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The race to become the next UN Secretary-General
World Report
The race to become the next UN Secretary-General The field of candidates running for the position of next UN Secretary-General is narrowing, but no nominee has made health a major campaign issue. Sharmila Devi reports.
In the vision statements published by the original 12 candidates, three of whom have since dropped out, the word “health” was found in only three of them and another spoke of “healthy” children while the subject barely featured in the dialogues at the General Assembly, said Matthew Lee, who runs Inner City Press, an investigative website that covers the UN in New York. “Health hasn’t featured as one of the buzz words of the
Health issues neglected Although the UN’s Sustainable Development Goals (SDGs) in 2014 laid out targets to be met by 2030 on www.thelancet.com Vol 388 October 1, 2016
UN Photo/Violaine Martin
“In the vision statements published by the original 12 candidates...the word ‘health’ was found in only three of them and another spoke of ‘healthy’ children while the subject barely featured in the dialogues at the General Assembly...”
candidates and only one of them, [Christiana] Figueres, said the UN should apologise for bringing cholera to Haiti”, he told The Lancet. This was before the UN admitted in August its part in starting a cholera outbreak there in 2010. Figueres has since dropped out of the race. The new UN chief will have to work with a new Director-General of WHO from July 1, 2017. The agency and its current head, Margaret Chan, have come under sustained criticism over the response to the Ebola crisis in west Africa and other issues in recent years. Leading health sector figures are looking for change. “I’m not a politician, I’m an aid worker but what I can say is we have this supranational platform that is the UN and we need to use it right now”, Joanne Liu, international president of Médecins Sans Frontières (MSF), told The Lancet. “This is what we’ve got and so we should harness the full potential of this platform to its full strength and today this is not happening.“
Antonio Guterres
Associated Press
poverty, hunger, education, and health, the broader issue of global health has barely registered as a separate issue in the candidates’ campaigns.
Miroslav Lajčák
Don Emmert/Staff
Antonio Guterres, the former Portuguese Prime Minister, leads a field of nine candidates to become the ninth Secretary-General of the UN in a contest that began with hopes of greater transparency but will be decided as usual in closed-door bargaining among the five permanent powers of the Security Council. South Korea’s Ban Ki-moon steps down at the end of this year after two terms in a post that has no formal job description. The prospect that he might be replaced by a woman for the first time in the UN’s 71-year history might be fading. As part of perennial demands for reform of the world body, candidates were subjected to a series of “informal dialogues” between April and July this year at the General Assembly, where all 194 UN members have equal representation. For the first time, civil society organisations were given an opportunity to put questions to the candidates. The final choice, however, will still rest with the 15-member Security Council and, above all, with its five permanent, veto-wielding members—the USA, Russia, the UK, China, and France—known as the P5. The remaining seats are filled by rotating members. Non-governmental organisations and global health experts hope Ban’s successor will provide the lead on global health issues, ranging from attacks on hospitals in conflict zones to combating pandemics, boosting drug research and development, and making medicines affordable for all.
The UN headquarters in New York
e7
World Report
UN Photo/Paulo Filgueiras
Secret ballots
Uli Deck/picture-alliance/dpa/AP Images
Vuk Jeremić
UN Photo/Manuel Elias
Srgjan Kerim
Associated Press
Irina Bokova
Danilo TÜrk
e8
The Security Council has held five straw polls, or secret ballots, and further polls are expected before a final decision is made. The 15 members make a choice between “encourage”, “discourage”, and “no opinion” for each of the nine candidates, five men and four women. A poll expected in the first week of October will for the first time distinguish the colour of the ballots of the five permanent members so candidates will know if they face a veto. After much public talk by Council members about both the desirability of a woman Secretary-General, voting so far has favoured Guterres, who served as UN High Commissioner for Refugees (UNHCR) from 2005 to 2015. Although the votes are secret, results are usually leaked to journalists in New York within half an hour. Guterres received two “discourages” in a Aug 30 poll amid speculation that Russia, which has a veto, was among those opposing him. If no clear candidate emerges from further polls, there is the possibility of additional candidates entering the race. Health experts say if Guterres were to win, he would be good for global health given that his UNHCR post gave him an understanding of the health and other needs of refugees and migrants in the current crisis facing Europe, the Middle East, and the rest of the world. The Elders, a grouping of elder statesmen and peace activists led by former UN chief, Kofi Annan, started lobbying the UN General Assembly in September to invest in universal health coverage in Africa and other resource-poor regions and countries. Global health needs, particularly those of women, children, and adolescents, were identified as a priority in the SDGs, Andrew Whitley, chief executive officer of The Elders, told The Lancet. “Health is a top issue and it’s important the next Secretary-General
puts political heft into the SDGs. We are pushing for universal health coverage that is publicly funded directly through taxation as the most progressive way forward.” “The next Secretary-General is also likely to face another major pandemic in the next 10 years, so we need to prepare the global system now. If weak domestic health systems are obliged to bear the brunt, that will only make matters worse.”
