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Margaret Chan takes a bow during the opening of the 68th World Health Assembly

Former Hong Kong, China, public health official Margaret Chan led the World Health Organization for 10 years.

Jean-Christophe Bott/Keystone via AP

Wanted: A leader for the toughest job in global health

Global health watchers will pay close attention to Geneva, Switzerland, on Wednesday, when the World Health Organization (WHO) will announce the final three candidates to take the agency’s top job. The decision by WHO’s Executive Board, made up of representatives of 34 member states, follows months of behind-the-scenes jockeying, campaigning by the candidates, and intense speculation. It will be followed in May by a final vote by WHO’s 194 member states.

Six countries have fielded candidates to succeed Margaret Chan, the former Hong Kong, China, health official who is stepping down after 10 years at the helm. Among the top contenders, many say, is former Ethiopian Health Minister Tedros Adhanom Ghebreyesus. The African Union has declared its support for him and some observers have suggested it’s time for WHO’s first director-general from the African continent. Another candidate widely seen as having good chances is David Nabarro, a physician nominated by the United Kingdom who has worked at WHO in various positions and was appointed the United Nations’ senior coordinator on Ebola in 2014.

The other candidates are Pakistani cardiologist Sania Nishtar; former French Health Minister Philippe Douste-Blazy; Hungary’s former minister of health, Miklós Szócska; and WHO’s assistant director-general for family, women’s and children’s health, Flavia Bustreo from Italy.

Tomorrow, the WHO Executive Board will select five of the candidates for interviews on Wednesday. The trio that will stand in the May election will then be announced on Wednesday evening.

The winner will earn a paycheck of more than $200,000 but also face a daunting task: reforming an organization that has been heavily criticized for its handling of the Ebola outbreak in West Africa and whose far-reaching mandate is “the attainment by all people of the highest possible level of health.” With an annual budget of about $2 billion, that’s a very tall order, says Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, Texas. “WHO does everything: disability and diabetes, outbreaks, smoking, human rights. All of these are important but you cannot do it all with $2 billion,” Hotez says. “I think what we need is a director-general who will look and see what you can actually do with the money.”

The most important skill for any future director-general will be a keen sense of politics, says Ashish Jha, a global health expert at the Harvard School of Public Health. “You don’t need the world’s greatest public health expert. You need somebody who can corral public opinion, someone who understands how states trade interests and jockey and negotiate.” Chan’s flaw as a director-general was that she felt she could only do what the member states wanted to do, he argues; in a 2015 interview with Science she described how complicated having “194 bosses” made her task. “I think that is a fundamental misunderstanding of the job,” Jha argues.