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Jim Kim is Not a Shoe-In to Run the World Bank

Posted on by Laurie Garrett

President Barack Obama today named Dr. Jim Yong Kim as his nominee to head the World Bank. Kim, who currently serves as President of Dartmouth College, is a physician and anthropologist: A professional combination never before put at the helm of the Bank.

Though he clearly wanted the job very badly, campaigned hard and was nominated by the government of Kenya, Columbia University’s Jeffrey Sachs today endorsed the Kim selection. Since the Bank has always been led by a White House-selected individual, it would seem that Jim Kim is de facto the new President of the World Bank. He is – if the Bank’s Board follows “gentleman’s protocol” and automatically votes in the U.S. choice. Since the Bank’s founding in 1944 the U.S. has consistently been the major donor to the Bank, and selected its leader, which was rubber-stamped by the Board.

But before we wax upon Kim, and the risks his choice may hold, it must be noted that two other very strong contenders have been nominated, one from Africa, the other from Latin America.

Dr. Ngozi Okonjo-Iweala is Nigeria’s Minister of Finance and former Managing Director of the World Bank. Officially nominated by her country, Okonjo-Iweala will give Kim a run for his money. Indeed, if the Board doesn’t share President Obama’s enthusiasm for a physician in the top post, Okonjo-Iweala is far better suited to fill a bankers’ shoes. Born into the Umu Obi Obahai Royal Family of Ogwashi-Ukwu, her father was the King, affording Okonjo-Iweala educational opportunities rarely available to girls in her country during the 1950s. She graduated magna cum laude from Harvard University, and went on to earn her doctorate in economics from MIT. She has served as both Finance and Foreign Ministers of Nigeria, authored two books, and managed the World Bank.

On top of that impressive list, Okonjo-Iweala brings an extraordinary depth of understanding about development of poor countries, anti-corruption efforts and governance. As Homi Kharas, of the Brookingsputs it:

  • Dr. Okonjo-Iweala has also focused on low-income countries but has increasingly been concerned with broader concepts of national development. She has fought hard to change the world’s perception of Africa away from a hopeless, charity-deserving continent to one of a continent with dynamic market opportunities and growth potential in many of Africa’s economies. With her background as finance minister of Nigeria, Dr. Okonjo-Iweala has worked diligently to restructure expenditures by reducing recurrent spending and increasing public investment in infrastructure while avoiding unsustainable budget deficits and high debt levels. She has championed the causes of transparency and anti-corruption. Her priority in Nigeria has been to create jobs and her experience has been with transformational change led by national policymakers. Her focus on national development strategies in low- and middle-income countries is also a priority for the World Bank.

I have always found Okonjo-Iweala an enthralling lecturer, hilarious conversationalist and passionate advocate for genuine economic development strategies. I’ve heard her speak on topics ranging from global petroleum policy to women’s survival in childbirth. Africa is buzzing with news of her nomination.

Dr. Jim Kim is not a shoe-in.

As if Okonjo-Iweala weren’t enough of a challenge for the Board’s vote, Brazil – one of the the World Bank’s greatest success stories – nominated former Finance Minister of Columbia, Jose Antonio Ocampo.

Though Ocampo’s government did not back his nomination, the mighty Brazil did, and that’s what matters. Like Okonjo-Iweala, Ocampo is amusing, charming, well-liked and has served inside the Bank. He earned his PhD in economics at Yale (yet another US Ivy League graduate in the running), and is one of the most widely published economists in the world. Fluent in Spanish, Portugeuse and English, Ocampo has been an influential economics and development advisor across all of Latin America and the Caribbean. Within minutes of his formal nomination the Financial Times posted a blog supporting Ocampo’s candidacy.

Some of Ocampo’s most innovative work has been around “green development,” finding ways to make environmental policies help poor nations prosper. He has published economics analysis that belies the notion that all poor nations must follow China’s route to economic prosperity, destroying their ecologies en route to wealth.

Will the Board vote for non-economist, physician Jim Kim?

Kim’s possible appointment is both a blessing and a challenge for global health and development advocates. Because he is the first individual nominateded to lead the Bank who lacks either economics, business or US government  experience, Kim will be watched closely for failures to comprehend or maneuver through the often Byzantine world of finance and development. Experts in the field argue financial figures in language more akin to that used on Wall Street than inside the NGOs and schools of public health that execute global health programs. Moreover, Kim is prone to speaking with moral authority, putting the weight of his experience tackling tuberculosis behind controversial calls to action. Bankers and “moral authority” don’t usually mix well together, even when the financial institution is meant to lend to the poorest of the poor.

I have always found Jim Kim an enthusiastic, energetic man who freely mixes academia/advocacy/data/passion in a mélange that can be both inspiring and intimidating. If you agree with him, Kim sweeps you up with his intelligence and passion. If you disagree, the same attributes can be off-putting. In either case, it is clear that Jim Kim is a far cry from being a stolid banker, austere university president, or cautious physician. A quick glance at his now-classic rap singing performance at a Dartmouth graduation immediately erases any notions that the conservatively-dressed Kim is the usual cut of World Bank cloth. After watching Kim rap out “Time of My Life” dreassed in tight white leather one can easily imagine him laying it phat on the Bank staff: 

I’m Prez of the Bank,

And I gotta be frank:

The economy sucks,

With worthless bucks.

