Chinese Physician Elected Head of WHO
Chan Instrumental In Fighting SARS, Bird Flu Outbreaks

By David Brown
Washington Post Staff Writer
Friday, November 10, 2006

The World Health Organization yesterday elected as its new leader a 59-year-old Chinese physician, Margaret Chan, who in the past 10 years played a key role in suppressing two disease outbreaks that had the potential to become global epidemics.

As Hong Kong's director of health, Chan led the responses to the original outbreak of H5N1 bird flu in 1997 and to severe acute respiratory syndrome (SARS) in 2003. Both required dramatic decisions, constant appearances before reporters and delicate closed-door diplomacy.

Chan's selection from a list of 11 candidates reflects the importance of WHO's leadership in controlling infectious diseases with planet-crippling potential. It also recognizes the unusual dual role played by China -- as incubator of emerging pathogens and as a country with the capacity to make or break the global response.

WHO, with headquarters in Geneva, has myriad functions, from providing advice on health policy and clinical medicine to poor countries, to coordinating campaigns against specific threats such as smoking, AIDS and influenza. It has a budget of $1.7 billion. Of its 8,500 staff members, about 6,000 are in nearly every nation on Earth.

Chan's appointment, confirmed by a vote of WHO's 193 member nations, is a diplomatic coup for China. She is the first Chinese national to head a major U.N. agency.

"Chan's appointment coincides with China's political and economic ascendancy," said Derek Yach, a former WHO executive who heads global health programs for the Rockefeller Foundation. "It will boost expectations of low- and middle-income countries that their needs and priorities will get support."

Nils Daulaire, an American physician who heads the Global Health Council, a Washington-based advocacy organization, echoed that view, saying: "The message is very clear that China is here on the world stage, and it was the appropriate time to recognize that with a senior position at a U.N. agency."

Chan succeeds physician Lee Jong Wook, who died in May from a brain hemorrhage. In the interim, the organization has been led by Anders Nordstrom, a physician who came to WHO in 2003 after serving in posts in his native Sweden and in international organizations, including the Red Cross.

The office of director-general is designed to be filled by a person with technical credentials, but the campaign to fill it is subject to international dealmaking at the highest level.

Chan's election was helped by strong, if quiet, encouragement by the United States and surprising, final-round support from Japan. She won 24 to 10 on the fifth ballot in the 34-member WHO executive board, which then submitted her name to the full membership for ratification. The runner-up was Julio Frenk, Mexico's health minister and the candidate many observers viewed as objectively most qualified.

The third-place candidate, Shigeru Omi, a Japanese WHO official, was eliminated in the next-to-last round of voting. Japan threw its support to Chan -- and the eight other countries that had supported Omi followed it.

"There must have been quite a deal struck," said one former WHO executive in Geneva for the vote.

Some observers speculated that the move by China's main rival in East Asia may involve Japan's ongoing effort to gain a permanent seat on the U.N. Security Council. China has a seat on the council and in recent years has resisted efforts to open it to new permanent members.

In her acceptance speech to the World Health Assembly, composed of the health ministers of WHO's member countries, Chan emphasized her commitment to the world's needy and to two groups in particular.

"I want us to be judged by the impact we have on the health of the people of Africa and the health of women. Improvements in the health of the people of Africa and the health of women are key indicators of the performance of WHO," she said. "This is a health organization for the whole world. . . . But we must focus our attention on the people in greatest need."

At a news conference later, she was asked about the significance of her nationality and the fact that Beijing was less than forthcoming with information in both the bird flu and SARS outbreaks.

"Being a Chinese national, of all people I hope I will have better access to various senior levels of the government," she said.

In the 1997 bird flu outbreak, Chan ordered the culling of every chicken in Hong Kong. This was a crucial step -- the final toll was only 18 cases of human illness and 6 deaths -- but a traumatic one, as it involved the largely public killing of 1.4 million birds in less than a week.

The government subsequently provided financial assistance to the 300 farmers and 1,000 vendors, as well as truck drivers and other workers whose livelihoods were interrupted by the months-long ban on poultry sales. Such compensation is viewed as an essential part of the global effort to encourage people and governments to report unexpected illnesses in domestic animals, rather than cover them up.

In an interview in 2005, Chan recalled another insight from the time.

"Many people see the media as an enemy. The lesson I learned was the media is an ally," she said. "They are asking the questions on behalf of the community. They are not personalizing the issue."

That became even clearer during SARS outbreak, which was far more dangerous and socially disruptive.

Chan was the face of Hong Kong's response to SARS, appearing before television cameras nearly every day for more than two months. She provided information about the epidemiology and biology of the newly discovered SARS coronavirus and offered advice on subjects such as when wearing a face mask might be worthwhile.

Behind the scenes, she pressured Beijing authorities, who initially hid the extent of the outbreak, to be more forthcoming. This created resentment. When Lee attempted to make her assistant director-general after his election as WHO chief in 2003, China opposed the appointment and she was given a lesser job.

Chan received undergraduate and medical degrees from the University of Western Ontario. She also studied at the National University of Singapore and Harvard Business School. She is married to a physician and they have a grown son, who is a lawyer.

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