What a New WHO Director-General Should Try to Do

Leadership at WHO today is less about issuing new strategies and more about resetting expectations—about what the organization can do, what it should stop doing, and how honestly it should speak when evidence is uncertain or inconvenient.

Leadership, constraint, and the limits of reform in global health

Every transition at the top of the World Health Organization (WHO) invites a familiar question: can a new Director-General (DG) meaningfully change the institution, or are its problems too deeply embedded to be moved by leadership alone? How should a new DG adapt to profound geopolitical shifts, rapid advances in biotechnology and artificial intelligence, and growing distrust—not in science itself, but in how scientific evidence is interpreted, communicated, and used by institutions?

The usual answers fall into two camps. One assumes that a determined DG, armed with political will and technical expertise, can "fix" WHO through reform and vision. The other treats the role as largely ceremonial—a figurehead presiding over forces beyond their control. Both are mistaken.

A DG cannot transform WHO by decree. But leadership still matters—not because the DG controls resources or commands states, but because the role shapes agendas, internal rules, norms of evidence, and the institution's willingness to acknowledge limits and correct course. What a new DG should try to do is therefore not to expand WHO's authority, but to realign authority with credibility in an organization where that alignment has steadily eroded.

That task is difficult precisely because the constraints on the DG are structural, institutionalized, and politically reinforced. They are not accidental obstacles to reform; they are themselves part of the problem that must be named.

1. Start by redefining what WHO is actually for

The most important act of leadership a new DG could undertake would be to insist on clarity of purpose.

Over time, WHO has accumulated responsibilities, initiatives, and rhetorical ambitions far faster than it has shed them. The organization now speaks with authority on almost every aspect of health and risk—from infectious disease and nutrition to climate, alcohol, trade, and social behavior—yet its ability to deliver measurable outcomes across this expanding portfolio remains uneven.

This is not primarily a failure of intent. It is a structural problem driven by incentives. Fragmented and earmarked funding rewards expansion into new thematic areas rather than disciplined prioritization. Programs are easier to add than to end; crises justify permanent mandates; scope gradually substitutes for success.

At the same time, WHO's original mandates remain legitimate and, in many low- and middle-income settings, still necessary. These include capacity-building for sustainable national health systems; standard-setting for diagnostics, medicines, and vaccines for high-burden, remediable diseases such as malaria, tuberculosis, neglected tropical diseases, and malnutrition; and surveillance and monitoring functions, including support for detecting substandard and falsified medicines where national regulatory capacity is weak.

A serious DG should therefore distinguish between functions that remain essential and those that have expanded largely through donor incentives or institutional inertia. Priority should be placed on a limited set of core roles where WHO has genuine comparative advantage:

setting surveillance and reporting standards;
producing credible disease-burden estimates;
synthesizing evidence into guidance using transparent and reproducible methods;
coordinating, rather than commanding, during health emergencies;
supporting evaluation of policy impacts on population health;
reinforcing bioethical norms;
and leading post-crisis learning and correction.

Narrowing scope requires explicit trade-offs. It means saying no to donors, regions, and constituencies accustomed to WHO endorsement—and may require politically uncomfortable decisions, including winding down programs whose public-health justification has weakened. Avoiding those choices has produced an organization that is everywhere and accountable nowhere.

2. Make transparency the default condition of authority

If a new DG wants to change WHO's trajectory, transparency is the most powerful lever available—and one that remains underused.

WHO's dependence on voluntary and earmarked funding is well known. What remains insufficiently visible is how that dependence shapes priorities, outputs, staffing decisions, and public messaging. Programs funded overwhelmingly by a small number of donors often operate under the WHO umbrella while being presented as neutral expressions of multilateral consensus.

A DG cannot unilaterally change the funding model. But they can insist on greater honesty about how it operates.

Concrete steps would include:

consolidated public reporting of earmarked contributions linked to specific programs;
systematic publication of outputs alongside independent evaluations;
standardized disclosure of conflicts of interest, secondments, and advisory roles across the organization.

These are not radical reforms; they are governance basics. Transparency does not eliminate donor influence, but it makes influence visible—and visible influence becomes contestable. The political cost is real: donors and member states alike often prefer opacity. But opacity carries its own cost in declining trust and institutional credibility.

3. Rebuild credibility by normalizing uncertainty and disagreement

One of WHO's most damaging tendencies over the past decade has been its discomfort with visible uncertainty.

