The Lancet takes sides

The Lancet, one of the world's leading medical journals, is taking sides in the battle for new Director General of the World Health Organization:

Mexico Health Minister Julio Frenk should be favored among 13 candidates to head the World Health Organization because of his technical and administrative skills, said Richard Horton, editor of the medical journal Lancet.

Frenk, 52, is the only contender for the agency's top job with a "high level" of experience in global health, policy- making and health-system management in a low- to middle-income country, Horton said. France's nominee, Bernard Kouchner, 66, and Finland's choice, Pekka Puska, 60, are the only others who can "meet the challenges of revitalizing the WHO's mandate as a global public-health agency," Horton said in an editorial. (Bloomberg)

Here is the list of candidates:

Kazem Behbehani, 59, assistant director general of WHO's external relations group, by Kuwait; Margaret Chan, 59, WHO's avian influenza coordinator and assistant director-general for communicable diseases; Alfredo Palacio, 67, president of Ecuador, by Ecuador; David Gunnarsson, leader of Iceland's delegation to the World Health Assembly, by Iceland; Nay Htun, a former deputy executive director for the United Nations Environment Program, by Myanmar; Karam Karam, a former minister of health in Lebanon, by Syria; Elena Salgado Mendez, who was president of the 58th World Health Assembly, by Spain; Pascoal Mocumbi, 65, the WHO's Goodwill Ambassador for Maternal, Newborn and Child Health for Africa, by Mozambique; Shigeru Omi, 57, the WHO's regional director of the Western Pacific, by Japan; Tomris Turmen, 62, a WHO family and community health specialist, by Turkey.

The Lancet's Horton believes five of the nominees are technically well qualified (Frenk, Karam, Mocumbi, Omi and Puska) and five have the required administrative skills (Chan, Frenk, Gunnarsson, Kouchner, and Palacio). Kouchner and Puska only appear on one list (each a different one). Puska is a specialist in chronic diseases and heads Finland's highly regarded Public Health Research Institute. Horton considers him technically well qualified but lacking in administrative experience. Kouchner is the reverse. A gastroenterologist, former French Health minister and co-founder of Doctors without Borders, Kouchner is brash, can be abrasive and says he is ready to break some china if he needs to. He identifies poverty as the world's worst public health threat.

Frenk appears on both lists. Poverty and access is also on his agenda:

Frenk said that, as health minister, he sought to improve access to medical services for minority women and provide health insurance for low-income people.

"People were becoming impoverished by health expenditures," Frenk said in a Sept. 8 telephone interview. "It was an unacceptable paradox: health was becoming an impoverishing factor."

As WHO director general, Frenk said he would use health as a foundation for sustainable development and improving global security while trying to bring more transparency and accountability to the agency.

"The basic notion is that of service to member states, and orienting WHO's work to unleash services to member states," he said. "We are at a moment of enormous opportunity because the importance and profile of public health has increased."

I have high regard for Horton. He and The Lancet have taken some courageous stands. So his opinion carries weight with me. His three choices are all good candidates, but very different. At the moment I am leaning to Kouchner, as I think he has the required boldness, but that may also be his weakness.

I don't get to vote though. Those who do will winnow down the choices to five or so in the few days before the meeting of the World Health Assembly, and by November 8, select a single candidate to that body for their (presumed) ratification on November 9.

The politicking is undoubtedly intense and isn't likely a thing of beauty.

Still, the stakes are high. And I've eaten a lot of sausages whose manufacture I'm glad I didn't see. Let's hope they get the right recipe here. Because the proof of the pudding will be in the eating and the call to dinner may come at any time.