Show Notes
Seven WHO Director-General candidates are out of the gate. In this podcast, Jocalyn and I handicap the field. She is approaching it from the standpoint of a medical journal editor. I am approaching it as an ex-insider who tried to reform WHO to be relentlessly focused on results. Neither of us has a horse in the race. We each have a race programme. When Jocalyn and I last spoke, in May, we titled the podcast after her BMJ piece on the “beleaguered WHO.” Some of my friends pushed back: what do you mean, beleaguered? We still differ slightly in how we put it. I say WHO is not at its best. Jocalyn reports that others in the field say it is at its worst in its 78-year history. Either way, the next Director-General inherits an organization that needs change. The seven, in alphabetical order, are: • Hanan Al-Kuwari, nominated by Qatar, former Minister of Public Health and former chair of the WHO Executive Board. • Hanan Balkhy, nominated by Saudi Arabia, Regional Director for the Eastern Mediterranean. • Hans Kluge, nominated by Belgium, Regional Director for Europe. • María Neira, nominated by Spain, who led WHO’s work on environment, climate change and health. • Budi Gunadi Sadikin, nominated by Indonesia, its current Minister of Health and a former banker. • Song Li, nominated by China, a physician who has led women’s and children’s health at China’s National Health Commission. • Gevorg Tamamyan, an Armenian paediatric oncologist nominated by Botswana. Nominations closed on 24 September, but under the “dumb, dumb, dumb” (my words) election rules, WHO publishes them only in early November unless a government asks for its candidate to be named earlier. So we may yet learn of more candidates. For now, we analyse what we know. Jocalyn’s framework, set out with Jim Campbell in a BMJ editorial last week, holds that the real issue is not architecture but “power, who has it, who yields it, and who’s willing to give some up.” It has four elements: there are no saviours; governance and accountability matter; civil society’s voice should be heard; and other gatherings, such as the G20 and BRICS summits, offer openings for health cooperation beyond this election. She wants to hear much more from the candidates about rights, which are being eroded for women in particular, and about gender equality. She has crunched the numbers: 4 women and 3 men, 5 physicians, 4 from high-income countries and 3 from upper-middle-income countries. Among the initial candidates, she counts three insiders (Balkhy, Kluge, Neira) and three outsiders (Al-Kuwari, Sadikin, Tamamyan). She says the outsiders currently have the edge. My framework is more results, less politics. It’s based on the lessons I learned inside WHO. More results means measuring results, institutionalizing them, holding global health agencies jointly accountable, and innovation and innovative finance. Less politics means keeping WHO’s science independent, being impartial (no double standards), and staying out of member states’ domestic wedge politics. I used these domains to rate the candidates and published the ratings last week. We discuss them on the podcast. Three candidates have now offered specific mechanisms. Hanan Al-Kuwari would protect the independence of WHO’s science through independent oversight of its scientific advice, with findings published in full, and would extend the transparency of WHO’s guidelines to emergency and interim guidance. Hans Kluge would appoint a WHO Rapporteur to act as an independent global monitor of attacks on health care, reporting to WHO’s governing bodies. I think that one could misfire: special rapporteurs at the Human Rights Council have themselves been vectors of politicization and, in the eyes of some member states, loss of neutrality. The third came after I published the initial scorecard. Gevorg Tamamyan called me, and I shared the lessons from my time at WHO. (I make the same offer to every candidate: my best advice, which they should feel free to
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A deeper understanding of science makes for better doctors — and better citizens. That’s the fundamental claim of my friend Bob Brunham, and it resonates with me. We’ve spent a lot of time walking around a small island in British Columbia, with Bob explaining science to me. Most people have heard of mRNA vaccines, monoclonal antibodies, CAR-T and CRISPR. Very few could say what they actually are. Ninety minutes listening to Bob on this podcast will fix that. Whether it’s Ebola, influenza, or cancer, science is driving improvement in survival and wellbeing. As Bob says, “In 1867, the time of Canada’s Confederation, the average lifespan was 40 years. In 1967, it was 72. Presently it’s 82. Between 1867 and 1967, science was introduced into medicine, medical education and medical research. And that made all the difference.” Bob was head of the British Columbia Centre for Disease Control and is Professor Emeritus of Medicine at University of British Columbia. His research is in immunology, genomics, and epidemiology of infectious disease. He has a knack for explaining science in an understandable way. Here, he explains: How B cells learn to recognize foreign invaders. In the context of the Ebola Bundibugyo outbreak in DRC, we explore the different