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Dr Aylward is the Senior Advisor on Organizational Change to the Director-General. In this capacity he has led the design and implementation of WHO's Transformation Agenda since September 2017.

In February 2020 Dr Aylward was requested by the Director-General to lead the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19).

From August 2016 through August 2017, Dr Aylward worked with the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), initially leading the inter-agency process that resulted in the first-ever system-wide activation procedures for major infectious disease emergencies, then establishing and leading OCHA’s Change Management Unit. In that role he took forward a wide-ranging functional review of OCHA to optimize its role, functions, structure and processes for the challenges of the 21st century.

From December 2015 through July 2016, Dr Aylward led the design and implementation of far-reaching reforms of WHO's work in emergencies, culminating in the launch of a new WHO Health Emergencies Programme. During this period he also led WHO’s response to a wide range of humanitarian and infectious disease emergencies, including the global response to Zika virus.

From September 2014 through July 2016 Dr Aylward served as Special Representative of the Director-General for the Ebola Response, directing WHO's 2000+ person response to the West Africa outbreak and providing strategic and technical leadership to the United Nations Emergency Ebola Response (UNMEER). Between the early 1990s and 2014, Dr Aylward served WHO in a variety of leadership positions in the areas of emergencies, disease eradication and vaccines and immunization.