Warning: Attempt to read property "post_title" on null in /home/clients/58f2a29976672af522a8f4d82ffa28b6/web/wp-content/plugins/better-image-credits/better-image-credits.php on line 227

Speculation in the hallways of United Nations headquarters in Geneva was rampant in the days and hours leading up to this afternoon’s election of a new director general to lead the UN World Health Organization, but solid information about who will win was hard to come by. The outcome after a series votes is expected sometime tonight. Update! According to sources, the first round of voting is over. Results: Tedros 95, Nabarro 52, Nishtar 38. Second round update! Tedros 121, Nabarro 62. Third round underway.

This election is being hailed as more transparent than in the past because it pits three candidates against one another to garner votes of the full WHO membership. But in the end, the vote taking place at press time in a completely closed room with no cameras or communication is entirely secret, so it will likely never be really known how governments voted.

The three candidates were given 15 minutes each today to address the annual World Health Assembly, taking place from 22-31 May.

Tedros Adhanom Ghebreyesus (“Tedros”) from Ethiopia, David Nabarro from the United Kingdom, and Sania Nishtar from Pakistan all opened their statements by offering condolences to victims of the attack in Manchester, England.

Under the secret ballot taking place now, with three candidates, if one gets two-thirds of all votes they win outright. If not, then the one with the least votes is out, and another round of voting is held between the top two finishers. Full rules on further rounds are explained at the bottom of this story. The WHO announced today (see below) that 186 members will vote, so two-thirds is approximately 124 members [Note: sources say the two-thirds only has to be 122 votes].

Speculation

Tedros had the lead after the Executive Board voted in January (IPW, World Health Organization, 25 January 2017).

Broadly speaking, WHO is just coming off of 10 years of a woman leader from an Asian country, which some would argue hinders the prospect for Nishtar. Others dismissed these factors as not the most relevant, since there are no rules against either happening again. Nishtar does reach out to developing countries, but is said to have a corporate and western tie as well, and appeals to groups focused on women’s and children’s health as well as noncommunicable diseases, according to sources.

Tedros and the African region supporters consistently raised the point that WHO has never had a candidate from Africa, even though in his remarks to the Assembly today he insisted he should not be elected just because he is an African candidate. Again the rules do not require a rotation in geographic representation but it is a factor in some member states’ minds. And Tedros also reaches out to developing countries while having a tie to western interests as former chair of the board of the Global Fund for AIDS, Tuberculosis and Malaria. In his remarks today, he repeatedly stressed support for universal health coverage.

Nabarro for his part today called himself the “global candidate,” and now does have substantial UK support but is not certain of Europe-wide support, especially with possible Brexit fallout. He has lived and worked around the world for decades, and is the most UN-experienced candidate.

Delegates asked in the hallways of the UN Palais this week and elsewhere in the weeks leading up to the election have shown remarkable inventiveness in evading questions and showing the slightest hint of which candidate they might support.

What has been publicly stated is that the African Union came out in support of Tedros. This is considered to be 54 countries. But only 47 of them fall in the African region under WHO’s regional groupings. And as one source noted, some of these countries might possibly give consideration to the candidate from an Islamic country (Pakistan) instead of Ethiopia. But then according to another source, the Islamic support might be divided somewhat based on Suni or other background.

Another of the many unsubstantiated factors swirling around is that India would oppose the Pakistan candidate on the basis of political differences, and might bring some countries like Sri Lanka with it.

One rumour said that the francophone African countries might be reacting negatively to pressure from France to support Tedros, but this could not be substantiated. Without francophone countries the African countries drop to about 30.

China is said by some to be supportive of Tedros, and that might bring some countries along, but this too is unconfirmed.

The Americas could be the biggest enigma as the United States is hard to read under the Trump administration (although the former Obama administration head of the Centers for Disease Control published an article defending Tedros from attacks relating to human rights in Ethiopia that have dogged him throughout the campaign.) One source said the Gates Foundation and others have supported Tedros but this could not be confirmed by press time. Tedros is said to have support of the more “left-leaning” South American countries such as Bolivia, Cuba, Ecuador and Venezuela, but Latin America is said to be divided on the candidates.

Another source suggested that Nabarro may have support of some English-speaking Caribbean nations, reinforced by his repeated mention of the importance of helping small island nations.

All of these suppositions and theories could be thrown out the window by virtue of bilateral horse-trading which has been going on through countless visits to capitals and missions as well as last-minute meetings here by the candidates. Candidates were said to be judged in those meetings by how knowledgeable they were about the subtleties and differences in the regions and countries, and in some cases may have scored points by mentioning making regional or local priorities their own. But no one reported any actual offers of deals, for instance, to open a clinic or new program in a country.

WHO said only 186 member states will be able to vote today, so this is another factor to take into consideration. It stated:

“Four (4) Member States’ voting privileges are suspended because they have not paid their dues in arrears to the Organization.

Those Member States are: Central African Republic (CAR), Comoros, Guinea-Bissau, and Ukraine.

Please note that Somalia’s voting rights were restored this morning when they made arrangements to pay their arrears.”

Here are the official rules for tonight’s voting:

“When three persons are nominated 

When the Board nominates three persons: (a) If in the first ballot a candidate obtains a majority of two thirds or more of the Members present and voting, this will be considered a clear and strong majority and that candidate will be appointed Director-General. If no candidate obtains the required two-thirds majority, the candidate having received the least number of votes is eliminated. If two candidates tie for the least number of votes, a separate ballot is held between them and the candidate receiving the least number of votes is eliminated. (b) In the subsequent ballot, a candidate will be appointed Director-General if he or she obtains a two-thirds or greater majority of the Members present and voting, a result that will be considered a clear and strong majority. (c) If no candidate receives the majority indicated in subparagraph (b), a candidate will be appointed Director-General if he or she receives in the subsequent ballot a majority of the Member States of the World Health Organization or more, which will be considered a clear and strong majority. The Board at its 139th session agreed to the Chairman’s proposal that, should that stage in the election be reached, and on the assumption that the membership of the Organization remains at 194, the majority required be fixed at 98. Nonetheless, although they will be counted for the purpose of calculating the majority required in this round of voting, Members having lost the right to vote will, as at previous ballots, not be entitled to participate in voting.1 (d) If no candidate receives the majority indicated in subparagraph (c), a candidate will be appointed Director-General if he or she receives in the subsequent ballot a majority of the Members present and voting, which will be considered a clear and strong majority.”

One thing is for sure, tomorrow, in the aftermath of tonight’s elections, every group, government and stakeholder will hail the outcome and express their eagerness to work with the new director-general on their issues.