Five candidates compete for regional director of WHO EURO
Authors: Clare Kapp, Udani Samarasekera
Journal: The Lancet (2009)

WHO's European region will elect a new leader on Sept 15. Five people, including three internal candidates, have applied for the post. Clare Kapp and Udani Samarasekera review their credentials. Roberto Bertollini, senior adviser of WHO's department of public health and environment, is one of the outsiders in the campaign to become director of the health agency's European regional office. Bertollini says he has the right mix of scientific competence and political experience to meet the challenges of the position. He says that his top priority would be to improve EURO's governance, technical expertise, and profile. “The regional office has to be a stronger voice for public health in the European region. At present it is not really present in the public debate”, he told The Lancet. The Italian national would also put greater emphasis on primary and secondary prevention, saying that much more could and should be done to prevent diseases such as cervical cancer. “It's time for primary and secondary prevention to be central to public health policy. At the moment it is not”, he says. He says that WHO should also be more proactive in dealing with emerging problems such as climate change and health, and the increasing elderly population. Bertollini, who holds a degree in medicine, a postgraduate degree in paediatrics, and a Masters in public health from Johns Hopkins University, has worked for WHO since 1991. Since 2007, he has been coordinator of the Evidence and Policy for Environment and Health unit, charged with developing WHO's response to the health effects of global climate change. Prior to that, he was director of the division for technical support, health determinants, at the European regional office and director of its special programme on health and the environment. Before joining WHO, he worked at the Epidemiology Unit of the Lazio region of Italy. He believes that WHO should do more to strengthen the stewardship function of the health sector and encourage governments to give health ministries a greater advocacy role on issues like climate change. He also believes that the European office needs to improve its technical excellence. “This is a problem which has to be addressed.” He wants the management of the regional office to become much more transparent with more active participation by the governing bodies. He is critical of the secrecy surrounding the nomination of the regional director and regrets that candidates were not called upon to make presentations to the World Health Assembly. “What has been missing in this campaign has been the possibility to express our views in a clear and transparent fashion”, he says. Zsuzsanna Jakab has led the European Centre for Disease Prevention and Control (ECDC) since its inception in 2005, overseeing its growth from a low-staff, low-budget agency into a centre of excellence on infectious diseases with some 250 staff. She now wants to take over the helm of WHO's European regional office. Jakab, a Hungarian national, says she would strengthen the relationship between EURO and the European Union (EU). “When WHO was established it was the only player on the scene. Now there are many other players around”, she told The Lancet. “It is an important time for WHO to get its partnerships right with the EU.” She has in-depth knowledge of the EU because she was Secretary of State in Hungary's health ministry and oversaw the adaptation of its health policies to European norms when it joined the EU. When she was appointed director of the ECDC, she became the first national from a new eastern European member state to head an EU agency. She also worked for 11 years at WHO's regional office, becoming director of country health development, with special emphasis on eastern European and former Soviet states, and then director of administration and management support responsible for overseeing the work of the governing bodies. “I know both sides”, she says of the relationship between WHO and the EU. Born in 1951, Jakab holds a Masters in political science from Budapest University and also studied at the Nordic School of Public Health in Gothenberg, Sweden. With her wealth of political and negotiating experience, she says that she is confident that she has sufficient support to win the nomination for regional director. “My vision is very much in line with what countries expect from WHO”, she says. She would like to boost EURO's technical capacity by improving its own research and development and its links with other scientific institutions. Jakab became the founding director of the ECDC, which was set up partly in response to the 2003 outbreak of severe acute respiratory syndrome to provide evidence, advice, and training to EU institutions and member states on infectious diseases. The centre collects data on nearly 50 different diseases and has a scientific programme covering everything from vaccine preventable diseases to health-care-associated infections. Through its Emergency Operation Centre, the ECDC has coordinated the EU's response to the spread of H1N1. Jakab describes the pandemic as “challenging, but manageable”, and warns that the forthcoming influenza season will be more complex than usual. She says that communicable diseases must remain high on WHO's agenda because “infectious diseases have a tendency to come back”. The European regional office's long-term number one priority should be stronger and more integrated programmes for chronic non-communicable diseases, which count for 80% of the disease burden, she says. She lists environmental health and climate change as other key issues, along with health system development and new challenges like the increase in elderly populations and growing antibiotic resistance. “WHO always has to be a few steps ahead of developments so it can lead the way”, she comments. Nata Menabde is seen as the frontrunner to become director of WHO's European regional office where she has worked for the past 15 years. She has been deputy regional director for the past 3 years, and was head of country support in 2002–06. She was previously involved with EURO's technical support programmes for former Soviet countries and worked in the public health sector in Georgia, being awarded a gold medal by the Republic's President in 1997 in recognition of her achievements. Menabde says her personal and professional background make her the ideal candidate. Born in Latvia and a citizen of Georgia, she gained a PhD in pharmacology in the former Soviet Union and a Masters in pharmacy in Georgia, and then went on to amass a string of public health and management qualifications in the USA, Britain, and Sweden. Her experience in both eastern and western Europe is one of the key strengths of her candidacy, she says. “I have been among the poorest of poor, in wars and crisis situations”, she told The Lancet. “I can play a crucial role in bridging the gap in countries themselves and between countries in the European region.” Her time in Copenhagen has given her an indepth insight into the institutional challenges facing WHO and the demands of the internal transformation process initiated by Geneva headquarters. Although European health indicators are better than those in other regions, Menabde is concerned that disparities are growing “no matter how many