Formally, WHO already possesses procedures for evidence grading, guideline development, and documentation of uncertainty. Many technical guidelines—for example in malaria treatment and pandemic influenza preparedness—demonstrate that rigorous processes are possible. The problem is not the absence of rules, but their inconsistent application, selective use, or circumvention when conclusions are politically or ideologically inconvenient.

Guidance is often presented as settled even when evidence is thin; disagreement is smoothed over rather than documented; changes in position are framed as updates rather than corrections. This pattern predates COVID-19, but the pandemic exposed it starkly.

A new DG should insist that epistemic discipline is applied consistently by:

enforcing published protocols for guideline development;
explicitly grading evidence quality and uncertainty;
documenting minority views where expert disagreement persists;
and ensuring that departures from established processes are publicly justified.

This would not weaken WHO's authority. It would re-anchor authority in process rather than posture. Institutions earn trust by showing how conclusions are reached—and how they change—not by projecting confidence at all costs.

4. Put correction at the center of pandemic governance

Future pandemics are inevitable. The more important question is whether WHO will approach the next crisis with greater institutional humility.

During COVID-19, WHO's formal legal authority did not fundamentally change, but its practical prominence expanded sharply through emergency declarations and global guidance. Yet mechanisms for retrospective evaluation and explicit correction remained weak. Guidance shifted, but rarely in ways that clearly acknowledged error, uncertainty, or trade-offs, fueling skepticism and political backlash.

A DG cannot rewrite international law or redesign the pandemic architecture. But they can institutionalize correction by:

mandating independent, published after-action reviews for declared emergencies;
clarifying evidentiary thresholds for emergency declarations;
and creating formal processes for correcting or withdrawing guidance.

Such measures would not undermine emergency response. They would make it more legitimate. Authority that cannot be questioned eventually will be.

5. Focus global guidance on outcomes rather than identity

Many controversies surrounding WHO share a common feature: rigidity when outcomes diverge from institutional orthodoxy.

Tobacco control provides a prominent example, but it is not unique. In multiple domains—including alcohol policy and pandemic response—WHO has increasingly framed guidance in absolute or moralized terms, despite heterogeneous risks, contexts, and trade-offs.

The stated objective of tobacco policy is to reduce death and disease. Yet risk-proportionate communication has often been sidelined, despite strong evidence that non-combustible nicotine products are substantially less harmful than cigarettes. Similar dynamics appear in alcohol policy claims that no level of consumption is safe, and in pandemic guidance that inadequately accounted for socioeconomic harms.

A new DG should try to reframe global guidance as a pragmatic public-health and clinical enterprise focused on outcomes rather than identity or symbolism. That would involve:

applying consistent evidentiary standards across policy domains;
communicating relative risks transparently;
embracing technological advances in prevention, diagnosis, and treatment;
and ensuring that treaty-based or normative frameworks do not insulate policies from outcome-based evaluation.

Treaty dynamics, activist pressure, and institutional culture make this difficult. But failure to confront these tensions has real costs: declining credibility, missed opportunities for harm reduction, and widening gaps between policy and lived behavior.

6. Accept decentralization, but insist on comparability

WHO is no longer the sole center of gravity in global health governance, if it ever was. Regional institutions, national authorities, private firms, and research networks increasingly shape surveillance, preparedness, and innovation. This should be treated as reality rather than as a threat.

A pragmatic DG would accept decentralization while insisting on comparability:

common metrics across regions;
shared definitions and reporting standards;
and independent audit capacity focused on delivery and integrity.

Improved contextualization of guidance—potentially through greater regional and country-level decision-making—would strengthen relevance without sacrificing coherence. Without standards, decentralization risks fragmentation; with them, WHO can remain relevant as a coordinator and standard-setter rather than a command center.

Why the constraints matter—and why they must be named

None of these priorities are radical. All are achievable in principle. Yet each encounters the same quiet resistance: an institutional ecosystem shaped by donor incentives, political sensitivities, and a long-standing preference for expansion over evaluation.

The constraints on a new DG are not merely limits on individual leadership; they are symptoms of a governance model that rewards confidence over correction, breadth over depth, and consensus over clarity.

A DG cannot resolve these tensions alone. But they can make them harder to ignore.

Success will not look like transformation or expansion. It will look like an organization that is narrower, more focused, more transparent, more willing to admit error, and therefore more credible. In the current global health environment, that would be a meaningful achievement.