types of ebola vaccines — viral vector and mRNA vaccines. We discuss the advantages of mRNA in the context of the very recent approval of the first mRNA influenza vaccine. We contrast these with protein vaccines (like hepatitis B) and whole-virus vaccines (like many childhood vaccines). We also talk about monoclonal antibodies. How one T cell therapy targets lymphoma — and another takes lung cancer’s foot off the brake. In the context of lymphoma, we talk about CAR-T therapy, which engineers T cells to attack lymphomas. But this therapy doesn’t work well with solid tumours, which are harder to infiltrate and have a mechanism to put their foot on the brake of T cells trying to kill them. In the context of lung cancer, we talk about checkpoint inhibitors, like Keytruda, which takes the cancer’s foot off the brake, enabling the T cells to attack the cancer. Hitchhiking on a protein turns off an elusive cancer growth switch. Many people have seen former Senator Ben Sasse discuss his pancreatic cancer, and a new drug he is on called Daraxonrasib. We talk about how small molecule drugs normally work and how the K-RAS protein, which is jammed in the ‘on’ position to drive tumour growth, has resisted this mechanism. K-RAS acts as a slippery ball with no druggable targets. Daraxonrasib gets around this by tagging along with a chaperone protein which does interact with K-RAS, flipping the switch and tamping down tumour growth. As Bob notes, talking about the role of chaperone proteins, “Evolution is cleverer than we are.” How a bacterial immune system became a human gene editor. CRISPR was discovered studying bacteria and how they fight off viruses. Then researchers turned it into a powerful tool for editing human genes. It has been used in sickle cell disease and thalassemia because blood stem cells were accessible in the bone marrow. Recently, it was enveloped in lipid nano particles landing in liver cells to turn off PCSK9, lower cholesterol, and decrease risk of atherosclerosis. Bob’s theory of medicine is that understanding science makes for better physicians. He explains it like this: “The evolved molecular components of the cell and how cells communicate with one another explain disease, explain therapeutics, explain prevention strategies — and physicians use that knowledge to diagnose, treat, and prevent disease.” He outlines a taxonomy of disease, by mechanism, that enables scientific understanding. He grounds this in evolutionary biology and the development of eukaryotic cells 2 billion years ago. Understanding science also makes for better citizens. Judging from how vaccines have become a political wedge, and how scientists who led the COVID-19 response have been painted as heroes or vil
Innovation in global health is needed more now than ever — and with development assistance for health collapsing from a COVID-era peak near $80 billion to the high $30 billions and falling fast, the pressure has only intensified. In this conversation, Dr. Karlee Silver, CEO of Grand Challenges Canada, makes the case that scarcity is forcing a long-overdue shift: from supplying innovations to building demand for them within health systems. I co-founded GCC fifteen years ago and remain a board member, so I'm not a neutral observer — but I think its hard-won lessons are a pathfinder for anyone serious about getting innovation to scale. In this conversation: - What Grand Challenges Canada is, and Karlee's path to CEO (01:27) - Why scarcity drives innovation — and the "silver bullet" trap of over-focusing on AI and digital while missing social and service-delivery innovation (04:34) - Why the aid collapse is "salutary" in the long run: real country ownership, real accountability (05:35) - The new strategy and $200M from the Government of Canada: the four directions — adapt, accelerate, choreograph, connect — and the half-push, half-pull rebalance toward demand (08:25) - The three "choreograph" barriers: weak demand and procurement, high cost and low investability, and lack of system coordination (14:34) - Neopenda (Kenya) — the "mountain model" and the procurement barrier: county decision-makers choosing a newborn vital-signs monitor on its merits, funded from existing budgets (15:05) - The Gavi Innovation Scale-Up Facility, with 500 Global — the investment barrier: impact-first and commercial capital side by side in a single window (20:11) - M-mama (Tanzania) — the system-coordination barrier: an "Uber ambulance" at national scale, lifting ambulance-handled transports from one in ten to eight or nine (22:11) - The target — 700 million people reached by 2035, up from ~170 million — and the 480/120/100 million breakdown of where it comes from (27:49) - The supply/demand math: two-thirds supply (the snowball already rolling), one-third intentional demand — and why that's the "pathfinder" lesson (29:57) - Karlee's open invitation to governments, funders, and philanthropy (31:42) - What "reached" actually means — and why not every life reached is a life saved (33:18) Read the full argument at Global Health Insights: singerp.substack.com Disclosures: I am a co-founder, former CEO, and current board member of Grand Challenges Canada. I used AI (Claude from Anthropic) for research, fact-checking, and editorial feedback; the writing and judgments are my own.