“‘The next Secretary-General is also likely to face another major pandemic in the next 10 years, so we need to prepare the global system now.’” Mogens Lykketoft, president of the General Assembly, said any new candidate would have to appear before the General Assembly to make a presentation before the Security Council could vote on him or her. This is a reform over previous practice when the Security Council would just come up with its own candidates. “One or two more candidates may come forward as this process could go into October and November but there is an understanding with the Council that the candidates would be called in before the General Assembly to make presentations before the Council can vote on them”, Lykketof told The Lancet. “This is the first time in the UN’s history that we’ve an open and transparent process and this has influenced the straw polls in the Council. The Council has ten elected members, as well as the five permanent members, and they are working to influence them. Yes, the P5 has the deciding power and can turn down candidates but even strong countries need friends and allies”, Lykketof said.
Other candidates In the last straw poll, Vuk Jeremić, former Serbian Foreign Minister, was in second place, and Miroslav LajČák,
Slovakia’s Foreign Minister, was in third place. The remaining six candidates were Danilo TÜrk, former Slovenian President, Susana Malcorra, Argentinian Foreign Minister, Irina Bokova of Bulgaria, who is Director-General of UN cultural organisation UNESCO, Srgjan Kerim, former Macedonian Foreign Minister, Helen Clark, New Zealand’s former Prime Minister who heads the UN Development Programme (UNDP) and who enjoys much civil society support, and Natalia Gherman, former Moldovan Foreign Minister. The final choice seems to hinge on Russia, which has made clear it would like to manage the process when it holds the presidency of the Security Council in October. Russia has been at loggerheads with the USA on recent global crises such as Syria and Moscow’s annexation of Crimea. Meanwhile, western diplomats have been saying in private that in the present list of candidates, only Guterres stands a chance of winning. “The question is: what is Russia’s game if indeed it voted ‘discourage’ against Guterres”, an international official told The Lancet. “Are they being tactical or strategic? Are they looking for a bargaining chip or looking to play a blocking game related to the UN or something completely different? I suspect only [Russian President Vladimir] Putin knows. But we hear the Russians are being very difficult inside the Security Council on the Secretary-General selection process.” The race is “for Guterres to lose”, Richard Gowan, a fellow at the European Council on Foreign Relations in New York, told The Lancet. “Guterres has benefited from the more transparent process and he did well in the dialogues but you’d think another white western man wasn’t needed in 2016”, he said. “By contrast, some candidates who were expected to do well didn’t shine in the dialogues and have suffered in the straw polls, such as Bokova, www.thelancet.com Vol 388 October 1, 2016
www.thelancet.com Vol 388 October 1, 2016
“Health experts said another urgent task for the next Secretary-General is to prevent attacks on medical facilities and personnel in areas of conflict.”
