World Health Organization Director General Dr Tedros Adhanom Ghebreyesus announced his new team of 36 directors at headquarters on Tuesday, according to an internal message to WHO staff, seen by Health Policy Watch.

Nine of the appointments, including key positions heading the Departments of Noncommunicable Diseases and Mental Health, and the newly-combined Department of Environment, Urban Health, Climate, Migration, and One Health, are “acting” with permanent appointees to be named at some point in the future, according to the message. 

The appointment of the directors completes the latest phase of WHO’s reorganisation following a budget crisis triggered by the withdrawal of the United States, WHO’s biggest donor, in January 2025, and its abrogation of dues payments, even for the 2024 year. 

In the wake of the US exit, WHO member states slashed WHO’s projected 2026-27 base budget by over 20%, yet it remains about $1.65 billion underfunded. In May, World Health Assembly members also agreed to a 20% increase in assessed fees for member states, handing a lifeline to WHO’s operations. Still, WHO is faced with a need to reduce overall staff costs by 20-25%. 

In May, Tedros slashed the number of major WHO programme divisions from 10 to just four, announcing a pared-down senior leadership team of six Assistant Director Generals, as compared to 11 previously.  Tedros also promised to reduce the number of costly D1 and D2 directors in WHO’s headquarters from over 76 to just 34, as the next step in the massive restructuring.

In fact 36 directors were named today, and the fate of other directors not named for positions at headquarters remains to be seen. As most directors hold long-term contracts, it’s likely the organisation will try to match them to positions elsewhere in regions, as contract termination costs would also represent a heavy expense.

The sweeping leadership cuts at WHO follow months of upheaval across UN agencies as organizations from UNHCR to OCHA that cut similar shares of staff to adapt to the first US withdrawal from their operations since the UN’s founding in 1945 – a loss of billions of critical dollars across Geneva.

Health Promotion, Disease Prevention and Control

Top amongst the familiar names in the big new division of Health Promotion, Disease Prevention and Control, headed by Jeremy Farrar, are: Katherine O’Brien, as director of Immunization, Vaccines and Biologicals;  Luz Maria De Regil, as director of Nutrition and Food Safety previously the unit chief for Multisectoral Action in Food Systems; and Etienne Krug, longtime director of the Department of Health Promotion, Social Determinants and a politically powerful WHO actor with strong connections to donors.

Tereza Kasaeva, former head of WHO’s TB department, has been named director of the newly combined WHO Department of HIV, Tuberculosis, Hepatitis, and Sexually Transmitted Infections. 

Meg Doherty, who formerly headed the HIV Department, has meanwhile, been named as director of the department of Science, Research, Evidence and Quality for Health, under the new Chief Scientist, Dr Sylvie Briand. 

The twin appointments of Kasaeva, a Russian national,  to the new HIV/TB Department and Doherty, an American, to the department under the Chief Scientist’s office represent a kind of Solomonic choice for Tedros, observers said.  Despite the US abrogation of its engagement with WHO, Tedros has been careful about ruffling geopolitical feathers on either side of the Atlantic.   

Meanwhile, Pascale Allotey has been named director of two major departments that remain distinct in name, at least for now. Those include the new WHO Department of Maternal, Newborn, Adolescent and Child Health; Healthy Ageing, and Sexual and Reproductive Health, a merger of three former teams. Allotey is also slated to lead the Human Reproduction Programme, a WHO-hosted joint initiative with the UN Development Programme (UNDP), the UN Population Fund (UNFPA) and UNICEF, the UN Children’s Fund.

Health Systems

In terms of the second of three big new programme divisions, Health Systems, headed by Yukiko Nakatani, Rogerio Gaspar, a well-respected Portuguese researcher, has remained as director, Prequalification and Regulation of Medicines and Health Products – a critical WHO department that evaluates new medicines, vaccines, and medical devices. 

WHO’s “prequalification” seal of approval is regarded as a greenlight for bulk procurement by UNICEF, the Global Fund, and Gavi, The Vaccine Alliance, as well as for national ministries of health that lack capacity to do independent evaluations themselves.   

Similarly, Deusdedit Mubangizi is remaining as director, Policy and Standards for Medicines and Health Products, which works hand in hand to develop WHO’s Essential Medicines List decision. Notably a new EML on weight loss drugs and drugs for rare diseases is supposed to be forthcoming soon. 

In other key appointments to that division: Alain Bernard Labrique, a former professor at Johns Hopkins and WHO Director of Digital Health, is now the director of Data and Analytics, Digital Health, and Delivery for Impact; Dr Yvan Hutin is now director of  Antimicrobial Resistance; while Kalypso Chalkidou, who has led WHO’s Department of Health Financing and Economics since last year, was named as director of the newly-combined WHO Department of Governance, Financing, Economics, Primary Healthcare, Universal Health Coverage.  

Health Emergencies Preparedness and Response 

In the third new programme division of Health Emergencies Preparedness and Response, where Chikwe Ihekweazu has replaced the retiring Executive Director Mike Ryan is being replaced by, five department directors have been named.

Those named include: Altaf Sadrudin Musani, as director of Humanitarian and Disaster Management; Nedret Emiroglu, a long-time WHO European office figure as director of Pandemic and Epidemic Management; Stella Chungong, former director of Health Security Preparedness, now morphed into the Department of Health Emergency Preparedness. 

In terms of their public-facing profiles, they are largely unknown quantities, observers say. 

