GENEVA — The race to choose the head of the World Health Organization is a test of who will shape global health after America’s retreat: Europe, rising powers in Asia or increasingly influential Gulf states.
Countries will decide next year who should lead the WHO after Tedros Adhanom Ghebreyesus’ second term ends in August 2027, handing the winner an agency recovering from the loss of its biggest donor, facing calls for institutional reform and the increasing threat of another global health crisis.
By convention, Tedros, who is from Ethiopia, is unlikely to be succeeded by another African candidate. Beyond that, the field remains wide open.
Europe is expected to produce at least one serious contender, but candidates from wealthy countries will face scrutiny over the unequal distribution of vaccines during the Covid-19 pandemic. Meanwhile, possible candidates from Asia and the Gulf reflect the growing financial and diplomatic influence those regions wield in global health. China is unlikely to field a candidate of its own, but Beijing’s diplomatic reach across the developing world could make it a decisive power broker.
Adding to the uncertainty is the Trump administration’s withdrawal from the WHO earlier this year. Unlike in previous races, when the United States held disproportionate sway as the agency’s biggest funder, this contest will play out without Washington formally at the table — though many countries will still be watching for signs of whom it might favor.
Some countries would “likely consider U.S. preferences in whom they support, but not all countries necessarily want the U.S. back in the WHO,” said Suerie Moon, a professor at the Graduate Institute in Geneva.
POLITICO spoke with 15 global health experts and officials, including delegates at the World Health Assembly in Geneva last month, to find out which names are circulating and how they might fare.
Gulf states: Growing influence but risk of splitting support
Two of the most discussed potential candidates come from the Gulf, a region whose financial and diplomatic influence in global health has expanded significantly over the past decade.
Saudi Arabia’s Hanan Balkhy appears particularly well-positioned. Since becoming regional director for WHO’s Eastern Mediterranean office in 2024, she has built a reputation as a capable operator, described by one global health expert as “ultracompetent and level-headed.” She has become one of the organization’s most visible leaders during conflicts in Gaza and Iran, calling for ceasefires and warning of nuclear disaster if conflict continues to escalate.
Her U.S. connections — she spent part of her childhood in America and trained at hospitals in Massachusetts and Ohio — and Riyadh’s alliance with Washington could make her attractive to countries hoping the WHO eventually rebuilds relations with America.
Balkhy combines top-level public health experience — she also led the Gulf’s Centre for Infection Control — with the credibility of a top WHO official. Her résumé makes her an obvious candidate to secure the support of neighboring countries in the Gulf region, but she faces a rival in former Qatari Health Minister Hanan Mohamed Al Kuwari.
Having led Qatar’s biggest health care provider and named by Forbes as the eighth most powerful businesswoman in the region, she could appeal to countries seeking a new face, especially a manager rather than a WHO insider.
Ultimately, the fortunes of both candidates will depend as much on diplomatic negotiations among Gulf governments as on their individual credentials.
Pakistan: The vaccine diplomat
Sania Nishtar enters the conversation with perhaps the strongest global health profle among the rumored candidates.
After unsuccessfully challenging Tedros in 2017, she now leads Gavi, the Vaccine Alliance — a public-private partnership that coordinates vaccine funding in low- and middle-income countries — placing her at the center of some of the most politically sensitive debates in global health funding.
Nishtar has already had to navigate relations with the Trump administration as it ripped up the prevailing norms in global health. Faced with U.S. pressure over shots containing thimerosal, a preservative widely considered safe but mistrusted by vaccine skeptics, she avoided direct confrontation while continuing to defend vaccination programs.
At the same time, she has publicly warned about the consequences of U.S. aid cuts — that they would likely come at the cost of “tens of thousands of children’s lives lost” — reflecting the balancing act any future WHO leader will face.
Her experience managing relationships with donors, governments and philanthropies could prove attractive at a time when WHO faces severe financial pressure. She is in a crowded field, however. Pakistan and the Gulf countries are in the same WHO region, where competition is hot.
Indonesia: A candidate for an Asian century?
No names generated more buzz during the World Health Assembly this year than Indonesian Health Minister Budi Gunadi Sadikin.
An impressive orator, he may have the personality to capitalize on an opportune moment for Southeast Asia. Budi “makes a lot of sense,” said Luis Pizarro, executive director at the Drugs for Neglected Diseases Initiative. “The center of gravity of global health will be moving to Asia for sure.”
At the World Health Assembly, Budi crammed in multiple side-events, repeatedly advocating for solidarity and technology-sharing, messages that resonate strongly across developing countries worldwide. He said he wanted Indonesia’s state-owned Bio Farma to give away vaccine technology “as fast as possible.”
Indonesia’s role as a global health hub strengthens the argument that the next WHO leader could come from Southeast Asia. His biggest vulnerability, however, is his relatively limited experience in health policy.
A former banker, he only entered the sector in 2020. While Tedros demonstrated that a medical degree is not essential for the job, some member states may still prefer candidates with a longer track record in public health.
Indonesia is not the only country from the region that could offer a strong candidate. Regional diplomats increasingly expect Thailand, another regional heavyweight, to put a name forward.
Europe: Experience versus political baggage
On paper, Europe has a strong claim — no European has been elected WHO director-general since 1998.
In practice, the region faces a political headwind.
Many developing countries remain frustrated by the drawn-out pandemic deal talks they hoped would build a fairer global health system than the one that left them back of the queue for vaccines during the Covid-19 pandemic.
Europe’s resistance during negotiations to lower-income countries’ demands on the sharing of drugs and vaccines, and its hardline support of the pharmaceutical sector, could make it difficult for a European candidate to build a broad coalition across Africa, Asia and Latin America. The European Commission maintains it is fully committed to the agreement.
German names are frequently mentioned as possible contenders. Angela Merkel aide Helge Braun’s seems the most likely but his position on border closures during the pandemic is likely to face scrutiny. Former Health Minister Karl Lauterbach is not thought to be a front-runner due to a lack of popularity in government.
Nonetheless, Germany’s continued status as one of WHO’s largest donors ensures a degree of influence.
The strongest European prospect is widely considered to be Hans Kluge, the Belgian physician who leads WHO’s Europe office. Kluge combines extensive WHO experience with a reputation for consensus-building and already enjoys strong support within the organization. “No kidding,” he replied when POLITICO told him his name had repeatedly come up in discussions.
Another is Jeremy Farrar, WHO’s assistant director-general and former chief scientist. A respected infectious disease expert with extensive experience in Asia and global health research, Farrar would likely appeal to countries seeking a technically strong leader and a vocal defender of equity and evidence-based policymaking. However, he said he has “no intention” of running for the top job.
For both Kluge (and Farrar), the biggest obstacle is political rather than professional. Even if many countries regard them as qualified, some may conclude that this is not Europe’s moment.
Update: This article has been updated with Jeremy Farrar’s response.
