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'One of Us'
WHO Chief Makes Historic Visit
To NIH, Proposes Partnership

By Carla Garnett

Photos: Bill Branson

On the Front Page...

No sooner did Dr. Gro Harlem Brundtland step down as prime minister of Norway 2 years ago than she was approached for a new assignment by the man she had appointed minister of health. It was just a few weeks following her third term. By then she had led the government for more than 10 years, though not consecutively. The first woman and the youngest person ever to lead the nation, she'd overseen tremendous success: When she left office, Norway had a 5 percent growth rate, inflation was less than 2 percent, the country had no foreign debt and was operating with a substantial budget surplus.


However, she said, she was ready to make way for someone younger with fresh ideas who also felt the need to contribute. Brundtland was relaxing more, relishing more time for herself for the first time in many years and just beginning to assemble her thoughts and sentiments for an autobiography. That's when Norway's minister of health came to talk to her.

WHO director-general
Brundtland addresses NIH.

"Gro, I have to give you a new challenge," he said.

"No," she said. "Please, no. It's too early. I need to have some time for myself and my family, some time away from obligations to everyone else."

But he was not deterred. So he called in his marker. In 1990, while Brundtland was prime minister, she had lured him back from a Harvard professorship to be her minister of education. "Look," she said to him then, "you have to do this. You have to make a difference." Dutifully, he had packed up his family and moved lock, stock and barrel from Boston to Norway to serve the post. Later, she called on him again, this time to move to the ministry of health. Now he felt justified in turning the tables. He wanted her to lead the World Health Organization. Even as she was demurring, he was presenting a convincing argument, giving her statistics on such growing global health woes as tuberculosis, diphtheria, drug abuse and alcoholism. "Look, you have to do this. You have to make a difference," he said, repeating her own words from nearly 2 decades ago and deliberately sealing her decision.

Following Brundtland's speech, NIH director Dr. Harold Varmus opened the floor for a question-and-answer period, during which the WHO leader addressed myriad issues.

"That's why I am here," Brundtland said. "When I took office on July 21 of this year, I pledged that WHO should reach out to the rest of the UN family, to the private sector and to civil society. The broad scientific community is indeed included in that ambition."

The foundations for the World Health Organization can be traced back to 1902 when the International Sanitary Bureau was established in Washington, D.C., to find ways first to prevent cholera, then plague. Cholera had spread throughout Europe, beginning in 1830. Efforts to begin an international sanitary convention had failed in 1851, and would not be adopted until more than 40 years later in 1892. Finally, with international cooperation, a bureau was formed that would be the forerunner of the Pan American Health Organization. By 1945, having added provisions against smallpox and typhus to its mandate, a new, autonomous international health organization, WHO, was born. In 1998, the World Health Organization -- headquartered in Switzerland with 6 regional offices worldwide and about 3,800 employees -- celebrates the 50th anniversary of the signing of its constitution and finds itself up against relatively recent global threats such as AIDS, and re-emerging tuberculosis.

Brundtland (l) met several NIH'ers during her recent visit, including Frances Humphrey Howard of NLM.

Enter Gro Brundtland, the first female head of the organization and the woman NIH director Dr. Harold Varmus described as a virtual "catalog of firsts."

"She is indeed one of us," Varmus said warmly in introduction, describing Brundtland's medical education at the University of Oslo and her subsequent training as a biomedical investigator who, as a postdoc, had her work published in the journal Nature.

When asked in January, as she was being nominated for the WHO post, why someone who had been educated and trained as a scientist and who had experienced such remarkable success as a postdoctoral investigator would decide to move into politics, she reportedly countered, "Why should we leave politics, which is one of the most important things in our society, to somebody who does not understand science?"

First Ladies: Dr. Antonia Novello (l), the first woman and first minority to serve as U.S. surgeon general, greeted Brundtland, the first woman to head WHO.

