Nearly a year after his appointment to a second term as WHO’s Director General, Tedros Adhanom Ghebreyesus has finished a revamp of his senior leadership team –  keeping key loyalists in place, while adding new faces that are a clear nod to powerful member states such as China, France and Japan. 

But the new team members come with a mixed bag of experience – and some have hardly any experience at all in the areas to which they have been appointed, WHO insiders were quick to say in reaction to the new appointments.  

The new appointees include Dr Ailan Li, a Chinese national and head of WHO’s Cambodia office, as Assistant Director-General for WHO’s ‘Healthier Populations’ cluster which covers the increasingly critical areas of climate change, pollution, healthy lifestyles and nutrition. 

Dr Yukiko Nakatani, currently deputy director in Japan’s Ministry of Health, will become Assistant Director-General for Access to Medicines and Health Products, a politically charged area of work marked by oft-highly charged battles between pharma companies and medicines access groups over drugs costs and IP rights. 

Another new appointment is Dr Jérôme Salomon, a French national, as Assistant Director-General for Universal Health Coverage, Communicable and Non-communicable Diseases.  Of the three, Salomon has the most extensive global public health experience, including stints on the WHO Emergencies Committee; as a director at Institut Pasteur in Paris, and as a  full professor at the Simone Veil Medical School, Paris.  

Significant to the success of the pandemic treaty negotiations is the appointment of Catherina Boehme, formerly chef de cabinet, as ADG of External Relations and Governance. In that role, Boehme will represent WHO in critical negotiations between WHO member states over the proposed treaty, as well as other processes, such as reform of the existing International Health Regulations.  As a German national who also previously served as chief medical officer at the Geneva-based Foundation for Innovative New Diagnostics (FIND), before becoming its CEO, she brings with her both deep speciality expertise as well as an understanding of member state pressures and needs – both in high income and developing countries.

Trusted advisor Aylward gets new role

Meanwhile, Bruce Aylward, a longtime Tedros senior advisor, was appointed Assistant Director-General of the Universal Health Coverage, Life Course Division – where he will “drive the organization’s agenda to transform primary health care as central to universal health coverage, as well as overseeing WHO’s work on health systems, immunization and reproductive, maternal and child health,” according to a WHO press release Monday announcing the new team.

Aylward had previously led the DG’s “Transformation” initiative which sought to revamp the organization’s internal structure until the COVID pandemic shifted his attention to health emergencies, where he participated in the first visit by senior WHO leaders to China at the outset of the pandemic in February 2020, and later led WHO’s work on the multi-agency Access to COVID-19 Tools Accelerator (ACT-A) Hub, including the creation of the COVAX vaccine facility. 

“In his new role, Dr Aylward will drive the Organization’s agenda to transform primary health care as central to universal health coverage, as well as overseeing WHO’s work on health systems, immunization and reproductive, maternal and child health,” said Tedros’ announcement. Aylward holds a medical degree and a master’s degree in public health.

Previously announced additions to the senior management team include Jeremy Farrar, former head of Wellcome Trust, as new Chief Scientist. Farrar, a noted epidemiologist who also played a key leadership role in the global public health response to COVID, is probably the most high-profile public health personality to join the WHO senior team. He replaces Indian national Soumya Swaminathan.  

Disappointment in healthier population cluster 

There was, meanwhile, disappointment in WHO’s internal ranks over the appointment of Li to the Healthier Populations cluster.  With a background primarily in emergencies and emerging infectious diseases, it is an area of work that will be entirely new to her professionally.  

“Clearly she has no experience in this area of work at all,” said one WHO staff member. Another insider who previously worked with her in the Western Pacific region described Li as a “micro-manager” who had performed a primarily political role until now as head of the Cambodia WHO office.

While it is common for the DG to give influential WHO member states a seat around the leadership table, previous Chinese appointees, such as Ren Minghui, also had significant public health careers alongside their political assignments and gained wide respect during their time in Geneva.  Minghui, a former ADG of WHO’s Universal Health Coverage cluster until recently, is now a director general at the Chinese Ministry of Health. 

