The two candidates vying to be the next regional director of the World Health Organisation South-East Asia Region (WHO-SEARO) are being described as chalk and cheese. One is Nepal's nominee, Shambhu Prasad Acharya, a public-health veteran with a doctorate in the discipline who has spent three decades holding various posts within the WHO. The other is Bangladesh's nominee, Saima Wazed, a clinical psychologist and the daughter of the country's prime minister, Sheikh Hasina. Wazed has no degree in public health though she was given an honorary doctorate by a university in Bangladesh in March 2023 and is currently pursuing an advanced degree in education and organisational leadership. She has been on the WHO's advisory panels on autism and mental health and been associated with global health programmes at the British think tank Chatham House since 2022. Her resume shows a focus on psychology and autism but little experience within any other health subjects. Her leadership experience is restricted to a small non-governmental organisation that she founded and roles on advisory boards under a government run by her mother. Wazed also holds a second citizenship from Canada.

Wazed's candidacy has raised uncomfortable questions in the international public-health community and sections of the media about potential nepotism in the WHO's election process, which was already under scrutiny for lack of transparency. In September, the highly respected medical journal The Lancet published a critical story drawing attention to Wazed's limited experience in public health and high-level leadership. It also carried an editorial raising concerns about the integrity of the WHO's regional offices, noting that in the South-East Asia region "one candidate is the daughter of the nominating country's Prime Minister." The editorial added: "These concerns threaten to delegitimise both the election process and the future credibility of elected WHO Regional Directors." The Lancet's red flags showed just how worrying Wazed's nomination is to the global public-health and medical community. Her candidacy has also raised concerns about possible conflicts of interest: if Wazed is elected to the position, she will be charged with providing independent and neutral policy advice on behalf of the WHO to her mother's government. The election for the position is due to be held between 30 October and 2 November, with one vote each for all the 11 countries included in the WHO-SEARO, barring Myanmar. 

The SEARO has thrown up only two candidates for this election, setting it apart from the WHO's other regions, which have multiple candidates to choose from in their equivalent elections. In the SEARO, "Bangladesh has been actively bullying nations to stop putting candidates forward so that their own candidate can have unopposed progress," Mukesh Kapila, a professor of global health and humanitarian affairs at the University of Manchester and a former director at the WHO headquarters in Geneva, told Himal Southasian. Bangladesh has also publicly called for Nepal's candidate, Acharya, to withdraw his nomination. 

Injurious to health

The SEARO includes 11 countries: Bangladesh, Bhutan, North Korea, India, Indonesia, the Maldives, Nepal, Sri Lanka, Thailand, Timor-Leste and Myanmar. These account for a quarter of the world's population, and the lion's share of the population of Southasia. The SEARO has high burdens of infectious diseases like measles, rubella and tuberculosis, of numerous neglected tropical diseases, of child mortality and nutritional deficits in women – and that is just to scratch the surface of the medical challenges facing its constituent countries. It also confronts new and growing threats from such things as non-communicable diseases and antimicrobial resistance. In the Covid-19 pandemic, the region has suffered some of the highest levels of excess mortality seen anywhere in the world. It is facing increasing numbers of heatwaves and other extreme-weather events due to climate change that are exerting even more pressure on health systems. Health systems in the region are inconsistent at best, and incapable at worst, in providing quality care to the people they are meant to serve. Large numbers of people here are often left to fend for themselves in public-health crises, as made clear in the pandemic. 

In this difficult scenario of stretched systems and underserved populations, the SEARO regional director provides important technical advice to member countries in improving their preparedness and health outcomes. The SEARO director must understand the nuances of wide-ranging public-health problems and provide leadership across the region with the potential to impact the health of roughly two billion people. In such a context, the director's qualifications and the process by which they are selected must be above any suspicion. A candidate who does not have credibility cannot have the authority needed to nudge national governments to do better on their health policies. 

"The WHO is the highest technical body for health in the United Nations system," said a former WHO official who spent nearly two decades in senior posts within the SEARO region and the WHO headquarters in Geneva. The former official spoke to Himal Southasian on condition of anonymity. While the UNICEF routinely carries out immunisation and nutrition-related programmes, the WHO is the only UN body whose mandate is to provide technical expertise related to health. Its role is an advisory one, where member countries are encouraged but not required to follow the WHO's lead. 

