When I walk down the street, I don’t see signs saying “Tedros for WHO” or “Vote Szócska.” The television and radio airwaves don’t have endless campaign commercials ending with the tagline, “I’m Flavia Bustreo, and I approve this message.” Sania Nishtar does not hold large public rallies in sports stadiums to bolster her candidacy. Neither David Nabarro nor Philippe Douste-Blazy do phonebanking.
These facts don’t distract from the fact that there is a vigorous and hotly-contested electoral race for the Director-General of the World Health Organization. Think of the current period as the primaries, with the general election campaign beginning when the WHO Executive Committee forwards the names of the three finalists to the World Health Assembly in February.
When WHO reformed its processes for selecting a new Director-General (which I detailed here), they set themselves up for a new and largely unprecedented experiment. For better or worse, most international organizations select their leaders through fairly opaque processes, and the public gets little glimpse into the decisionmaking process. Even when we have seen multiple candidates competing for the top office, such as the 2012 race for the presidency of the World Bank, the formal campaigns have tended to be brief.
WHO’s election process is different. It is openly contested. It features some of the same trappings of other political campaigns. It requires a degree of public engagement not usually seen in international organizations. The United Nations’ search for a new Secretary-General was supposed to be more transparent, but the process came to a surprising early conclusion when the 15 members of the Security Council announced their unanimous support for former Portuguese prime minister António Guterres.
So far, the WHO DG election does not show signs of ending early. Part of that may be because of the procedures WHO established for the election, but it also reflects the keen interest in the job. When the nomination period closed on 23 September, WHO announced that there were six candidates:
- Tedros Adhanom Ghebreyesus of Ethiopia
- Flavia Bustreo of Italy
- Philippe Douste-Blazy of France
- David Nabarro of the United Kingdom
- Sania Nishtar of Pakistan
- Miklos Szócska of Hungary
The final list of six surprised a number of observers. Tedros (as he prefers to be called), Douste-Blazy, and Nishtar were not surprises, as all three had essentially been campaigning for months prior to the official nomination period. Bustreo, Nabarro, and Szócska, though, were not among the names being bandied about.
The candidates themselves are an interesting mix. Despite the fact that WHO has been criticized for only having had DGs from Europe or Asia since 1973, only one candidate comes from outside those two regions. Two candidates—Tedros and Douste-Blazy—have served as their country’s Foreign Minister. Bustreo is the only candidate who is currently employed by WHO, but Nabarro headed up one of WHO’s post-Ebola reform panels and previously worked in the Director-General’s office. Nishtar would be the first Muslim to lead the organization if she were selected. Three of the candidates come from traditional donor states to WHO. All but Tedros are medical doctors, while Tedros holds a PhD in community health.
As part of the campaign process, the candidates are reaching out to the voters/member-states. Four of the candidates—Tedros, Douste-Blazy, Nabarro, and Nishtar—have specific campaign websites, and Bustreo and Szócska are active on Twitter. and all six responded to a candidate survey from The Lancet. The African Union announced its support for Tedros’ candidacy (and the value of having an African in the top job) earlier this year. Given that African states are the largest single bloc within WHO, that could give him an early advantage—assuming all AU member-states vote in unison.
All of the candidates appear to meet the basic requirements for the position, so which factors are likely to make a difference in the election? Let me call attention to three issues that are likely to play a big role in the deliberations. First, WHO’s budget is a mess. More than 80 percent of its outlays come from voluntary contributions pledged for specific programs. As a result, WHO has little control over how it spends most of its money, and it lacks the financial flexibility to allow it to respond to an emergency like Ebola. That said, member-states have been reluctant to give WHO more money without seeing proof of WHO’s efficacy. A successful candidate will need to show an ability to simultaneously get WHO the resources it needs to carry out its mission and convince member-states that it can use those funds efficiently and responsibly. There may also be opportunities to develop new financing structures, like UNITAID’s airline ticket levy. (Incidentally, Douste-Blazy has been the chair of UNITAID since 2006.)
Second, WHO needs to restore its international credibility. To a large degree, that is likely to mean that member-states are going to want to know specifics from the candidates about what sorts of reforms WHO will introduce to function better. WHO cannot do everything, so the question is what direction the different candidates would go in their understanding of the organization’s scope. That will also touch on how much autonomy WHO should have: is it there simply to do the member-states’ bidding, or should it have control over its own agenda?
Finally, WHO’s leader will need to show an ability to play politics. Outgoing DG Margaret Chan has been criticized for not being an effective diplomat, especially in contrast to someone like former WHO DG Gro Harlem Brundtland. Like it or not, global health is an inherently political field; a focus on solely on the technical aspects simply will not work in this environment. Indeed, Josh Busby, Karen Grépin, and I argued earlier this year that the next WHO DG specifically needs political experience.
In many ways, the WHO DG election could provide a template for international organizations looking to elect their leaders publicly and transparently. As such, it is all the more important to keep an eye on it—and to pick up some sweet campaign swag.