As the Global Fund to Fight AIDS, Tuberculosis and Malaria heads into a secretive but highly contentious election of a new Executive Director, the names of three candidates who are reportedly on the shortlist, all US citizens, have surfaced. They include former Global Fund Executive Director Mark Dybul, former Trump appointee William Steiger and a former NYC public health official, Ashwin Vasan. 

Whoever emerges victorious from the current election must immediately confront a $5.36 billion funding gap for the next three-year cycle. And separate from the details of who may be nominated, some voices are calling for greater transparency in the process of finding a new leader for an agency that drives a massive pooled procurement mechanism supporting market-shaping pharma contracts for drugs and other supplies required by the world’s poorest nations.

Among them is former Global Fund board member Jirair Ratevosian. “Confidentiality is not the enemy, opacity is, and leadership selections for institutions like the Global Fund and Unitaid should not feel like papal conclaves,” he told Health Policy Watch.

Meeting behind closed doors, the Global Fund’s Executive Director Nomination Committee (EDNC) convened in the first week of June 2026 to evaluate the long-list of candidates for the top post and create an initial short list. Those candidates will be interviewed in a first-round of interviews in July, followed by a second round in September, when the “short-list” is to be narrowed to four-five candidates, according to an official Global Fund timeline. A final appointment decision, is scheduled for the Board meeting of 28-30 October.

The opaque process stands in stark comparison to the more public election of a new Director-General of the World Health Organization, set for May 2027.

Despite a $4 billion annual budget and a broad, multilateral scope of influence in global health policies and procurement choices, the Global Fund remains a donor-supported and governed entity with key administrative decisions shielded from public scrutiny.

The ED Nomination Committee operates under a highly restrictive framework, assisted by the executive search firm Russell Reynolds Associates. The Global Fund declined to comment on the candidates, how many are on the present shortlist, or other aspects of the process, pointing to its strict confidentiality.

So far, all the top contenders mentioned by sources familiar with the proceedings are also US citizens, and at least two of those reportedly have US government backing. Considering the importance of the US as a donor, and the Trump administration’s clear linkage between funding and political influence, support from Washington may very well turn out to be one of the most important factors in the final selection.

At the same time, the US administration is increasingly bypassing the multilateral system, and allocating its own global health aid budget largely on the basis of bilateral agreements – with over 30 signed so far.  That could put any new Global Fund leader in the uncomfortable position of steering between the Global Fund’s multilateral mission and US priorities, as well as drug procurement preferences, in the coming years.

As for the three leading candidates whose names have so far surfaced, Health Policy Watch reached out to all three for comment, but did not receive a response before publication. Here’s a rundown of who they are:

Safe hands for the Global Fund in challenging times?

This would be a second term for Mark Dybul, who served as the Global Fund’s Executive Director from 2013-2017. With his deep institutional experience, some observers say Dybul could represent a safe pair of hands who can steady the Global Fund as the organisation navigates a precarious moment, battling massive funding shortfalls and geopolitical turmoil.

During his previous tenure as Executive Director, he took over an organisation reeling from financial uncertainty. He also oversaw a new and more flexible funding model that provides countries with up-front allocations based on disease burden and allows them to set their application timelines.

Evaluating his leadership record, supporters praise his success in lowering the prices of key commodities like insecticide-treated nets and antiretrovirals, but official reviews also challenged his administration to effectively translate its sustainability policies into practical implementation. Nevertheless, concurrent assessments by the UK government and multilateral networks awarded the institution top ratings for its financial transparency and overall organisational strength under his watch.

Dybul began his career as a young internist treating AIDS patients in San Francisco.

He acted as the principal architect for the President’s Emergency Plan for AIDS Relief (PEPFAR), and served as the United States Global AIDS Coordinator from 2006 to 2009.

Today, PEPFAR faces an uncertain future and a dramatically reduced reach following the dismantling of USAID and its absorption into the State Department under the new administration’s “America First Global Health Strategy”. The programme’s scope now focuses strictly on treating existing patients and preventing mother-to-child transmission.

Beyond his historical track record, Dybul remains an advocate for systemic reform, urging the global health community to abandon old aid models that tend to prioritise organisational self-preservation. Opening up to technological advances, he recently joined the US-based private company Redwood AI as a public safety and defence advisor to guide the application of artificial intelligence in global health preparedness.

