The other election: Director General of WHO

The Lancet is my favorite medical journal. Maybe it's because I've had the privilege of publishing there on occasion, but mainly because they have consistently taken a public health perspective despite the fact they are a medical journal. Often that perspective has been controversial and just as often courageous. Like another of my favorite journals, Nature, The Lancet is published in the UK, which might explain its interest in global issues, compared to US medical publications like The New England Journal of Medicine or The Journal of the American Medical Association.

In any event, The Lancet's new blogger, Hannah Brown, has been up to the minute on the hotly contested WHO DG "election" process now taking place in Geneva at WHO Headquarters. Yesterday the WHO 34 member Executive Board narrowed the candidate list from twelve to five using a process you'd probably rather not know about. If you want the grubby details, you can find it at Brown's blog. Here's the result:

Margaret Chan, China, was the first to secure her place for the interviews tomorrow, with Shigeru Omi, Japan, and Julio Frenk, Mexico, close behind. The fourth and five places were much more hotly contested, finally going to Kazem Behbehani, Kuwait, and Elena Salgado Mendez, Spain. (Lancet blog)

Today the Executive Board will interview each for 30 minutes apiece and select one candidate to present to WHO's governing body, the World Health Assembly, on Thursday.

Many commenters here are dismissive of WHO, having written them off over their performance in SARS and bird flu. I think their SARS performance was a high point and much better than their bird flu performance, which ahs been inconsistent, timid and often incoherent. As a result WHO's credibilty and prestige have slipped noticeably in the last two years. Moreover in global health they are no longer the only game in town, sharing the stage with wealthy philanthropies like the Gates Foundation and the Clinton effort.

But they are still the only intergovernmental agency, and as such, critically important. The Lancet's interest in the Director General election should be some evidence that astute, committed and very knowledgeable scientists believe this is an important event.

For what it's worth, we agree. If a pandemic occurs in the next five years, WHO will be a pivotal actor in the global public health response, like it or not. We think Margaret Chan, China's choice, is the wrong choice, although she is considered a favorite. WHO's Shigeru Omi also represents the WHO of the past, including the past practice of semi-autonomous regional fiefdom's ill-suited to the kind of well coordinated response that will be needed in a fast moving pandemic. Both chan and Omi are very competent, to be sure, but that's not the issue. WHO will need more than competence. It will need vision, courage, political will and the daring to take some risks. The Lancet's Editor, Richard Horton, has endorsed Mexico's Frenk, with whom he has had a professional relationship. How much that personal connection colors his views is hard to say. We know too little about Behbenhani and Salgado Mendez to state a preference. Our personal choice, France's Bernard Kouchner, didn't make the short list.

Today all eyes are on the US election. As the world's last remaining semi-Superpower, the US results will have major consequences for the world. The less noticed WHO election may also turn out to have momentous consequences, either because it chose someone who rose to the challenges of public health in the 21st century -- or because it didn't.