Six 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.

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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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  • i have much respect to Dr tedros adhanom he is talented, rational and committed leader. he achieved a milliniom development goals in few years while he was a healthy minister. if he selected as the director to WHO i hope he will bring a significant change in achieving a WHO goals. god bless you sir your our hero we love you

    #attention; those who comment negative abut Dr tedros are not Ethiopians they are our enemies they are African enemies they are world enemies.

  • I would like to say a lot about it if I were an English spoken person. But to give a comment for such kind of useless WHO candidates I think i don’t have to be perfect . I very wander, how a person is going to be worlds health president who ever never done beter to his own people in a small country? In Tewodros’ country thousands of people are dying because of unqualified hospitals, millions of people are dying because they can’t even get clean water to drink .. most of doctors are not qualifed. no medicine, no emergency , no ambulance , lot of people are dying before they get in hospital. Please don’t be blind , allow this person to do a bit change in to his hometown for his own people first then after you will choose him if he could bring any changes. Or you can tell us if there is any thing else that we didn’t know that what plans do you may have that you purposely need a person from Africa to kill more people in the future.

  • For me Tedros Adhanom is more of a politician who served a very brutal and dictatorial regime of Ethiopia who massacred 1000 s of peaceful protestors and arrested tens of thousands within a year. He is unprofessional, ethnic biased politician who cannot represent Ethiopian … he has no professional or ethic capacity to lead WHO.

  • Hello dear! Let me write a piece of information about Dr.Tedros.He had neen working hard as a minister of health in his country with a fully committed way of service.During his time, Ethiopia successfully achieved the WHO health pakages.
    And he has been serving for his country as a foreign affairs minister and he made unreseved diplomtic works. So, I am sure he with his full qualifications and experiences, he will successfully achieve the world’s health programmes.

  • First of all, thank you for your commitment to allow me leaving the comment. Then after, as you now Ethiopia has successfully achieved the MDG health packages before the time table schedule reached. So, Tedros is a known committed & fruitful leader in his career from African Ministerial leaders. But, just take a correct correction about his name,i.e, Dr. Tedros.

  • Though i am late for this comment but why did you eliminate the ethiopian candidate education status. As i can see you mentioned the two other candidates(on the second paragraph) as Dr. but when you came to Dr. Tedros Adhanom Ghebreyesus you seem to forget( remove it deliberately) the Dr.

    Hope you will write letter of apology to the candidate

  • CONFLICT OF INTERESTS & UNETHICAL PRACTICE & CORRUPTION
    Conflict of interest, unethical practices and corruption within WHO may require urgent attention. This may continue to undermine organizational integrity. This may also continue to undermine the trust, confidence, neutrality and sustained core systems and program financing and low levels of performance of the organization as the leading UN Global health agency.
    Two examples
    • Health Partnerships and alliances housed within WHO that appear part of WHO and not WHO that continue to be fund to run parallel global health activities that undermine the international work of WHO
    • WHO Long term staff recruited through the back door first as interns, consultants, contractors, seconded staff and WHO short term staff from countries and organizations giving special extra funds to WHO
    More and more Transparency may be required on all areas of the work and management of WHO and may be annual independent rating by organizations such as Transparency International.

  • Why is Dr. Flavia Bustreo, the WHO’s assistant director-general, on salary while she campaigns? Like all civil servants, she should take unpaid leave while campaigning. That is effectively a form of corruption as WHO is financially supporting her WHILE she campaigns for the position of D/G.

  • WHO is a great organization but it’s also responsible for global health initiative. To nominate someone who let alone unqualified for responsibility & honor of the organization. Who’s also wanted for genocide in a country that’s currently led by a dictatorship which he’s a main part of the government. Denied political prisoners and journalists that need urgent medical attention specifically by Dr. Tedros Adhanom. It’s not only irresponsible we send a wrong message to countries that suffer by Tyranny. Please, do not fail democracy that is the hope of the society by rewarding criminals like Tedros Adhanom. Look in Human Right & Amnesty organization report regarding Tedros Adhanom’s government.
    We need to send a clear message we hold people accountable for the crime they commite and not tainting a great organization like WHO to lose credibility.
    Sincerely Yours
    Ruth H.

    • @ Ruth, Jesss what’s wrong with you? this is nothing to do with Dr. Tedros. conflict and protests are everywhere even in US right now, whatever political opinion you have try to think outside the box. this is scientific research and running for WHO and everyone knows who is who. please stop poising people with your ridiculous ideas.

      Brgds
      Esayas

  • Dr Chan the current WHO Director General leaves a legacy

    Yes the campaign for a new WHO Director General should be widened and taken directly to all the people of the member states of WHO. Choices should be not left only to their representatives. Real people and their lives and survival are at stake in this race for individual and institutional Global Public Health Leadership.

    1-In public health there is need for use of clear definitions and classification

    Divided Europe has apparently three candidates-France, Hungary and may be UK
    David Nabarro may after BREXIT represents UK and may be Europe
    Sania Nishtar may represent West Asia and may be more WHO Eastern Mediterranean region. Asia is a big place.

    Today Tedros a scientist, public health worker and diplomat has the unanimous endorsement of 54 countries of the Africa Union. What is the reason for a show of unity of the Africa continent where the double burden of communicable and non communicable diseases are the highest ?

    2. There may be need for consistency in describing current position and former position of all candidates.

    3. Qualifications to be a leader of global health and CEO/ Manager of a global health organization is not only basic qualification in science and medicine but also post graduate qualification in public health and management. More important is in-depth insight and experience in day to day leadership and management of country public health systems.

    WHO is a UN specialized global health organization with a mandate and responsibility for global health systems and health service delivery. We do not need not only opinions from institution from the North but also from the South, East and West countries of he Global Health systems.

    Yes the issues today in Global Public Health are governance, transparency, accountability to deliver high organizational performance. This can increase the focus on global and national health service delivery beyond repeated research and data gathering and more and more fragmented , standards and norms, guidelines, workshops and meetings with slow progress in access, equity and coverage with integrated essential package of quality public health services.

    • Who should not allow affirmative action dictate who would be it’s director. Qualification, expertee and conviction should be the only measure of the mn or the woman who aspire the pozition. Because there was no african before should not be a positive factor in determining who should be elected. Specially you can’t bless those who have done very little to eradicate ordinary disease and million die unnecessary death under their watch to be in charge of a global institution like WHO. for the record, I am african!

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