The shortlist of five finalists to serve as the next Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria was published on Wednesday (30 September), launching the final phase of its leadership search. 

By narrowing the global applicant field to five candidates, the Global Fund’s Executive Director Nomination Committee (EDNC) has taken a major step towards appointing the organization’s next chief. The new leader will assume office in early 2027, facing a massive funding shortfall and mounting geopolitical pressure to overhaul the global health architecture.

Two high-level United States global health leaders are shortlisted. As reported earlier by Health Policy Watch, Mark Dybul is on the shortlist. He has previously served as executive director of the Global Fund (2013 to 2017), as well as US Global AIDS Coordinator, leading the implementation of PEPFAR.  He is current a senior advisor to the Accra Reset initiative.

Joining him is Richard Hatchett, the outgoing chief executive of the Coalition for Epidemic Preparedness Innovations (CEPI) and a former US biodefense official.

Observers describe Janti Soeripto, president and CEO of Save the Children US, as a surprising candidate. Representing civil society, the Dutch-Indonesian brings experience in international humanitarian operations and private-sector management.

The high-level private sector candidate, Lutz Hegemann, is Novartis president of global health. The Swiss national currently leads company programs targeting malaria and neglected tropical diseases.

Rounding out the slate is Tanzanian diplomat Joyce Msuya, former UN Assistant Secretary-General and Deputy Emergency Relief Coordinator, who brings extensive experience across multilateral development and humanitarian agencies.

Shortlist prompts concerns over geopolitical interests

With two high-profile US candidates on the shortlist – and several senior global health leaders describing Mark Dybul to Health Policy Watch as the most likely candidate – observers emphasize the delicate balance between maintaining US financial support and preserving the agency’s multilateral mission.

A successful US candidate would maintain Washington’s global health influence, even as it has withdrawn from multilateral involvement in agencies like the World Health Organization (WHO).

Under an “America First” policy framework, Washington is increasingly pursuing direct bilateral agreements with recipient nations, bypassing multilateral approaches to secure domestic interests.

Speaking on the condition of anonymity, an African global health leader warned that the US approach risks politically driven US procurement, commercializing pharmaceutical innovations and treatment access at the peril of recipient states, particularly in Africa.

Health Policy Watch reached out to the United States Department of Health and Human Services and the US candidates but did not receive a response before publication.

Senior European global health experts interviewed by Health Policy Watch warn that European states risk being reduced to “passive watchers” if Washington exerts growing influence over the agency’s strategic direction and leadership selection.

Earlier, German policymakers had voiced frustration after the nomination committee did not shortlist the sole German-backed applicant during the initial round.

Governance divides and voting thresholds

The Global Fund Board will formally vote to appoint the next Executive Director at its 56th meeting in Geneva, held from 28 to 30 October.

To secure the post, the winning nominee must initially obtain a two-thirds majority in both donor and implementer Board blocs. Should a deadlock occur, the voting threshold is incrementally lowered – first requiring a two-thirds overall majority with a simple majority in each bloc, then a two-thirds overall majority regardless of groups, and finally a simple majority of at least 11 of the 20 total board votes.

Pointing to structural inequalities, sources note that around 40 African nations share just two voting seats. Meanwhile, major nations hold individual donor seats, including the US, the United Kingdom, France, Germany, and Japan, alongside private foundations.

Critics emphasize that this setup preserves legacy power dynamics that contrast sharply with the one-country, one-vote model of the WHO.

Health Policy Watch reached out to the Global Fund but did not receive a response ahead of publication.

Closed deliberations versus public debate

Despite calls from civil society for public candidate forums similar to the WHO election, the Global Fund is conducting the final evaluation process behind closed doors.

Former Global Fund Board member Jirair Ratevosian argued that the institution is “too important to treat this as just another executive search,” noting that the selection will shape health programs worldwide.

“The Executive Director will be responsible for leading the institution through a period of major political and financial change,” said Ratevosian, calling for public forums to test how contenders plan to address artificial intelligence, new financing models, and country ownership under the Accra Reset.

However, the Global Fund Board defended its restrictive protocols, asserting that strict confidentiality is vital to safeguard candidate privacy and recruitment integrity. Board leadership reaffirmed that candidate engagement will occur through structured constituency meetings rather than public debates.

“They have led a merit-based, transparent and well-governed process, carefully balancing the confidentiality of candidates with the Board’s responsibility to identify the strongest possible leader for the Global Fund,” said board chair Roslyn Morauta in a press statement disclosing the five finalists.

High stakes for global architecture

The election comes after major donor nations – including the United States, Germany, France, and the United Kingdom – cut official development assistance and have signalled further budget trims into 2027.

Reeling from an eighth replenishment that secured $12.64 billion against an $18 billion target, the multilateral fund faces unprecedented fiscal headwinds.

Amidst these cuts, recipient nations are demanding a fundamental shift toward health sovereignty under the Accra Reset framework, seeking to build local production capacities and expand country leadership.

Urging global health initiatives to “commit, collaborate, consolidate and close,” the framework warns that duplicative agencies must prepare for time-bound wind-downs and potential shuttering over the next decade.

Whoever takes the helm will inherit an institution at a historic crossroads, charged with bridging a $5.36 billion shortfall while proving the Global Fund can evolve rather than erode in a reordered global health landscape.

Who Should Lead the Global Fund? Let the Candidates Make Their Case

Image Credits: HPW, UNDP, Global Fund/Vincent Becker, Milken Institue.