Who is the Likely Forerunner in the WHO Director-General Election?

The following is a guest post by my colleague Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations, and his research associate Gabriella Meltzer.

With the generous support of the Rockefeller Foundation, the Global Health program at the Council on Foreign Relations hosted a three-part roundtable series, “The Next Director-General of the World Health Organization.” Speakers were invited to discuss topics including the new election procedures, the performance of past WHO director generals, and the skills and qualities needed in the organization’s next leader. Following the convening of this series, we administered an online survey to individuals affiliated with international organizations, nonprofits, foundations, academia, and the private sector, all of whom have expressed interest in attending global health related events hosted by Yanzhong Huang at CFR. The questions in this survey covered the themes addressed in the roundtable series, as we were curious to assess the current opinion climate among those invested in the future of global health. By November 5, 2016, we received fifty responses, among whom a majority (68 percent) were affiliated with NGOs, foundations, think tanks, and academic institutions.

Needless to say, the sample size is relatively small and the respondents may not be representative of the entire global health community. But this “straw poll” can be illustrative of the political dynamics surrounding the WHO director-general election. There are currently six candidates nominated by their respective countries. In no particular order, they are the following:

1. Tedros Adhanom Ghebreyesus, former foreign affairs and health minister, Ethiopia
2. Flavia Bustreo, WHO assistant director-general for family, women’s, and children’s health, Italy
3. Philippe Douste-Blazy, former health and foreign minister, France
4. David Nabarro, special advisor to Secretary-General Ban Ki-moon on sustainable development, United Kingdom
5. Sania Nishtar, former health minister, Pakistan
6. Miklós Szócska, former health minister, Hungary

When asked to rank each of the candidates, the respondents highly favored Dr. David Nabarro. More than one-third of the respondents identified him as their first choice. They commented that he is “qualified and able,” and “has the vision, the consensus building ability, the view from both inside and out, and the technical knowledge required” to succeed in the position, particularly given his wealth of experience within the UN system. Some respondents highlighted the fact that Nabarro’s British nationality may work against him given the argument that the position should rotate geographically. Interestingly, despite their experience in the developing world, neither Nishtar (8 percent) nor Ghebreyesus (15 percent) received particularly high rankings in comparison to Nabarro.

It is compelling to note the correlation between the qualities respondents seek in a candidate relative to those they identify with the candidates themselves. A large share of respondents (36 percent) ranked “vision and ability to set direction” as the most important trait, followed by “ability to build consensus” (16 percent) and “ability to take necessary action independently” (15 percent). Respondents deemphasized the value of “technical competence” (14 percent) and “demonstrated skills in managing, investing and raising large multi-billion dollar budgets” (10 percent). Many people’s comments cited Nabarro’s “vision” as the rationale for their choice, and only one mentioned the importance of fundraising capabilities (in the context of Philippe Douste-Blazy), a necessity that has been strongly voiced by Flavia Bustreo. Clearly, those surveyed envision the next director-general as being an inspirational politician, a savvy negotiator, and stalwart advocate for the importance of global health rather than merely a technocrat with substantial public health and financial management experience.

The new procedures to elect the WHO director-general introduced this year have generated strong opposition from a number of prominent global health voices. Nearly half (47 percent) of the respondents expressed a moderate or severe lack of confidence in the likelihood that the secret, one-country one-vote system would result in the election of an exemplary leader. It does seem, however, that everyone is looking to the WHO election to produce a strong leader who can guide global health governance into its next phase. When presented with the statement, “Political leaders in member states, especially those from industrialized countries, prefer a WHO director general with weak leadership qualities,” half (50 percent) disagreed, compared with 26 percent who agreed. A large share of those (38 percent) who agreed were aforementioned roundtable attendees. This could indicate more nuanced knowledge of traditional power dynamics, as one commented: “Strong WHO leadership, which could lead to stronger world standards and eventually a stronger focus on emerging economies, could negatively impact the interests of large, Western pharmaceutical and medical companies, which wield strong political weight.”

Given the current geopolitical uncertainty that has accompanied waves of populism and isolationism throughout Europe and the United States, the global health community eagerly anticipates Margaret Chan’s successor to navigate the transnational tides of change and sustain the WHO’s leadership in global health governance.