AIDS is set to skyrocket. How does the agency plan to respond? Research and development needs are also pressing in AIDS. These needs include the development of new fi xed-dose combinations of second-line drugs and formulations for children, and simpler fi eld-adapted diagnostics. Drugs in research must be specifi cally developed to answer the needs of resource-poor settings—and not only cater for populations of patients in rich countries. On a programme level, WHO will need to address more forcefully the crying need for greater human resources in medicine, which has become a critical bottleneck preventing further scale-up. It will also need to think of the longer term and make sure that more patients are not only started on treatment but are also kept alive by making second-line drugs available. A suffi cient quality of country programmes must also be assured. more connected with the citizens of this world, to better understand their needs and to share knowledge. Knowledge is the secret of success and should not remain only in the domain of a privileged few. With the multitude of international, national, public, and private agencies, institutions, and enterprises that are active in the health fi eld today, in a well-organised eff ort, together with governments, we can all make a diff erence to the lives and life expectancy of millions around the world. Every life counts and every life is important. Those with knowledge should help others to learn more and to use that knowledge for better health of the individual and family, and for greater social and economic devel opment in their country. Kazem Behbehani Genthod, Geneva 1294, Switzerland [email protected]