Between success and failure: Lee Jong-wook and the global health agenda
Authors: Desmond Avery
Journal: Journal of the Royal Society of Medicine (2013)

In the summer of 2012 Margaret Chan of Hong Kong began her second term as head of the World Health Organization (WHO), while Ban Ki-moon of South Korea was settling into his second term as head of the United Nations (UN). One or other of them would not have been in that position if Lee Jong-wook of South Korea had not died six years previously. He had been WHO's Director-General for less than three years at that time, and was campaigning for the UN Secretary-General post.

‘The world has lost a great man today,’ Kofi Annan said when Lee died suddenly on 22 May 2006 at the age of 61. News media, health journals and public figures endorsed that view, and health diplomats have elaborated on it warmly ever since. The most recent occasion to praise him was at the launch of a biography of him commissioned by WHO and the Korean government. This took place on 22 May 2012 at a side-show of the World Health Assembly, where Margaret Chan and others spoke in glowing terms of her predecessor's gifts. Lee was talented and likeable, but in what sense could he be called great, and how did the world come to lose him?

The WHO press release issued on the Monday morning of his death said, ‘He had been in hospital since Saturday afternoon, where he underwent surgery to remove a blood clot on his brain (a subdural haematoma). He remained in intensive care. At 07:43 this morning he was declared dead.’ No further information on the cause of death has been forthcoming from WHO or the Hopital Cantonal in Geneva where he died. There was said to be no head injury or use of anticoagulants, the usual causes of subdural haematoma. He had been fully active up to the time of his collapse at an official lunch on Saturday, though complaining of headaches that morning and the day before. After leaving the table to lie down in an adjoining room, he vomited, lost consciousness and never recovered it. The most likely cause of the bleed according to neurologists is a ruptured cerebral aneurysm. No equivalent of a coroner's report has been issued, and no public access to the medical record is allowed.

Lee took over as head of WHO from Gro Harlem Brundtland of Norway in July 2003. One of his simpler election pledges was inherited from her: to complete the global eradication of polio – a commitment which Chan was to inherit from him in her turn. That effort, begun in the 1980s for completion by the year 2000, is still ‘at a tipping point between success and failure,’ Chan said recently. WHO's most successful leader to date, Halfdan Mahler of Denmark (Director-General from 1973 to 1988), won enduring fame with the eradication of smallpox. Marcolino Candau of Brazil, on the other hand, at the helm from 1953 to 1973, was less fortunate. He was deeply committed to the eradication of malaria, one of the outstanding human failures in health history. The global health agenda, however it is set, puts reputations in the balance, as well as lives.

More shrewdly in a way, Lee also set the target of getting three million people with AIDS in poor countries onto antiretroviral therapy by the end of 2005. The campaign was controversial at the time, but helped to win recognition for that need, thereby speeding up access to the treatment. Admittedly, only one million of the target population were receiving it by 2006, but in the longer run, history was on his side: eight million were receiving treatment by July 2012.

Two of his other promises turned out to be rasher than they seemed at first. These were to make WHO an even better place to work and to decentralize its resources. His effort to downsize headquarters led to staff unrest culminating in the first ever strike at WHO in November 2005. Some of the directors in charge of WHO's six regional offices were also getting restive, having expected more resources and autonomy than they were receiving.

Lee did not place all his hopes in hitting targets and solving management problems, however. He was more ambitious than that, one could say, and had a sense of prestige which he used in imaginative ways. One of these was tree planting ceremonies in the spacious grounds of WHO in Geneva. The King and Queen of Spain, the King and Queen of Norway, the Prince of Wales and other dignitaries marked official visits in this way, suggestive of a kind of international royal society role for WHO, independent of mundane success and failure. In addition, he had 70 Japanese flowering cherry trees planted along the approach to the WHO building which add a touch of poetry to the workplace, as well as a memorial to himself. To make another symbolic point, about humble service and responsibility, he chose a Toyota Prius as his official car instead of the traditional powerful Mercedes.

He read widely, had a quirky sense of humour and took a lively interest in other people and their ideas, all of which helped him to establish a sense of loyal complicity with those whose support he needed. More tangible accomplishments include the adoption by the Health Assembly of the revised International Health Regulations in 2005, and the construction of a state-of-the-art situation room for health emergency management at WHO's headquarters.

On the whole, however, difficulties at WHO may have made him eager to find a way out. By the end of 2005 the search for a successor to Kofi Annan was under way, and the principle of rotation favoured a candidate from the Republic of Korea. The Korean government was campaigning for Ban Ki-moon, its then Foreign Minister, but Lee canvassed support for himself behind the scenes – most notably by establishing friendly personal relations with the Presidents of the US, France, Russia and China – four of the five permanent members of the Security Council, which makes the appointment. An argument against Ban was that having both the UN and one of its larger specialized agencies headed by Koreans would produce an imbalance in the multilateral system. A solution would then have been just to move the WHO man up to the Secretary-General position. By the time the Security Council voted on the candidates, of course, in October 2006, that was no longer an issue.

Lee Jong-wook was apparently expecting to get the job, but if he had, would he have done better at it than Ban Ki-moon? His track record is debatable but his subtle talents could have made him a popular and successful Secretary-General. In that case Kofi Annan would have been right, in a way, to call him ‘a great man’. If Lee had failed to get the New York job and gone on to serve a second term in Geneva instead, he would still be there now. In either case he could have been in quite a lot trouble by now. His sudden death, whatever caused it, may have brought him more goodwill and approval than any other career move he had had in mind.

Desmond Avery is the author of Lee Jong-wook: a Life in Health and Politics. Hyderabad: Orient Black Swan, 2012.