Other appointments include Oliver Morgan as director of WHO’s Health Emergency Intelligence and Surveillance, replacing Ihekweazu at the helm of the Berlin-based hub; and Abdirahman Sheikh Mahamud as head of the department of  Health Emergency Alert and Response Operations.

Notably, Maria Van Kerkhove, who was one of the most familiar faces of WHO during the COVID pandemic, and has remained the go-to expert on the virus in recent press briefings at WHO headquarters, was not named to a position in the Emergencies Division.

Director General’s Office 

In the Director General’s Office, Dr Jamal Abdirahman Ahmed is continuing as director of Polio Eradication following his appointment to the role in March.  

Derek Walton will remain in his role as chief legal counsel for the agency. Gaudenz Silberschmidt remains director, Partnerships, Resource Mobilization, Envoy for Multilateral Affairs. And Alia El-Yassir continues as director of Gender Equality, Human Rights, Health Equity, and Prevention of and Response to Sexual Exploitation and Abuse.

Unfilled and acting posts 

The nine key positions which remain officially vacant, and for which only acting directors have been named, include key strategic departments such as Noncommunicable Diseases and Mental Health (Devora Kestel) and the Department of Environment, Urban Health, Climate, Migration, and One Health, where Rüdiger Krech is taking over from WHO’s Maria Neira, the iconic face of WHO’s climate and environment work, who is retiring.  As per Tedros’ announcement, the old department of Health and Migration also appears to have also been grafted into that new mega-Department since the initial WHO organigram was published in May.

In the key post of WHO Director of Communications, Gaya Gamhewage, previously director of the Prevention & Response to Sexual Misconduct, will serve as acting director, taking over from Gabriella Stern, who is also retiring. 

Within the Division of Health Systems, the Director’s post for the Global Centre for Traditional Medicine will remain vacant, with Shyama Kuruvilla acting.

As for the new department of the WHO Academy, Health Workforce and Nursing – a merger of three former entities – the acting director is David Atchoarena, who was appointed in 2023 to head the WHO Academy, a flagship project of Tedros, following a long career at the UN Educational, Scientific and Cultural Organization, UNESCO. 

The directorship of Malaria and Neglected Tropical Diseases also remains vacant, with Daniel Ngamije Madandi as acting.

In addition, the directorship of TDR, the Special Programme for Research and Training in Tropical Diseases, also remains vacant following the retirement just last month of John Reeder, an Australian national.  

With respect to TDR, another WHO-hosted programme, there has also been talk of appointing a director of a related WHO department as dual director for TDR – rather than making another distinct and costly appointment. 

Continuity or complicity? A leadership dilemma

While the new appointments mark an important step in WHO’s structural reform, they also underscore a deeper tension: how much continuity is too much?

Many of the individuals retained or reappointed to leadership positions are well-tested and respected professionals in their fields. Others, while familiar, are also emblematic of an entrenched culture that critics argue is ill-equipped for WHO’s current crisis.

But others arrived at WHO, not as a result of truly open global searches, but rather via internal handpicking — a trend that has accelerated under the current Director-General, eroding transparency and weakening trust in WHO’s merit-based system.

Some, like Dr Tereza Kasaeva, reportedly arrived with overt political backing (in her case, Russian authorities at the time of Dr Tedros’s first election), raising longstanding concerns about geopolitics shaping technical leadership.

Invisible retention and the illusion of reform

Despite the rhetoric of bold reform and downsizing, critics fear that many senior staff not formally reappointed may still be quietly retained within WHO’s financial system — undermining the promise of a leaner, more accountable leadership.

According to reports from staff with access to WHO’s Global Management System (GSM), the Canadian physician Bruce Aylward, formerly Assistant Director General for Universal Health Coverage and Life Course, so far remains listed on the WHO payroll records as a D2-level official until his retirement in 2027 –  even after being left out of the new six-member WHO senior leadership team, announced by Tedros in May.

Similarly, Santino Severoni, former director of Health and Migration, reportedly continues to be listed in WHO’s GSM records as a D1 director until 2029, despite the fact that he has not been named to any department so far.

These arrangements raise difficult questions about whether WHO is truly cutting fat or simply relocating it.

Meanwhile, others like Krech, who previously directed WHO’s Department of Health Promotion, was made the acting director of the newly merged Department of Environment, Urban Health, Climate, Migration, and One Health, despite a lack of intimate familiarity with that arena. 

“We hope there will be an open advertisement,” commented one source. 

Financial governance itself is now overseen in part by Sushil Rathi (acting director of finance), a figure whose own entry into WHO came via a process tied to the now-defunct Indian firm Satyam — the same company that originally built WHO’s Global Management System (GSM).

The hidden costs of keeping the old guard

Financially, retaining internal appointees is the easier path. It avoids large indemnity payouts for terminated contracts and offers a surface-level appearance of continuity. But the cost of clinging to underperforming or politically tainted leaders may be far greater in the long run — eroding staff morale, weakening donor trust, and compromising the boldness needed for WHO to truly reinvent itself.

“We are caught in a trap. Either we recycle leaders who helped create this mess, or we bring in outsiders with no real grasp of WHO’s dysfunction,” said one senior staffer privately.

Without a robust, meritocratic and depoliticized process to identify the next generation of WHO leadership, the reforms risk being cosmetic — changing the structure while leaving the culture untouched.

Image Credits: US Mission in Geneva / Eric Bridiers via Flickr, WHO, WHO, 2025, Japan MoH, Edith Magak, Israel in Geneva/ Nathan Chicheportiche, Guilhem Vellut.