The following is a guest post by my colleague Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations.
For those who have been used to the noise and excitement in U.S. presidential elections, the campaign for the director general (DG) of the World Health Organization (WHO) is not just overshadowed by media reports on Trump, Syria, and nuclear proliferation—it itself seems to be unglamorous and uninformative. As observed by a recent New York Times article, the candidates’ positions are similar on most issues, from the WHO’s budget to emergency response. Indeed, they also behave similarly—they not only avoid publically criticizing one another, but also seek not to give people the impression that they are critical of any member states, existing programs, or nonstate actors.
The candidates have ample reason to be cautious on the campaign stage. In the past, the thirty-four-member WHO Executive Board essentially decided who would become the next WHO DG. This year, the WHO DG will be selected through a secret vote by 194 member states based on the one country one vote principle. Under the new election procedure, candidates have strong incentives to maximize their number of votes by pleasing all member states. Furthermore, the secret balloting allows those who actually cast the vote (e.g., ministers of health) to switch votes at his or her will—sometimes against the wishes of the governments they represent. The candidates must be careful not to offend any WHO stakeholders.
That may explain why thus far, none of the candidates have significantly differentiated themselves on fundamental, but sensitive, issues. From the viewpoint of a candidate, play safe is a rational strategy, for any hard-edged remarks or clear-cut stands over important, but controversial, issues could be interpreted as a lack of collaborative spirit or a willingness to challenge the authority of member states. One may still recall the highly contentious decisions made under the leadership of former WHO DG Gro Harlem Brundtland—the publication of the World Health Report 2000 and the issuance of travel advisories during the SARS outbreak—made concerned member states uncomfortable. Not surprisingly, candidates in their interviews with media or other public appearances have dodged some fundamental questions on WHO reform and global health governance, including whether they are willing to say no to member states once elected, which issue areas should be “deprioritized,” and how to restructure the relationship between Geneva and the WHO regional offices. When asked “who is your favorite WHO DG?” two candidates chose to name no names, while the third gave three names, adding that “all the three were good.”
Such a rational campaign strategy nevertheless may not bode well for the future of the WHO. As Joanne Liu, international president of Médecins Sans Frontières has suggested, in light of the mass governance failure in addressing the Ebola outbreak and the lack of fundamental change in reforming the agency thereafter, international society is desperately seeking a competent leader “who is prepared to …confront the political powers, when necessary for health of the people.” Put differently, the agency needs a strong leader who is out front, bringing countries on board after making the best possible decisions, rather than waiting for member states to tell him or her what to do. When candidates try to hide their true colors, it becomes difficult for voters to differentiate them in terms of what a candidate really champions and what leadership skills he or she can bring to the ailing organization. Voters are unable to obtain information from the media, whose coverage on the election is sporadic at best, or global health experts, who often do not want to speak out for fear of alienating the future winner. Indeed, thus far, we have not seen major global health personalities, journals, or organizations endorse any particular candidate.
Last summer, I invited a leading global health expert to speak at our WHO DG elections roundtable series. He politely declined, but suggested that he did not believe the election was going to make a difference. I thought he was too fatalistic. But as time goes on, I am increasingly convinced that politics, including secret horse trading, will be the primary driver of the entire election process. Major powers will continue to be relevant in the game—the United Kingdom has pledged its support to Dr. David Nabarro, while China has signaled it will back Dr. Tedros Adhanom Ghebreyesus, although under the new election procedure, their support may no longer be crucial unless they are willing to use their diplomatic clout to persuade their friends and allies to follow suit. This highlights the importance of endorsement from regional international organizations. Dr. Tedros now has the formal endorsement of the African Union, which should guarantee fifty-four votes. Dr. Sania Nishtar is allegedly backed by the Organization of Islamic Cooperation, which consists of fifty-five member states. Given the uncertainty surrounding the election, it will very likely take two to three rounds for the World Health Assembly to pick a final winner in May. But I remain suspect it will bring about the change the WHO is looking for.