StatNews describes it as a blunder:
The global health community is struggling to make sense of a blunder that has shaken confidence in the new director-general of the World Health Organization and given rise to concerns — both outside and within the WHO — about the impact the episode will have on the credibility of the agency he leads.
… Tedros Adhanom Ghebreyesus appointed Zimbabwean President Robert Mugabe to a ceremonial position of honor, naming the longtime authoritarian as a WHO goodwill ambassador …
…[T]he stunning incident has created a sense of deep unease about why Tedros made the sure-to-be-challenged appointment …
Was it a blunder or just politics as usual?
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Does the WHO play politics with its health recommendations?[/pullquote]
Some have questioned whether the move was an attempt by Tedros to reward those who supported him in the race for director-general. Though balloting during the May election was secret and there’s no way to be certain who voted for whom, the 55-member African Union had unanimously endorsed his candidacy.
The road to that endorsement was paved by a vote by the union’s executive council in January 2016, which came just as Mugabe ended a year’s term as the African Union’s chair. Mugabe chaired the meeting.
Human Rights Watch and others denounced the appointment:
HRW’s Kenneth Roth said Mr Mugabe’s appointment was a cause for concern because the president and some of his officials travel abroad for treatment.
“When you go to Zimbabwean hospitals, they lack the most basic necessities,” he said.
Zimbabwe’s main MDC opposition party also denounced the WHO move.
“The Zimbabwe health delivery system is in a shambolic state, it is an insult,” spokesman Obert Gutu told AFP.
“Mugabe trashed our health delivery system… he allowed our public hospitals to collapse.”
Other groups who have criticised Mr Mugabe’s appointment include the Wellcome Trust, the NCD Alliance, UN Watch, the World Heart Federation and Action Against Smoking.
The appointment of Mugabe was a spectacularly bad decision, and has since been rescinded, but those of us who care about the health of women and infants have long suspected that the WHO plays politics with its recommendations as well as its appointment.
Consider the WHO’s longstanding endorsement of an optimal C-section rate of 10-15%. It was fabricated from whole cloth in 1985, apparently to suit the prejudices of the man behind it, Marsden Wagner, MD, a noted supporter of natural childbirth pseudoscience. There was never any evidence to support it.
In 2009, buried deep in its handbook Monitoring Emergency Obstetric Care, you can find this acknowledgment:
Although the WHO has recommended since 1985 that the rate not exceed 10-15 per cent, there is no empirical evidence for an optimum percentage … the optimum rate is unknown …
Yet the WHO has returned to promoting this nonsensical “optimal” C-section rate despite the fact that the existing scientific evidence shows that a C-section rate of 19% is the MINIMUM C-section rate compatible with low rates of perinatal and maternal mortality.
Think about that for a moment. The WHO is publicly advocating an optimal C-section rate that not merely has no basis in scientific evidence, but has actually been shown to be INCOMPATIBLE with safety. Why? I suspect it’s just politics as usual. It suits the needs and prejudices of executives at the WHO, science be damned.
The WHO is also playing politics with its breastfeeding recommendations. Most are unsupported, or even contradicted by the existing scientific evidence. For example, pacifiers are banned despite the fact that they don’t interfere with breastfeeding and actually prevent sudden infant death syndrome. The WHO grossly exaggerated the benefits of breastfeeding and utterly ignores the risks. They tout the “lifesaving” benefits of breastfeeding without being able to cite any population data showing that breastfeeding has an impact on infant mortality rates.
And most recently, despite a presentation to WHO executives by a panel of professionals concerned about high rates of breastfeeding complications and deaths, those executives actually declared that such injuries and deaths are “not a priority.”
That’s not healthcare, that’s politics. Decision makers at the WHO are promulgating recommendations that reflect their personal prejudices, rather than recommendations that follow scientific evidence.
The WHO should be a beacon of accurate health information for the world. Instead, it plays politics.
Any group that appoints an authoritarian despot as a health ambassador indicates that it values politics above health; it cannot necessarily be believed when it makes health recommendations. Those recommendations may represent political accommodations within the organization rather than the actual scientific evidence. Sadly, it appears that’s just what has happened with WHO recommendations on C-sections and breastfeeding.