Meanwhile, Nakatani, appointed ADG in the Access to Medicines cluster, is regarded as a largely unknown quantity by Geneva observers of the complex set of issues circling around that topic – which range from the high cost of cancer drugs to issues around the transparency of clinical trial data and prices paid by countries for bulk medicines purchases. 

A paediatrician by training, Nakatani has worked on topics such as medical device reimbursement and price-setting regimes during her time at Japan’s Ministry of Health – sometimes defending policies that raised the ire of industry.  

During her two years as a WHO technical officer, she also co-authored a number of papers on assistive technologies.  But she appears to lack the rich policy background of her predecessor, the Brazilian Dr Mariângela Simão, in the area of medicines access. Prior to arriving at WHO, Simão was a senior official at UNAIDS and in Brazil’s Ministry of Health, where she led successful negotiations with pharma companies to lower the price of HIV medicines.   

Appointments of trusted associates a Tedros hallmark  

Only a handful of senior officials who served in the first five years of Tedros tenure, remain in the new leadership team. Those include  Dr Hanan Balkhy, a Saudi Arabian national, as Assistant Director-General for Antimicrobial Resistance (AMR), where she is leading a multi-sectoral collaboration with the Food and Agriculture Organization, the World Organization for Animal Health, and the United Nations Environment Programme, to enhance prevention of AMR through better management of animal and environmental drivers.

Prior to joining WHO, Dr Balkhy, a paediatrician, was Executive Director for Infection Prevention and Control at Saudi Arabia’s Ministry of National Guard. 

Other long-serving staff include Mike Ryan, Executive Director of Health Emergencies, and Samira Asma, head of Data, Analytics and Delivery for Impact (DDI).   

Ryan, a respected emergencies specialist, was the public WHO face of the global COVID response. But he also demonstrated intense loyalty to Tedros echoing his statements on controversial WHO positions, such as opposition to public masking in the early days of the pandemic.  

Asma is considered a close Tedros confidante. Her management of DDI has been controversial internally insofar as she lacks the health statistics, measurement and monitoring of her predecessor, Ties Boerma, now a professor at the University of Manitoba. As the head of WHO’s former department covering health metrics and monitoring, he wielded huge influence and authority in both the strategic direction and implementation of WHO’s work.  

Triple Billion targets – a movable goalpost 

Asma is also tasked with showing progress on WHO’s ‘Triple Billion’ targets for achieving access to universal health coverage, improved health emergencies’ response, and healthier lifestyles and environments for three billion people worldwide by 2023. 

The Triple Billion targets were the centerpiece of Tedros’ strategic direction in his first five years of office.

In Monday’s announcement, the DG recalled them once more, saying that the reformed senior leadership team aims to: “accelerate progress on implementation of WHO’s 13th General Programme of Work (GPW13), and achievement of its “triple billion” targets and the health-related Sustainable Development Goals.”

But critics say that the targets are a moveable goalpost – a useful public relations tool but targets for which it is virtually impossible to demonstrate concrete, measurable progress, in the ways outlined by WHO’s 13th Programme of Work (2019-2023).   

Disappointment among senior civil servants 

There was also some disappointment that none of the senior WHO staff that had been serving as interim Assistant Director Generals received final appointments to Tedros management team, with the exception of Aylward. 

Influential member states like the United States had earlier expressed some hopes that the promotion of more senior WHO staff through the ranks to senior leadership positions could help convey a stronger sense of professionalism and accountability within the organization’s ranks. 

Instead, four senior staff who had briefly served as interim ADG’s were summarily dismissed by Tedros with little more than a ‘thank you’ conveyed via an internal note sent out to WHO staff simultaneously to Monday’s announcements.

Observed one WHO scientist, “I think our organization needs a very clear and honest agenda first of all. We need strong technical competency, less political mumbo jumbo, and honesty and accountability; this is what we have lost over time.” 

-Updated on Tuesday, 18 April 2023

Image Credits: Guilhem Vellut, DFID, WHO, Japan MoH, WHO.