Effect Measure

What the world needs now . . .

Two members of the UN Security Council, China and France, broke with tradition last week and nominated candidates for the position of WHO Director General. In the past Security Council members have not had citizens in that post. China’s candidate is Dr. Margaret Chan. She has a controversial history as health director in Hong Kong during the SARS and 1997 H5N1 outbreaks. Whether she is fairly or unfairly blamed is a matter of debate, but Karl Greenfeld’s book on SARS, The China Syndrome, does not indict her particularly, although it has harsh words for the Chinese leadership. Our concern about is two-fold: the championship of China, a government without sufficient respect for openness and the free flow of information; and her very decorous manner, which we think is not well suited for the kind of public head knocking an effective DG will have to do in this age of emerging and re-emerging infectious diseases.

A decorous and gentile manner does not seem to burden the former French health minister, Bernard Kouchner. Kouchner is also the co-founder of Doctors Without Borders with a reputation for strong opinions, confidently expressed in a brash and aggressive manner. Here is what one of our European readers (Ana) said last week in the comment thread about the WHO DG race:

Kouchner is an astute politician, with a long career in both France (e.g. Minister of Health) and the EU. He is a good talker with a big mouth. Also a prolific author, a bit all over the board, somewhat like the ‘French philosophers’ such as B. H. Levy, people who surf on the TV and capitalise on whatever is going on, with indignation and platitudes.

He is the inventor of ‘humanitarian action’ – i.e. bombing and invading and killing for ‘humanitarian’ reasons (one pov). His pro-active stance garners him followers, those who think that ‘savages’ (les sauvages) should be forcibly stopped from running amok, and the dictator ‘du jour’ smashed.
He has strongly supported the US invasion of Iraq – “against dictatorships”

He embraced the break-up of Yugoslavia (and the bombing) – “for justice!” and served there post conflict until K. Annan replaced him (no idea why.)
He calls himself a social democrat …

I confess to have been horrified by this. He sounds like an asshole. And maybe he is. But on further reflection I began to wonder if this kind of attitude — to make an omelet you have to break some eggs — might not be just the thing for WHO at this point. We’ve had too many nutcases like this in foreign policy, but the WHO job is different. Maybe breaking a little China (no pun intended) is just what international health needs now. Still, I am uncomfortable about this. It is risky. Here’s more from an AP piece, yesterday:

“I was a free, flexible, inventive and an anarchist NGO,” Kouchner told reporters of his field work. “I am still acting with that kind of spirit.”

During his years in the field, Kouchner said he learned that a doctor “is not someone who sits on his (behind). He must be close to the people.”

Kouchner also said his 18 months as head of the UN administration in Kosovo – which ended in January 2001 – gave him a good understanding of the UN system.

The world faces huge medical problems and a growing gap between developed and developing countries, he said. “The big disease of the world is poverty. Fighting for good health means you’re fighting poverty.” (AP via Canadian Press)

Two other candidates, Dr. Shigeru Omi, director of WHO’s Western Pacific regional operation, and Mexican Health Minister Dr. Julio Frenk are among candidates considered to have a reasonable chance at the job. As usual we welcome information from readers who might have some insights or views into any of these candidates. If you send them to us by email, indicate how much can be shared and of course you can leave them in the comment thread to this post. Rants about WHO are strongly discouraged. This thread is not the place for them.

More can be found in our previous post, here.


  1. #1 william
    September 13, 2006

    Kouchner, Cheney, and the Neo-Cons may be very happy when they read the news report below. If Israel attacks, WHO may disappear along with the rest of us.
    This is the most dangerous situation since the 1962 Cuban Missile Crisis.

    Israel Fears Nobody Will Stop Iran

    September 11, 2006 4:30 p.m. EST

    Ryan R. Jones – All Headline News Middle East Correspondent

    Jerusalem, Israel (AHN) – With the international community reluctant to impose sanctions on Iran, the head of Israel’s military intelligence warned the Cabinet Sunday that the Islamic Republic’s nuclear program is unlikely to be stopped in time, reported The Jerusalem Post.

    Maj.-Gen. Amos Yadlin said the international community has reacted slowly and in an ineffective manner to Iran’s nuclear program, in particular the enrichment of uranium, and its defiance in the face of UN demands and deadlines.

