In a first, WHO Regional Directors must take a leave of absence to run for the top job, the World Health Organization (WHO) confirmed to Health Policy Watch on Monday. This sweeping election reform closes a crucial loophole in the ongoing Director-General election process, aiming to curb shadow campaigns just as the first candidates officially enter the race. Meanwhile, Dr Jarbas Barbosa, WHO Regional Director for the Americas / Pan American Health Organization, who had been reported as a possible contender, told Health Policy Watch he is not running.

The rules of global health diplomacy have quietly shifted as the WHO Director-General Election approaches. WHO Director-General Dr Tedros Adhanom Ghebreyesus has closed a controversial governance loophole with a new directive, which will require WHO Regional Directors who enter the race to become WHO’s next Director-General to take leave on one-half of their salaries, while they campaign.

“All internal candidates will be placed on leave to ensure a clear separation between their campaign activities and WHO’s functions. For the first time this requirement applies also to elected officials, such as Regional Directors,” the WHO confirmed, responding to a query by Health Policy Watch.

New rule upends past precedent

A playbook of rules for the upcoming campaign, reviewed by the Executive Board in their last meeting in May, had already stated that the “Director-General intends to place internal candidates on special leave to ensure a clear separation between their campaign activities and WHO’s functions.”

However, these election guidelines had historically exempted Regional Directors because they are elected by WHO member states in their region. RD’s thus enjoyed a distinct structural advantage over any other WHO candidates because they could retain their influential platforms, high salaries and extensive institutional travel budgets, as well as full authority while quietly mounting a bid for the top job.

Other WHO staff, on the other hand, were required to take unpaid or half-paid leave to run for office, ensuring a clear separation between their campaign and their official work.

Regional Directors will face the same rules as other WHO staff

Now, however, under the new directive recently issued by Tedros, Regional Directors will face the same financial realities. They will be required to exhaust their accrued annual leave before being placed on half-paid special leave until the Executive Board nominates the finalists. To maintain operations, the Director-General will designate an officer-in-charge to replace any campaigning Regional Director.

As of now, the required leave triggers once a candidate’s name is published on the WHO website.

In the email response to Health Policy Watch, WHO said, however, that it reserves the right to pull the trigger even earlier in some cases: “WHO reserves the right to place staff on leave before this in the interests of the Organization, for example in the event of an earlier public and official announcement of a candidacy by a member state,” the organisation explained.

Furthermore, any internal candidates not yet publicly known will be automatically disclosed as prospective candidates once their candidacies are formally accepted following the 24 September submission deadline.

The DG issued the new leave order based on the WHO “Code of Conduct” for the DG elections, last updated by the World Health Assembly in 2020. The code states: “WHO staff members, including the Director-General in office, who are proposed for the post of Director-General, are subject to the obligations contained in the WHO Constitution, Staff Regulations and Staff Rules as well as to the guidance that may be issued from time to time by the Director-General.” (Section IV)

Grey areas remain

Even so, the revised mandate leaves a procedural grey area regarding the point at which a candidate is “officially recognised” – and thus needs to step down.

Official acknowledgement, in the form of publication on the WHO website, typically occurs at the specific request of a nominating member state to WHO.

However, should a country to delay their formal nominating request, that could feasibly allow their candidate to continue high-profile diplomatic travel, maximising their institutional privileges and travel budgets to build support for their campaigns, added a source close to the election process.

“The real grey area in this connection may be about campaign activities that take place before the formal process is launched,” explained former WHO legal counsel Gian Luca Burci, responding to a query by Health Policy Watch.

However, Burci notes that WHO Code of Conduct can should apply to any electoral activities, regardless of the exact timeline. Behind the scenes, sustained international travel to major donor capitals by regional leaders has already drawn scrutiny.

First contenders emerge, Barbosa rules out bid

The reform arrives as the formal succession race begins, with Saudi Arabia and Qatar reportedly circulating the first diplomatic notes to nominate Dr Hanan Balkhy, the current Regional Director for the Eastern Mediterranean, and former public health minister Dr Hanan Mohammed Al Kuwari, respectively.

Questions submitted by Health Policy Watch to Balkhy regarding her candidacy and when her mandated leave will commence remain unanswered as of publication time.

An enquiry sent to Dr Hans Kluge, Regional Director for Europe, regarding his potential candidacy had not yet received a response either.

One rumoured contender who will not be impacted by the new mandatory leave directive is the Director of the Pan American Health Organization (PAHO), Dr Jarbas Barbosa. “I am not running for WHO DG,” said Barbosa, responding to a query by Health Policy Watch.

While expressing that he was honoured to be listed as a potential candidate, the regional leader noted his focus is to lead PAHO through these uncertain times and advance regional health agendas, including the PAHO Elimination Initiative for 30 diseases and the Better Care for NCDs programme.

Campaigning amid institutional crisis

The tightening of campaign regulations unfolds against the backdrop of a severe financial crisis.

Due to the outstanding payments by, among others, the United States after its announcement to withdraw from the WHO, the organisation has been forced to execute massive workforce cuts to address a critical funding gap.

The organisation is shedding up to 23% of its global staff, reducing the headcount to approximately 7,283 personnel. This includes 1,275 voluntary separations and 1,232 posts abolished outright.

Even after slashing its 2026-2027 base budget proposal to roughly $4.27 billion, the core mandate still faces a 15% shortfall of $660 million. Meanwhile, the organisation’s overall budget gap is projected at $1 billion.

The contrast between this dire financial reality and potential lavish, globe-trotting campaigns has sharpened scrutiny. As the field of contenders widens before the September deadline, the true test will be enforcement.

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Image Credits: Guilhem Vellut, Felix Sassmannshausen/HPW, X/Tedros Adhanom Ghebreyesus, Hannan Balkhy.