Nature Medicine | Spoonful of Medicine

WHO’s the boss: Chan set to stay at the helm of the global health agency

margaret-chan-20111120.jpgThe US Republican party has a long list of potential candidates to choose from for the 2012 presidential bid, but the World Health Organization (WHO) has no such leadership race. Today, the WHO, the Geneva-based health arm of the United Nations, announced that the organization had received just a single nomination for its next director-general: the incumbent Margaret Chan.

Chan first got the job after the untimely death of her predecessor, South Korea’s Jong-Wook Lee, in 2006. With her experience tackling epidemics, including Hong Kong’s bird flu and SARS as the special administrative region’s director of health, Chan, who had been working for the WHO since 2003, easily beat out the other 13 nominees for the post.

When Chan took office, she pronounced “improvements in the health of the people of Africa and the health of women” to be the “key indicator of the performance of WHO.” However, her defining role as director-general has probably been her management of the swine flu outbreak in 2009. By declaring a global ‘pandemic’, Chan spurred world leaders into action, and the flu’s spread was halted within months. However, governments spent hundreds of millions of dollars on flu vaccines from Roche and GlaxoSmithKline — many of which went unused. And when word got out that Chan’s emergency swine flu committee included scientists with financial ties to pharmaceutical companies, Chan personally received criticism for allowing pharma interests to have undue influence. The WHO denied the allegations.

If reappointed, Chan will have a new challenge to tackle in her second term as director-general: the WHO budget. In May, the organization cut nearly $1 billion from its budget and fired hundreds of workers. Even so, the organization has said that it expects to post a $300 million shortfall this year.

Many experts say that the WHO’s $4 billion-a-year budget — around a quarter of which comes from UN membership fees, with the rest stemming from voluntary contributions — is simply too small for the organization to reasonably achieve its mandate of providing leadership on global health matters. And because the WHO is largely reliant on external funding, conflicts-of-interest will continue to haunt its future, as an article published last week in Foreign Affairs points out.

Perhaps the best way to prevent such conflicts would be to increase the mandatory contributions from member states, but this is unlikely to happen given the current global financial situation. The only way out is for Chan to learn from her mistakes made during the swine flu outbreak and up the organization’s transparency, says Larry Gostin of Georgetown University in Washington, DC, who directs the WHO’s Collaborating Center on Public Health Law and Human Rights. “I would stick with trying to mobilize the private sector for global health but not let them influence WHO’s agenda,” he says.

A final decision on the WHO leadership will be made in May of next year. Chan’s current tenure runs through to June 2012.

Image: Margaret Chan at the Annual Meeting 2011 of the World Economic Forum in Davos, Switzerland, January 28, 2011. Image via the World Economic Forum, under Creative Commons licensing.


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