The organisation's regional directors are often the point people in dealing with health ministers. "They have to have some amount of prestige and knowledge and background to talk authoritatively to the minister of health," the former WHO official said. "If you go to my country, the regional director must know enough to tell my minister that 'here are other facts which show the issues that arise in your country.'" The WHO's own criteria for the post of regional director call for a candidate to have "public health background and extensive experience in global health." 

"Historically, the WHO-SEARO – the first WHO regional office – has had an impeccable public-health legacy of supporting the member states to eliminate major public-health scourges, from smallpox to control of the Covid-19 pandemic," Dr Rita Thapa, a prominent public-health expert from Nepal who has spent several years working with the WHO, said. "To effectively uphold such a demanding public-health legacy, the next WHO-SEARO regional director must possess the necessary technical and managerial competencies and exhibit political astuteness." 

The outgoing SEARO regional director, Poonam Khetrapal Singh, did not train in clinical medicine or public health but had a long career in the Indian Administrative Services before joining the WHO, working extensively at both the state and national levels of the Indian government. The former WHO official said that,through her wide administrative experience, Singh acquired enough public-health knowledge to do the job. Singh is currently serving the second of two five-year terms as the regional director, which she first assumed in 2014. At the start of her first term, she identified flagship programmes that needed attention, including efforts at ending tuberculosis and addressing antimicrobial resistance, and set clear priorities for the WHO's offices in the SEARO countries. A person currently working in one of the SEARO's country offices told Himal Southasian that Singh gave country offices clear direction and drove impact. The former WHO official described her performance in the job as average, and not particularly inspiring.

A major priority for the SEARO in the coming years is delivering access to universal healthcare (UHC) across the region. To achieve this, all citizens should get access to a range of health services even when they cannot afford to pay for them. Sri Lanka instituted UHC in the 1950s and Bhutan's free healthcare system covers about 90 percent of its small population, but other SEARO countries are not on track to meet their UHC goals as set by the WHO for 2030. The SEARO regional director will need to push this agenda forward, and will need deep knowledge of different approaches that can be employed to achieve UHC in the region. "The regional director needs to be aware of the very large picture of the countries," the former WHO official said. "They can't say, 'I know one area very well and so I can be a regional director.'" 

Left unsaid

The media in Bangladesh has not published any critical analysis of Wazed's nomination. A senior journalist from the country told Himal Southasian about an unwritten rule that journalists cannot talk about the first family critically. The senior journalist asked to remain anonymous out of concern of possible retribution. In 2015, the daily Prothom Alo ran a story on a controversy surrounding Sheikh Hasina's niece Tulip Siddiq, a British politician. Siddiq had accompanied Hasina on a state visit to Russia and was pictured alongside the Russian president, Vladimir Putin. The British press criticised Siddiq for this, and Prothom Alo reported on it. As a result, it lost all access to Hasina's office. The prime minister has since publicly vilified the newspaper, taking issue with other parts of its coverage. The senior journalist said Bangladesh's media has been reduced to writing promotional features about Hasina and her family. 

The Bangladesh press has reported on Wazed being recognised by the WHO in 2017 for her work on autism. Her most notable public-health role is as the chairperson of the Shuchona Foundation, which focuses on mental health issues and neurodevelopmental disorders. She has been in the post since 2014. The foundation appears to have benefitted from Wazed's proximity to the prime minister – it has been part of official events and Hasina has accepted donations for the foundation from several banks. "Sheikh Hasina herself raised the money [for the foundation] using her position and then her daughter became chairman of the foundation," the senior journalist said. The journalist added that Bangladesh had no dearth of good candidates for the WHO-SEARO role, but they stood no chance of securing a nomination against Wazed. Numerous experts Himal Southasian spoke to agreed that Wazed was not the most qualified candidate from the country. 

