With two months to go before the election of a new director-general of the World Health Organization, the outcome remains far from clear. The process has worked well until now, whittling down six strong and diverse candidates to three. These are now engaged in a gruelling round of interviews and public debates.

The choice is between Sania Nishtar, a Pakistani cardiologist with particular strength in non-governmental health work who has also had ministerial experience; Tedros Ghebreyesus Adhanom, an Ethiopian former health minister who built a respected community health worker network; and David Nabarro, a British senior UN official who helped co-ordinate the responses to pandemic flu and Ebola.

Each candidate has drawbacks, and none has so far significantly differentiated themselves on fundamental but sensitive issues.

These include relations between the Geneva HQ and the quasi-autonomous regional organisations within the WHO, and how to prioritise in an agency facing tough budgetary pressures, criticisms of inefficiency and mission creep.

Judging by an informal @FT_Health Twitter poll after a public debate in Geneva this week, Tedros Adhanom was marginally in the lead. But that says more about who is active on social media than the pressures influencing the world’s health ministers when they cast their votes in May. This race will be determined by the candidates’ track records, the ability of their countries to provide support, and complex wider political trade-offs. The decision is far from made.

You can watch the Geneva debate here.


Three questions . . .

Lilianne Ploumen, Dutch minister for foreign trade and development co-operation, launched the She Decides initiative to replace $600m in international family planning support that is in jeopardy after the US said it would no longer aid organisations that offer or provide information on abortion.

How serious is the US decision?

I think there will be a huge impact on the lives of women and girls. The Guttmacher Institute estimates that for every $10m less spent on family planning, there will be 200 more maternal deaths, 38,000 more abortions — including 30,000 which are unsafe — and 95,000 more unintended pregnancies.

When you are in the US in April, what will you say to the administration?

The US has been a great partner in the past, and Donald Trump has stood up for women’s rights. Every democratic government is entitled to its views and there is a strong pro-life sentiment. I’m a Catholic myself and I think everyone should be able to make their own decision — and an informed decision. But the impact will be more abortions not less.

What are your plans for She Decides?

We have had really amazing support from 57 countries with €181m in pledges. We need to raise $600m a year with all kinds of activities, with citizens, countries and foundations, through events and on the margins of international conferences. We will keep going.


News round up

Vaccine benchmark How effective are pharmaceutical companies at increasing vaccination rates? The Access to Vaccines Index, launched this week, aims to answer this question by analysing corporate R&D activity, drug registration, pricing, manufacturing and supply. The index paints a mixed picture of industry efforts. (Access to Medicine Foundation, The Lancet)

Many of the world’s 1.5m child deaths could be prevented by more timely immunisation but the problem is not just supply of drugs. India faces strong opposition to vaccination programmes on social media, while others fear the US president’s alleged scepticism about the value of vaccines could make the problem worse. (Scientific American, Vaccine Confidence Project, Impatient Optimists) 

Antibiotic action The US Centers for Disease Control and Protection detailed investments in antibiotic resistance, as fears were raised over the agency's funding. (CDC, Stat). Campaigners stepped up their fight against the WHO’s “baffling omission” of a TB superbug from its “priority pathogen” list. (Letter to the FT)

Longevity More educated people live longer, new OECD data show. At the age of 25, the gap in life expectancy between high and low-educated people is on average eight years for men and five for women. This inequality is highest in Hungary, Czech Republic, Latvia and the lowest in Italy and Canada. (OECD insights).

Trumpcare’s birth pains US Republicans’ plans to replace Obamacare came under fire from all sides: Conservatives attacked them for offering healthcare tax credits and for the delay in curbing the expansion of Medicare. Democrats and the American Medical Association said Trumpcare was regressive and limited access to care for too many. The FT looked at the likely impact on healthcare investors. (FT, Politico, NYT). Keep up with the developments in the legislative process at www.ft.com/health.

