[e-drug] More on WHO DG stepping down

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E-drug: More on WHO DG stepping down
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Lancet 2002; 360: 695 (31 August)

WHO chief announces surprise move to stand down

WHO Director-General Gro Harlem Brundtland dropped a bombshell on Aug 23 by
announcing that she will not stand for re-election when her 5-year term
expires next July. The former Norwegian prime minister said she had informed
the chairman of the Executive Board-- Burma's deputy health minister Kyaw
Myint--that she would "not be a candidate for nomination" when the board
makes its choice in January.

"My decision to complete my work as Director-General at the end of my
current term reflects the fact that I have had leading positions in
political and public office for nearly 30 years, and would be 69 at the end
of a second term", she stated.

The news shook the UN community in Geneva out of its summer slumber and set
WHO corridors abuzz. The US diplomatic mission to the UN lauded Brundtland
for bringing "new strategic direction". The British Medical Association
(BMA) lamented her departure as premature. "Identifying the problems was the
first achievement, implementing them is the second thing, and you need more
than 4 or 5 years to achieve that", said BMA spokesman Nigel Duncan.

Brundtland associates said she wanted to spend more time with her three
children and nine grandchildren in Norway, and has become weary with the
travel. She is currently in southern Africa to discuss the humanitarian
crisis and for the World Summit on Sustainable Development. She then attends
meetings in Jakarta, Copenhagen, Washington, Cairo, and Brazzaville.

Some WHO officials speculated that their boss was tired of being criticised
and was bogged down by reforms. These were intended to make WHO more
efficient and open but have led to low morale and constant changes in senior
management, disparagingly called the "Harlem Shuffle" by insiders.

Brundtland took office in July, 1998, when the agency was at an all-time
low. She replaced Japan's Hiroshi Nakajima, who was widely criticised for
poor management and lack of direction. She vowed to place health on the
international development agenda, to find new partners to reduce the
reliance on governments, and to make WHO more responsive.

"WHO is solidly on track to fulfil the many demands being placed on it",
said Brundtland in her resignation notice. "The critical role of health in
development has gained wide acceptance. The world has turned its attention
to our priorities", she declared.

There is widespread agreement that Brundtland successfully combined her
political savvy from her 10 years as prime minister with her zeal as a
clinician to catapult health up the international agenda. This was not least
through her Commission on Macroeconomics and Health, which reinforced the
view that health is a prerequisite for, rather than the result of,
development.

But away from the declarations at summits and in policy documents, WHO
struggled to improve its infamously ineffective country representation and
aid national health systems.

Brundtland ushered in new initiatives such as Roll Back Malaria and
pioneered partnerships, such the Global Alliance for Vaccines and
Immunization, with private organisations such as the Gates Foundation.

This opened up new sources of funding, but weakened WHO's grip. "There are
other powerful partners in health these days, from the Gates Foundation
which has injected welcome resources into the health sector, to the
pharmaceutical companies who are making donations of drugs--all of whom are
influencing international policy", commented Gill Walt, professor of
international health policy at the London School of Hygiene and Tropical
Medicine.

Brundtland's embrace of the drug industry has proved most controversial.
Health activists charge that WHO has sold its soul to big business and has
hidden in the shadow of non-governmental organisations (NGOs) such as
M�decins Sans Fronti�res on access to essential medicines. Brundtland allies
counter that WHO's quiet negotiations with pharmaceutical companies have
done as much to slash the price of antiretrovirals as the more
confrontational tactics of NGOs.

Above all, Brundtland looks set to be remembered for her crusade against
smoking. The Framework Convention on Tobacco Control --scheduled for
completion next August just after she leaves office--will likely be weaker
than she wanted, but will be the first international treaty against a
product which currently kills 4 million people a year.

"She has done a tremendous job on tobacco. She single-handedly put tobacco
control back on the agenda", said Amanda Sandford, research manager at ASH.
"That will be a lasting legacy to Brundtland."

Behind-the-scenes jockeying to take up the reins has already begun.
Governments have until November to submit nominees. The 32-member Executive
Board decides next January and this is, in theory, endorsed by the full
World Health Assembly in May.

With the exception of Nakajima's 10-year tenure, Europeans have
traditionally held the post. Brundtland's closest challenger in 1998 was Sir
George Alleyne of Barbados. Next year, developing countries may feel that it
is their turn.

Clare Kapp



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