Health priorities Looking ahead, Liu of MSF said “one of the big issues in global health is what I call the Ebola legacy” and that lessons had yet to be learnt. “I’m pretty confident in what I’m saying right now because of what happened with the current yellow fever epidemic that spread to the DRC [DR Congo]”, she said. “It’s an example of the fact that we haven’t been able to enact the changes that are required to avoid an epidemic to continue to propagate itself.” Tarik Jasarevic, a WHO spokesman, told The Lancet that the agency had been coordinating with partners to control the outbreaks in DR Congo and Angola. “We cannot compare the response to yellow fever with the response to Ebola. They are very different situations”, he said. On Sept 13, WHO announced the outbreak had been brought under control by a large emergency vaccination campaign in Angola and DR Congo. Separately, Ivana Milovanovic, WHO coordinator with the UN system, told The Lancet that the UN SecretaryGeneral “is the voice of the people around the world. Good health and wellbeing is not only high on each individual priority list but an essential part of any development agenda.”
“The work between the UN and WHO is a two-way street. All the Secretary-General’s health-related work and initiatives are based on technical work, evidence, and data provided by WHO. WHO’s policy advice provides the backbone for the recommendations and advocacy on all global health issues the SecretaryGeneral engages in.” Health experts said another urgent task for the next SecretaryGeneral is to prevent attacks on medical facilities and personnel in areas of conflict. “From the medical point of view, such attacks are among the most heinous crimes”, Sir Michael Marmot, president of the World Medical Association, told The Lancet. “I would also like to see the global community doing all it can to address health challenges in inequality and the social and economic determinants of health.” Mandeep Dhaliwal, director of the HIV, health, and development group at UNDP, also wanted to see a push on the social determinants of health. “It needs a broader approach and more collaboration because health can’t just be left to the health sector or medics”, she told The Lancet. “The focus should be on prevention of HIV, non-communicable diseases, and other conditions because it’s the most effective way.” Any of the many other likely priorities of the next UN chief should not come at the expense of full implementation of the SDGs, said Mohga Kamal-Yanni, senior health and HIV policy adviser at Oxfam. She also noted the importance of acting on the recommendations of the UN’s High-Level Panel of Access to Medicines. “We need a real leader who has vision and who can push”, Kamal-Yanni told The Lancet. “The UN has been weakened and a strong Secretary-General should contradict member states when they’re wrong.”
Susana Malcorra
Associated Press
told The Lancet. “The P5’s veto is used to make deals in which a P5 country offers support to a candidate in return for a promise to give a key post to that country’s national. This is why we’ve had France run peacekeeping, the UK runs OCHA [the UN’s Office for the Coordination of Humanitarian Affairs], and the Americans run the UN’s Department of Political Affairs.”
Helen Clark
Associated Press
who entered as a frontrunner, and Malcorra, who was understood to be a US favourite.” Kristalina Georgieva, who is Bulgarian and is the European Commission’s budget chief, and Kevin Rudd, former Australian Prime Minister, have been spoken about as outsiders who could be pulled into the race. “I can’t rule out a lastminute candidate like Rudd and the rules permit another country to nominate him even if his own has decided not to do so”, said the international official. It was unclear why New Zealand’s Clark did so badly in the Security Council after enjoying public support although the USA is said not to favour her outspokenness and she may also have suffered because of turf wars within the UN. “Her public campaign was good but the US didn’t like her”, a UN insider who supported her candidacy told The Lancet. “The US did like Malcorra, so the Russians went against her. Vuk [Jeremić] is too arrogant while most of the others are too bland.” The greater transparency in the election process was a victory for the 1 for 7 Billion campaign, which has brought together more than 750 civil society organisations from around the world calling for a better process to select the UN chief. Yvonne Terlingen, who is on the steering committee of the campaign, welcomed what she called the “unprecedented” public interest in the process. But she said the campaign was still urging for reforms, including a call for the Security Council to choose two candidates so that the General Assembly could vote on a final choice rather than rubber-stamp one candidate. The campaign also wants the Secretary-General to serve one, 7-year term so that his or her time is not spent currying favour to win election to a second, 5-year term. “Our campaign is also very active on the question of entitlements, which affects the way the UN is run”, she
UN Photo/Mark Garten
World Report
Natalia Gherman
Sharmila Devi e9
The race to become the next UN Secretary-General The field of candidates running for the position of next UN Secretary-General is narrowing, but no nominee has made health a major campaign issue. Sharmila Devi reports.
