The Japanese Knot in the World Health Organisation

By Theo Klein
De Volkskrant 2 May 1990

It gives you a bit of a shock to stand face to face with the bronze statue of Ryoichi Sasakawa in the head office of the World Health Organisation (WHO) in Geneva. It doesn't look the most obvious place to pay tribute to the probably most controversial Japanese nationalist.

But it really is him; the Sasawaka, even before World War II the founder of the fascist party Kokusui Taishuto, who especially dedicated himself to indoctrinating the Japanese youth. After the war he was imprisoned by the Americans for three years for war crimes committed in China.

According to the text on the pedestal the meanwhile 91-year-old is now "friend of the World Health Organisation". It is not difficult to see why. In recent years the immensely rich Japanese has become the biggest private donor of the United Nations. Within this organisation the WHO is his darling.

With 100 million dollars Sasawaka founded the Saswaka Trust Fund and amongst other things he supports the WHO fight against leprosy with many millions. Every year the Sasawaka Price (100 thousand dollars) is awarded to people who made themselves useful in the improvement of public health.

Next Wednesday that honour falls to three winners, among whom Cardinal Angelini. Sasawaka can allow himself to be generous. After the war he collected billions during the reconstruction of the destroyed wharves in Japan. Besides, he controls the popular betting on motorboats. In the Japanese press Sasawaka is described as the Godfather, owing to his powerful manipulating behind the political scenes. By means of his influence and his donations he's trying to correct the historic view of himself and Japan.

His critics still consider him the dangerous fascist who is trying to explain away the Japanese atrocities in World War II. In January a riot broke out at York University in Canada, when it appeared that the board had accepted a million dollars from one of Saswaka's foundations.

Harry Arthurs, chairman of the board, defended the decision by referring to similar donations that had earlier been accepted by prestigious institutions as Berkeley, Princeton and Oxford. The University board assumed that Sasawaka wants to make up for faults in the past with his donation.

This should be possible, half a century after the war, the board reasoned. The member sates of the UN already adopted that opinion a long time ago. And not only when Sasawaka's money is involved. Japan should finally take its position in global forums, which it deserves seeing its status and rapidly increasing financial contributions, is the opinion of Japan's government as well.

For some years Tokyo has been claiming those positions in the organisations. The first exponent of this change of course was Hiroshi Nakajima, who was founded director-general of the WHO. Thus he became the first Japanese to hold a high UN position. The very reason led to him being followed with extra attention.

The combination Nakajima-Sasawaka at once led to speculations. Immediately after the election of Nakajima rumour spread that delegates had been bribed. In the corridors of the Palais des Nations, where this week and next the 43rd assemblée of the WHO will be held, there is still scornful talk of the 24 Toyota ambulances with which Sasawaka is said to have bought Malawi's vote for his countryman. Pictures showing the delivery of the "loot" circulate in the building.

Therese Gastaut, spokeswoman of the director-general, reacts furiously. "Sure I know those stories", she says. "They are ridiculous. It's an offence tot think that countries allowed themselves to be bribed. It is so unfair; it was only suggested because Nakajima and Sasawaka are Japanese."

According to the Frenchwoman it is purely coincidental that the biggest private donor of the WHO and the director-general are from the same country. Nakajima earned his position, he didn't buy it. With an emotional argument she spoke in defence of her boss, who has been exposed to severe criticism for months now. "Undeserved attacks from a few people who cannot stand Nakajima and who want to have personal matters out via the WHO."

Gastaut emphasises that Sasawaka was not brought in by Nakajima, but by his predecessor Halfdan Mahler. The annual donations of the multimillionaire to the WHO were already fixed the moment Nakajima took the position in 1988. The member states had accepted that long before. Nakajima didn't use this, according to Gastaut. "And that statue of Saswaka, should we take that away again?"

Persistent rumours about corruption fit the atmosphere of distrust that has increased at the WHO the last few months. A number of donors, amongst whom the Netherlands, find Nakajima's style of rulership hard to stomach. The Japanese approach of the director-general causes chaos and threatens to lead the WHO into disaster.

In a leaked out report from the Dutch representation in Geneva to Minister of Foreign Affairs Van den Broek, as to this words were used that were quite explicit. Conversations with employees of the WHO, who without exception want to stay anonymous, confirmed the picture described this week.

