Enhancing the World Health Organisation (WHO) Director-General 2027 Election Process

The process for the election of the Director-General (DG) has undergone substantial changes over  time, in particular towards a system that would seek to balance the intrinsically political nature of the election with principles of fairness, equitable regional representation, emphasis on the qualities of individual candidates, transparency and legitimacy. 

The process implemented until the 1990s was informal, with no fixed deadline for the presentation of candidates or detailed rules on the role of the Executive Board (EB). Members of the Executive Board could even propose candidates directly during the session of the EB, which would then submit a single nominee to the Health Assembly (WHA). The need to revise the election process and to make it more predictable and fairer arose during the 1990s as an aspect of a broader review of WHO’s governance undertaken by the EB. The Board introduced clear deadlines and guidance on the length of submitted documentation to avoid significant imbalances between candidates; short-listing by secret ballot in case of more than five candidates; compulsory secret ballot voting both in the Board and the Assembly; and a limit of two terms of office of five years each, which was extended to regional directors. What remained unchanged was the nomination by the EB of one candidate to be submitted to the WHA.  This concentrated considerable  power in the hands of the Board, since the Assembly always confirmed the nominated candidate.

However, beginning in 2006, some regional groups strongly demanded the introduction of a compulsory rotation of the post of DG among WHO’s regions, arguing that this could promote greater equity among WHO regions . The equally strong rejection of that request by other regional groups led to an increasingly polarized debate in the governing bodies of the WHO and to an acute crisis at the 2010 WHA. 

In order to reconcile apparently opposing views and priorities, the whole election process was radically revised in 2012 and 2013 and the EB and the WHA have been fine-tuning it and implementing its details up to the present (see Question 2 below). Dr. Tedros was the first DG to be elected under the revised process in 2017. The process currently underway will be the second test of its effectiveness and legitimacy since Dr Tedros ran unopposed in 2022 for a second term of office.

The procedures established by the WHA in 2012 and 2013 build on the revisions of the 1990s but go further and introduce important innovations that make the WHO’s process stand out among other international organizations, at least among UN specialized agencies and related organizations such as the International Atomic Energy Agency (IAEA) and World Trade Organization (WTO).  It is not possible to review in detail here the phases of the overall process which is quite lengthy and elaborate. The WHO website provides a dedicated page including all relevant WHA and EB decisions and a Handbook reviewing every step in detail.

As noted above, the purpose of the reform was to reconcile divergent viewpoints that reflect the fundamental principles underlying the election of the DG: the balance of power between the Executive Board and the Health Assembly; the regionalized structure of WHO; the fairness, transparency and equitable nature of the process; and the balance between the political nature of the election and the personal qualities of the candidates. WHO’s membership addressed all this by establishing a highly procedural, predictable and reasonably fair and transparent process with the following main highlights:

The most significant  reform has been to shift the institutional balance of power by giving the WHA the authority to select the successful candidate since the EB will have to submit three nominations.  As long as the EB could only nominate one person and the WHA was limited to an up-and-down vote, securing a maximum of 18 votes in the EB was enough to win the election.  Critics of the previous system argued that this structure created incentives for political bargaining within the EB and could favor Member States with greater political influence. Having to secure a substantial majority in the WHA changes the political nature of the process and emphasizes the role of regional and other groups away from securing the vote of individual states.

• A Code of conduct for the election of the Director-General, which sets out agreed standards of conduct for Member States and candidates throughout the election process. Most notably, it concerns the election campaign that does not form a part of the constitutional process and, therefore, is not submitted to statutory requirements under the applicable WHO rules. The Code serves as an important political statement that Member States and candidates  should conduct themselves in a manner that  promotes a “level playing field,” including by avoiding the misuse of institutional positions and resources.

• Much effort has gone into enabling individual candidates to interact with Member States, present their positions and qualifications and be subject to public scrutiny by posting their names and documentation on WHO’s website. To this end, the reform has introduced forums with Member States, both virtual and in-presence, as well as limited and standardized the documentation that proposing Member States can submit so as to facilitate a comparative assessment of experience, qualities and achievements. This “personal approach”, in turn, has encouraged public engagements with the candidates outside WHO, as is notably the case of the Enhancing the WHO Director-General 2027 Election Process project by the Global Health Centre described in this page;

• The most significant  reform has been to shift the institutional balance of power by giving the WHA the authority to select the successful candidate since the EB will have to submit three nominations.  As long as the EB could only nominate one person and the WHA was limited to an up-and-down vote, securing a maximum of 18 votes in the EB was enough to win the election. Critics of the previous system argued that this structure created incentives for political bargaining within the EB and could favor Member States with greater political influence. Having to secure a substantial majority in the WHA changes the political nature of the process and emphasizes the role of regional and other groups away from securing the vote of individual states.

It is difficult to make a clear-cut comparison of processes that reflect the institutional structure and political culture of different organizations and that do not follow a single common blueprint.  In some organizations such as the IAEA and WTO, the overall process is rather informal and relies on consultations led by the chairpersons of their relevant governing bodies. From another perspective, the process of some organizations such as the International Labour Organization (ILO) and Food and Agriculture Organization of the United Nations (FAO) is implemented by a single governing body (i.e. the ILO Governing Body and the FAO Conference, respectively) instead of a two-step process as in the United Nations and WHO. This changes not only the duration of the process but also the political strategies of candidates and their respective Member States. 

The election of the UN Secretary-General, moreover, is distinctive in several respects, given the central role of the Security Council, including the veto held by its five permanent members, and the fact that there are no deadlines or formalities for the submission of candidatures. The ongoing “straw polls” in the Security Council are a unique feature of the UN process.

At the same time, the trend within global international organizations has been towards an increasing emphasis on predictability, transparency, procedural and political fairness and, as importantly, exposure to the scrutiny of public opinion. This reflects a broader understanding  of  executive heads as individuals with their own qualifications, experience, and public responsibilities  rather than simply  as representatives of Member States in an intergovernmental process.  From this perspective, and for the reasons summarized above, the WHO process stands out for the extent to which it combines not only the institutional steps but also most importantly the expectations and principles underpinning the campaign of candidates and their sponsoring states.