International Herald Tribune

Now Hiring for Global Health

Next week, 34 international government officials will fill what is potentially the most important position in global health. The individual they pick will crucially influence—for good or ill—the effectiveness with which the world tackles its most crucial health challenges.

Yet unless things change unexpectedly, that choice will be made in a closed politicized process that would shame a papal conclave.

It may be hard to get excited about how the next director general of the World Health Organization is picked, or who gets the job. Yet we should care, because the state of our health—like so much else today—truly has become a globalized concern.

Thirty years ago, who would have guessed that an unknown disease among Central African monkeys would develop into the global scourge of AIDS? Or that human health and prosperity in the world's most affluent countries would be under threat from an infectious disease among East Asian ducks and chickens?

The WHO is the one agency that has a truly comprehensive global mandate in the public health field. It alone has the responsibility to help the world's national health systems work together to tackle all the toughest cross-border challenges.

Of special importance, the WHO is charged with helping the world's poorest and least-prepared countries bring state-of-the-art, evidence-based approaches to bear on their desperate health challenges.

Since its establishment in 1948, the agency has racked up important triumphs, including the successful program that eradicated smallpox worldwide in 1979; campaigns between the '50s and '70s against crippling tropical diseases like river-blindness and yaws.

Yet many informed observers worry that in recent decades, for a variety of internal and external reasons, the agency has not been firing on all cylinders.

Gro Harlem Brundtland, a former prime minister of Norway who was director general of the WHO from 1998 to 2003, is widely credited with raising the organization's public profile. But overdue internal reforms made less headway. Brundtland's successor, Lee Jong Wook, was tragically struck down by illness in May of this year, barely three years into his term.

The WHO has a critical leadership role to play in global health. Its next director general will set the agency's direction for years to come.

Yet the hiring process as it stands does virtually nothing to ensure that the job goes to the best-qualified candidate. Instead it is dominated by behind- the-scenes political horse trading among member governments, described in the respected British Medical Journal as "a secretive game of political favors that excludes the general public."

It is too late for fundamental reforms to the electoral process this time. Such reforms - half- heartedly considered by the WHO in 2003 but then apparently forgotten—should be taken up in earnest after this year's election.

Here are four measures, all feasible under the present rules, that would help open up the process next time around, and have relevance this time, too:

First, have an open campaign. There should be public debates to allow the candidates to present and defend their platforms and to exchange views on issues and priorities.

Second, the WHO itself should as a minimum take basic steps to promote improved transparency. The agency's Web site currently lists only the names of the 13 proposed candidates and the countries that nominated them. This is inadequate. The agency should publish the candidates' qualifications and statement from each on how they would address the challenges facing the WHO.

Third, organizations working in health at all levels need to demand information and contribute to the debate. The names of the government representatives who will do the voting should be published to allow interested parties to contact them.

Finally, country representatives should be encouraged to vote on election day for the candidate who offers the most convincing proposals to make the WHO a stronger, more effective agency. This may sound naïve—most electors will no doubt be mandated to vote a certain way—but the fact that the ballot is secret gives the electors a practical opportunity to vote their conscience.

Progress on global health matters to us all—more than most of us realize. Let's all do everything we can to ensure that the world's leading health organization gets the vigorous, forward-looking leadership it so urgently needs.