Nakajima uses a autocratic style of rulership. He has surrounded himself with a number of faithful with whom all decisions are pre-digested. Without noticeable participation changes in the organisation and staff are made. Managers returning from their holidays learn that their department has been abolished, or that they themselves have got another position.

"Sometimes decisions are prepared behind closed doors for months to be announced by circular letter overnight", according to the Dutch report. According to insiders it mirrors the way boards of Japanese firms treat their personnel.

This has stirred up bad feelings with the on the whole western staff (4500 people work at the WHO). A European employee: "You don't know where you stand anymore. Decision making is completely unpredictable. This has a paralysing influence on those people who are used to clarity and responsibility of their own. Everything is stalling."

From the Dutch secret memorandum: "It goes without saying that this style of rulership affects the apparatus in a highly demotivating way. Morale is decreasing. (...) The urge for innovation and initiative are put under pressure. Enthusiasm has made way for suspicion. Nakajima is feared by many, and commands respect with few people."

At the head office of the WHO people think back wistfully about the years under Mahler. This Dane reforged the WHO from a sluggish technocratic organisation to an efficient apparatus, tuned to improvement of health care in the Third World.

Mahler directed the WHO activities clearly at aid to the very poor; the apparatus was put into action for Primary Health Care. He knew how to inspire his people and the donors. He linked up health care, education, hygiene and diet. The fact that he strove for social changes was not appreciated by al governments.

Wilbert Bannenberg, spokesman of Health Action International, which follows the WHO critically: "From Nakajima's entire approach appears that obviously he's paying less attention to this. He's a technocrat, not a passionate man like Mahler. Verve is lacking. On paper it still continues, but the tendency has definitely changed."

With this he touches directly the interests of the main donors of the WHO, who want to continue Mahler's policy. The organisation is actually financed by fifteen European countries, the US, Canada, Australia and Japan.

In order to prevent everything at the WHO getting bogged down into a sluggish bureaucracy, they finance the big programs such as the AIDS program and Essential Drugs Program (EDP) apart from the WHO budget that has been frozen for years. In this way they keep a maximum of control over the programs which they consider the most important.

Thus the US pay the lion's share of the AIDS program, and the Netherlands and Denmark are the main financiers of the EDP. This year the programs for the special programs even exceed for the first time the usual WHO budget (650 million dollars).

According to insiders in Geneva that construction is a thorn in Nakajima's flesh. "The managers of the special programs have always operated quite independently. Mostly they are strong characters, who also bring in donations personally. Nakajima cannot stand the fact that all splendour reflects on those barons."

The Japanese director made his intentions soon clear. Three days after taking up his position he took the first measures to discuss the freedom of action of the director of the EDP program, the Dane Ernst Lauridsen. He was slowly but surely side-tracked. Nakajima recruited the Italian pensioner Fattorusso as head of the department.

Lauridsen drew the obvious conclusion and left. Fattorusso is among the employees who are absolutely loyal to their Japanese boss. In the 1980s the Italian co-operated with Nakajima on the Philippines. An employee of the EDP program: "For Nakjima's choice quality is not important, but loyalty. Therefore that man cannot stay much longer. If it was limited to Nakajima, it wouldn't be that bad. We would survive those three years. But he's employing so many uninspired people. If this continues for three years, the WHO will still be left with the consequences in the next twenty years."

In March the second viceroy, Jonathan Mann, director of the AIDS program, was guillotined. Within five years the American had expanded the WHO activities against AIDS into an extensive and successful program, the donors of which provided 100 million dollars annually. He resigned overnight.

In the 'New Scientist' the American tells why. According to him Nakajima is insufficiently dedicated to the program. "The epidemic is getting worse, but the director-general assumed an attitude of 'business-as-usual', according to Mann. He got tired of waiting for months for the necessary decisions at the top of the WHO organisation.

There was no reply to Mann's request to investigate what action the member states had taken against the discrimination of carriers of the HIV virus, which causes AIDS. Almost all important dossiers were dealt with in this way, according to Mann. When Nakajima forbid him to attend a meeting in Copenhagen, that was the limit for Mann and he resigned to the utter astonishment of all concerned.

