World Health Organization : The mandate of a specialized agency of the United Nations

PART IV: The election of the new Director-General: what is the future of the WHO?

What will be the future of the health agency of the UN? What will happen now that a new Director-General has been elected for the next five-year term? What will be the mandate of the World Health Organization?

The reason why we all should be interested in the election of the new Director-General is that the WHO could be compared to the World's Ministry of Health, and, therefore, the world's inhabitants are directly affected by who will be the next Global Health Minister[1].

Our health, and therefore our lives, depend on who takes care of them. This contribution has previously defined health as a human right, and it has accepted the interpretation according to which health depends on two determinants factors: individual's freedom and entitlements[2]. While the first element is totally private, the WHO and its chief technical and administrative officer, just recently elected, have a lot to do with the second element. For this reason, we care about the Director-General's election. Nils Daulaire, a former senior policy advisor at USAIDS and now resident of the Global Health Council in Washington says: "I would not say the future of the world rides on the election, but I would say that the future of millions of lives does"[3].

The last part of the present contribution, therefore, will deal with the election of the new Director-General of the WHO, and it will try to foresee the future of such a fundamental Organization. First, I will present the procedure for the election, the candidates and the winner; and, secondly, it will follow an evaluation of the previous Director-General's term, in order to delineate how the current one will have to act to improve WHO's performance.

Chapter 1

THE ELECTION OF THE NEW DIRECTOR-GENERAL

On 23 August 2002, Dr Brundtland unexpectedly sent a message to the staff of the World Health Organization. She stated that, on that day, she had informed the Chairman of the EB that she would not be a candidate for the next Director-General nomination. This would be the first time that a WHO Director-General has not been in office for at least two terms.

The reasons she presented were basically private: "I have had leading positions in political and public office for nearly 30 years, and I would be 69 at the end of a second term"[4], and again "I do not want to get into a situation in my life where I am not fully energetic and able to do my job as I would like it"[5]. Dr Brundtland's associates said she wanted to spend more time with her three children and nine grandchildren in Norway, and that she had become weary to travel[6]. Nevertheless, many still attribute the cause of her sudden stand down to the amount of criticisms she received about the process of renewal she started in 1998, especially within the Organization. Anyhow, Dr Brundtland will retire at the end of her mandate in July 2003.

The successor of Dr Brundtland has been recently nominated by the 111th Executive Board on the last day of meeting, on 28 January 2003. His name has been submitted to the World Health Assembly which will be in charge of his appointment in May. The new Director-General will be Dr Jong Wook Lee, director of the Stop TB Initiative since 2000. The following paragraphs will describe the procedure of his election, and the steps which led him to the victory.

1.1. Election procedure

The procedure for the election of the Director-General is set out by article 31[7] of the Constitution and by Rule 52 of the Rules of Procedure of the Executive Board[8].

Article 31 defines the respective roles of EB and WHA. The EB is in charge of nominating the Director-General and the WHA is subsequently expected to appoint him/her.

Rule 52 of the Rules of Procedure of the Executive Board delineates the election process step by step, highlighting in particular the role of the EB. The implementation of such a Rule is described by two further text, 'Implementation of Rule 52 of the Rules of Procedure of the Executive Boards: nomination for the post of Director-General'[9] and 'Implementation of Rule 52 of the Rules of Procedure'[10].

An additional text to be considered is the resolution of the EB which lists the criteria for the election of the Director-General[11].

Taking into account the abovementioned documents, the procedure and particularly the role of the EB can be summarised, as follows[12]:

1. The Director-General has to inform member states and members of the EB that they may propose persons for the nomination for the post of Director-General, at least six months before the opening of the EB session where the Director-General is to be nominated[13].
2. The proposals of candidates can be submitted to the EB till two months before the opening of the EB session[14]. Each proposal must be accompanied by a curriculum vitae which should be only two to three pages long and should include a statement on the vision of the candidates on priorities and strategies. In particular, it has to address the criteria established by the EB for the candidates: a strong technical and public health background and extensive experience in international health, competency in organisational management; proven historical evidence for public health leadership; sensitiveness to cultural, social and political differences; a strong commitment to the work of WHO; the good physical condition required of all staff members of the Organization and sufficient skill in at least one of the official and working languages of the EB and WHA[15]. The proposal has to be submitted in a sealed envelop to the Chairman of the EB by mail or hand delivery.
3. The Chairman of the EB will open the proposals, which will be translated and distributed to EB members under confidential cover, not less than one month before the opening of the EB session.
4. The nomination process during the EB session is composed of four different stages:
   1. Initial screening: the EB determines whether any candidate does not meet the criteria set by the EB;
   2. Determination of a short list of five names through one or more secret ballot[16];
   3. Interview of the candidates[17], equally divided between an oral presentation of the candidate's vision of the future priorities of the Organization (30 minutes), and a question-and-answer period (30 minutes);
   4. Vote on the candidate to be nominated[18]. If no candidate receives the simple majority required of members present and voting, the candidate receiving the least number of votes is eliminated at each ballot until one candidate receives majority.

According to Rule 52, only the IV phase was supposed to be held in public. However, the EB decided, in its 100th session, that also the three first stages should be not public[19]. This has caused numerous criticisms inside and outside the Organization.

During the last 111th session of the EB, I could recognise the uncomfortable feeling of a WHO staff totally excluded by the process of determination of their future leader. Clare Kapp defines the EB session as a "secretive gathering", and affirms that the election process is "a procedure which gives the rest of the world little to say"[20]. In other words, the EB session seems to be "a secret publicly unaccountable ballot of 32 faceless bureaucrats"[21].

Again, in a Lancet editorial, the process is defined as "an odd one by today's standards of democracy […] most candidates will not publish manifestos for public scrutiny and debate. There will be no formal hustings. There will be few analyses of the issues facing a new Director-General in the mass-media. And there will be no forum to discuss a position that will affect the lives of million of people"[22].

The British Medical Journal joins The Lancet opinion, affirming that "the election process is captured by politics. All board members take orders from their governments when they elect WHO's new leader. […] Candidates themselves, through their lobbying campaigns, will try to sway the board's voting. But their success depends to a great extent on how much support they get from their government"[23]. The authors suggests an opening up towards all the member states and to a public debate in order to render the process less politicised[24].

Yet the worst opinion is expressed by Richard Horton, editor in chief of The Lancet, who describes the process of election of the Director-General as "a process typical of a totalitarian regime of 20 years ago. It is secrete, it is not transparent, it is not accountable. There will be no formal debate associated with the election process. A group of men will meet in a room in January and cast a vote secretly. We have no idea what the criteria will be for the election of the next Director-General of WHO. This is an antediluvian process"[25].

In front of these criticisms, not even a civil servant totally devoted to his Organization, as Dr David Nabarro, WHO Senior Policy Advisor, can try to defend these proceedings. He affirms that "there are some aspects of our processes that are perhaps a little in need of improvement […] it will be as transparent as I think people want it to be and all 192 member states will get a chance to vote on the proposed candidate when they meet together in May"[26]. For the meanwhile, an ad hoc open-ended Intergovernmental Working Group to review the working-methods of the EB has been created and has been working on this issue[27].

1.2. The candidates

The candidates for the election of the Director-General were initially nine:

• Pascoal Mocumbi, Prime Minister of  Mozambique, since 1994;
• Peter Piot, from Belgium, Executive Director from UNAIDS and Under Secretary-General of the UN since 1995;
• Julio Frenk Mora, Secretary of Health in Mexico, since 2000;
• Awa Marie Coll-Seck, Minister of Health from Senegal, since 2000;
• Jong Wook Lee, from South Korea, Director of the WHO's Stop TB Initiative, since 2000;
• Ismail Sallam, former Minister of Health and Population in Egypt;
• Karam Karam, Minister of Tourism and Alternate Minister of Health in Lebanon, since 2000;
• Djamil Fareed, from Mauritius, Adviser of the Minister of Health and Quality of Life;
• Joseph Willans, former Prime Minister and current member of parliament for overseas, from Cook Islands.

The list was cut to five candidates the second day of the 111th EB meeting, and comprised:

• Pascoal Mocumbi;
• Peter Piot;
• Julio Frenk Mora;
• Ismail Sallam;
• Jong Wook Lee.