In the vision statements published by the original 12 candidates, three of whom have since dropped out, the word “health” was found in only three of them and another spoke of “healthy” children while the subject barely featured in the dialogues at the General Assembly, said Matthew Lee, who runs Inner City Press, an investigative website that covers the UN in New York. “Health hasn’t featured as one of the buzz words of the
Health issues neglected Although the UN’s Sustainable Development Goals (SDGs) in 2014 laid out targets to be met by 2030 on www.thelancet.com Vol 388 October 1, 2016
UN Photo/Violaine Martin
“In the vision statements published by the original 12 candidates...the word ‘health’ was found in only three of them and another spoke of ‘healthy’ children while the subject barely featured in the dialogues at the General Assembly...”
candidates and only one of them, [Christiana] Figueres, said the UN should apologise for bringing cholera to Haiti”, he told The Lancet. This was before the UN admitted in August its part in starting a cholera outbreak there in 2010. Figueres has since dropped out of the race. The new UN chief will have to work with a new Director-General of WHO from July 1, 2017. The agency and its current head, Margaret Chan, have come under sustained criticism over the response to the Ebola crisis in west Africa and other issues in recent years. Leading health sector figures are looking for change. “I’m not a politician, I’m an aid worker but what I can say is we have this supranational platform that is the UN and we need to use it right now”, Joanne Liu, international president of Médecins Sans Frontières (MSF), told The Lancet. “This is what we’ve got and so we should harness the full potential of this platform to its full strength and today this is not happening.“
Antonio Guterres
Associated Press
poverty, hunger, education, and health, the broader issue of global health has barely registered as a separate issue in the candidates’ campaigns.
Miroslav Lajčák
Don Emmert/Staff
Antonio Guterres, the former Portuguese Prime Minister, leads a field of nine candidates to become the ninth Secretary-General of the UN in a contest that began with hopes of greater transparency but will be decided as usual in closed-door bargaining among the five permanent powers of the Security Council. South Korea’s Ban Ki-moon steps down at the end of this year after two terms in a post that has no formal job description. The prospect that he might be replaced by a woman for the first time in the UN’s 71-year history might be fading. As part of perennial demands for reform of the world body, candidates were subjected to a series of “informal dialogues” between April and July this year at the General Assembly, where all 194 UN members have equal representation. For the first time, civil society organisations were given an opportunity to put questions to the candidates. The final choice, however, will still rest with the 15-member Security Council and, above all, with its five permanent, veto-wielding members—the USA, Russia, the UK, China, and France—known as the P5. The remaining seats are filled by rotating members. Non-governmental organisations and global health experts hope Ban’s successor will provide the lead on global health issues, ranging from attacks on hospitals in conflict zones to combating pandemics, boosting drug research and development, and making medicines affordable for all.
The UN headquarters in New York
e7
World Report
UN Photo/Paulo Filgueiras
Secret ballots
Uli Deck/picture-alliance/dpa/AP Images
Vuk Jeremić
UN Photo/Manuel Elias
Srgjan Kerim
Associated Press
Irina Bokova
Danilo TÜrk
e8
The Security Council has held five straw polls, or secret ballots, and further polls are expected before a final decision is made. The 15 members make a choice between “encourage”, “discourage”, and “no opinion” for each of the nine candidates, five men and four women. A poll expected in the first week of October will for the first time distinguish the colour of the ballots of the five permanent members so candidates will know if they face a veto. After much public talk by Council members about both the desirability of a woman Secretary-General, voting so far has favoured Guterres, who served as UN High Commissioner for Refugees (UNHCR) from 2005 to 2015. Although the votes are secret, results are usually leaked to journalists in New York within half an hour. Guterres received two “discourages” in a Aug 30 poll amid speculation that Russia, which has a veto, was among those opposing him. If no clear candidate emerges from further polls, there is the possibility of additional candidates entering the race. Health experts say if Guterres were to win, he would be good for global health given that his UNHCR post gave him an understanding of the health and other needs of refugees and migrants in the current crisis facing Europe, the Middle East, and the rest of the world. The Elders, a grouping of elder statesmen and peace activists led by former UN chief, Kofi Annan, started lobbying the UN General Assembly in September to invest in universal health coverage in Africa and other resource-poor regions and countries. Global health needs, particularly those of women, children, and adolescents, were identified as a priority in the SDGs, Andrew Whitley, chief executive officer of The Elders, told The Lancet. “Health is a top issue and it’s important the next Secretary-General
puts political heft into the SDGs. We are pushing for universal health coverage that is publicly funded directly through taxation as the most progressive way forward.” “The next Secretary-General is also likely to face another major pandemic in the next 10 years, so we need to prepare the global system now. If weak domestic health systems are obliged to bear the brunt, that will only make matters worse.”
