The World Health Organization (WHO) is busy electing new leaders in three of its six regions.  Previous articles  have considered the issues at stake and the candidates competing for the position of regional director in WHO’s Eastern Mediterranean Regional Office (EMRO) and the South-East Asia Regional Office (SEARO). This article, the final one in the series, considers the dynamics at play in the Western Pacific Regional Office (WPRO), where member states will meet in Manila on 16-20 October to elect the region’s new director. 

 The election comes under strained circumstances with the dismissal in March 2023 of the previous regional director, Dr Takeshi Kasai, for  “abusive, racist, and unethical behaviour”. The decision by the region’s member states was a landmark because WHO is not historically known for its decisive approach towards staff misconduct following staff complaints and allegations. However,  under Director General Tedros’s zero-tolerance policy, a tougher stance is evident. 

 WPRO comprises 1.9 billion people in 37  countries and areas straddling a vast geography  from the steppes of North Asia to remote islands in the depths of the Pacific and icy Antarctic fringes.  For the past year, it has been under the interim leadership of former WHO Deputy Director General and European Regional Director, Dr Zsuzsanna Jakab.

 A far-flung region of rampant geopolitics

 The Western Pacific region covers 27 sovereign nations (Australia, Brunei, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Lao, Malaysia, Marshall Islands, Micronesia, Mongolia,  Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, South Korea, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu, Vietnam. It also includes 10 territories administered by China (Hong Kong and Macau), France (New Caledonia, Wallis and Futuna, French Polynesia), New Zealand (Tokelau),  UK (Pitcairn Island) and US (Guam, Northern Mariana Islands).  

Then there is Taiwan’s paradox of  24 million people – larger than most WPRO members – but with no formal voice in the WPRO Regional Committee mechanisms, unlike, say, Pitcairn (population around 50).  Taiwan is excluded by decisions of WHO governance, and the Organization is at pains to avoid offending China. Even ad hoc Taiwanese participation in WHO technical events with Beijing’s permission has lessened as China asserts belligerent sovereignty.

Normally, the election of a regional director at a distant WHO outpost would not set the blood racing.  WPRO is different. Its Pacific rim is a region of  intense geopolitical competition as a repository of oil, gas, fish, and precious sea-bed resources coveted by regional and global powers. There is almost daily confrontation as  China contests the rights of others such as the Philippines, Canada, Japan and US to navigate the South and East China seas which are major international trade routes. 

China’s unilateral claims to large maritime territory have been rejected by international courts as also its occupation of islands belonging to others, construction of artificial islands, and even claims to submerged reefs. An assertive China  that sees the region as its own backyard is embroiled in territorial disputes with Japan, The Republic of Korea, Vietnam, Philippines, Brunei, and Malaysia.

Meanwhile, under WHO’s constitution, out-of-region powers that administer territories within the region vote on their behalf. Thus France, UK, and US  are part of WPRO’s 30 voting member states. They also happen to be allied with Australia, Japan, South Korea, and Philippines in an increasingly muscular security pact to counter China.

Inevitably, the tiny Pacific island states – each with a precious vote in WHO fora – are caught in the middle. Ending a long period of neglect, they are being showered with economic largesse and other inducements. The Solomon Islands have already joined the China camp and others such as Palau and Kiribati have been coerced to de-recognise Taiwan and agree to deals that advantage Beijing’s business and military interests. 

Climate change poses existential threats to small island states

There is a fearful existentialist underpinning. Rising sea levels from climate change may mean that some island states will disappear in coming decades. Where will their people go? Most would prefer to make new lives in the United States or Australia rather than in China.

Why should such power games affect the  small matter of an election in the branch office of a technical body? It is because health is securitised in geopolitics.  Human health and access to essential supplies to sustain it contributes to the strength of nations and is an area of intense competition.  

