ix people from Europe, Africa, and Asia are in the running to become the next director-general of the World Health Organization, the Geneva-based agency announced on Friday.

Until now, only three candidates had been publicly in the race: Dr. Sania Nishtar, Pakistan’s former health minister; Tedros Adhanom Ghebreyesus, Ethiopia’s foreign affairs minister and former health minister, and Dr. Philippe Douste-Blazy, a former health and foreign minister of France.

Joining them are Dr. Flavia Bustreo, the WHO’s assistant director-general for family, women’s, and children’s health, who is from Italy; Dr. David Nabarro of Britain, a UN veteran who is currently special adviser to Secretary General Ban Ki-moon on sustainable development; and Dr. Miklós Szócska, a former health minister of Hungary.


Five are physicians; Tedros, as he is known, has a PhD in community health.

Bustreo will be asked to take a leave of absence while she campaigns, according to information provided by the WHO.  She will receive half her salary during that time; if she makes it to the short list of candidates in January, she will be paid her full salary until the election.

An African has never led the WHO, and there has long been talk that it is Africa’s turn. In the run-up to the nomination period, a number of potential candidates from that continent had been discussed. But in the end, only Tedros came forward and in late January, the African Union announced that it, as a bloc, is supporting Tedros.

But whether that makes him a front-runner is impossible to say. As the rules of the race are currently written, countries will vote in a secret ballot next May — a process critics are hoping can be changed.

Dr. Julio Frenk, the University of Miami president who was runner-up in the last contested director-general election in 2006, said voting by secret ballot allows for horse trading, and in some rare cases corruption, in which representatives do not end up following the instructions of their governments.

“You’re not guaranteed the best outcome,” said Frenk, adding that public voting “would make it more likely that the vote will favor the best candidate.”

Suerie Moon, a lecturer at the Harvard School of Public Health and a co-author of a post-mortem report on the WHO’s handling of the West African Ebola crisis, agreed.

“I do think it would be a significant improvement in the process if governments were required to be transparent in their voting,” she said.

The candidates are vying to replace incumbent Dr. Margaret Chan, whose second term ends June 30, 2017. WHO director-generals can only serve two terms; a term lasts five years.

So far the campaign has taken place largely under the radar, though would-be candidates have been clearly working the circuit, meeting with world leaders at meetings like the opening of the UN General Assembly.

For instance, Douste-Blazy has photographs on his Facebook page of attending a meeting between France’s President Francois Hollande and Egyptian President Gen. Abdel Fattah Al-Sisi, as well as a selfie with Canadian Prime Minister Justin Trudeau taken at last weekend’s pledging conference in Montreal for the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The lack of attention on the race so far concerns observers.

“I wonder if, to some extent, people are not convinced that this election will be consequential,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “I actually disagree — I think it is very consequential. But I wonder if some proportion of people have just decided: It almost doesn’t matter who’s elected.”

The agency has been subjected to harsh criticism over the past few years, particularly in the wake of the catastrophic Ebola outbreak in West Africa, during which more than 11,000 people died.

The WHO was slow to respond to that crisis and investigations later revealed the agency was concerned about angering the involved countries, which initially did not want to acknowledge the scale of the problem.

The agency is caught in a vicious cycle, observers say. It is perennially underfunded — starved, Frenk said, noting the second largest contributor to the agency is not a country but the Bill and Melinda Gates Foundation. “Without it I don’t know what would happen to WHO.”

Jha, who was also a co-author with Moon of the report on the Ebola crisis, explains it thus: “People don’t trust WHO to be effective, so they don’t want to fund it. And the lack of funding makes it really hard for WHO to be effective. What the next [director-general] needs to do is break out of that cycle.”

Frenk agreed, saying the only way the WHO can fulfill its mandate and do the job the world needs it to do is if countries agree to fund it properly.

“WHO is not going to be fixed, no matter how charismatic and effective a leader is elected, if the member states don’t commit to the idea that this is the instrument for their collection action,” he said.

To make that happen, the next director general will need to be a strong individual with lots of political clout, said Lawrence Gostin, an international health law expert at Georgetown University and director of the World Health Organization’s collaborating center on public health law and human rights.

“Since Gro Brundtland that’s been the track record,” Gostin said. Brundtland is a former Norwegian prime minister who served as WHO director general from 1998 to 2003.

“You ask nicely, they say no, and you say ‘All right, I’ll try something else.’ That’s got to end. Because it’s made WHO into the laughing stock of the world, when it should be the undisputed leader of global health,” Gostin said.

The current director-general was elected in November 2006, after her predecessor, Dr. J.W. Lee, of South Korea, died three years into his first term. Chan ran against 12 other candidates in 2006, but was uncontested when she sought a second term in 2012.

In January, the WHO’s executive board will winnow down the field of candidates to a list of five, who will be interviewed.

From there, the executive board will recommend up to three candidates to the WHO’s annual general meeting of member countries, the World Health Assembly. It will elect Chan’s successor when it meets in May 2017. He or she will take office July 1, 2017.

This story has been updated with more information about the candidates and analysis of the WHO’s future.

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