It’s election season in Geneva.  Three candidates are squaring off to become the next head of the World Health Organization. The electors are every national government on the planet.

Dr. Margaret Chan has been Director General of the World Health Organization for the last decade. It’s not a lifetime position, though. She has served two five-year terms as “DG,” and now she’s stepping down. Replacing her won’t be easy. The Director General of the WHO is elected, not appointed, and that election process is surprisingly complex.

The process began in September, when six candidates were nominated by member countries of the UN. Those candidates went on to do live forums, public outreach, and other forms of campaigning for the position, in addition to the confidential back-room wrangling that’s been a traditional part of the DG selection process. It has been a surprisingly intense election. The candidates have campaign websites and media advisors. Some of them have been positioning for years for the nomination.

In January, the WHO executive board selected three of those candidates as finalists election. At the end of May, at the 70th World Health Assembly, member nations of the WHO will vote for their new DG.

The Three Candidates

Dr. Tedros Adhanom Ghebreyesus was nominated for the position of DG by the government of Ethiopia. His campaign, including attending global health meetings and hosting receptions, has been financially support by the Ethiopian government and a solidarity fund supported by East African governments. Dr. Tedros has the most government experience of the three candidates. He has served as Ethiopia’s foreign minister the past 4 years and was minister of health from 2005 to 2012. He has the backing of all 54 African Union states, and many people feel that’s time for an African to lead the WHO.

Dr. David Nabarro, Special Envoy on Ebola, at a press conference in New York in November 2015. UN Photo/Loey Felipe 

Dr. David Nabarro is a UN-insider. Nominated by the UK, he’s been a senior player at the UN since 1999. Among other roles, he was Special Envoy of the United Nations Secretary-General on Ebola from 2014-2015, and chair of the Advisory Group on Reform of the World Health Organization’s (WHO) Work in Outbreaks and Emergencies with Health and Humanitarian Consequences. He hasn’t shied away from the thankless roles; most recently, he’s led the WHO effort to raise funds to fight cholera in Haiti. His campaign, consisting almost entirely of bilateral visits to key countries, has been funded by the government of the UK.

Dr. Sania Nishtar was nominated by the government of Pakistan, has deep experience in civil society, having built two well-respected health NGOs in Pakistan, Heartfile and Heartfile Health Financing. She was briefly Pakistan’s Federal Minister for Health, Science and Technology, Information Technology, and Higher Education. She also has UN experience. She is currently Chair of the UN Secretary General’s Independent Accountability Panel for the Global Strategy for Women’s, Children’s and Adolescents’ Health and is co-Chair of the WHO Commission on Ending Childhood Obesity. Her campaign, including receptions, major global health meetings, and bilateral visits, has been supported by the government of Pakistan.

Whoever wins this election is going to face some major challenges.

 The World Health Organization has a huge mandate. It provides technical support to national governments on health issues, establishes international health norms and regulations through research and analysis, and monitors global health trends. It promulgated and monitors the international health regulations, which are a legally binding set of rules to ensure the international community can prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide.These responsibilities lead naturally to WHO taking a leadership role in epidemic response and setting the global agenda on health priorities. However, the WHO structure is massive. It has 7,000 employees, 150 country offices, and six regional offices, and its relationships with host countries are built on consensus and mutual support. That is not an organizational design that lends itself to rapid response in emergencies. The WHO’s performance during the Ebola pandemic has been widely criticized, even as experts admit that the WHO charter and funding mechanisms hamper the organization’ s ability to respond effectively to emergencies.

In a world of constantly evolving global health threats – from avian influenza to antibiotic-resistant superbugs – the next Director General of the WHO will somehow need to convince skeptical donors that a flawedWHO needs more financial support, not less. A strong, effective WHO could be the difference between a minor disease outbreak in the next five years and a globally destructive pandemic. Let’s hope we get the leader we need.

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