    Yadlin warned that Iran is growing increasingly confident that its defiance will result in no punitive action, as leading world powers choose to engage in endless rounds of diplomatic talks.

    The European Union on Sunday said that the latest talks between its envoy and Iran’s top negotiator were “very serious,” and should remain the preferred avenue for seeking a halt to Iran’s nuclear program, according to the AP.

    But hours later, Reuters reported that Tehran publicly denied that it had offered a two-month suspension of its efforts to enrich uranium in order to give negotiations a chance.

    Under threat of economic sanctions, the UN had given Iran until August 31 to halt uranium enrichment, a key step in the production of nuclear arms.

    Israeli officials last month said that the Jewish state would likely have to take matters into its own hands if Iran was not stopped soon. Jerusalem views a nuclear Iran as an existential threat, after Iranian President repeatedly expressed his desire to see Israel destroyed.

  2. #2 Robert
    September 13, 2006

    This may or may not be a useful addition to the discussion, but I thought it worth pointing out that public head knocking may not always be the most effective tactic either. I would be interested in hearing from someone who lives in China, but from my experience as an expat living in Japan I’ve seen that in Asian culture direct confrontation can quite often be counter-productive. I don’t know anything about Dr. Chan in particular so I really cannot comment on her. But with China as an important and problematic country to deal with I think someone with experience in Asia and a knack for combining hard dealing with creative ways of preserving the dignity of ones opponent is more likely to be successful than a ‘bull in the China shop’, so to speak.
    Given the current friction between China and Japan, Dr. Omi may not be a good candidate, however. It is quite easy to imagine the Chinese government continuing or worsening its less than cooperative stance while grandstanding for a domestic audience.
    Who that leaves as a good candidate, I have no idea.

  3. #3 Name
    September 13, 2006

    Both Chan and Kouchner would be disastrously wrong for the post, if these descriptions are even close to accurate. We can all understand China’s motivation, but what were the French thinking?! Perhaps we should stick with tradition and rule out Security Council members’ candidates.

    Just curiosity (and I’m not promoting a Canadian candidate!), but what’s the feeling about the Canadian (I forget his name) who speaks for WHO from time to time? Is he any good or even in the running?

  4. #4 M. Randolph Kruger
    September 13, 2006

    Well anyone but M. Chan. While people died she was trying to devise the name “SARS” but had to clear it because its the same as the semi-autonomous region. The last thing is that we want a Chinese puppet on the throne.

    Did the Canadians put anyone up? I vote for one of their guys because they dont back off. They have the compassion of Revere and the French, the bulldog of the Brits and are just enough Americans to keep it even and they get along with everyone. We are going to need a real sonuvabitch though I think in the near future. Better to get one on the front end rather than firing Chan on the back end. Politics though. We want China’s support for sanctions against Iran. I dont like William think that the Israelis are going to wait much longer on getting the Iran question settled. So its all intertwined.

    Do we get killed by viruses or radiation…take your pick.

  5. #5 FrenchieGirl
    September 13, 2006

    Mr. Kouchner is a man of action, he calls a cat a cat and has a reputation for honesty. He’s not frightened of “the Establishment” and is a man of conviction. Even if he has uncouthed manners, a big mouth, and he is a bit of an anarchist. He’s one of the few free thinkers left we may have. Frankly, I think he’s admirably suited to give WTO a good shake and get it active in the fight against bird flu.

  6. #6 FrenchieGirl
    September 13, 2006

    Oooops, I meant WHO, not wto of course!

  7. #7 Ana
    September 13, 2006

    Kouchner, according to my daily paper, so ?, is no longer a candidate. How he became one is also a mystery to me. (From a Security Council country, and not? proposed by the French Gvmt. But I know little about these things.)

    He was also once candidate for the director of UNHCR was not appointed, Annan chose Guterres (Portuguese.)

    What strong stands, Frenchie?

    Beyond TV mouthings?

    Argh, I feel singled out. I wouldn’t have posted if I didn’t seriously I consider this man was dangerous. (From my meager knowledge.) I don’t make such judgments lightly… and I am someone who understands the political moves that ppl make.

    Heh and he is a handomse hunk of a man always saying the right thing.

    I could post a lot or partisan articles, condemning him, the history of what happened in Yugo is not known to Americans.

