Urgent changes are needed at the World Health Organization (WHO) to revitalise its role as global public-health agency, states Richard Horton, Editor of The Lancet, in a Comment published early online today to coincide with the announcement that a new director-general of WHO will be chosen in November 2006.

On May 22 Dr Lee Jong-wook, Director-General of the World Health Organization (WHO), died unexpectedly. Yesterday, the Executive Board elected its new Chairman, Dr F Antezana Aran?r of Bolivia. Aran?r and WHO’s Executive Board are now contemplating the process by which a new director-general will be elected.

However, Dr Horton warns: “The danger is that, in coming weeks, WHO’s future will depend more on back-room political lobbying, bribery, and compromise - the usual process in the run up to an election at WHO - rather than a serious and transparent debate about the priorities the organisation faces in the coming decade. For the truth is that although Lee did much to capitalise on [Gro Harlem] Brundtland’s successes and to redress her deficiencies, WHO now needs an urgent course correction if it is to remain on an upward trajectory towards renewal.”

Horton argues that WHO needs to make a number of changes, which include:

 
• Adding three principles - equity, human rights, and sustainability - to the Millennium Development Goals, a series of time-bound targets dominated by health that are the spine of political action for WHO’s work.  
• Upgrading its influence. WHO needs to hold other institutions, in particular, the World Bank, World Trade Organization, the Global Fund to fight AIDS, Tuberculosis, and Malaria, the Global Alliance for Vaccines and Immunisation (GAVI), and the US President’s Emergency Plan for AIDS Relief, accountable for their actions that impact on health.  
• Strengthening its initiatives through partnerships with organisations such as UNESCO and the UN Development Programme.  
• Rededicating itself to research on health systems and burdens of disease to develop strategies and guide budget allocation. Currently, WHO’s global strategy lacks scientific cohesion.  
• Introducing more consistent standards to its scientific publications. Currently, the quality of WHO’s published guidelines is highly variable.  
• Implementing a much stronger programme of performance management and internal peer review. Many new initiatives at WHO, which carry considerable budgets, go unaudited and are widely known internally to be weak.  
• Improving its governance. WHO has seven elected leaders, the director-general and six regional directors who all compete for power and prominence. Only one person should run WHO: the director-general.

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