Hiroshi Nakajima

Hiroshi Nakajima (born May 16, 1928, Chiba City, Japan—died January 26, 2013, Poitiers, France) Japanese physician and director general of the World Health Organization (WHO; 1988–98).

Nakajima studied at Tokyo Medical College, where he received a doctorate in 1954. He then went to the University of Paris, where he specialized in neuropsychopharmacology, the study of the ways in which drugs influence behaviour through their effects on the brain and nervous system. Beginning in 1958, Nakajima conducted his research in neuropsychopharmacology at the French National Institute for Health and Medical Research in Paris. In 1967 he accepted a position as director of research and administration at the Nippon Roche Research Centre in Tokyo. After joining the WHO in 1974, he spent several years at the organization’s headquarters in Geneva, where he was appointed chief of the Drug Policies and Management Unit in 1976. From 1979 to 1988 he was assigned to Manila, where he carried out the WHO’s health programs as director of its Western Pacific region.

As Nakajima’s second term in Manila was drawing to a close, the WHO was preparing to celebrate its 40th anniversary and choose a replacement for Halfdan Mahler of Denmark, whose term as director general was due to expire in May 1988. In January 1988 the executive board of the WHO recommended that Nakajima be elected the WHO’s fourth director general. Four months later the general assembly of the WHO approved the recommendation, and on July 21 Nakajima became the first Japanese to head a United Nations (UN) agency.

Some months after assuming office, Nakajima returned to Japan to ask for greater cooperation and assistance. He also urged the government to be more aggressive in promoting the WHO’s health programs. Nakajima launched campaigns to fight infectious diseases, especially AIDS, malaria, tuberculosis, and dengue fever. He also put great emphasis on preventive medicine in the form of vaccinations for children. His enthusiasm for such programs derived in part from his visits to remote areas in Africa and elsewhere. Despite such efforts, Nakajima endured significant criticism in 1990 after Jonathan Mann, head of the WHO Global Programme on AIDS (GPA), resigned. Mann, widely credited with galvanizing a worldwide effort to combat the then-incipient AIDS pandemic, cited conflicts with Nakajima as the cause of his resignation. In particular, Mann disagreed with Nakajima’s decision to reallocate funding and resources intended for GPA to other projects.

Nakajima’s election to a second term seemed to be taken for granted until June 1992, when Algerian neurosurgeon Muhammad Abdelmoumene announced his candidacy for director general. He had been second in command at the WHO until Nakajima fired him. Abdelmoumene’s chief support came from the United States, France, and other European countries. An unexpectedly bitter battle ensued. While Japan lobbied hard in support of Nakajima, his critics charged that he lacked management skills, leadership qualities, and an ability to formulate and enunciate ideas. Nakajima was also accused of bypassing budgetary procedures in allocating WHO funds. Critics claimed that the WHO was in disarray and that morale was low as a result of Nakajima’s mismanagement.

At the same time, some Western media accused Japan of threatening to slash imports from less-developed countries that did not support Nakajima’s reelection. Japan vehemently denied this and all other charges. In January 1993 the WHO’s executive board recommended (18–13) that Nakajima be nominated for a second term. An investigation of accusations that he had approved WHO contracts for members of the executive board in exchange for assuring his renomination cleared him of wrongdoing in March 1993. When the World Health Assembly convened in May 1993, Japan and its Third World allies prevailed. Nakajima was reelected by a vote of 93–58.

In August 1994 Nakajima traveled to Japan for the 10th international conference on AIDS. Among the 10,000 public health officials, researchers, patients, and journalists in attendance were representatives of the WHO, who had prepared extensive data on the current status of AIDS around the world. Earlier that year a measure had been introduced to unify the AIDS initiatives of the WHO with those of various programs organized by the UN, including the United Nations Children’s Fund (UNICEF), the World Bank, and the United Nations Educational, Scientific, and Cultural Organization (UNESCO). The goal was to combine these programs under the aegis of a single governing body by 1996. The result was the Joint United Nations Programme on HIV/AIDS (UNAIDS), an organization that by some accounts Nakajima actively worked to undermine in order to regain political control of the issue.

Nakajima continued to champion efforts to combat other diseases. In 1995 he advocated for the increased use of a new approach to tuberculosis treatment, the directly observed treatment short-course (DOTS), which had been shown to increase cure rates in India. DOTS required that doctors observe patients while the patients took prescribed tuberculosis medications. It also required the active participation of individual governments and demanded political commitment and government financing for human and laboratory resources, training, and management. Thus, DOTS was successful because it ensured not only that patients took the drugs correctly and for the entire course prescribed, but also that a constant supply of drugs and funding for human resources were in place.

In May 1995 a resolution demanding Nakajima’s resignation was introduced at the WHO annual meeting after comments he made about Africa were construed as racist. The resolution was later withdrawn. In 1997 Nakajima announced that he would not run for reelection. He stepped down in July 1998 and was replaced by physician and former prime minister of Norway Gro Harlem Brundtland.