This is evident with the  still-continuing controversy into the origins of the Covid-19 pandemic, and China’s refusal to share information with WHO or allow unhindered investigatory access.  That came after earlier accusations against China for covering up the spread of SARS. Avian influenza also originated in China, and with massive environmental and climate changes underway in the region, further pandemic-potential organisms are expected to originate there. Will China cooperate better in future pandemics?  

 With trust among nations at an all-time low, an additional concern is bio-insecurity through the weaponisation of disease-causing organisms, with uncontrolled artificial intelligence accelerating their development. With China and US glaring at  each other across the Pacific, the international framework of law that could block such sinister developments is badly frayed. A new health security race is underway.

 Who wants to run WPRO?

Following Kasai’s dismissal in March, there are now five contenders for the regional directorship.

 Dr Song Li of China,  is a respected practitioner and influential advocate for reproductive, maternal and child health at home and abroad, participating in strategic WHO fora along the way. Her career has seen her focused in this area without apparent wider public health orientation. 

 Dr Song Li is quietly professional but will China refrain from influencing her so that she can function genuinely independently? Chinese incumbents in international organisations often remain under obligation to their own authorities, and can even be summoned home if they displease their masters.

 Dr Susan Mercado of the Philippines is also a dual citizen of the United States.  She is passionate about public and global health with extensive experience in government in policy and legislative support roles. During COVID-19, she acted as a strategic advisor to the Red Cross in Asia and also worked for 15 years in WPRO itself where she was involved in change management.  Recipient of many awards, her work has spanned food systems, anti-tobacco advocacy, climate change, AIDS, COVID-19, mental health, NCDs, emergency health, health communications, and capacity building

 Dr Jimmie Rodgers of the Solomon Islands, an ally of China, has public health qualifications, and strong diplomatic, organisational and management skills. He led the Secretariat of the South Pacific Community with commendations from many countries, and latterly as Secretary to the Prime Minister, including competently handling COVID-19.   He accepts his lack of Asia experience but counters, in his own words, that his wife is Chinese which ensures that he is “exposed to and is well-schooled in Asian culture” which will be an “advantage” in WPRO.

Dr Saia Ma’u Piukala of Tonga is its health minister, having also held portfolios in public enterprises, and internal affairs, after an early surgical career. He chairs the Pacific Ministers of Health Group and is also experienced in WHO governance, having served on its Executive Board, WPRO’s Regional Committee, and High-Level Commission on NCDs.

Dr Tran Thi Giang Huong of Vietnam has a public health and health emergencies background. Currently serving as divisional director at WPRO she was a major player in the region’s Covid-19 response. She has previously worked in senior roles in the Ministry of Health handling international co-operation, after a career in paediatrics.  

Will a good election process be enough?

 WPRO is alone among the three regional offices in holding an open forum where candidates presented themselves and faced questions from electors. Reviewing that and the written applications, Mercado appears to have won the hustings through the scope of her experience, her understanding of issues, her vision and deliverables, and the empathy and fluency of her communications.

 However, all acquitted themselves well and the region is fortunate to have a diverse slate of credible contenders of both genders. There is also general consensus on the region’s needs,  including changing the toxic culture of the regional office. The desired health policies and strategies to tackle ageing, non-communicable diseases and mental illness, climate change and disasters, new infectious threats and anti-microbial resistance, finishing off old conditions and advancing universal health coverage are not contentious despite the diversity of size, culture and development status of WPRO’s membership.

And WPRO’s feverish geopolitics suggest that the technical merits of the candidates as reflected in their CVs and applications may not be enough in deciding on the best appointment. Perhaps the region is best served by a regional director who can rise above and bridge the divisions among nations while holding firm to fundamental WHO principles for advancing the health of all.

 That requires strong moral and political leadership to defend humanity against looming risks and dangers. Will that be asking too much?

Mukesh Kapila is a physician and public health specialist who has worked in 120 countries, including as a former United Nations (UN) Resident and Humanitarian Coordinator in Sudan and a UN Special Adviser in Afghanistan.

Image Credits: WHO /WPRO, WHO/WPRO , WHO / Yoshi Shimizu, WHO.