Trump appointee joins the roster

Another name reportedly on the shortlist is Dr William R. Steiger, a former Trump appointee. Steiger also served on the 2017 Global Fund selection committee that chose today’s outgoing Executive Director, Peter Sands, who concludes his second four-year term this year. Steiger also advised the Global Fund’s General Manager in 2012 and acted as staff director for an independent panel that triggered wide-ranging institutional reforms in 2011.

During President Trump’s first term, Steiger served as Chief of Staff at USAID as a political appointee. He thus brings to his candidacy credentials that align with Washington’s “America First” policies. He currently serves as a Global Health Consultant at the George W. Bush Institute and as the CEO of Malaria No More.

In early 2026, Steiger co-authored a policy paper assessing the Trump Administration’s America First Global Health Strategy alongside Bush Institute Deputy Director Hannah Johnson and Deborah Birx, the former White House Coronavirus Response Coordinator. The authors supported the administration for “rightfully” pushing low- and middle-income countries toward self-reliance through the new five-year bilateral agreements intended to replace PEPFAR. However, they warned that “not all countries will be able to replace PEPFAR support” within such a tight timeframe.

To bridge this gap, the authors argued that continuing targeted, cost-effective U.S. engagement in these special cases would ultimately strengthen the broader goals of the America First strategy. They emphasised that preventing a resurgent HIV or malaria epidemic is essential to maintaining a safe environment, which in turn is required to attract risk-averse U.S. companies and build successful bilateral partnerships in key strategic industries like critical minerals, oil and gas, and pharmaceuticals.

The arguments mirror the current administration’s strategy, which clashes with the overall multilateral thrust of the WHO Pandemic Agreement in preventing and responding to emerging disease threats.

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Alternative public health profile

Alongside Dybul and Steiger, some sources also mentioned Dr Ashwin Vasan as a top candidate bringing significant early-career experience with the WHO. In the early 2000s, working under WHO’s Director of HIV/AIDS Dr Jim Yong Kim, Vasan helped launch the “3 by 5 Initiative” to expand antiretroviral treatment access to three million people living with AIDS across low- and middle-income countries by the year 2005. The campaign fell short of reaching the initial 2005 target date, but ultimately far exceeded the goal for getting people on ARVs in the years that followed, helping to transform the face of HIV treatment.

More recently, in 2022, Mayor Eric Adams appointed Vasan, also a mental health expert, to lead New York City out of the COVID-19 pandemic. However, Vasan unexpectedly resigned in late 2024 ostensibly to spend time with his family. He denied that his departure had any connection to the swirling federal corruption investigations targeting the mayor’s inner circle.

Before leaving, Vasan launched the ambitious “HealthyNYC” campaign. This initiative aims to extend the average life expectancy of New Yorkers to 83 years by 2030 by aggressively targeting chronic diseases, overdoses, and maternal mortality.

German candidate sidelined from shortlist?

As these high-profile names from the United States emerge, European member states that are also among the Global Fund’s largest donors are struggling to maintain their traditional influence in the agency’s orbit.

The ED Nominating Committee reportedly removed the only applicant endorsed by the German government from the shortlist during its early June meeting. The dismissal of the German-endorsed contender emerged as a source of intense frustration in Berlin, sources familiar with the process told Health Policy Watch.

Observers continue to perceive Europe and Germany in particular as “weak” on the global stage, with the country still struggling to translate its financial weight into executive leadership.

But the bigger issue is whether the US will have a stranglehold on the process, given its weight as a donor, while stepping back from organisations such as the WHO.

The German Federal Ministry for Economic Cooperation and Development (BMZ) declined to comment, responding to a query: “The BMZ does not comment on ongoing selection processes or confidential discussions.”

Calls for more transparent elections with public articulation of vision by candidates

Independent of the frictions in the current nomination process, Ratevosian, a former Board member and global health policy expert at Duke University, has recently argued for a more transparent leadership selection process for the agency that wields billions of dollars in medicines procurement budgets.

“These are public-interest decisions. They should be moments to widen the tent, strengthen legitimacy, and reinvigorate the global health community,” he told Health Policy Watch.

In a Lancet article published on 23 June, he proposed creating open forums for candidates to present their visions and engage directly with Board constituencies before the field is narrowed.

