The resignation of Dr. Jonathan Mann as head of the World Health Organization's AIDS program is a serious blow to the global campaign to contain the AIDS epidemic. It inevitably raises questions about the leadership of Dr. Hiroshi Nakajima, WHO director general since 1988.
Mann launched the program in 1986, building on his work in Zaire for the U.S. Centers for Disease Control on the spread of the human immunodeficiency virus (HIV) that causes AIDS. From a staff of two and a budget of $500,000, he built the WHO program into a staff of 200, with program agreements with 155 nations and a budget of $109 million provided by voluntary contributions so as not to divert funds from the WHO budget. It became the largest single program in the organization's history, dwarfing other programs funded from the regular budget which is financed by assessments of member nations.
Much of the success was attributed to the energy and flexibility of Mann's highly personal leadership. He won international respect from public- health professionals and the confidence of leaders of nations beset by the spreading disease. He won praise for his professional and scientific work in mounting epidemiological and education structures to try to contain the infection, and for his ability to challenge and resist prejudice and ignorance that threatened the containment effort.
In all likelihood, it was Mann's imaginative personal leadership of the huge and independently funded program that was the source of conflict with the new director general. Nakajima has a reputation for strong personal management not distinguished by delegation of authority.
Nakajima has issued a statement regretting Mann's departure and renewing WHO's commitment to a "reinforced effort" to contain AIDS. Extraordinary reinforcement will indeed be required to fill the void left by Dr. Mann.