In the run-up to the SEARO election, Hasina and her government are believed to be actively pushing Wazed's candidacy at global forums. Wazed has joined her mother on several official international trips. In September alone, she travelled to the ASEAN Summit in Jakarta, the UN General Assembly in New York and the G20 Summit in New Delhi. In the wake of the concerns raised over possible nepotism and corruption, Wazed has also been sharing letters of support and endorsement from people associated with regional organisations that largely work on autism. 

While The Lancet and also the Financial Times have carried stories about the problems with Wazed's nomination, the Bangladeshi press has carried Wazed's defence of her candidacy. She has called the allegations of nepotism unfounded and highlighted her professional achievements, and also attributed criticism of her nomination to sexism. The Bangladesh government has also been framing her nomination as a win for women's rights. However, this carries little weight since Wazed is hardly the first woman to aim for a regional director's position in the WHO. The SEARO director's post has been occupied by a woman for the past decade, and a woman – the Saudi Arabian physician Hanan H Balkhy – was just recently elected to be the new director of the WHO's Eastern Mediterranean region.

Two-horse race

The circumstances of Balkhy's election differed significantly from the one Acharya and Wazed find themselves contesting. The election for the Eastern Mediterranean region had a choice of six candidates, and the one for the Western Pacific region had five, as opposed to just the two in the running in the SEARO.

The WHO, like any other body under the United Nations umbrella, is as much a political organisation as it is a humanitarian one. The candidate who gets the most votes will win. Of the 11 countries in the SEARO 10 will vote, since Myanmar's ruling military regime is disenfranchised under UN sanctions. The former WHO official pointed out that many of the SEARO countries – like Bhutan, Timor-Leste and the Maldives – are small, with populations of under a million, and each will have one vote. Meanwhile India, with its 1.4 billion people, will also have one vote. The ballot is also secret, adding to the lack of transparency in the election process. 

Thailand has already expressed support for Wazed. As far back as in March 2021, in a joint statement issued after the Indian prime minister Narendra Modi visited Dhaka, Bangladesh "thanked the Government of India for confirming support in favour of Bangladesh's candidate to the post of Director, South East Asian Regional Office of the WHO in 2023." 

Kapila, a veteran of international affairs, said that horse-trading was routine in all such elections. "People put up their candidates. They pursue their national interest, and then they do deals, they do trade," he said. "What I understand from reliable information, because people have spoken to me, is that Bangladesh is busy doing deals. It's promising investments, trade, and the way these things come is in return for votes." Nepal, meanwhile, "is an extremely poor country, and its foreign affairs are not as strong as Bangladesh, and they're unable to offer competing deals – and neither should they." 

Bangladesh gave Sri Lanka a USD 200-million loan in 2021 to tide the country over during its financial crisis, and also donated medicines earlier this month. On the sidelines of the ASEAN Summit in September, Bangladesh signed an agreement with Indonesia to cooperate on health and energy. Nepal recently signed a deal with Bangladesh to sell electricity to it, and is said to be facing pressure to not promote its candidate in return, the senior journalist from Bangladesh said. 

However, the Nepal government has continued to support Acharya, as have citizens' groups in the country. Speaking to Himal Southasian, Acharya said that he was grateful. "I have all the qualifications to be the regional director, you know, from leadership, management, technical background, working across the public-health areas, and working from grassroot level to the global level," he said. 

In response to emailed questions and a request for comment, including on the concerns being raised over her qualifications, Wazed wrote back: "Your line of questioning indicates to me that you are uninformed about my professional career over the last 20 years. I suggest you visit my website www.saimawazed.info and perhaps my LinkedIn profile as well."

The newly appointed SEARO director will take charge in February 2024. At the moment, the momentum is with Wazed, but countries have been known to change their votes at the last minute. The WHO has been under intense scrutiny over its appointments even before Wazed's nomination was announced. Earlier in 2023, it had to fire Dr Takeshi Kasai, the regional director for the Western Pacific region, for misconduct. "Considering the public-health challenges we are facing, it would be shameful to have the next WHO-SEARO leadership without adequate qualifications and experience in public health," Thapa said.

Kapila explained that having its nominee in the position of regional director did not bring any huge benefit to the nominating country. The current battle for the SEARO director's post has acquired such geopolitical dimensions because, "Bangladesh sees this, or because some countries can see this, as an expression of the national ego," he said

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