Global health chief race set with new entrants

Three new candidates entered the race to lead the World Health Organization on Friday, responsible for tackling crises from Zika to the spread of superbugs, bringing the total in the running to six.

The Geneva-based public health agency with 194-member countries announced Italian WHO official Flavia Bustreo, former Hungarian Health Minister Miklós Szócska and British U.N. adviser David Nabarro had entered the contest for the €214,000-a-year job.

They join earlier candidates to succeed Margaret Chan, whose mandate as director general ends next June, are Pakistan’s former Health Minister Sania Nishtar, Ethiopia’s Foreign Minister Tedros Adhanom, and France’s former health and foreign minister Philippe Douste-Blazy.

Chan ran unopposed for a second term in 2011. In 2006, before she was ultimately chosen, there were 13 candidates. 

New rules for the election aim to bring more transparency and fairness to the process — but much still happens outside of public scrutiny, in private meetings with country representatives.

"I am pledging in my manifesto that I will voluntarily make my own electoral campaign financing a matter of public record for scrutiny” — candidate Sania Nishtar

Every country gets one vote, meaning a tiny Pacific island has the same voting power as China or India. In the past countries simply rubber-stamped the board’s pick, endorsing the single candidate it proposed.  That was the case when Chan was selected.

The new methodology has amped up the potential for political horse-trading. One candidate so far has hired a public affairs firm to make his case.

“Obviously almost any U.N. job has a political dimension … behind closed doors there are trade-offs,” said Michael Merson, director of the Duke Global Health Institute in Durham, North Carolina.

The money

While a separate new code of conduct encourages candidates to be transparent about their campaign activities and funding, its recommendations aren't binding.

Tedros’ campaign says East African countries including Kenya and Rwanda are pooling resources to support him, but they didn’t say how many countries or how much money.

And the Ethiopian candidate has hired U.S.-based Mercury Public Affairs to help him with his bid. The company would not disclose how much that contract is worth.

"His candidacy has support from many countries outside of Africa, ... in every region of the world," said Molly Toomey, a vice president with the firm.

Philippe Douste-Blazy, former French Minister of Health | Fabrice Coffrini/AFP via Getty Images

Neither of the other two officially in the running has hired an outside firm, they said.

Douste-Blazy said his travel expenses during his campaign are paid by the French government and said his per diem is about €100. He also said he has paid for many hotels out of his pocket.

"I'll disclose all my spending and urge everyone to do the same," he said.

Pakistan’s Nishtar said she was going by the book and taking advantage of WHO regional committee meetings for her campaign.

“Regarding the campaign budget, I am being sponsored by the government of Pakistan and no one else," she said. "I am pledging in my manifesto that I will voluntarily make my own electoral campaign financing a matter of public record for scrutiny,” she said.

No cushy job

The job is not seen as a plum U.N. assignment.

The WHO has been under fire for its response to the Ebola epidemic that started in 2014, during which more than 11,000 people died.

A major line of criticism was that the agency was slow to react and lacked leadership, and was bogged down by several lines of command at the regional and global level. Ebola broke out in Guinea in March 2014, but it took the WHO five months and more than 900 deaths before it declared it an international public health emergency.

After a series of withering reports on its handling of the epidemic, the 194 members agreed to hike funding for emergencies by nearly 50 percent.

But Chan has had to goad members to contribute.

Earlier this month, Chan urged member countries to increase their annual contributions. Just 20 percent of the WHO’s budget is made of this stable, hassle-free funding; The rest comes from special sponsored projects that usually come with strings attached. “You want us to do more work… Where is money?” Chan warned on the last day of WHO Europe’s regional committee meeting in Copenhagen.

What she's calling for: A 10 percent increase in member countries’ annual assessed contributions — for a total of $95 million. “It’s peanuts out of a $4 billion budget,” Chan said.

Whose turn

At the same time, like many international institutions, the question of "whose turn" it is to run the agency is in play.

Leaders in the agency's 68-year history have come from Brazil, Canada, Denmark, South Korea, Norway and Japan. One acting director general was from Sweden.

The African Union has thrown its support behind Tedros' candidacy and argues it’s time for the continent to have more high-profile international roles.

In January 2017, WHO’s executive board will secretly vote on a short list of up to five candidates. The board’s 34 members will then interview those candidates and whittle the list to three names.

“It seems that people are looking at whose turn it is, what region of the world. That’s a shame — we should be looking at who’s the best candidate we can find in the world,” said Merson, of the Duke Global Health Institute.

In October, member countries will get to interact with the candidates on a password-protected forum hosted on the agency’s website.

On November 1, a live forum will kick off, where all candidates will get to make their pitch to country officials in no more than 30 minutes and then answer questions, with the whole interview lasting no longer than an hour. All will be out of reach of the media.

In January 2017, WHO’s executive board will secretly vote on a short list of up to five candidates. The board’s 34 members will then interview those candidates and whittle the list to three names to submit to the World Health Assembly in May.

The candidates will be allowed to address the Assembly for up to 15 minutes before the final secret electronic vote. If none gets the two-thirds majority required to win in the first round of voting, a simple majority will do.

The new director general will then take office July 1, 2017.

Carmen Paun contributed reporting.