Drug prices A tweet from President Trump on Tuesday about greater competition in the drug industry sent pharma stocks reeling (again). (Bloomberg)

US drug companies often cite R&D costs for such high prices, but new research questions the claim. (Health Affairs)

Sweet spot The UK’s sugar tax has bought in less cash than expected, the chancellor said in his annual Budget statement, partly because manufacturers are lowering the content of the sweet stuff in their products. Nestlé said it would remove 10 per cent of sugar from all its snacks in the UK and Ireland by 2018. (FT, Guardian). In the US, regulators struggled to come up with a workable definition of healthy food. But, in more encouraging news, sales of bottled water have finally overtaken bottles of soda. (Stat, WSJ)

Social care The UK government promised an extra £2bn for social care to ease pressures on the NHS. Delays leaving hospital due to inadequate care provision have doubled in five years, the IPPR think-tank said. A government panel is separately looking at alternative funding models in countries such as Japan and Germany, as well as Uber-style tech initiatives. (FT, IPPR) 

Yellow Fever is back After Dengue, West Nile, Zika and chikungunya there is a new arbovirus in the Americas: Brazil has been hit by yellow fever. US officials have expressed concern. (NEJM, Washington Post)

Bird flu Malaysia reported its first H5N1 outbreak in nearly 10 years while the H5N6 strain in South Korea brought more culls, bringing the winter total to 35m — more than a fifth of the country’s poultry. (NEJM, Times of India)

Alzheimers Total annual payments for Alzheimer’s care in the US have now passed $259bn. (Alzheimer's Association)

Something in the air Excess emissions from Volkswagen cars will lead to 1,200 premature deaths in Europe, according to researchers at MIT. The World Health Organization said polluted environments caused 1.7m child deaths a year. (MIT News, WHO)

Marking International Women’s Day Strategies for women in leadership roles ; profiles of pioneering women in global health; discussion (audio) on gender inequalities and improving health outcomes; and a look at how Afghan nurses are overcoming cultural norms to serve a country with serious health burdens. (Imperial College, Health Policy and Planning, Global Fund)

Health in a war zone How staff at a Mosul hospital are restarting services after three years of Isis rule. (FT)

Medicine and mysticism: The unproven therapies on offer at top US hospitals. (Stat)

Digital developments With healthcare and technology two of the country’s hottest investment areas, Chinese health apps have attracted plenty of private capital and venture funding. But the inability of these companies to turn a profit is making investors think again. (FT)


Best from the journals

Heart problems: Almost half of US heart-related deaths are linked to bad eating habits. (JAMA)

Social media: How Facebook, fake news and friends are warping your memory. (Nature)

Policy: Redefining universal health coverage in the age of global health security (BMJ)

Obesity: How the condition is becoming more acceptable.(JAMA)

Tanning: More efforts are needed to reduce indoor tanning and prevent skin cancer. (JAMA)

Dementia: What can we conclude from research on dementia trends? (PLOS)

Cryopreservation: New hopes for bringing back organs from the deep freeze. (Science and Stat)

Pheromones: They don’t work like we think they do. (Royal Society)


Podcast of the week

The Siri of the cell — how language processing is allowing scientists to talk to the cells of our bodies. Recent developments have huge implications for human biology and the fight against diseases such as cancer. (Guardian “Chips with everything” series, 15m)


You may have missed

FT Health issue 1 and issue 2.

Sign up for the Friday email at www.ft.com/fthealth.

FT Masters of Science series
Neuroscience: understanding the brain is the key to beating counterfeiting
Ageing: new developments that give us hope we can turn back the years

FT Magazine The problem with facts — as foreshadowed in the battles between big tobacco and scientists

Latest news at www.ft.com/health and on Twitter @FT_Health


Coming up

WHO LEADERSHIP Join Andrew Jack and David Heymann from Chatham House — and formerly of the WHO — for a Facebook Live discussion next week.

US AID Perspectives on US investment in international development. Online discussion from the Center for Global Development, Monday March 13. 


Parting thought

The world celebrated the achievements of women this week. But despite forming a large part of the global work healthforce they are still massively under-represented in leadership roles. Concerns over sexual and productive rights are also growing. The fight for equality is clearly far from over.

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