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JONATHAN MANN, the director of the Global Programme on AIDS at the World
Health Organization in Geneva, announced his resignation last week. The
surprise move has aroused misgivings among researchers and officials about
the future of the AIDS programme, and reflects a growing crisis in the management
of the UN agency.

Mann cited a ‘great variance’ between himself and the WHO’s director
general, Hiroshi Nakajima, as his reason for leaving. He will go in June,
at the end of his current two-year contract.

Nakajima accepted the resig nation, but was unavailable for comment.
Staff at the WHO fear Mann’s departure will spell disaster for the Global
Programme on AIDS, which under his four-year tenure became the leading international
agency coordinating study and control of the infection.

Mann says he is leaving because Nakajima is not, in his view, sufficiently
committed to the fight against AIDS. ‘The epidemic is worsening,’ he says,
but Nakajima wants to take a ‘business-as-usual’ approach to AIDS.

In the two years since Nakajima took over at WHO, ‘there have been constant,
unconscionable delays, of months and months, in actions I consider important’,
says Mann. ‘I couldn’t be responsible for directing a programme of words
rather than actions.’

Mann says he asked Nakajima more than two months ago to ask member states
of WHO if they have enacted policies to prevent discrimination against carriers
of HIV, the virus that causes AIDS. The member states voted to do so two
years ago. ‘That initiative, like virtually all important initiatives, has
been stalled on his desk for months,’ says Mann. The US would have been
among those embarrassed by such an inquiry. Mann recently criticised the
American policy of screening for HIV carriers among applicants for visas
to enter the US.

Another concern, says Mann, is ‘how AIDS drugs and vaccines can be made
available to the whole world, and not just to the rich’. Leaving matters
as they are, he says, will lead to ‘a repeat of the hepatitis B story’.
A safe vaccine against the hepatitis B virus, which kills two million people
a year, has been derived from recombinant DNA. It has not been widely administered
to the people in Asia and Africa who need it, because it costs too much.

‘I have pleaded with the director general to take the initiative, which
only he can take, to bring together pharmaceutical companies, academics,
researchers, funding agencies and countries to talk about how we can change
the status quo,’ said Mann. Nothing, he says, has been done.

Mann denies reports, backed by some of his colleagues, that he opposed
Nakajima’s insistence on working through the six regional offices of WHO,
and not directly with health authorities. Nakajima denied permission in
February for Mann to attend a meeting at WHO’s office in Copenhagen on AIDS
in Eastern Europe. ‘That is not something that would have made me quit,’
says Mann. ‘But what does that say about (his) commitment to this problem?’

Mann’s departure comes at a time of growing demoralisation at the WHO,
centred on Nakajima’s management. Staff say he has ‘unceremoniously’ replaced
programme directors. Top jobs, including assistant directors general, have
not been officially filled, but are held by ‘acting’ retired staff who have
received their pensions as well as the positions’ salaries.

Some at WHO have criticised the amount of resources devoted to AIDS,
which kills far fewer people than diarrhoea or malaria, which get much less
money. Mann says Nakajima may have had problems with the fact that ‘AIDS
is by a factor of three the largest programme at WHO’. The AIDS programme
has $100 million per year, all donated in addition to the WHO’s regular
budget of $340 million per year.

Nakajima was formerly head of the WHO’s regional office for Asia in
Manila, and campaigned to be elected after the resignation of Halfdan Mahler
in 1987.