Summary This episode explores the upcoming WHO leadership race, the challenges facing the organization, and the qualities needed in its next leader. Jocalyn Clark, international editor of the BMJ, shares insights from her recent article and interviews with global health experts. Episode description WHO is in an existential crisis, the worst in its 78 year history. It is beset by financial crisis, staff reductions, and geopolitical friction. That’s what experts interviewed by Jocalyn Clark, International Editor of the BMJ, told her, as she recounted in an article published today, entitled “Who will be the next leader of the beleaguered WHO.” Jocalyn Clark and I have been friends and colleagues for decades. So it was a particular joy for me to discuss the WHO Director-General election with her on my podcast. Jocalyn interviewed global experts familiar with WHO and created a composite picture at this point in the WHO Director-General race. The race has kicked off although no candidates have yet come forward — they have until September 2026 to do so. The race culminates in an election at the World Health Assembly in May 2027. She also heard from her interviewees that the desired profile of the next DG is a ‘polymath’ — someone who has technical expertise, can raise money, and has sophisticated diplomacy skills. Opinion was divided on whether DG candidates should spend time courting the US to try to get it to rejoin. We agreed that US return to the organization before the May 2027 election was unlikely but that it would be desirable for candidates to at least create the enabling conditions for a future return. My mantra for this campaign: ‘more results, less politics.’ Jocalyn and I drilled into what technical expertise really means. WHO substitutes process for results. The future leader should focus relentlessly on results. These are achieved in country and are the primary responsibility of countries themselves. WHO should be there to help; it should be able to measure and manage its contribution in support of countries. Jocalyn and I both agreed that the “norms and standards” brigade was just not specific enough about this, too process-oriented, and maybe a bit backward looking. We also batted around what it meant to be less politicized. We agreed that diplomacy was key: the elevation of the DG’s relationships from health ministers a decade ago to also include foreign ministers, finance ministers, and heads of state and government today was a good thing. But on specific issues, like conflict, there was some disagreement among Jocalyn’s interviewees about whether the DG should ‘take a stand.’ I argued for the importance of neutrality and impartiality, a fundamental value of UN organizations. I spoke about a recent report released by the Center for Medical Integrity on how WHO monitors and communicates on attacks against health care. I thought this report was excellent and every candidate should be pressed on whether they agree (or not) with its recommendations — including strengthening the verification methodology, increasing transparency to enable independent scrutiny, and addressing systematic bias and underreporting. Finally, we talked about the insider / outsider issue. Normally, if an organization is in crisis, you would want an outsider. In Jocalyn’s reporting, for this reason, people were tilting towards an outsider. But I don’t subscribe to the saviour theory of WHO DGs. We agreed that insider candidates should distinguish themselves from the current path and offer their prescription for improvement. It was a fun conversation between friends. We plan to do it again as the race unfolds and specific named candidates put themselves forward. I hope you enjoy the conversation too — check it out above or wherever you get your podcasts (under ‘Global Health Insights’). Read Jocalyn’s article in the BMJ. And let us know what you think! If we are not careful, we could get more politics and less results. Resources Jocalyn’s article
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Summary In this conversation, Katri Bertram shares her insights on leadership in global health, discussing the lessons learned from her extensive experience in various organizations. She emphasizes the importance of accountability for results and humility in leadership. We discuss the lack of progress in Universal Health Coverage as a case example calling for leadership. Katri also reflects on the future of global health, and offers advice for young people entering the field. We also talk about the desired leadership traits of the next WHO Director-General. More: singerp.substack.com Keywords global health, leadership, accountability, universal health coverage, future of health, leadership lessons, health systems, mentoring, results-driven leadership, health equity Takeaways Katri Bertram emphasizes the importance of knowing what you want as a leader. Purpose is crucial for effective leadership in global health. Authentic buy-in from staff is essential for success. Leaders must appreciate the value of their team members. Letting go of control is a significant challenge for leaders. Accountability is key to achieving results in global health. The global health landscape is becoming increasingly fragmented. Young professionals should be encouraged to speak out and ask questions. The golden era of global health funding is over, requiring new leadership approaches. Health is inherently political, and leaders must take responsibility for their actions. Sound Bites "Health is a political choice." "The golden era is over." "We need more people speaking out." Chapters 00:00 Leadership Lessons in Global Health 07:16 The Essence of Effective Leadership 14:31 Best and Worst Leadership Experiences 21:20 Accountability and Results in Global Health 27:53 Accountability in Global Health 28:48 The End of the Golden Era? 29:55 Future of Global Health Leadership 33:47 Fragmentation and Competition in Leadership 36:50 The Role of WHO in Global Health 41:26 Existential Questions for WHO 42:34 Unifying Goals in Global Health 45:22 Health as a Political Choice 47:54 Leadership Roles in Global Health 50:34 Advice for Young Global Health Professionals Links Katri Bertram’s blog on leadership https://katribertram.wordpress.com/2025/11/24/lead-the-ship/ Peter Singer’s blog on leadership in global health Singerp.substack.com