It is well known that the voting for this position will involve a lot of backroom diplomacy and ‘horse-trading’ deals between Member States.

What makes a great WHO chief A conversation with Halfdan MahlerWHO website
Blog Blog Thursday, May 18, 2017 - 17:32

By Dr Franklin Apfel (1)

Like many of my colleagues who have personally experienced how the World Health Organisation (WHO) works (or doesn’t work), I believe that the election of the Director General (DG) next Tuesday (May 23rd, 2017) is critically important for public health. It offers our Global Public Health community, through our 194 national representatives, a unique opportunity to select a leader who can (or cannot) revitalise and reposition WHO and champion Public Health values and approaches on a global level. A vital input that is sorely needed in these politically, morally and ethically challenging times.

It is well known that the voting for this position will involve a lot of backroom diplomacy and ‘horse-trading’ deals between Member States. It is also suspected that some countries will “be instructed to” vote based not necessarily on what is best for WHO and Global Public Health but rather on what their National Foreign and/or Health Ministries determine to be their strategic needs. It is also known that voting will be impossible to track with the secret ballots and that a few countries are openly declaring their preference. As this later factor allows for the possibility of designated delegates to “vote their conscience”, I would like to pass on to these voters some insights on “What makes a great WHO DG”, that I had the privilege to learn, from Dr. Halfdan Mahler nearly 20 years ago and have been holding in trust for the right moment to emerge.

That moment is now!

In 1998, I spent 14 hours traveling from Almaty to Copenhagen with Dr. Mahler. For those who may not know about him, he was three times DG of WHO and played a critical role in the ground-breaking Health for All (HFA) strategy. It was the first and only time I ever met him personally. We had both been attending a twentieth anniversary meeting celebrating the Alma Ata agreement and were booked on what serendipitously turned out to be very delayed flights back to Copenhagen. I remember well that conversation came easy, ranged broadly and that we shared a lot of personal reflections and stories. Time flew.

Most of all, I remember Dr. Mahler’s reflections on putting HFA first and how he said that this was his “heaviest and most precious stone” to carry as DG. He told me it was an objective that guided all his actions. No simple task then, you will agree and even more complicated now. All of us international public health advocates have to grapple with a vast and often daily array of challenges and conflicts in putting international Health For All (HFA) first. These can be:

·      personal - do I go to the meeting or attend my kid’s birthday party?

·      national - do I report on the cholera outbreak in my country and risk damaging our tourism   industry?

·      political - do I dare criticise a prime minister and keep my job?

·      economic- do I stand up to unhealthy developers, hazard merchants and charities (invested in hazardous companies) who fund so much public health work?

·      human rights - do I defend the rights of ethnic and other minorities and journalists who report on abuses?

These challenges are of course exponentially increased for the WHO DG. This person has the unique duty (and opportunity) to be THE global health value and standard-bearer, THE spokesperson for health in halls of power and THE public health role model for all.

I had heard many stories over my years at the WHO of Dr. Mahler’s extraordinary capacities to take on these duties; to champion WHO’s constitutional values; to lead, catalyse, inspire and guide staff and countries in taking action for HFA. Many of us, reflecting on what they considered WHO’s golden days, talk about his ability to help people feel proud to be public health workers and to feel the “force” of being part of the ‘worthy’ global movement of Health For All. During our extended traveling dialogue, I had, what turned out to be a once in a lifetime privilege to hear the man himself, humbly and personally reflect on actions the WHO took during his tenure. He shared many simple-sounding “we did this and this happened stories” about what actually were monumental and legendary public health achievements that changed history! I still get goose bumps just thinking about them.

Dr. Mahler told me about how, under his leadership, WHO stood up to the pharmaceutical industry when they passed the first essential drug lists. How they stood up to the food industry when they developed the code on infant formula marketing. How many countries didn’t immediately “get” or support the need for a primary care focus for healthcare systems which was eventually so elegantly and inspirationally expressed in the Alma Ata declaration.

While many attribute the declaration to Dr. Mahler’s use of evidence and eloquence, he said that the WHO’s most decisive contribution, according to him to Alma Ata was to help countries find the motivation for and way to a consensus. He said this was made possible by letting everyone know that they could achieve something REALLY GREAT with this Declaration and that unity could be found in well-articulated common values and aspirations.  

My vision of what makes a great DG was concretised on that day. To me it is all about the capacity to embody, communicate and use WHO constitutional values to inspire, catalyse and lead people to take actions that put HFA first.  We all know that Mahler and “his” HFA by the year 2000 approach was criticised by many as being too aspirational and unachievable. And that the consensus that informed the HFA approach was eventually undone by the International Monetary Fund (IMF) and the World Bank (WB) neo-liberal (re)structuring policies as well as UNICEF’s strategic shifts to focus on “vertical” selective primary care programmes (eg. vaccination and diarrhoea). But for many of us, it was WHO’s and public health’s finest moment and provided us with a glimpse of how the power of putting international HFA values and principles first could be a public health “force” to be reckoned with; how it created what Mahler called “a warm moment for social change.”

As you, our delegates, gather in Geneva next week to vote for a new WHO DG, you too have the opportunity to do something GREAT. You can select the one ‘internationalist’ candidate who can help our public health community rekindle ‘the force’ that emerged from the Alma Ata consensus, underpinned our HFA movement and has been on the WHO’s backburner now for many years. You can ask yourselves Dr. Mahler’s questions above and ensure you select the candidate who has the best capacity to put international Health For All first.

Disclosure: Dr Apfel and Dr David Nabarro who is running to be WHO’s next DG worked together at WHO between 1999- 2002.  Dr Apfel believes that Dr Mahler’s “force” is strongest in Dr Nabarro and supports his candidacy for WHO DG.

[1] Franklin Apfel MD MHS is Founder and Managing Director of World Health Communication Associates ( and is former head of Communications for the WHO Regional Office for Europe 1995-2003.

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