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Who Should Lead the WHO? Q&A with Ruth Levine

May 22, 2006

The sudden death of World Health Organization director general Lee Jong-wook at the start of the World Health Assembly has created a leadership vacuum at a time when the WHO faces immense challenges. Ruth Levine, who heads CGD's Global Health Policy Research Network, argues that the WHO leadership must become more independent so that science can shape public health policies and practice.

Q: What is the most pressing challenge facing the WHO today?

A: The WHO needs to figure out its place within an increasingly complicated group of funders, technical agencies, and advocacy voices in global health. The WHO is far from being the single authoritative voice or influence in the field and it weakens itself when it tries to do too much. It should focus on strengthening technical expertise around what might be called regional and global public goods: surveillance of infectious diseases, with transparent global reporting; stimulating investment in neglected diseases; and generating sound scientific knowledge about how to implement public health programs with broad social benefits.

Q: In your blog post on Lee Jong-wook's sudden death you urged greater independence in the leadership of the WHO. What do you mean by independence, and how can it be assured?

A: The WHO is severely hampered by a budget inadequate to its mandate and a staffing arrangement in which key positions are year-to-year appointments. Governance of the organization is fundamentally and explicitly political: the organization is responsible to ministers of health, who tend to be politicians, not people with deep technical expertise. Of course, there are notable exceptions, but by and large the organization is governed by a political body. Because of this, WHO seems to be in a perpetual cycle of trying to raise resources for programs that might be attractive to one or another interest group, but might not really be the most important to achieve better health. The WHO also faces intense scrutiny about some of its decision making – for example, how it recommends and pre-qualifies pharmaceutical products for use in developing countries - and has not always been able to be clear about the rules of the game. It’s almost as if the U.S. Centers Disease Control and Prevention or the FDA were directly managed by the U.S. Congress. The WHO would be stronger with a more arms-length relationship between the governing bodies and the technical work of the organization.

Q: How will the new director general of the WHO be selected?

A: According to the WHO Constitution, the director general is appointed by the World Health Assembly on the nomination of a 32-member Executive Board. The member states vote and in the past there has been lots of politics and horse-trading. As in the other international organizations where governance and leadership have been criticized, the process would be better if it were more truly merit-based rather then reflecting which region’s turn it is and other political considerations.

Q: What personal characteristics do you think are most important in the future leader of the WHO?

A: A strong commitment to science and evidence, and an ability to be politic without being political; that is, somebody who understands issues of national sovereignty and the sensitivities of different interest groups without subjugating technical decisions to such considerations.

Q: What can ordinary people do to help ensure that Dr. Lee’s successor will be adequate to these challenges?

A: The selection of the next director general will be decided by member countries' ministers of health. In the U.S. context this means Secretary of Health and Human Services, Mike Leavitt, who is currently in Geneva for the World Health Assembly. (Note: Staff in Sec. Leavitt’s office told CGD they are not authorized to give out his e-mail. They suggested that Americans interested in the U.S. role in the selection of the next director general of the WHO fax him at (202) 690-7203.)