There’s a lot of turmoil in global health governance these days, and it looks like it’s only getting more chaotic. The Global Fund to Fight AIDS, Tuberculosis, and Malaria is hitting the reset button in its quest to identify a new leader “due to issues in the recruitment process”—precisely at a moment when there are real fears about the future of funding for global health initiatives.
What’s happening within the Global Fund may at first glance speak to dysfunction within that specific organization, but it’s better to think of the problems as emblematic of larger questions about legitimacy and the future of multilateralism under the Trump Administration.
The need for a new Executive Director of the Global Fund is not a surprise. Mark Dybul, an American physician who directed PEPFAR between 2006 and 2009, has served in the role since January 2013 and announced two years ago that he would step aside when his contract ends this coming May. The Global Fund manages nearly $4 billion annually and has more than 450 active grants in more than 100 countries, so its role in global health governance is incredibly important.
(UPDATE: the Global Fund named Marijke Wijnroks as interim executive director when Dybul’s contract ends. Wijnroks is currently Dybul’s #2 and previously served as the Netherlands’ Ambassador for HIV/AIDS.)
In mid-February, word came out that there were three finalists for the position: Helen Clark, the former prime minister of New Zealand, former director of the United Nations Development Program, and previous candidate for UN Secretary-General; Dr. Muhammad Ali Pate, a former Nigerian health minister widely praised for his efforts to combat polio; and Subhanu Saxena, the former CEO of the Indian pharmaceutical manufacturer Cipla.
Over the next two weeks, concerns emerged about all three candidates. Pate came under fire for his Twitter feed. Saxena raised questions about conflicts of interest, given that Cipla holds multi-million dollar contracts to supply the Global Fund with anti-AIDS drugs. Clark withdrew her nomination after she expressed concerns about the selection process and others questioned whether her UN background with the UN would antagonize a Trump Administration skeptical about the UN’s value. On February 20th, countries and organizations that receive money from the Global Fund sent a letter to the Board raising “grave concerns” about the candidates and the process for selecting them. Other leaders of health and development organizations said they were “not wildly enthusiastic” about the finalists and wondered whether the lack of a US candidate among the finalists would decrease the country’s support for the Global Fund.
A week later—on the day that the Board had planned to announce who the new Executive Director would be—we got an announcement that the process would be reopened. What exactly that new process will look like is entirely unclear at this point.
The Global Fund’s process for selecting a new Executive Director is odd for at least two big reasons. First, even though the organization had long known that Dybul had announced his intention to return to his position at the O’Neill Institute for National and International Law at Georgetown University, it did not begin its process until this past November. That did not give them a lot of wiggle room for identifying, selecting, and inaugurating a new leader for such an important global health institution, and instead led to a rushed process.
Second, and even more curious, at a time when multilateral institutions are increasingly moving toward more open and transparent processes for selecting their leaders, the Global Fund opted for something more opaque. It created a committee of 9 current and former Board members and hired an executive search committee to recommend no more than four finalists to the Board, which would then vote during a retreat in late February. This is a process similar to the one used to hire Dybul. There was no plan for any public element to the process or transparency in the voting process—something that grant recipients have called for.
This private process is directly the opposite of what the World Health Organization is using to identify its next Director-General. As I’ve written about on here previously, WHO is using a highly public process with candidates openly campaigning and states casting public ballots. This is part of a larger effort to re-establish WHO’s legitimacy and credibility in the wake of its inadequate response to Ebola. It also provides a degree of public influence on the processes.
In the Global Fund’s case, the only reason we even know who the finalists were is that the information was leaked to the New York Times. This does not suggest that transparency is high on the Global Fund’s list of priorities and works against the organization’s ability to demonstrate that it remains a demand-driven body that emphasizes country ownership over projects. Then again, the Global Fund is not structured like other international organizations. It’s a conduit for funding from public and private sources, not a traditional membership organization. That fact raises the question of to whom it should be accountable—those who fund it, or those who receive the funds from it?
At the same time, the Global Fund is trying to navigate the uncertain terrain of multilateralism with Trump’s election. The new US administration has adopted an America First foreign policy, which may leave international organizations severely weakened. The United States is the largest donor to the Global Fund, and losing its support (and $4.3 billion pledged over the next three years) would seriously imperil the organization’s operations. Is it a mark of political savvy or political cowardice to shun candidates who may not be in line with Trump’s foreign policy? Nothing has come out so far to suggest that the United States directly influenced the selection process; rather, it’s a case of candidates being questioned because of their potential for upsetting the American administration.
The first effort to find a new leader of the Global Fund failed, so there’s only one answer moving forward: a Eurovision-style contest complete with formulaic songs, costume changes, and back-up dancers. You want to lead one of the largest funders of infectious disease programs in the world? You better make sure you can sing.