[Ip-health] Wall Street Journal: Three Top Jobs In Global Health Face Vacancies

[Thiru Balasubramaniam]

http://online.wsj.com/article/SB115742353433353518.html


Three Top Jobs
In Global Health
Face Vacancies

By *BETSY MCKAY*
September 5, 2006; Page A15

Three of the most important global public-health jobs are up for grabs
this fall. How these leadership positions are filled will help determine
the world's strategy for confronting health threats ranging from AIDS to
pandemic flu for years to come.

The United Nations' World Health Organization is preparing to elect a
new director-general following the unexpected death in May of its former
chief, Lee Jong Wook, of a stroke. Nominations for the job are due
today. The Global Fund to Fight AIDS, Tuberculosis and Malaria is
interviewing applicants to fill its top post, succeeding Richard
Feachem, who will step down as executive director in January after more
than four years on the job. And the World Bank has a search under way
for a new senior vice president for its human-development network, who
will oversee its health programs, following the retirement of the
incumbent this past July.

The unprecedented number of simultaneous openings comes at an unnerving
time. Global health crises are mounting -- from the march of avian flu
to increasing resistance to critical drugs to the continued inability to
stem the death toll from AIDS.

At the same time, the emergence of influential private organizations
like the Bill & Melinda Gates Foundation, growing involvement in health
by groups like the World Bank, and solo government programs like Pepfar
-- President Bush's AIDS relief program -- have shifted the balance of
power in public health. That has raised questions about the role of
agencies like the WHO. With an annual budget of about $1.66 billion, the
U.N. agency is constrained financially. It also has no regulatory power,
so it can't force member countries to adopt or adhere to its policies.

"People complain that WHO is getting marginalized," says Kelley Lee, a
global health governance expert at the London School of Hygiene &
Tropical Medicine. But, she says, "WHO needs to be a coordinating body
-- no other organization could fulfill that role."

The new leaders have the opportunity to reshape the public-health
landscape. As the U.N.'s public-health agency, the WHO now sets policies
and standards for health care in 192 member countries and coordinates
global public-health responses to outbreaks. The Global Fund, created in
2002 by the U.N., has committed $5.5 billion to finance programs in 132
countries. The World Bank devotes an average of $1.4 billion annually in
loans and credits to health programs.

Veterans of the WHO and other public-health agencies have thrown their
names into the hat for the WHO director-general slot. Their campaigns
are already in full swing, and a new chief is expected to be chosen in a
special election Nov. 9. Candidates include Margaret Chan, the WHO's top
communicable-diseases official and a former health director in Hong
Kong, whose experience combating avian flu and severe acute respiratory
syndrome, or SARS, makes her a formidable candidate; Shigeru Omi, the
WHO's regional director for the Western Pacific, also credited for his
experience in battling avian flu and SARS; Julio Frenk, Mexico's health
minister, credited with reforms to bring health coverage to his
country's millions of uninsured; Pekka Puska, a Finnish expert in
strategies to prevent heart disease and other chronic conditions; and
Tomris Turmen, a Turkish pediatrician and expert in family and community
health at the WHO. (WHO officials who are running have taken leaves of
absence from the agency.)

The choice for WHO chief is steeped in U.N. politics. The decision is
made through rounds of voting by secret ballot that frequently involve
horse-trading between countries, as officials trade nonhealth-related
favors for support of one candidate or another, say agency veterans.
"There is a political give and take which often means the very best
doesn't get through," says Derek Yach, director of the Rockefeller
Foundation's global health program in New York and a former top WHO
official.

In contrast, the search for a new Global Fund executive director
resembles hunts for new corporate CEOs. The London-based search firm
Odgers Ray & Berndtson collected 334 applications for the position. The
search firm and a nomination committee created by the fund's board drew
up a list of 18 top candidates, and the board nomination committee is
scheduled to discuss in a telephone meeting today which candidates it
will interview in person later this month.

Officials who have applied for the job include Arata Kochi, the WHO's
malaria chief, who is on an aggressive campaign to overhaul the agency's
prevention and treatment strategies, and Jacob Kumaresan, a former
tuberculosis expert at WHO and president of the International Trachoma
Initiative, a New York-based organization. Their status on the list
isn't known.

While the World Bank has started searching for a new human-development
chief, it's unclear when the position will be filled, according to a
World Bank spokesman.

Despite the importance of the positions, the selection of leaders for
both the WHO and the Global Fund are made behind closed doors. An
article in The Lancet last week called the Global Fund's decision not to
make the names of serious candidates public a "perplexing hypocrisy" and
called for an open debate on the choice. Keeping the list secret "will
prevent the public scrutiny necessary to ensure that the Fund
accelerates its growth," the Lancet concluded. A Global Fund spokesman
said the board's chair had read the Lancet article, and that the board
would "weigh the different concerns" raised in the piece.

Filling the jobs with strong, visionary public-health leaders would
create an opportunity to shape new strategies and find more efficient
ways for the growing number of organizations involved in public health
to coordinate their efforts, public-health experts say. The WHO in
particular faces growing pressure to assert greater leadership over the
new players. "There's a chance to make sure there are really strong,
public-health-minded people with clear visions who understand that the
world has changed dramatically and are able to interact with a complex
set of players," says Dr. Yach. "The stakes are high, and there are real
opportunities."

Complaints have grown among public-health experts that the WHO and other
health organizations too frequently duplicate efforts or tread onto one
another's turf. A push by the WHO into AIDS treatment with its so-called
"3 by 5" program raised questions about whether the agency was stepping
too far out of its main policy-setting mandate. The program failed to
meet its goal of providing life-saving drugs to three million people in
poor countries by the end of 2005. Critics have also called on the WHO
to police global health programs more aggressively, ensuring that health
groups employ the proper strategies and treatments.

The new Global Fund chief will face another set of challenges:
persuading countries and organizations to contribute to the independent
Geneva-based foundation despite donor fatigue. The fund needs someone
who has strong managerial skills but is also a talented fund-raiser,
public-health experts say. The organization is currently trying to raise
money to fund a sixth round of grants. It says requests for funding from
97 countries total $5.8 billion over the next five years. It estimates
its shortfall to fully fund the sixth round of approved grants at $500
million.

*Write to *Betsy McKay at betsy.mckay@wsj.com <mailto:betsy.mckay@wsj.com>