Experts urge more scrutiny of WHO regional elections after racism scandal

Five candidates are vying to lead the World Health Organization’s regional office in the Western Pacific. Experts say whoever gets elected needs to be technically and managerially competent, and boost morale in an office that saw its previous head, Dr. Takeshi Kasai, dismissed for misconduct. They’re hoping more transparency in the process would help ensure that. Had there been more scrutiny of candidates during the regional elections back in 2018, the scandal in WHO’s leadership in Western Pacific could have been prevented, said Dr. Colin Tukuitonga, the Pacific associate dean at the Faculty of Health and Medical Sciences at the University of Auckland. He was New Zealand’s candidate in 2018 and came second to Kasai, Japan’s candidate, in that election. Several WHO staff accused Kasai of racism and abusive conduct in an Associated Press report in 2022. “People knew already about Takeshi before the election,” he told Devex. “So had there been a more robust process, those areas, those gaps, those weaknesses may have been picked up,” he told Devex. The process to elect WHO’s regional leaders is at times driven more by country influence and politics, experts say. In the Western Pacific, for example, candidates from Japan and South Korea have dominated the regional director position for years. Five out of 7 directors since 1951 have been from either Japan or South Korea. Over 60 health experts based in different countries globally are hoping this would change and have issued a letter — seen by Devex — to WHO leadership and its board, including the current regional directors and regional committee heads led by member states, asking for greater public scrutiny of the candidates through an online public forum and an open town hall. Their ask comes ahead of the regional director elections for the WHO Western Pacific, Southeast Asia, and Eastern Mediterranean regions, all of which are taking place in October. An influential position WHO regional directors are politically elected by its member states, making the position powerful and influential in itself. Regional directors provide health advice to countries and engage in policy dialogues. They can pursue their own health agenda, according to the needs of the region, and champion issues that may not necessarily be the priority at headquarters. Having strong WHO regional directors helps serve the organization as a whole, as they can help resolve issues in their respective regions, foster trust, and ensure alignment across the organization by making sure they speak in one voice, particularly when advising countries on global health issues. While experts don’t see the political process changing, they are hoping more transparency would ensure the best candidates get the job. “[T]he selection of the Regional Director will be the decision of Member States and will involve geo-political considerations and bargaining for votes in return for support on other issues, including development assistance. That can’t be changed. But what can be done is ensuring that all candidates that are put forward have adequate qualifications, experience and calibre. More transparent processes can help in that regard,” Kent Buse, the director of Healthier Societies Program at the George Institute for Global Health and one of the signatories to the letter to WHO, wrote to Devex. “We hope that external scrutiny is a tide that will lift all boats – even if they do so in stormy political waters, so to speak,” he added. Devex reached out to WHO’s executive board chair regarding the letter but had not received a response at the time of publication. However, a source close to the matter told Devex that the chair has engaged on the issue and that a variety of interim measures are being explored for the upcoming elections. The case for transparency WHO issues guidelines on the conduct of elections for regional directors. A code of conduct exists for each region, which states that campaigns for the regional director position should be fair, open, and based on merit. It also provides guidance on the conduct of the electoral campaigns by the candidates and member states themselves, including disclosure of campaign activities and refraining from influencing the nomination process through the use of financial or other benefits in exchange for support for a candidate. Member states with candidates for the post are also asked to “consider disclosing grants or aid funding for the previous two years in order to ensure full transparency and mutual confidence among Member States.” “I grant you this is the U.N. system, and there's always going to be geopolitics. But at the end of the day, the WHO is a technical agency. And so technical competence has to be very important.” --— Vivian Lin, who previously served as director of health systems at WHO’s Western Pacific office The code of conduct, however, isn’t legally binding, and some experts said it isn’t always followed. “In a public office like this, the democratic principles of integrity and fairness has to prevail, but it's anything but transparent nor ethical. And we know, Japan and Korea buy votes, either directly from the individual ministers or they promise an airport extension or some such thing. And WHO says, you're not supposed to do that, but everyone knows it goes on,” Tukuitonga said. This leaves candidates from lower-income countries with less resources and influence with little chance to secure the position, he said. “That's why I think transparency is really