Another High-Stakes 2017 Election: WHO Director-General

When Margaret Chan’s tenure as Director General of the World Health Organization (WHO) draws to a close in June, she will be remembered as a likeable technocrat but one whose shortcomings have done serious institutional damage. After ten years of internal divisions and mishandled crises, her successor will need strong leadership skills but also to be political savvy with the ability to orchestrate rapid responses. The three candidates to replace her as Director-General will face the competing challenges of filling budget shortfalls, solving internal disputes, and responding to crises as quickly as possible. All are current and former health ministers or academic experts in public health; in May, each of them will give a presentation to the assembled WHO member states, who will then vote for their preferred successor.

Ultimately, it will be up to the countries that make up the organization to decide on which of the three finalists fit the bill: Ethiopia’s former health minister Tedros Adhanom Ghebreyesus (who goes by his first name), Pakistan’s former health minister Dr. Sania Nishtar, or British UN sustainable development adviser Dr. David Nabarro. Before the list of candidates was narrowed down on January 25, it appeared Europeans would figure prominently in the next vote. Unfortunately for the Continent, the French, Italian and Hungarian candidates who had made it into the last six were knocked out of the running after interviews with the 34-member executive board.

Nabarro might be the only European left in the race, but the stakes of this election remain incredibly high for the European Union and Europe as a whole. With much of its work based here and the risk of grave health crises (especially the Ebola epidemic in West Africa) on Europe’s doorstep, an efficient and effective WHO should be a key concern for EU leaders and national governments. After ten years in office, Margaret Chan’s record has left the global health body struggling on both fronts.

Ironically, one of the main criticisms levelled at Chan has been that she is too eager to please and build consensus, even when tough executive action was needed instead. The most infamous example is 2014’s Ebola outbreak, which left more than 11,000 dead. The outbreak was first reported in Guinea in March 2014, but it was not until August (and after 1,000 people had died) that the WHO declared it a global emergency. While Chan and her organization dithered, Doctors Without Borders frantically rang the alarm bells to have the outbreak recognized as an emergency so as to mobilize the global response necessary to contain it. Looking back on the WHO’s handling of the crisis, an assessment panel put it mildly: “independent and courageous decision-making by the director general and the WHO secretariat…was absent in the early months of the Ebola crisis.”

Chan’s ability to manage internal politics and rivalries has also come under fire. In 2013, for example, she allowed opposition from African and Middle Eastern governments to torpedo a report on improving the health and wellbeing of LGBT individuals. European and American officials couldn’t help but note that a more imposing Director-General would not have been so acquiescent in the face of what can only be described as homophobic opposition.

European policymakers have also struggled to contend with the WHO’s impact on their own thorny regulatory debates, with one of the most recent examples provided by the organization’s conflicting pronouncements on the weedkiller glyphosate—an intra-WHO dispute that has had a clear, measurable impact on European agricultural policy. Since June, farmers across the EU have been waiting to find out whether the European Commission will extend the product’s approval past the end of this year. The controversy was sparked by the WHO’s International Agency for Cancer Research, which classified glyphosate as “probably carcinogenic” only to be refuted by a joint panel comprising… the WHO and the Food and Agriculture Organization (FAO). The product’s safety has been endorsed by both the European Food Safety Authority (EFSA) and the Environmental Protection Agency (EPA) in that time, but the damage has seemingly already been done.

Similar issues in the United States have prompted an American congressional committee to review US taxpayer funding for the WHO’s cancer research agency, an unwelcome development for the WHO considering the organization’s existing funding shortfalls and the Trump administration’s posturing on United Nations funding. Whether or not the WHO and other UN agencies, like the World Food Program, can effectively fund their operations has real-world effects for Europe: the migration crises in Africa and the Middle East stem in part from the inability of the various United Nations agencies to assist refugees on the ground, and the funds they do have come in large part from Europe.

In trying to overcome these, some candidates have more factors working in their favor than others. Tedros, a former foreign minister, can lean on his diplomatic background in a race where political acumen is prized. If he wins, he will need those skills to wrangle the WHO’s six regional offices, each with their own director elected by the regional member states. Even the reformed selection process remains convoluted: a motion put forward by Canada and Colombia to make the interviews public was rejected, and behind-the-scenes political machinations will still decide the outcome. Nabarro’s candidacy, for example, could lose out on European votes as part of wider Brexit backlash regardless of his qualifications.

Whoever emerges victorious, the stakes are high both for the WHO itself and for its partners, Europe chief among them. Now as much as ever, the world needs effective responses to global health questions. It will be up to Margaret Chan’s successor to make sure we have them.