“‘The next Secretary-General is also likely to face another major pandemic in the next 10 years, so we need to prepare the global system now.’” Mogens Lykketoft, president of the General Assembly, said any new candidate would have to appear before the General Assembly to make a presentation before the Security Council could vote on him or her. This is a reform over previous practice when the Security Council would just come up with its own candidates. “One or two more candidates may come forward as this process could go into October and November but there is an understanding with the Council that the candidates would be called in before the General Assembly to make presentations before the Council can vote on them”, Lykketof told The Lancet. “This is the first time in the UN’s history that we’ve an open and transparent process and this has influenced the straw polls in the Council. The Council has ten elected members, as well as the five permanent members, and they are working to influence them. Yes, the P5 has the deciding power and can turn down candidates but even strong countries need friends and allies”, Lykketof said.
Other candidates In the last straw poll, Vuk Jeremić, former Serbian Foreign Minister, was in second place, and Miroslav LajČák,
Slovakia’s Foreign Minister, was in third place. The remaining six candidates were Danilo TÜrk, former Slovenian President, Susana Malcorra, Argentinian Foreign Minister, Irina Bokova of Bulgaria, who is Director-General of UN cultural organisation UNESCO, Srgjan Kerim, former Macedonian Foreign Minister, Helen Clark, New Zealand’s former Prime Minister who heads the UN Development Programme (UNDP) and who enjoys much civil society support, and Natalia Gherman, former Moldovan Foreign Minister. The final choice seems to hinge on Russia, which has made clear it would like to manage the process when it holds the presidency of the Security Council in October. Russia has been at loggerheads with the USA on recent global crises such as Syria and Moscow’s annexation of Crimea. Meanwhile, western diplomats have been saying in private that in the present list of candidates, only Guterres stands a chance of winning. “The question is: what is Russia’s game if indeed it voted ‘discourage’ against Guterres”, an international official told The Lancet. “Are they being tactical or strategic? Are they looking for a bargaining chip or looking to play a blocking game related to the UN or something completely different? I suspect only [Russian President Vladimir] Putin knows. But we hear the Russians are being very difficult inside the Security Council on the Secretary-General selection process.” The race is “for Guterres to lose”, Richard Gowan, a fellow at the European Council on Foreign Relations in New York, told The Lancet. “Guterres has benefited from the more transparent process and he did well in the dialogues but you’d think another white western man wasn’t needed in 2016”, he said. “By contrast, some candidates who were expected to do well didn’t shine in the dialogues and have suffered in the straw polls, such as Bokova, www.thelancet.com Vol 388 October 1, 2016
www.thelancet.com Vol 388 October 1, 2016
“Health experts said another urgent task for the next Secretary-General is to prevent attacks on medical facilities and personnel in areas of conflict.”
