Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
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Wall Street Journal - November 6, 2006
Betsy McKay, betsy.mckay@wsj.com
The post is one of the most important leadership positions in global public health. The person chosen to fill it will play a huge role in determining the world's strategy for combating health threats -- from AIDS to pandemic flu, tuberculosis and heart disease -- for years to come.
The United Nations agency has the power to shape the public-health landscape with policies and programs that determine which diseases to tackle most aggressively. But WHO is also under pressure to assert greater leadership over a growing number of organizations involved in public health.
The emergence of powerful private groups such as the Bill & Melinda Gates Foundation has shifted the balance of power in public health, sometimes creating competing programs or priorities and raising questions about what WHO's role should be. The Geneva-based agency is constrained financially: It has an annual budget of only about $1.66 billion. The Gates Foundation spent $1.36 billion in 2005. WHO has no regulatory power, so it can't oblige countries to adopt policies that it sets.
While all of the candidates for the WHO job are public-health veterans, international politics will play nearly as big a role in deciding the winner as professional credentials. The winner will be chosen over three days of horse-trading and voting this week behind closed doors by the U.N. health agency's executive board, which consists of representatives of 34 countries.
While handicapping is difficult, the two top candidates for the job appear to be Margaret Chan and Julio Frenk. Dr. Chan is WHO's top communicable-diseases official (currently on leave) and a former health official in Hong Kong. Her experience on the front lines of the battle against severe acute respiratory syndrome, or SARS, and the earliest outbreaks of avian flu, along with the fact that she was nominated by China, made her a front-runner from the start. Global-health officials want closer ties with China, where SARS first erupted and whose government has been slow to disclose health threats.
Dr. Frenk is Mexico's health minister, admired for sweeping health overhauls that are expected to deliver health-insurance coverage to 22 million of his country's poorest citizens by the end of this year. Dr. Frenk has been criticized for cutting a deal with some tobacco companies that helped to fund some of those overhauls, but he also has a reputation for being tough on tobacco. In a recent open letter to tobacco-control advocates, he pledged to "strongly oppose voluntary agreements with the tobacco industry."
Also in the running are Shigeru Omi, WHO's regional director for the Western Pacific (currently on leave), known for his experience in fighting SARS and avian flu; and Pekka Puska, a thoughtful Finn credited with successful strategies to lower rates of heart disease and other chronic conditions.
Those with the power to choose public-health leaders appear to be getting pickier about their choices these days. The board of the Global Fund to Fight AIDS, Tuberculosis and Malaria decided last week to abandon debate over a list of five finalists for that organization's executive director and to seek a fresh crop of candidates.
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