By David Brown
Washington Post Staff Writer
Sunday, November 5, 2006
There is another election this week. The issues are not war, taxes, morals or international credibility. They are microbes, diseases, data and international credibility.
Eleven men and women are competing to become director general of the World Health Organization, a 58-year-old branch of the United Nations with headquarters in Geneva.
It is an office -- barely known outside public health circles -- whose occupant can potentially affect the well-being of nearly every person on Earth. For that reason, it is one of the few international elective contests to which countries bring to bear a full range of hardball, but soft-voice, diplomacy.
The current campaign features an intense rivalry between Japan and China, an influential medical journal's support of Mexico's candidate, and widespread rumors of electoral horse-trading.
The election will fill the vacancy created in May by the sudden death from a brain hemorrhage of Lee Jong Wook, the South Korean physician who had headed WHO since July 2003. Anders Nordstrom, a Norwegian and longtime WHO executive, has been acting director general since then.
The voters are the 34 members of WHO's executive board, each from a different country. They will vote by secret ballot to whittle the field to a single nominee by Wednesday and then present the name to representatives of WHO's 193 member states on Thursday to be ratified or rejected.
The organization, whose founding objective is "the attainment by all peoples of the highest possible level of health," has a theoretically infinite portfolio of tasks.
WHO functions as the chief technical adviser to many developing countries on such issues as the use, safety, cost and effectiveness of drugs and chemicals. It provides information to governments on how to run vaccination programs and anti-smoking campaigns, and to practitioners on how to best prevent malaria and treat AIDS. It gathers disease and demographic data, the windows into global health needs -- and achievements.
WHO also periodically makes forays into operational roles.
It led an unsuccessful campaign to eradicate malaria in the 1960s and a successful one against smallpox in the 1970s, and it is overseeing the troubled assault against polio now. It has led global efforts that controlled Ebola, severe acute respiratory syndrome (SARS) and other diseases. The "3 by 5" initiative, which sought to help developing countries treat 3 million AIDS patients by 2005, missed its target by a wide margin but still transformed the world's expectations about care for that disease.
The candidates have run global campaigns underwritten by their governments. For example, Mexico's candidate, Julio Frenk, visited 26 of the 34 countries on the executive board. (He could not get into Iraq or Afghanistan, which are both represented on the board.) Two visited The Washington Post. But handicapping the race is extremely difficult.
"It is such an opaque process. There is so much that is based on quiet deals," said Nils Daulaire, a physician who heads the Global Health Council, an advocacy organization based in Washington.
The leading candidates appear to be Frenk; Shigeru Omi of Japan, who is WHO's director for the Western Pacific, one of the organization's six regional offices that elect their own leaders; and Margaret Chan of China, who is on leave from her job as head of WHO's communicable diseases section and pandemic planning. All are physicians.
Frenk, who also holds a doctorate in sociology from the University of Michigan, in the late 1990s headed the WHO office in charge of marshaling health data to help governments make well-informed policies. In 2000, he left to become health minister in the administration of President Vicente Fox and oversaw creation of a universal health insurance program after data revealed that 4 million Mexican families were becoming impoverished each year by medical expenses.
"We found an unacceptable paradox," he said in an interview earlier in the fall. "Improved health is a key element to fight poverty, except paradoxically, health care can be a source of impoverishment when a society doesn't have fair financing."
The Lancet editorialized a month ago that Frenk "must surely be the objective front-runner" and put that assertion on the journal's cover.
Omi is running on a "stand-pat" platform, committed to continuing Lee's agenda, which included reduction in malaria and TB mortality and broadening access to AIDS drugs, among other goals.
Omi was openly critical of China during the SARS outbreak in 2003 and proposed an advisory that warned the public against travel to Hong Kong and Guangdong province, a key step establishing WHO's leadership in the response to the outbreak. That may be part of the reason China strenuously opposes him.
China's candidate, Chan, led Hong Kong's response to SARS and in 1997 to the first outbreak of H5N1 avian flu, roles for which she has been praised. Chan's and the city's commitment to transparency was believed to be one of the reasons the Chinese government blocked her appointment as an assistant director general of WHO at the start of Lee's term. She got a lower-level job.
Other candidates of note are Bernard Kouchner, co-founder of the humanitarian organization Medecins Sans Frontieres (Doctors Without Borders) and former health minister of France; Pascoal Mocumbi, who served as health minister and, for nearly a decade, prime minister of Mozambique; and Pekka Puska, who headed a landmark project that lowered by up to 80 percent the astronomically high heart attack rate in eastern Finland by promoting community-wide changes in diet, smoking, and exercise. They are also physicians.
The United States has not declared whom it supports.
In the last election, the late voting was twice deadlocked between Peter Piot, a Belgian who is the charismatic head of the United Nations AIDS program, and Lee, who was a career WHO manager. It is widely believed that the U.S. representative broke the tie by switching from Piot to Lee.
Many observers believe that among other things, the U.S. delegation voiced its opposition to certain reproductive health policies WHO was evaluating, including access to contraception and nonsurgical methods of abortion.
"The visibility of that work seemed to be one [thing] that the U.S. wanted reduced," said Derek Yach, a former WHO executive who now heads the Rockefeller Foundation's global health program. Over the next few years, it was, he said.