Between August 2002 and January 2003, as it would have been for any kind of election, a strong debate started over the issue: 'who is going to be the next Director-General?'. In particular, journals such as The Lancet and the British Medical Journal tried to lead a public discussion. Fortunately, I happened to be at the WHO headquarters during this period of time, and especially during the 111th EB session. For this reason, I could partly experience the suspense which is typical of certain kind of moments.

The general opinion[28] was that Mocumbi was the frontrunner because it was Africa's turn to lead WHO, and also because he had withdrawn against Dr Brundtland in the election of 1998. Furthermore, after Dr Brundtalnd announced to stand down, he organised a strong lobbying campaign of the heads of the State at the Johannesburg Summit in September 2002. He also had, as Prime Minister, the political support of his country.

Peter Piot was not likely to win because of his Belgian, and therefore European nationality. The WHO would not have two European Director-Generals in a row. He tried, for this reason, to emphasise his UN administrator character.

Julio Frenk Mora was mentioned as a possibility because he was sustained by the United States in the EB. However, he was strongly opposed by the Brazilian member, because he produced, while at the WHO, the World Health Report 2000 assessing the effectiveness of national-health system.

Ismail Sallam was sustained by the idea that Arab countries are underrepresented in the top UN posts, whereas, just to mention a couple of persons, Kofi Annan is from Ghana and FAO Secretary-General is African as well.

Finally, Dr Jong Wook Lee could count on the fact that he was a veteran of the WHO, having worked in it for 19 years. Taking into consideration the criticisms against the 'outsider' Dr Brundtland, the WHO was likely to desire a return to a home-made product. However, Dr Lee was also from an Asian country, and we have seen the negative aura surrounding the previous Japanese Director-General, Nakajima.

1.3. And the winner is …

Dr Jong Wook Lee was finally nominated for the post of Director-General of the WHO on 28 January 2003, the last day of the EB session. Dr Lee accepted the charge and briefly said to the EB: "to be nominated as Director-General is truly a privilege and a great honour. I will do my best to serve WHO and its member states"[29]. The nomination will then be submitted to the WHA scheduled to meet in Geneva from 19 to 28 May 2003. The new Director-General will take office and start his five-year term on 21 July 2003.

The election of Dr Jong Wook Lee was quite a surprise for everyone. Among the five candidates of the shortlist, he was the only one with no experience as Minister or head of a UN agency. For this reason, he was initially not deemed appropriate to establish the necessary relationships with heads of State, Prime Ministers or Ministers of Finance, and to push health to the centre of the global agenda. However, he proved wrong this general opinion, when he persuaded 53 members of the US Congress to write to Secretary of State Colin Powell and Health and Human Services Secretary Tommy Thompson, in order to insist on US to support him for his submission[30].

As long as it concerned the other candidates, Ismail Sallam and Julio Frenk Mora were respectively eliminated after the first and second rounds. Pascoal Mocumbi was the third one to be eliminated, failing to pick up more than seven votes in any of the rounds. Lee and Piot tied on 16-16 votes in the fifth and sixth rounds. On the seventh round, one executive - believed to have represented a Latin American country - switched candidate[31], and Lee turned out to be the final winner: 17-15[32].

Jong Wook Lee was born in Seoul, Republic of Korea, on 12 April 1945. He received his Medical Doctor degree from Seoul National University, College of Medicine, and a Master in Public Health from the University of Hawaii.

Dr Lee has gone through a whole career inside the WHO. He has worked at the Organization for 19 years in technical, managerial and policy positions, notably leading the fight against two of the greatest challenges to health and development: tuberculosis and vaccine preventable diseases of children[33]. First, he joined WHO as a consultant on its leprosy control team for the South Pacific in June 1983. A few years later, from 1986 to 1990, Dr Lee became Regional Adviser for chronic disease. From 1994 to 1998, he took up two important positions, as Director of the Disease Prevention and Control Department in WPRO, and as Director of WHO's Global Programme on Vaccines. Later on, he became Senior Policy Adviser to the Director-General, and in 1999, he was declared Special Representative of the Director-General. In 2000, he was nominated Director of the Stop TB Initiative, which now is, as we have previously mentioned, a coalition of more than 200 international partners with the aim of controlling the expansion of tuberculosis[34]. In the last few years, he gained a reputation as an efficient and popular manager of about 55 members of staff. He is actually running one of the WHO's most effective programmes. He speaks Korean, English, and Japanese.

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Edited by Aldo Campana,