Intended for healthcare professionals


Who will lead WHO?

BMJ 2006; 333 doi: (Published 02 November 2006) Cite this as: BMJ 2006;333:938
  1. Anne Glusker
  1. Geneva

    Deals and politicking characterise the contest for a new director general of WHO, says Anne Glusker¶

    In its closing days, the contest for the next director general of the World Health Organization is revealing itself to be a peculiar race in a peculiar year. The election will fill the vacancy created by the untimely death in May of the previous WHO chief, Lee Jong-wook. But two factors are complicating the battle.

    Embedded Image

    Dr Margaret Chan of China (left) and Dr Shigeru Omi of Japan (right) might be at a disadvantage in their contest for the WHO leadership compared with Dr Julio Frenk of Mexico (centre) because they are Asian and the new secretary general of the UN is of Asian origin

    Credit: P VIROT/WHO



    Firstly, two other key public health organisation are also about to name new leaders—the Global Fund to fight AIDS, tuberculosis, and malaria and the World Bank's health programmes section.

    Secondly, two of the presumed front runners for the WHO leadership are from Asia, and the next secretary general of the United Nations, Ban Kimoon of South Korea, is also from the region. UN tradition dictates that the same region may not hold both spots. But veteran UN observers say that this year the custom may not hold.

    Three leading contenders have emerged. Dr Margaret Chan of China has been WHO's assistant director general for communicable diseases since 2003 and as a public health official in Hong Kong has great experience of handling avian flu and severe acute respiratory syndrome (SARS).

    Dr Shigeru Omi of Japan, WHO's regional director for the Western Pacific, is a real insider, with 16 years at the organisation and experience similar to Chan's in working to fight both SARS and avian flu. Both he and Chan have stood down from their current WHO posts to stand in the election.

    And Dr Julio Frenk has been Mexico's public health minister for the past six years and was previously an executive director at WHO and so has experience of WHO from the inside and from the perspective of a member state. As public health minister, his biggest achievement was to greatly expand access to health coverage.

    But a fourth candidate has also appeared as a strong contender. Dr Pekka Puska of Finland, director of his country's National Public Health Institute, has a strong background in combating cardiovascular disease and is viewed as a reasoned, thoughtful leader who will attract some serious support. Of the original 13 candidates, two—Dr Karam Karam of Syria and Dr Alfredo Palacio Gonzalez of Ecuador—have already dropped out (BMJ 2006;333: 567.)

    In their official statements, all the leading contenders acknowledge the need to guard the world against pandemics of influenza and avian flu. And all seem keenly aware of the need to balance WHO's historical mandate of policy setting with its hotly debated role on the ground in countries. All candidates pay heed to the necessity of fighting AIDS, malaria, and tuberculosis; to working towards tobacco control; and to attaining the UN millennium development goals.

    The differences between the candidates lie beneath the surface, and charges and countercharges have been flying thick and fast. Some observers say that Chan and China were insufficiently transparent in combating avian flu in 2003.

    And a heated campaign to undermine Julio Frenk is coming from anti-tobacco groups, whose ire was provoked by a deal Frenk made with Philip Morris in 2004, in which the cigarette manufacturer donated $400m (£210m; €315m) to fund health programmes in exchange for a moratorium on new cigarette taxes (BMJ 2006;332: 313-4).

    In this contest, sadly, there seems to be no guarantee that the best person will necessarily win. Rather, it seems to be the most astute politician who will triumph. Alliances shift as candidates quit and their number narrows, but promises continue to be made and favours dangled by rich nations to their poorer fellow WHO members.

    Examples of candidates currying favour with voters—the 34 members of WHO's executive board—have allegedly included, at one end of the spectrum, gimmicks such as distributing iPods loaded with a candidate's mission statement to committing to hold a summit on Chinese-African trade in Beijing in early November, an attractive move for the numerous African leaders expected to attend.

    One commentator explained the perhaps uncoincidental timing of the meeting by noting that trade—rather than outright aid—is what seems most appealing to African nations right now.

    In this fraught and uncertain contest, the commentators can speculate all they want about the two Asians, Omi and Chan, cancelling each other out; about Frenk's chances against the antitobacco movement; about the odds of Puska's unseating all three; or of an outsider such as Dr Bernard Kouchner of France, the founder of Médicins Sans Frontières, coming up from the shadows.

    But it won't be until 9 November, after the politicking and promise making and favour currying have come to an end and the secret ballots have decided a single name to be presented to the executive board for ratification, that WHO will have its next director general.