What the race for WHO’s top job means for Pakistan

Pakistan, that hosts one of the World Health Organisation’s (WHO) largest polio operations, is one of the countries most exposed to antimicrobial resistance and is among the most donor-dependent on immunisation and TB financing. That makes the contest to lead the WHO from 2027 more than a Geneva affair. Whoever is elected by secret ballot inherits an organisation rebuilding its finances after the United States’ withdrawal, and Pakistan is among the countries with the most riding on how that rebuilding goes.

One declared candidate already sits more closely to Pakistan than the others. Dr Hanan H. Balkhy, nominated by Saudi Arabia in late August for the 2027-2032 term, is currently WHO’s Regional Director for the Eastern Mediterranean, which includes Pakistan. A paediatric infectious disease specialist and the WHO’s first assistant director-general for antimicrobial r

esistance (AMR), she is one of the six candidates nominated for the role, alongside nominees from Qatar, Belgium, Botswana, Spain, and Indonesia.

Speaking to Business Recorder, Dr Balkhy addressed five questions on what her candidacy would mean for a country like Pakistan: polio funding, “country ownership,” antimicrobial resistance, vaccine manufacturing, and the significance of a Saudi nomination.

Polio: the scale is clear; the split is not

Asked how much of the $1.6 billion in additional programme resources she has mobilised across the region for polio and emergencies has actually reached Pakistan, Dr Balkhy did not give a figure. The number, she says, is regional: “covering polio and emergency programmes across 22 countries and territories.” What she offers instead is the size of the operations. “Pakistan is one of WHO’s largest polio operations globally,” she says, citing “more than 400,000 vaccinators mobilised, around 45 million children targeted in national campaigns, and one of the largest and most sensitive poliovirus surveillance networks in the world.” The next campaign, due to begin later this month, is expected to reach more than 31 million children in 115 districts.

On who keeps that pipeline funded if she moves from the regional post to Geneva, her answer is institutional rather than personal. “Responsibility for that pipeline sits with the institution, not one individual. There is an agreed transition plan with the new acting regional director, and polio remains a standing global commitment regardless of who holds either post.” The programme, she notes, is funded through the Global Polio Eradication Initiative and WHO’s country office, “with Pakistan, Saudi Arabia, and other partners contributing.”

The forward-looking commitment points to predictability. “As director-general, I would want funding for programmes like Pakistan’s polio effort to be more predictable,” she says, tying it to the first pillar of her campaign — trust, “Built on a more diversified and reliable donor base.”

“Country ownership” without abandonment

“Country ownership” is a phrase that is growing increasingly common in global health, so for countries like Pakistan, we asked if it meant more control or absorbing the costs the WHO can no longer cover. Dr Balkhy’s answer rejects the second reading without committing to specifics: “Country ownership should never become a euphemism for countries being left to manage alone. It means countries having a stronger voice in setting priorities, deciding what support they need, and being accountable for the results, while WHO and the wider global health community remain reliable partners in delivering them.”

She points to a Pakistani example she says she is “particularly proud” of: the launch, by the Government of Pakistan together with the WHO and 20 business leaders, of the country’s first WHO Council for Partnership with the Public and Private Sectors. The model, she says, “is spreading gradually across the Eastern Mediterranean region” and “creates space to address some of the most difficult, and often most burdensome, health challenges.”

Her summary of the relationship is concise: “countries lead; WHO listens, brings the best evidence and technical expertise, partners with the country to mobilise the support it needs, and holds itself accountable for measurable results.”

Antimicrobial resistance: from recognition to implementation

On AMR, when asked about the nature of the problem, Dr. Balkhy was direct: It is a “phenomenon rather than a disease per se,” driven by “poor hygiene and the misuse of antimicrobial agents in both the human and animal sectors,” and aggravated by conflict, overcrowding, and poor sewage infrastructure. “It is a silent pandemic and affects all countries in different ways”, she says.

She credits Pakistan with a concrete step: in late 2025, its National Institute of Health and the WHO published the country’s first national priority pathogen list, “against a burden of over 200,000 attributable and associated deaths a year. That country-led, evidence-based foundation is exactly the measurable impact I want the WHO to deliver.”

The question of who pays got a process rather than a name. Her role as director-general, she said, would be to “work with Pakistan and other member states to embed AMR into their national health investment plans, and to convene governments, the private sector, researchers, and financiers around sustainable models for surveillance, stewardship, and access to effective medicines.” No specific financier or financing mechanism was named.

Vaccine manufacturing: realistic, but “phased”

The fourth question asked whether technology transfer and local manufacturing under the Pandemic Agreement are a realistic ask for a country like Pakistan. Dr. Balkhy’s answer distinguished between two horizons. The agreement, she says, commits parties to support geographically diverse production and technology transfer, including through WHO-coordinated regional hubs.

But for Pakistan, “the realistic near-term path is participation in regional manufacturing and technology-transfer partnerships, alongside strengthening its own regulatory system so it is investment-ready when opportunities arise.”

In other words, near-term participation in regional efforts rather than a domestic vaccine plant. She notes she has “already prioritised our support for strengthening Pakistan’s regulatory authority,” and that Pakistan is twinning with Egypt on the latter’s hepatitis C elimination agenda. Her promise as director-general was to make the agreement’s provisions “operational rather than aspirational” — with a qualifier she states herself: “implementation will be phased and depends on partners willing to transfer that know-how.”

The Saudi question

The final question addresses the political subtext: a Saudi national, nominated by Saudi Arabia, running for a post that shapes health funding in a region where Gulf capital is increasingly active, including in Pakistan. Dr Balkhy declines the premise that WHO leadership steers that flow.

“Gulf countries have become significant health partners, but that trend is led by those countries themselves, not something WHO leadership shapes from Geneva,” she says. “WHO director-general is not a national position. If elected, my responsibility would be to all 194 member states.” It is worth noting that the Gulf is not a single lane in this race: Qatar has nominated its own candidate, Dr Hanan Al Kuwari.

What the answers leave open

Dr Balkhy’s responses set out a coherent frame, built around her campaign’s three pillars of trust, impact, and value, and a consistent argument that health security is shared across borders. What they do not supply, on the questions most specific to Pakistan, are figures: Pakistan’s share of the regional polio funding, the identity of AMR financiers, or a timeline for domestic manufacturing capacity. Those are the details donor-dependent health ministries will be watching for as the race moves towards a decision. For a country whose polio, immunisation, and AMR programmes depend on predictable external financing, predictability of the kind she promises is the test that matters.