According to insiders in the WHO circles "calamities" like that could be foreseen when Nakajima took up his position. The 61-yer-old Japanese was already known as a little inspiring ruler, who had a dislike of meddlesomeness in the Third World. Before he came to the WHO, he had been working as a research director at Hoffmann-La Roche for some years.

His reputation that he is kind to the pharmaceutical industry dates back to that period. Before Nakajima came to Geneva he headed the regional WHO office in Manila. "He ran the staff of over 200 as the head of the family", according to a spokesman in Geneva.

When in 1988 Nakajima unexpectedly put up for the highest WHP position, the western countries in particular had doubts about his management capacities. With the exception of France and West Germany they favoured the Brazilian rival candidate Carlyle Guerra de Macedo.

Three votes appeared necessary to force a decision. Eventually Nakajima won 17-14. Since then the sombre expectations have come true. The WHO has no momentum anymore. The organisation threatens to slide down to the washed-out level of the food organisation FAO and the Unesco, which is still coping with the results of many years' mismanagement.

Not that the WHO is suffering under a dictatorship, the way the Senegalese M'Bow ruled UNESCO, but the autocratic system of Nakajima, which probably works in Japan, makes Geneva bristle up. Within two years the director has isolated himself almost completely from his surroundings, which does not help his position.

The WHO employees who under Mahler established with pleasure that the authority of their organisation increased, fear they will lose ground through the aloof attitude of their highest boss. Nakajima wants to get rid of the paternalistic attitude that the WHO according to him, sometimes assumes. He thinks the countries in the Third World should decide themselves what they need, for instance necessary drugs.

According to the critics this offers ample possibilities for the pharmaceutical industry. Under Mahler they worked energetically on the EDP, which wants to restrict the sales of drugs to developing countries and give priority to a strictly necessary package.

That made the Dane unpopular with especially the large German, American and Japanese multinationals, who saw billions of sales in jeopardy. Under Nakajima the atmosphere has been improved considerably, the world federation of pharmaceutical manufacturers IFPMA admits.

Jean-Francois Gaulis, spokesman of the IFPMA in Geneva: "This year we agreed for the first time on a declaration of intent about co-operation with the WHO. We also are in favour of restriction of drugs that governments in the developing countries should be able to supply. But beside that we want to keep our private market. We do not intend to take up the position of the Health Minister. Neither does the WHO. Our organisations co-operate in many fields: supplying drugs, distribution, investigation and education."

During the official part of the 43rd assemblée one could hardly notice the opposition against Nakajima. The director-general was seated high above the 1200 delegates from 167 countries, who droned their typed speeches in a sleep-inducing manner. Meanwhile specialised groups were working behind closed doors on decisions on for instance the AIDS programme, the limitation of drugs export to the Third World and accentuating the code for baby food.

Most attention was drawn towards the second attempt of the PLO to gain membership. For a long time the WHO was spared political debates, because of which it could dedicate its time and energy to health care. Last year this changed. Especially the US blame Nakajima very much that he didn't succeed in keeping this tricky matter from the agenda.

By clumsy action of the director-general the application of the PLO was adjourned for one year in 1989. His bungling gave the Japanese government cause to put the professional diplomat Hiromi Sato next to the director-general. This week the delegations were busy finding a compromise.

The American Secretary of Foreign Affairs Bolton made it very clear that his country would withdraw all donations to the WHO if the PLO would have it their way.

The US are one of the donors that are in a position to determine Nakajima's fate. Officially Washington is fully backing the Japanese director-general. But in informal talks the Americans also make it known that they will not shed a tear for him. In the corridors and on the lawns of the Palais des Nations there was much speculation on Nakajima's successor. After the blow that The Hague unintentionally delivered the Japanese top-ranking official in January, the Dutch delegation do not commit themselves.

The leaked out report of minister Van den Broek forced ambassador Boddens-Hosang to a whitewash announcement to Nakajima. Formally the Netherlands do not have much to find fault with the director-general. Meanwhile observers in Geneva wonder how long the donors are going to tolerate Nakajima's activities.

From the report to Van de Broek: "The time seems near to unmistakably signal Nakajima that this can't go on." A diplomat in Geneva: "Eventually it will be the Japanese government who will have to take the plunge. The question is if there should be another Japanese, and if that is possible without loss of face." *