And they’re off — the WHO Director-General Race

Seven WHO Director-General candidates are out of the gate. In this podcast, Jocalyn and I handicap the field. She is approaching it from the standpoint of a medical journal editor. I am approaching it as an ex-insider who tried to reform WHO to be relentlessly focused on results. Neither of us has a horse in the race. We each have a race programme. When Jocalyn and I last spoke, in May, we titled the podcast after her BMJ piece on the “beleaguered WHO.” Some of my friends pushed back: what do you mean, beleaguered? We still differ slightly in how we put it. I say WHO is not at its best. Jocalyn reports that others in the field say it is at its worst in its 78-year history. Either way, the next Director-General inherits an organization that needs change. The seven, in alphabetical order, are: • Hanan Al-Kuwari, nominated by Qatar, former Minister of Public Health and former chair of the WHO Executive Board. • Hanan Balkhy, nominated by Saudi Arabia, Regional Director for the Eastern Mediterranean. • Hans Kluge, nominated by Belgium, Regional Director for Europe. • María Neira, nominated by Spain, who led WHO’s work on environment, climate change and health. • Budi Gunadi Sadikin, nominated by Indonesia, its current Minister of Health and a former banker. • Song Li, nominated by China, a physician who has led women’s and children’s health at China’s National Health Commission. • Gevorg Tamamyan, an Armenian paediatric oncologist nominated by Botswana. Nominations closed on 24 September, but under the “dumb, dumb, dumb” (my words) election rules, WHO publishes them only in early November unless a government asks for its candidate to be named earlier. So we may yet learn of more candidates. For now, we analyse what we know. Jocalyn’s framework, set out with Jim Campbell in a BMJ editorial last week, holds that the real issue is not architecture but “power, who has it, who yields it, and who’s willing to give some up.” It has four elements: there are no saviours; governance and accountability matter; civil society’s voice should be heard; and other gatherings, such as the G20 and BRICS summits, offer openings for health cooperation beyond this election. She wants to hear much more from the candidates about rights, which are being eroded for women in particular, and about gender equality. She has crunched the numbers: 4 women and 3 men, 5 physicians, 4 from high-income countries and 3 from upper-middle-income countries. Among the initial candidates, she counts three insiders (Balkhy, Kluge, Neira) and three outsiders (Al-Kuwari, Sadikin, Tamamyan). She says the outsiders currently have the edge. My framework is more results, less politics. It’s based on the lessons I learned inside WHO. More results means measuring results, institutionalizing them, holding global health agencies jointly accountable, and innovation and innovative finance. Less politics means keeping WHO’s science independent, being impartial (no double standards), and staying out of member states’ domestic wedge politics. I used these domains to rate the candidates and published the ratings last week. We discuss them on the podcast. Three candidates have now offered specific mechanisms. Hanan Al-Kuwari would protect the independence of WHO’s science through independent oversight of its scientific advice, with findings published in full, and would extend the transparency of WHO’s guidelines to emergency and interim guidance. Hans Kluge would appoint a WHO Rapporteur to act as an independent global monitor of attacks on health care, reporting to WHO’s governing bodies. I think that one could misfire: special rapporteurs at the Human Rights Council have themselves been vectors of politicization and, in the eyes of some member states, loss of neutrality. The third came after I published the initial scorecard. Gevorg Tamamyan called me, and I shared the lessons from my time at WHO. (I make the same offer to every candidate: my best advice, which they should feel free to take or leave.) A few hours later, he committed that each year the Director-General and Assistant Directors-General would present a public report card to the Executive Board on progress against their metrics. The proposal was his. It gives governance a lever to hold management to account for results. He has since added an annual survey of member states’ satisfaction with WHO’s work, also presented to the Executive Board. Tamamyan has also made specific proposals about WHO’s own workforce. In Berlin he committed to a baseline staff survey, with staff satisfaction above 90% by 2032, and Health Policy Watch reports that he is the only candidate to have publicly addressed WHO’s caseload of abuse and harassment. These fall outside my rubric, but they are worth mentioning. Without mechanisms this specific, we have only slogans, and there is nothing to debate. I have now updated my scorecard post. The update includes the candidates’ panel at the World Health Summit in Berlin, which four of the seven attended. No candidate offered a new specific mechanism within my rubric in Berlin. I have not yet rated Song Li; I found no public statements from her on these domains. On the podcast, we also talk about China’s candidate, whose nomination was announced on 8 October. Jocalyn doesn’t expect Song Li to win, citing Margaret Chan’s tenure and the custom of regional rotation. She feels that only time will tell if this is a really serious nomination. She sees two ways to read the nomination: as a provocation to the United States, which has left WHO but still exerts a lot of influence over it, or as a flex of Chinese soft power and a turn toward multilateralism after years of bilateral health diplomacy. Either way, I think having one of the world’s two superpowers put forward a candidate polarizes the race. Jocalyn outlines the rest of the race: final list in early November, candidates’ forum 18 November, Executive Board shortlist of up to three by 2 February, second forum 15 March, vote at the World Health Assembly in May, new Director-General in office on 16 August. African ministers will also hold a dialogue with all the candidates in Addis Ababa on 23 November. I invite every candidate onto the Global Health Insights podcast to discuss their scorecard findings. The campaign trail rewards handshakes and selfies. The scorecard does not. *Disclosure: I used AI (Claude from Anthropic) for research assistance and editing. The arguments, judgments and conclusions are my own, and I take full responsibility for them. I was a member of Dr Tedros’s 2017 campaign team and then Special Advisor to the WHO Director-General. Neither Jocalyn nor I has a role in any current campaign. Jocalyn leads the BMJ’s ongoing series on geopolitics of global health:* https://www.bmj.com/geopolitics-of-global-health This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit singerp.substack.com