Paris

Pascoal Mocumbi (left) and Peter Piot are in the running to head the World Health Organization. Credit: AP

An African official is emerging as the front-runner to succeed Gro Harlem Brundtland as director-general of the World Health Organization (WHO) in May.

If he is elected, Mozambique's prime minister Pascoal Mocumbi will be the first African to head the WHO. The chances that Mocumbi will win a secret ballot of the WHO's 32-strong executive board to be held next week increased after his strongest African rival, former Senegalese health minister Awa Marie Coll-Seck, withdrew from the contest. Mocumbi says that he would resign from his current position if appointed to lead the Geneva-based organization.

Others shortlisted are Julio Frenk Mora, Mexico's health minister; Peter Piot, a former AIDS researcher who now heads the Joint UN Programme on HIV/AIDS (UNAIDS); Jong Wook Lee, a physician from South Korea, who heads the WHO's tuberculosis programme; and former Egyptian health minister Ismail Sallam. The World Health Assembly is expected to endorse the board's choice when it meets in Geneva in May.

The WHO is under strong pressure to end the political horse-trading that traditionally characterizes its elections. This time, The Lancet and the New York-based Rockefeller Foundation have organized a campaign to introduce greater openness into what they describe as the “secret and generally unaccountable process” of the election.

Critics of the election process say that it reflects the highly politicized workings of many international agencies during the cold war, and should be replaced by a more open and merit-based contest when the next director-general is elected in 2008.

Under pressure to fight an open campaign, candidates initially agreed to take part in a two-hour question-and-answer session on 19 January, set up by non-governmental organizations and the Interactive Health Network's World Health Channel, and broadcast live on the Internet. But several of the candidates pulled out of the session.

Each candidate has, however, taken up The Lancet's challenge to provide detailed responses on its website to ten questions about the WHO's future direction.