Election for new Director General of WHO: why should we care?

The US midterm election will be held on November 7 and American politicians are busy doing what they do best: pointing fingers at each other and avoiding the issues. They are not the only ones campaigning for office next, week. The two days after the US elections the World Health Organization executive committee will also elect a new Director General. The choice may or may not turn out to be of equal importance to the US election. It will depend on who is elected.

Why might it matter? WHO is reaching a critical point in its history. Founded in 1948 in the wake of the Second World War, WHO was at once an intergovernmental agency of the United Nations and an agency stamped by the 300 year old international system of sovereign nation states (see our posts here, here, here, here and here). For most of that time, with few exceptions, it has not been able to act except at the behest or with the permission of a member state. While each of them is in theory sovereign, they are also part of another structure of international politics and its shifting alliances and logic.

Meanwhile global public health faces a challenge not envisioned at WHO's founding, the challenge of emerging and re-emerging infectious diseases and deadly global pandemics, of which AIDS is the most dramatic but perhaps only the most recent. In our tightly interconnected world, it would be surprising if more were not to follow, of which a deadly influenza pandemic seems the most plausible. Now waht goes on within the borders of a sovereign state can affect everyone. The old rules no longer work. Globalization, multi-national corporations, economic migrations of workers, new political forms like the European Union have led to a fraying and even crumbling of the "national system" around its edges. New actors on the global health stage like the Gates Foundation are working outside the national system with even greater resources than WHO.

The new DG of WHO will be bringing the agency into a new world. Some will do it timidly and unsuccessfully. Others might have a bolder vision that could lead global public health rather than see it more and more marginalized by a world that is changing around it.

The field is exceptionally crowded, although slightly less so as of the past week. The Ecuadorian candidate, Alfredo Palacio Gonzalez, has withdrawn, still leaving twelve in the competition. As in the US election, the WHO DG election has its pundits and websites. The UK medical journal, The Lancet, has just started its own blog and surveys the watchers (mentioning us in the process). The Lancet's blogger, Hannah Brown, also is keeping track of the campaign tours:

Pekka Puska, Finnish nominee, has been spotted in Bahrain, Jamaica, and the USA. Bernard Kouchner, France, has been promoting his manifesto in Denmark and collecting an award in Memphis. Nay Htun, Burma's candidate, has been speaking to the Thai press, who report his candidacy is back by the foreign ministers of the ASEAN nations. Pascoal Mocumbi's trip to Lisbon earlier this month won him the support of the Committee of Portuguese Speaking Countries, ensuring him at least two of the Executive Board's vote (from Portugal and Brazil). Tomris Turmen, Turkey, has been visiting Azerbaijan, while her government has been doing a bit of campaigning for her by promoting her candidacy to the USA. Julio Frenk, Mexico, has promised to visit 29 of the 34 Executive Board members. (The Lancet Blog)

Earlier this week we mentioned the controversy over candidate Julio Frenk's history of dealing with the tobacco industry as a trade-off for more money for the poor and underserved in Mexico. Some think it was a pragmatic and wise bargain. Others think it was a bargain, too: a Faustian bargain. The flap is part of the intense politicking over the DG position.

Agence France Presse reports that the French candidate, Bernard Kouchner, is also on the campaign trail. Kouchner may be many things (good and bad), but one thing he isn't is a shrinking violet. In 1971 he was a co-founder of Doctors without Borders and has remained a brash, some would say cocky, figure.

Kouchner, who turns 67 on November 1, said the WHO has to be the focal point of an international health strategy and must go beyond publishing research papers and dishing out advice to playing a more catalytic role.

Otherwise, the WHO will become less relevant, especially with the emergence of other global bodies and philanthropists like software mogul Bill Gates, who are fighting problems like Acquired Immune Deficiency Syndrome (AIDS), he said.

"You can offer papers to the rest of the world. But papers will remain papers. You need political will," said Kouchner, displaying the gung-ho spirit that has brought him to often dangerous humanitarian missions in poor places where other doctors feared to tread.

While there should be continued focus on containing AIDS, bird flu and other high-profile diseases, this should not detract the world from dealing with malnutrition and "neglected diseases" such as malaria and tuberculosis, which are also killing millions of people, he stressed.

One of his objectives is to involve the WHO in getting the support of governments, groups and individuals so that the poor in developing countries can be given access to minimum health care and basic health insurance.

"We have to consider that health is not a commodity. Health is partly a commodity in a rich country but in the majority of the world there is no network of care, no health insurance, no money," he said.

He would also like to bridge what he said was a gap between the WHO headquarters in Geneva and the organisation's autonomous regional bodies. (AFP)

In our view Kouchner is the candidate most likely to shake things up. He is said to have approved of the Iraq invasion on the grounds that despots like Saddam Hussein should be dealt with regardless of the niceties of international law. That view is anathema to us and we see the costs of that mistake. But Kouchner isn't running for Director General of the UN or President of the United States. That same attitude may be just what is needed at this point in WHO's history. It is any of the other candidates will have Kouchner's boldness of vision.

He is a high risk candidate, to be sure. We think WHO needs to take some risks, however. If it doesn't, it will see its prestige, credibility and effectiveness continue to slide.

So there are two elections this week. Fate hangs in the balance.