good policies are put in place”. Notwithstanding the current challenge of the H1N1 pandemic, which has swept nearly all the states in the European region, Menabde says the most serious long-term priority is to tackle the burden of lifestyle-related non-communicable diseases. Another important area is the performance of health systems, she says. Given the constraints in an organisation of just over 700 people, Menabde says that EURO should be doing much more to tap the huge amount of existing technical expertise in the region. She argues that the health agency needs to improve its links with member states and other scientific institutions and so exploit existing capacity to far greater effect, especially given the economic crisis and the 10% reduction in the region's programmed budget for 2010–11. “We are facing more challenges in mobilising the necessary resources for the region”, she says. Of the shortlisted candidates, Menabde has run the most high profile public campaign. Her website gives details of her experience, priorities, and vision in English, French, German, and Russian. She decided to use the internet as a tool to reach the wider public health community rather than just the narrow political circle involved in the decision-making process in the 53 member states. She says feedback has been positive. If elected regional director, she says, “I will visit, I will listen, and I will continue to learn from the wealth of best practice around the region”. She vows to provide “high quality leadership”. Although the nomination process is a secretive one, Menabde has not shied away from publicising on her website the favourable assessment of WHO's regional search group which found her to be highly motivated and deeply committed. “She has solid experience in managing complex and diverse public health institutions in Europe and a record of producing measurable and significant results”, it said. Marc Sprenger has been the director-general of the National Institute for Public Health Care and the Environment (RIVM) in the Netherlands, his native country, since 2003. He says that his training as a medical doctor, past work as a researcher in infectious diseases, and management experience at various European health organisations, make him the ideal candidate for regional director of WHO EURO. At RIVM, 47-year-old Sprenger heads up an institute with 1500 staff. He was responsible for transforming the organisation from a research-dominated agency to a results-based management agency, which, he says, allowed it to actively execute general and public health programmes. He adds that this reform “required the ability to inspire significant culture change”. If elected regional director, he would also like to revitalise the WHO EURO office. “It's time for change—time to develop new initiatives. The world is changing, so it's important that the regional office adds value”, he told The Lancet. He is not in favour of more reports or conferences and does not want to “reinvent the wheel”. He says that he “really would like to understand how we can help people”. He says that the major challenges for public health in Europe include obesity and diabetes. He thinks that more attention needs to be given to health promotion and education to encourage people to change their lifestyles. He lists other goals as developing primary health care in the region and ensuring that eastern European countries have responsive health systems. If elected, he would like to attract highly qualified people to work in the regional office. Member states would like to rely on the expertise of the regional office, he says. Sprenger, who worked on his country's health-system reform when he was director of health at the Dutch Healthcare Insurance Board, thinks that the regional office should provide advice to member states on health-system design. “In my view, WHO is a medical expert organisation. WHO should focus on what they do best: high quality health expertise and knowledge. They are the ones who are able to formulate requirements and to evaluate outcomes of health systems.” He thinks that other organisations, such as the World Bank, are better equipped to assist member states with the design and implementation of health systems. “We need to learn how to complement each other's efforts and not duplicate them”, he explains. Sprenger, along with Menabde and Jakab, was shortlisted by WHO's regional search group as one of the three candidates who most closely met the criteria for regional director. He says that among those shortlisted, he is aware that he is an outsider but feels that this is actually an advantage in these troubled economic times. “I have a fresh, innovative and future oriented approach to the region with the intention to be responsive to people's basic health needs, and being able to assist ministers through advice, technical assistance, and new partnerships for their policies”, he told The Lancet. Greek national, Agis Tsouros has worked in various capacities at the WHO EURO office for 20 years. This experience has given him a deep knowledge of the region, he told The Lancet. Tsouros, who is seen as an outsider to win the election, is a medical doctor with extensive training and experience in theoretical and practical public health. He says that he is a “true believer in the public health approach”. At present, he heads up the unit for non-communicable diseases, lifestyle, and the environment at the regional office. He is also an Honorary Professor in the Department of Epidemiology and Public Health at University College London. The 55-year-old says that: “WHO is at a turning point in a sense that there is a completely new situation with public health, with combined challenges such as climate change, the financial crisis, the ageing population, migration, and a pandemic. Public health has to find its place quite high on the agenda of policy makers. It's not business as usual.” Tsouros was appointed as the first programme manager of the healthy cities movement at WHO in 1989 and helped guide and develop the initiative. He says that one of his key achievements in this endeavour has been his ability to make health the business of non-health sectors. He believes that EURO “should be much more upfront and much more engaged with other sectors to make an impact”. While working for WHO, Tsouros was seconded to various health posts in his native country. In one of these posts, he helped lead the public health preparedness and services for the 2004 Olympic Games in Athens. His campaign website lists eight priorities for WHO EURO. These include enhancing the depth and quality of work with member states, strengthening and broadening EURO's partnerships, addressing regional inequalities between and within countries, advocating for action on the social determinants of health with a broader range of stakeholders, and anticipating the future and promoting innovation. Tsouros is disappointed that the regional election was not more transparent and was not seen as an opportunity for open debate. His blog on his campaign website calls the election the “best kept secret in Europe”. Who should lead WHO EURO?On Sept 15, the 53 member states of WHO's European region will elect a new director for the regional office (WHO EURO). In The Lancet today, we publish short profiles of the five candidates, summarising their experience, achievements, and vision for WHO EURO. Full-Text PDF