Health priorities Looking ahead, Liu of MSF said “one of the big issues in global health is what I call the Ebola legacy” and that lessons had yet to be learnt. “I’m pretty confident in what I’m saying right now because of what happened with the current yellow fever epidemic that spread to the DRC [DR Congo]”, she said. “It’s an example of the fact that we haven’t been able to enact the changes that are required to avoid an epidemic to continue to propagate itself.” Tarik Jasarevic, a WHO spokesman, told The Lancet that the agency had been coordinating with partners to control the outbreaks in DR Congo and Angola. “We cannot compare the response to yellow fever with the response to Ebola. They are very different situations”, he said. On Sept 13, WHO announced the outbreak had been brought under control by a large emergency vaccination campaign in Angola and DR Congo. Separately, Ivana Milovanovic, WHO coordinator with the UN system, told The Lancet that the UN SecretaryGeneral “is the voice of the people around the world. Good health and wellbeing is not only high on each individual priority list but an essential part of any development agenda.”
“The work between the UN and WHO is a two-way street. All the Secretary-General’s health-related work and initiatives are based on technical work, evidence, and data provided by WHO. WHO’s policy advice provides the backbone for the recommendations and advocacy on all global health issues the SecretaryGeneral engages in.” Health experts said another urgent task for the next SecretaryGeneral is to prevent attacks on medical facilities and personnel in areas of conflict. “From the medical point of view, such attacks are among the most heinous crimes”, Sir Michael Marmot, president of the World Medical Association, told The Lancet. “I would also like to see the global community doing all it can to address health challenges in inequality and the social and economic determinants of health.” Mandeep Dhaliwal, director of the HIV, health, and development group at UNDP, also wanted to see a push on the social determinants of health. “It needs a broader approach and more collaboration because health can’t just be left to the health sector or medics”, she told The Lancet. “The focus should be on prevention of HIV, non-communicable diseases, and other conditions because it’s the most effective way.” Any of the many other likely priorities of the next UN chief should not come at the expense of full implementation of the SDGs, said Mohga Kamal-Yanni, senior health and HIV policy adviser at Oxfam. She also noted the importance of acting on the recommendations of the UN’s High-Level Panel of Access to Medicines. “We need a real leader who has vision and who can push”, Kamal-Yanni told The Lancet. “The UN has been weakened and a strong Secretary-General should contradict member states when they’re wrong.”
Susana Malcorra
Associated Press
told The Lancet. “The P5’s veto is used to make deals in which a P5 country offers support to a candidate in return for a promise to give a key post to that country’s national. This is why we’ve had France run peacekeeping, the UK runs OCHA [the UN’s Office for the Coordination of Humanitarian Affairs], and the Americans run the UN’s Department of Political Affairs.”
Helen Clark
Associated Press
who entered as a frontrunner, and Malcorra, who was understood to be a US favourite.” Kristalina Georgieva, who is Bulgarian and is the European Commission’s budget chief, and Kevin Rudd, former Australian Prime Minister, have been spoken about as outsiders who could be pulled into the race. “I can’t rule out a lastminute candidate like Rudd and the rules permit another country to nominate him even if his own has decided not to do so”, said the international official. It was unclear why New Zealand’s Clark did so badly in the Security Council after enjoying public support although the USA is said not to favour her outspokenness and she may also have suffered because of turf wars within the UN. “Her public campaign was good but the US didn’t like her”, a UN insider who supported her candidacy told The Lancet. “The US did like Malcorra, so the Russians went against her. Vuk [Jeremić] is too arrogant while most of the others are too bland.” The greater transparency in the election process was a victory for the 1 for 7 Billion campaign, which has brought together more than 750 civil society organisations from around the world calling for a better process to select the UN chief. Yvonne Terlingen, who is on the steering committee of the campaign, welcomed what she called the “unprecedented” public interest in the process. But she said the campaign was still urging for reforms, including a call for the Security Council to choose two candidates so that the General Assembly could vote on a final choice rather than rubber-stamp one candidate. The campaign also wants the Secretary-General to serve one, 7-year term so that his or her time is not spent currying favour to win election to a second, 5-year term. “Our campaign is also very active on the question of entitlements, which affects the way the UN is run”, she
UN Photo/Mark Garten
World Report
Natalia Gherman
Sharmila Devi e9