Ratevosian clarified that increasing transparency does not mean turning the process into a popular election. Instead, he suggested that hosting open forums would allow civil society, recipient countries, and affected communities to evaluate the candidates’ priorities while still preserving the Board’s ultimate hiring authority.

“The case for greater openness goes beyond institutional accountability,” he added, noting that because the institution relies heavily on taxpayer dollars from donor governments, citizens have a fundamental right to understand who is selected to manage those resources.

Framing transparency as a strategic defence, Ratevosian concluded: “A more open selection process that brings candidates into public view could also help build the broader public case for global health investment at a moment when that case is under attack.”

Echoes of past disastrous leadership election 

According to the nomination timeline, the Nominating Committee schedules first-round interviews from 12 to 23 July in London. Second-round interviews follow in early September, before finalists attend a Board Retreat on 1 and 2 October to conclude the race. The final appointment decision awaits the main Board meeting spanning 28 to 30 October 2026, marking a definitive end to the selection period.

Before the final decision, the board uses multiple weighted voting cycles to gradually eliminate contenders and identify a single preferred nominee.

Yet, for veteran health diplomats, the current atmosphere evokes uncomfortable memories of the organisation’s previous leadership crisis.

In 2017, the Global Fund was forced to completely scrap its Executive Director selection process after divergent political agendas created a blocking minority that made consensus impossible.

The crisis escalated when an anonymous email criticised insufficient due diligence by the executive search firm, leading finalist Helen Clark to withdraw before a leak to the New York Times ultimately poisoned the proceedings. Following the collapse of this initial search, the process was restarted and culminated in the appointment of Peter Sands as the new Executive Director in November 2017.

To prevent a repeat of the past failures, comprehensive confidentiality frameworks and robust ethical guardrails were implemented throughout the current leadership selection process. 

Current political factionalism risks creating a destructive leadership deadlock, as the final candidate must secure a two-thirds majority from both the donor and implementer constituencies, which each hold 10 of the Board’s 20 voting seats. To counter this, if consensus fails, the voting threshold is gradually lowered until a simple majority with just 11 votes of the full Board – regardless of donor or implementer blocs – can appoint the winner.

Funding crisis confronts renewed leadership team

The victorious candidate will join forces with a renewed board leadership team. Former Norwegian Prime Minister Erna Solberg and global public health leader Javier Hourcade Bellocq recently secured the Chair and Vice-Chair roles, respectively. This new leadership duo also begins their three-year term in late October, meaning an entirely fresh executive trio must immediately steer the institution through challenging times.

Whoever emerges victorious from the current diplomatic friction must immediately confront severe financial constraints. The eighth replenishment cycle secured only $12.64 billion against an $18 billion target for the next three years of the fund’s life-saving work.

Consequently, the next Executive Director inherits an institution that was recently forced to manage devastating mid-cycle reductions to country grant budgets. While the most immediate, core services have been protected, looming cuts in longer-term investments threaten imminent reversals in critical disease prevention.

Simultaneously, the US administration’s 2027 budget proposal would intensify the rippling impact of its massive cuts in global health spending seen last year by eliminating disease-specific accounts entirely.

While Washington and the Global Fund recently expanded joint commitments to supply lenacapavir, the US administration is increasingly bypassing the multilateral system, relying instead on strict bilateral agreements.

These, in turn, could help drive a wave of preferential procurement deals with primarily US-based drug manufacturers. Politically-driven procurement deals that systematically prefer certain nations or manufacturers could render the Global Fund procurement mechanisms far less effective, as well as fostering a dangerous reliance on a smaller number of pharma companies, experts warn.

It might also undermine the Global Fund’s recent efforts to foster more local procurement from African manufacturers – as compared to manufacturers located largely in Asia or the Global North.

At the same time, the organisation may find itself between a rock and a hard place. Following the US announcement to withdraw from the WHO, the Global Fund now has to defend its multilateral model to a highly sceptical Washington. A shortlist featuring prominent American candidates who offer strategic overlap with the current administration’s agenda might be one way to achieve exactly that.

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Image Credits: UNDP, The Global Fund, Felix Sassmannshausen/HPW, Guilhem Vellut via flickr, Georgetown University, George W. Bush Presidential Center, Columbia University, Milken Institue, European Union/Daniel Hayduk.