    As far as I am concerned, any standard candidate, from whatever country, a figure head, anything, is better than Kouchner. Better for the people of the world, at least a humanitarian org. will not be killing people outright.

    That is impossible to justify in a short post. Anyway he has so many enemies, is loathed and disconsidered, and was just on the list through whatever personal influence thingie, and is now out of it, ouf, so maybe we can forget this particular murderous personage.

  8. #8 FrenchieGirl
    September 13, 2006

    Why I take such a strong stance? I am all for diplomacy whenever it can bring useful results. Now, I think the time for diplomacy and complacency has elapsed. Big problems require strong characters who don’t mince words. He has that ability. He has a further invaluable asset in getting the world to prep: a wife who is a national news caster… No-one said to hire him in WHO for eternity. Just enough to shake it and clean it up, act efficiently against bird flu (inter alia), give a new impetus to the world of health. After that, hopefully we’ll come to quieter times more suited to tranquil diplomacy again. Anyhow, I wanted to bring a French view to this thread… I’m done.

  9. #9 tan06
    September 13, 2006

    The Chan information we could obtain yesterday by your and my link, Revere, is removed to the Archives of Bangkok Post. One has to register there (free) and we can get the full text for one week.
    To all who are reading this later on I think Bangkok Post will, by mentioning its name and the author, not have major objectives against some citations here. Their article is important enough not to be lost in the coming weeks.


    Topic & Description Published
    Should WHO chief save face or save lives?

    Category : TEXT / General News 13 Sep 2006


    < FULL TEXT >


    Hong Kong _ Yesterday was the closing date for candidates to lead the World Health Organisation. Let’s hope that when elections are held in November, they find someone with the character to tackle both new transnational health threats such as avian flu, and persistent killers such as diarrhoea, TB, malaria and Aids. Unfortunately, at least one candidate has already shown signs that she might not have what it takes.

    One of the favourites to replace the late Dr Lee Jong Wook, who died suddenly in May, is China’s candidate Margaret Chan. Currently in charge of the WHO’s response to avian flu, she was also director of health in Hong Kong from 1994 to 2003, a period that coincided with the emergence of both avian flu and severe acute respiratory syndrome or Sars.

    As avian flu marches up the global political agenda, her experience in these two roles should make her a shoo-in. After all, the World Bank has just announced that Indonesia’s economy has already been affected by bird flu and the WHO is the only agency with the skills and mandate to coordinate the response to this kind of pandemic health threat. What could be better than a leader who already has a track record of dealing with them?

    The problem is Dr Chan’s past actions show her to be more concerned with saving face than saving lives, an unsuitable candidate for a position that requires honesty, accountability and genuine leadership.

    Take the Sars outbreak of 2003. Dr Chan was then chief health adviser to the Hong Kong government and responsible for determining strategy. Although the outbreak came to an end fairly swiftly, it killed a total of 298 people in Hong Kong.

    A subsequent enquiry by the Hong Kong legislature concluded that Dr Chan’s response to the Sars outbreak was unsatisfactory, condemning her for not attaching sufficient importance to soft intelligence on the epidemic and not taking account of the heavy passenger flow between Guangdong and Hong Kong.

    If Dr Chan had announced the epidemic in Guangdong in the two months before the outbreak arrived in Hong Kong, hospitals would have had time to prepare. Instead, Hong Kong’s hospitals acted like an incubator for the disease before it spread out into the community.

    More egregiously, Dr Chan spent the vital early days of the outbreak wrangling with the WHO over its choice of the name for the disease: Sars.

    This choice was coincidentally similar to the official abbreviation for Hong Kong, the Special Administrative Region (SAR). Instead of immediately setting in train the necessary procedures to tackle the outbreak, Dr Chan wasted time trying to save China’s face by protesting against the name Sars.

    Without this delay many lives could have been saved.

    Dr Chan’s handling of avian flu in Hong Kong was equally inept. When the H5N1 virus was first identified in 1997, nobody knew if it could spread to humans. Dr Chan sought to reassure a jittery public by declaring, ”I eat chicken every day.”

    However, as it emerged that poultry were dying in great quantities, the Department of Food Hygiene decided to intervene before a crisis developed. Even though Dr Chan had famously told everyone to carry on eating chicken, the Hong Kong government slaughtered approximately 1.6 million and banned all chicken imports.

