David Nabarro;  Tedros Adhanom Ghebreyesus;  Sania Nishtar

The three finalists. From left to right: David Nabarro, Tedros Adhanom Ghebreyesus, and Sania Nishtar.

(Left to right): UNMEER/Simon Ruf; European External Action Service/Flickr; Benedikt von Loebell/World Economic Forum/Wikimedia Commons

Meet the three people who hope to lead WHO in the Trump era

Now the race is really on. Only three candidates remain for the highest post at the World Health Organization (WHO), widely seen as one of the toughest jobs in global health. Chronically underfunded, WHO is a complex bureaucracy that has come under heavy fire for its handling of the Ebola catastrophe in West Africa. And its new boss arrives just as the United States, WHO’s most important financial contributor, has chosen a president who has little appreciation for international organizations and who reportedly wants to slash U.S. contributions to the United Nations, of which WHO is part.

The three who say they’re up to that challenge are former Ethiopian Health Minister and Minister of Foreign Affairs Tedros Adhanom Ghebreyesus, U.K. physician and United Nations official David Nabarro, and Pakistani cardiologist and former science minister Sania Nishtar.

Today, the candidates introduced themselves during consecutive press conferences in Geneva, Switzerland. From now until the election in May, they and their countries will campaign in the media and lobby furiously behind the scenes to get as many of WHO’s 194 member states as possible on their side.

The outcome will depend in part on what happens on the international stage in the months ahead, says Ilona Kickbusch, an independent global health consultant based in Brienz, Switzerland. What influence will Brexit negotiations have on European support for U.K. candidate Nabarro? If U.K. Prime Minister Theresa May draws closer to U.S. President Donald Trump, will that hurt Nabarro’s chances? Which candidate will be able to convince member states to give WHO more money, not less? “This is the first time that world politics will play such a big role” in WHO’s election, Kickbusch says.

Yesterday, media stories reported that the Trump administration may cut contributions to the United Nations and other international organizations by as much as 40%. Although they didn’t specifically mention WHO, some worry that the United States’s $400 million contribution to WHO’s $2.4 billion annual budget may be at risk as well. (Trump has also reinstated the so-called Mexico City Policy banning foreign aid to organizations that discuss abortion, a move almost universally decried in global health circles.)

Nishtar is considered by many to be the outsider in the race. But Pakistan’s first female cardiologist convinced many countries with her professionalism and technical knowledge, Kickbusch says. “I think she was underestimated in the beginning.” Being the only female candidate might also turn out to be an advantage—although perhaps less so after 10 years of Margaret Chan at the helm. (She was WHO’s second female director-general; Gro Harlem Brundtland from Norway led the agency from 1998 until 2003.)

Nishtar has been working hard. After her candidacy was announced, she stepped down from all positions to focus on the election. “I had bilateral meetings with more than 185 member states and I will continue to make sure that I meet all of them now that I have been nominated,” she told the press conference today. Nishtar said she wants to focus on transparency and value for money at WHO, eliminating inefficiencies and duplication. She suggested she would not shy away from making hard choices, saying, “I realize that every attempt at priority setting in the past has only come up with a longer wish list.”

I think to be director-general of WHO is a job I have been training for the whole of my life.

David Nabarro, United Nations

Nabarro is widely seen as the candidate with the most technical experience. He started out working in developing countries for nongovernmental organizations and the U.K. government and in 1999 joined WHO, where he led the Roll Back Malaria Partnership. He has also held several positions at the United Nations and is currently leading that organization’s response to Haiti’s cholera outbreak, which was inadvertently set off by U.N. peacekeepers from Nepal. “I think to be director-general of WHO is a job I have been training for the whole of my life,” he said this morning. With WHO in rocky waters, many countries are looking for an old hand to steer the organization, says Kickbusch, which may bode well for Nabarro. The fact that another European, António Guterres from Portugal, recently bagged the job of U.N. secretary-general may work against him.

Asked about the reports about potential cuts by the Trump administration, Nabarro said he had read a lot about Trump and talked to people coming into the administration and members of Congress. What they want is “that the purpose for which international bodies are working is absolutely clear and is in line with their national objectives,” he said. “I’m not sitting here thinking that the noises that are coming from a number of people in the legislature are going to lead to terminal problems for WHO.”

Tedros has the support of the 54-country African Union, and many observers argue that it is time for the first African leader of WHO. Tedros served as Ethiopia’s foreign minister the past 4 years and was health minister between 2005 and 2012. “I believe I am the best candidate because I have a mix of national and international experience,” he told the press conference, highlighting Ethiopia’s strides in combatting HIV, malaria, and tuberculosis and in overhauling the health system. “If I could get a chance to lead this organization, I can help countries to implement reform in a comprehensive way, because I have the hands-on experience.” But some say international criticism of Ethiopia’s human rights record may work against Tedros.

“Now that there are three candidates there will be more opportunity to see who provides the replies the governments want to hear,” says David Heymann, head of the Centre on Global Health Security at Chatham House in London. “The horse trading that is going to happen is probably quite substantial,” predicts Ashish Jha, a global health expert at the Harvard T.H. Chan School of Public Health in Boston.

Background and experience matter, but so does character. “The organization needs a really strong personality,” Kickbusch syas. “There will be a lot of conflicts to weather, with staff, with member states, and with other actors like the sugar industry, for instance.” But Jha says it’s not the most important issue. “Over the next 4 months we have to make sure it is not about personality,” he says. “I want to hear from them what their priorities are. And priorities also means: Which important things are you not going to do?”