"Her ambitions at the World Health Organization are no less audacious," said Varmus. "She wants to roll back communicable diseases -- starting with malaria, tuberculosis and AIDS, to reduce the burden of noncommunicable diseases -- starting with an attack on tobacco, to launch an effort to build a sustainable and equitable health system that works in many countries in the world, and to speak out for health -- backing her case with science and evidence....More than aspiring to be the first, she aspires to be the best."

Varmus pointed out that Brundtland's influence for change is already evident. Six out of 10 of the most important people sitting around the table at WHO are women, he said.

"I do not feel like a visitor," she said, beginning her appeal to establish a formal partnership with WHO, NIH, the World Bank and private industry to attack communicable diseases.

Speaking at 11 a.m. to a packed Masur Auditorium, she had already that morning joined Varmus and HHS Secretary Donna Shalala to announce her rollback initiative at a media breakfast hosted by Public Radio International's The World, and then met with NIH institute and center directors. In her honor, a reception and poster session featuring international public health research efforts supported by NIH or conducted by NIH scientists was held before and after her lecture. Her 5-day swing through Paris and the United States began with a meeting with French President Jacques Chirac and other top government and public health officials in France. Also on the agenda were a visit with First Lady Hillary Rodham Clinton to announce a "Stop TB" initiative, a meeting with prominent international business leaders and the Centers for Disease Control and Prevention in Atlanta to discuss partnership opportunities and a "Roll Back Malaria" joint press conference in New York with leaders of the World Bank, UNICEF and the United Nations Development Program.

"I come to you as a colleague," Brundtland continued. "Those of us [who are working for health] must make opportunities to reach out, to gather the knowledge required to address the issues common to humankind and relevant to health and development," she said, expressing surprise -- and some dismay -- that before now the sitting WHO director-general has never visited NIH. "We really need to take [cooperation on global health problems] very seriously," she added. "Otherwise we are losing the potential and undermining the sum total of our efforts."

Brundtland said the challenges of WHO's mandate -- that all peoples attain the highest possible level of health -- are much larger than the relatively small organization.

"The way ahead for WHO lies in improving what we do by focusing our effort to reduce the burden of ill health and to help countries and communities build healthy populations," she said. "That is a very bold and challenging mandate. We will be speaking out for health, and in all we will strive for having access to the latest and best evidence and the latest scientific breakthroughs. Here lies the core of our partnership. We in this room share the belief that science and research have crucial roles in all our common endeavors. WHO and NIH are engaged in a number of joint activities already and I believe there is much more we can achieve together, a fact that was confirmed in our discussions this morning."

Describing the link between science and health as a relatively recent marriage whose ties are so strong "there can never be a divorce," Brundtland said health researchers and public health policymakers of today have a debt to repay to their predecessors for "rescuing civilization from the dark ages of the unknown.

Among those who welcomed the WHO director-general to NIH are (from l) NIDDK director Dr. Phillip Gorden, NIH associate director for intramural affairs Dr. Philip Chen and NCI's Dr. Joseph Fraumeni.

"Not long ago," she said, "magic, superstition and astrology were the only weapons our ancestors had to fight diseases and epidemics that haunted the world."

Over time, she continued, the need for cooperation in the fight for global health became apparent. "The suffering of the many must be a common concern in an interdependent world," she said. "Even the strongest of nations stands to lose from isolationism. Health is the most striking reminder of national, regional and global interdependence...Good health needs to be seen as an investment, not merely an expenditure."

Following Brundtland's talk, Varmus opened the floor for a question-and-answer period, during which the WHO leader addressed issues ranging from the medical to the economic to the political: mother-to-child infections via breastfeeding, tobacco advertising aimed at the world's children, the growing AIDS epidemic in sub-Saharan Africa, the affordability of providing vaccines to developing countries, the ethics of providing disease therapies that may also cause some side effects.

Calling "persistent poverty the single biggest source of ill health and human suffering," she lamented that health workers occasionally "win battles, but rarely win wars." She outlined her ambitious restructuring of WHO that, in addition to new efforts to reach beyond itself to other health organizations, will also put more resources into a rejuvenated research and development division. With NIH's help, she concluded, the potential of the partnerships WHO is cultivating will be increased. "We need your evidence and insight."

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