    So it was actually the head of the Department of Food Hygiene who took the tough decision that risked embarrassing Beijing. Dr Chan, meanwhile, was more concerned about saving her boss’s face than with protecting public health.

    China is at the centre of a number of emerging health threats. In addition to avian flu, for which honesty and openness from China will be absolutely vital if a devastating global pandemic is to be prevented, China has a burgeoning Aids problem which threatens millions of people. However, censorship and the restriction of free speech has meant that these two diseases have either been underplayed or officially disavowed in China, denying people the knowledge needed to protect themselves.

    If Dr Chan held the top job at the WHO, China would effectively have carte blanche to continue the deceptions and ignorance on which infectious diseases such as HIV/Aids and avian flu thrive.

    Avian flu is perhaps the biggest communicable disease threat facing the world. To defeat it and to defeat the many other existing diseases and emerging threats will require accountability and honesty from the WHO, the only agency that has the ability to coordinate action on a global scale.

    Dr Chan’s past actions in dealing with avian flu have shown her to be more concerned with politics than public health. WHO member states could save face now by electing someone else.

    Simon Lee is a Hong Kong-based analyst and a columnist for ”Apple Daily”.

    So this is it. I don’t have to say here free information is crucial around the globe.

  10. #10 william
    September 13, 2006

    “The high levels of H5N1 in the upper respiratory tract of patients in Vietnam, coupled with the high levels of Indonesian H1N1 in the noses of ferrets in the CDC reassortment experiments, as well as high levels reported in the nose and throats of fataly infected members of the Karo cluster, all suggest that efficient H2H transmission of a very lethal H5N1 is just one sneeze away.”
    This recent post here by Henry Niman should scare the shit out of you. If it doesn’t, you are brain dead.
    Whoever gets named to take over WHO, we are in deep do do.

  11. #11 Tom DVM
    September 14, 2006

    Time for someone from the outside to empress this organization.

    All of the insiders have too much blood on their hands from SARS and H5N1…and very probably from other things that have not been uncovered from the pile yet.

  12. #12 tan06
    September 14, 2006

    Bill Gates perhaps? It solves the money problem right away. Leaves out those political interests of members.
    NEJM is only publishing what his foundation has accomplished last years. Rather impressive.


  13. #13 tan06
    September 16, 2006

    So that’s a better stance to deal with forthcoming information possibilities. IMHO.


    A new data system in the UK, reporting all possibilities of BF in given antivirals, pneumonias and flu symptoms as soon as possible (and not after one week or so).

    And now I (but who am I?) would like to get this information system in the air not only for GP’s, but also for all people who like to consult it at the Internet!
    For that would be the best way to prevent any spread of H5N1.

  14. #14 kent nickell
    September 17, 2006

    Just came across this editorial in the World Medical Journal written by the Secretary General of the organization, Dr. O. Kloiber, the organization is based in Cedex, France. I don’t have a link but the journal is WMJ, Vol 52 No 2 June 2006. I’ll just take out a few excerpts…

    The WHO is a good example of an institution which many people believe it to be a moral authority for health care. Something it never was and most likely never will be.

    The organization was built right in the middle of a political minefield between the east and the west. The old demarcation lines have gone. In time of globalisation, trade determines the rules. But the borders and frontiers are not gone. They are now more complex, sometimes invisible and often blurry. Players in the globalisation game often don’t know whether they are friends of foes. And all may be different tomorrow.

    There are many, many things the WHO has to be praised for. If it wasn’t there, we would have to build it.

    How much do we trust reports from countries without free press, without the freedom of expression? Large parts of the WHO work are ideologically biased, they are neither the reflection of high morals nor of good science but just of political powers.

    To take out politics will be the biggest political challenge for the new DG. To orient WHO towards health and not political problems will help to shift resources in the right direction. More transparency to and cooperation with the health community is high on our wish list.

    At WHO many people work as staff and as volunteers who care for health. They deserve our cooperation and support. They also deserve a powerful DG who is able to free their way. WHO doesn’t need a compromise candidate, it needs a leader who knows that the Organization is there to serve the people of the world- and governments only if they do exactly the same.

  15. #15 revere
    September 17, 2006

    Thanks, Kent. Very interesting commentary. I agree with the basic propositions, although I read the history somewhat differently and I also think we need a DG willing to put public health first and be willing to defy some member states. Basically I agree with it, though.