Vital Signs Blog

Blog: U.S. likely to play minimal role in selection of new leader of WHO

Photo by United States Mission Geneva
Just two weeks ago, a major international healthcare organization kicked off the search for its next top leader. After 10 years at the helm, the current chief executive—an important global figure—will cycle out in June 2017.

The World Health Organization—the central coordinating body for international health within the United Nations' system, which employs more than 7,000 people in 150 offices around the world—is due for a new chief executive.

With critical elements of the WHO election set to coincide with turnover in the U.S. administration, the U.S. is poised to have a minimal role in deciding who will be the international system's next top healthcare chief. This also comes at a time of great pressure for the WHO to change how it goes about business as usual.

Dr. Margaret Chan, the first Chinese national to serve in this role, will step down after she completes her second term next summer, which opens a transitional opportunity for an agency that many agree badly needs reform to overcome its stodgy and uncoordinated processes.

The international body's slow response to West Africa's Ebola outbreak, which health experts characterized as an “egregious failure,” is one of the latest illustrations of how the WHO has failed to prevent global health crises from escalating and alleviate pressure on health systems around the world.

“If health risks are not contained in their countries of origin they can go anywhere,” said Gary Cohen, acting CEO of GBCHealth, a group that convenes businesses with government and international organizations to further global health objectives.

That's bad all around. When diseases spread the impact goes far beyond the health system, notes Cohen, who also serves as executive vice president at the global medical technology business Becton, Dickinson and Company. “It also has a potentially massive impact on economic activity, as demonstrated by the SARS epidemic in Asia,” he said.

The WHO has not been able to do the preventive work needed because it is chronically underfunded. Most of the WHO's funding is from earmarked donations and member state dues, which have been stagnant since the 1990s.

“If the WHO didn't have to beg for money all the time and were a stronger institution internally, it would have much more thoroughly developed associations and preparations with industry, including pharmaceutical industries for rapid drug development,” said Laurie Garrett, a global health expert at the Council on Foreign Relations.

“The ability to mobilize forces is more than just putting a few scientists on an airplane,” Garrett said. “It's in everybody's interest—regardless of where you live, in a rich country or a poor one—to have some institution, preferably the WHO, capable of that rapid mobilization.”

Amidst a backdrop of calls for reform and money woes, the WHO plods along. On April 22, the agency began inviting member states to nominate candidates to be its next director-general. Countries have until Sept. 22 to submit their proposals. After a process of campaigning, the WHO's executive board will narrow the field, and up to three candidates will be chosen for the election at the World Health Assembly in May 2017. The global agency's new chief will take office next July succeeding Chan, who is finishing out her second five-year term.

So far, three candidates have announced their intentions to enter the race: Philippe Douste-Blazy, a former French minister of health; Tedros Adhanom Ghebreyesus, Ethiopia's minister of foreign affairs; and Sania Nishtar, Pakistan's former top health official.

There are a few striking aspects to this election. On the procedural side, it is the first election in which all members of the World Health Assembly get to vote for the director-general—albeit by secret ballot. Previously, the body's executive board, composed of 34 individual members appointed by member states, selected one nominee for confirmation at the annual World Health Assembly.

The more democratic process might give way to a different kind of leader. Specifically, this could be the first time the WHO is led by a non-MD. Dr. Chan and all her predecessors have been medical doctors. Of the candidates we know about so far, Douste-Blazy and Nishtar both have medical degrees, but Ghebreyesus does not. He has advanced infectious disease and public health degrees. Additional candidates who don't come from a clinical background are expected to enter the race in the coming months.

Finally, the timing of this election is not ideal for the U.S. with all the key elements taking place around the same time we face a transition of power in this country after the presidential elections. The U.S. likely won't have a health team in place at the U.N. until after the WHO executive board votes on the final three candidates. “This is going to be (a WHO election)—one of the few—where the United States is going to be a minimal player,” Garrett observes.

But given America's notoriously poor showing in international health rankings, that might not be a bad thing.


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