important, because clearly, it’s not being honored,” he added. That should include, he said, a forum where candidates can disclose what they plan to do to address particular issues if elected for the position. Recalling the 2018 campaign he was involved in, Tukuitonga said “When we came to Manila, on the day of the election, I did a short presentation. And then people asked me questions. But that's hardly anything. … The process should be more robust, more demanding. And there should have been an interview process.” J.V.R. Prasada Rao, who previously served as India’s health secretary, added it should be clear from the start what the eligibility criteria is for a candidate before nominations are even submitted, and their competencies should be evaluated by an independent committee or WHO’s regional committee itself. Questions over priorities A public forum could shed light not just on candidates’ competencies, but what they plan to do to address existing and emerging health threats. In the case of Western Pacific for example, experts want to know what candidates’ plans are to address the health impacts of climate change and noncommunicable diseases, or how the next regional director plans to address universal health coverage and emergency preparedness to ensure the region is ready for the next pandemic. Candidates’ post-COVID plans are a top priority across regions. In Southeast Asia, Rao said one of the jobs of the regional director is to have a framework of pandemic preparedness for the region, and then ask each country to go through that and have a pandemic preparedness plan concerning the health sector. “How are you going to face the health emergency if …something like COVID again comes tomorrow. I think that has to be an outstanding priority of the regional director,” he said. Khadija Moalla, a lawyer from Tunisia and an expert on gender, human rights, and global health, said the regional director for the WHO Eastern Mediterranean office would need to address rising HIV cases and drug use among youth in the region. “It's important to know who's coming and to do what? And then to be able to [hold] this person accountable [for] implementing that vision and that program and strategy,” she said. A needed overhaul? Some hope current discussions will lead to a much broader discussion on the current WHO system. “This organization is now 75 years old, so it might also be time to rethink some of the regional concepts,” said Anders Nordström, outgoing global health ambassador for the Swedish Ministry for Foreign Affairs and who was acting director-general before Margaret Chan was elected to the position in 2006. One of the challenges unique to the organization is that regional directors are appointed in a political process similar to the director-general. This gives them the political mandate but also creates confusion about whom they should be accountable to. Often, regional directors feel accountable to their regions, but “they do not primarily feel accountable to the director-general … or to the World Health Assembly” leading to tensions between the director-general and regional directors, Nordström said. “People have been aware about this for ages. No one has been able to do anything about it,” he added. He thinks the director-general should appoint regional directors, much like the way directors-general appoint the rest of their senior team. That should be done through an open, transparent process that involves a selection committee that can help put the proper process and criteria to select the best people for the job. “If you look at other international organizations, when they recruit deputies, it's not a political process. They have proper selection committees; people will apply. Often they use search companies to help them to get the right competencies,” he said. WHO’s process will likely continue to be political, but “one can still bring in a little bit more rigor in terms of being clear about the criterias, [and] being clear about how you've evaluated those people against those criterias,” he said. Breaking the duopoly Neither Japan nor South Korea has submitted their own candidates for this year’s regional elections in the Western Pacific, leaving the position up for grabs from candidates coming from China, the Philippines, the Solomon Islands, Tonga, and Vietnam. Experts said it’s going to be difficult to predict who’ll emerge as victor. Whoever member states vote for needs to have managerial competence, and the ability to manage political relationships, said Vivian Lin, the executive associate dean and professor of public health practice at the University of Hong Kong, who previously served as director of health systems at WHO’s Western Pacific office. Countries such as China, Japan, and South Korea may have their historical animosities, but she said through WHO these countries can discuss health cooperation. “So I think this is where the managerial and the political, and the managerial and the technical competence really is something that needs to be understood and evaluated,” she said. “I grant you this is the U.N. system, and there's always going to be geopolitics. But at the end of the day, the WHO is a technical agency. And so technical competence has to be very important, and not just the politics of country alignment,” she added. That person also needs to have change management skills, Tukuitonga said. “WPRO needs to rebuild from the ground. The staff are demoralized. … So you need someone who can build and rebuild the house because it's been through a difficult time,” Tukuitonga said.