The shape of the global response to HIV/AIDS is likely to be changed, one way or another, by the election next week of a successor to Gro Harlem Brundtland at the head of the World Health Organization (WHO). Dr Brundtland, the former Norwegian Prime Minister, announced last August that she was stepping down as WHO Director-General.
UNAIDS head Dr Peter Piot is one of the contenders and his appointment, should it happen, would inevitably spark a rethink about the proper relationship between WHO, UNAIDS and the Global Fund to fight AIDS, TB and Malaria.
The most senior politician, Dr Pascoal Manuel Mocumbi, Prime Minister of Mozambique, is from a country with a generalised HIV/AIDS epidemic compounded by TB, in which he previously served as health minister and foreign minister.
The one WHO insider, Dr Jong Wook Lee, from South Korea, heads WHO's Stop TB programme and has previously been responsible for immunisation programmes. TB is massively, and increasingly, connected with HIV in many of the countries where control of the disease is most difficult. WHO has a key role in developing strategies for the delivery of effective vaccines which will, in turn, determine the usefulness of any new vaccines that may be developed against AIDS, TB or malaria.
The election, by the WHO Executive Board, is due to be held at their next meeting, in Geneva, from 20 to 28 January. The 32 members of the Executive Board consist of health ministers and officials from a diverse assortment of countries, with Myanmar in the chair. Ethiopia is the largest African country represented and stands out as having the most severe HIV/AIDS epidemic, although Brazil, China, Russia and the USA each have hundreds of thousands of people living with the virus. The UK is a member of the Board and will be represented at the meeting by Chief Medical Officer Sir Liam Donaldson.
In the first stage of the election process, five candidates will be chosen by secret ballot out of the seven declared*, to form a short-list for interview. Each of the five will then give a presentation to the Board, and be questioned on it, before a final ballot, or series of ballots, is held on 28 January. Just one candidate will then be put forwards for formal election at the World Health Assembly in May 2003.
The former Egyptian Health and Population Minister, cardiac surgeon Ismail Sallam, may be a challenger to Dr Mocumbi. He is credited by his supporters with revitalising Egypt's healthcare system and acting in support of women's rights, taking strong measures to outlaw female genital mutilation in Egypt. There is reported to be a strong feeling among middle-eastern and North African countries that their region is under-represented at senior levels in the UN, and Dr Sallam appears to have stronger credentials than the other candidate from the region, former Lebanese health minister, Dr Karam Karam.
Dr Julio Frank Mora, the Mexican Health Minister, is a public health expert who - it is said - will not have the support of Brazil which took exception to a controversial WHO report in 2000, jettisoning the 'Health for All' framework previously championed by the organisation, with which he was closely associated. Should he be seen as overly close to the US administration, this could count against him with countries such as North Korea, Myanmar, Iran, Cuba, Venezuela and others on the Executive Board.
Dr Joseph Williams, a parliamentarian and former Prime Minister of the Cook Islands, in the Pacific, appears to be too much of an outsider to be a serious contender.
The international medical journal, The Lancet, has been running a series of articles on this election - available free of charge on its website here which include detailed responses from most of the candidates (Julio Frank Mora is the exception) to ten questions about the future direction of WHO.
* The one female candidate, Dr Awa Marie Coll-Seck, Senegal's health minister and former UNAIDS Policy Director, has now withdrawn from the election.