Yo, yo, yo, yo!

What’s your GDP rank?

Born in South Korea, Kim immigrated with his family to the U.S. when he was five, swiftly learned English and American cultural ways, and soared scholastically. By the time he entered his third decade of life Kim had graduated from Brown University, finished studies at Harvard Medical School and obtained a PhD in anthropology from Harvard. Together with Paul Farmer and a few other Harvard physicians, Kim foundedPartners in Health.

In the 1990s Kim ran a Partners in Health program in Lima, Peru, where tuberculosis was rampant and drug-resistant forms of the microbe were common. The Peru TB project came on the heels of a multidrug-resistant TB outbreak in New York City, caused by a strain of the microbe that had originated in a prison in Tomsk, Russia. In the post-Soviet collapse of health and prison programs in Russia supplies of antibiotics were intermittent, at best, and prisoners became walking Petri dishes for tuberculosis mutation. When a Russian strain slammed New York City, local health officials learned how difficult it was to both obtain adequate supplies of the 10 key drugs used in combinations to treat the disease, and to get patients to take those drugs every single day, for a minimum of six months. Kim and his Peruvian colleagues drew from the treatment experiences in New York, Tanzania and several other countries that had battled such mutant strains of TB, adopting the strategy previously dubbed Directly Observed Therapy (Shortcourse), or DOTs. In the scheme, a friend or healthcare worker visually verified every day that a patient swallowed all prescribed medicines.

Kim’s key innovation was in applying basic DOTs in an impoverished setting rife with mutant drug-resistant TB. He and Farmer developed what they dubbed DOTS+, which entailed giving a larger combination of antibiotics to poor patients, and battling drug companies to knock medicine prices down to rock bottom. The 2002strategy was not initially well-received by WHO, where Kim locked horns with pragmatists that felt the method was overly complex and costly to prove feasible in poor countries. Though WHO’s position on DOTS+ has changed, the strategy remains controversial simply because tuberculosis is evolving faster than health experts can manage to adapt treatments.

WHO estimates that in 2010, 8.8 million people had active tuberculosis, and rates of drug-resistance are soaring so rapidly that over the next three years at least 2 million will contract MDR-TB (Multidrug-resistant). Even those grim numbers have been challenged by health experts and NGOs, claiming the TB toll is far greater. Sweeping the world now are strains of XDR-TB, or Extremely drug-resistant, and in recent weeks India has been plagued with so-called TDR-TB, or Totally drug-resistant. Far from proving to be the end-stage TB strategy, Kim’s 2002 DOTS+ scheme seems to have spawned a virtual industry of constantly revisingapproaches to tuberculosis control and treatment.

Of course Kim cannot be blamed for the failure of his DOTS+ strategy to stop TB; he also cannot be credited with finding the magic bullet (though some enthusiastic commentators have so-portrayed the situation).

WHO’s resistance to the DOTS+ idea cemented strong distrust of the agency in Kim’s mind. When fellow Korean Dr. Lee Jong-Wook was nominated to lead WHO in 2003, Kim enthusiastically joined forces with him. Director-General Lee put Kim in charge of the agency’s 3-by-5 Initiative:

The "3 by 5" initiative, launched by UNAIDS and WHO in 2003, was a global TARGET to provide three million people living with HIV/AIDS in low- and middle-income countries with life-prolonging antiretroviral treatment (ART) by the end of 2005. It was a step towards the GOAL of making universal access of HIV/AIDS prevention and treatment accessible for all who need them as a human right.

Once again Kim’s leadership had controversial outcomes. Guided by his experience battling what he called “WHO bureaucrats” over TB control, Kim entered the Geneva headquarters with sharp elbows, firing many, bringing in allies, and making numerous enemies. Though the institution was, indeed, rigid, Kim did not play his political cards with finesse. Moreover, the Initiative was launched without pre-arranged backing from major donors, and in direct competition with President George Bush’s PEPFAR program. (In fairness, PEPFAR leaders at the time tactfully spoke of “parallel efforts.”) Unable to gain significant funding, or take leadership in policy directives, the 3-by-5 Initiative failed to meet its targets. When Kim’s protector, Lee, died suddenly in office in 2006 Kim moved on to Harvard.

For three years Kim ran the Francois-Xavier Bagnold Center, commonly called Harvard’s FXB Center for health and human rights. Founded in the 1990s by the Countess Albina du Boisrouvray in honor of her deceased son, the FXB Center was originally envisioned to focus on research to ensure the health of women and children in very poor countries. Shortly after taking its helm in 2006 Kim announced, “Today, we are shaping a new science that targets this gap between theoretical knowledge and on-the-ground implementation. Drawing from a broad spectrum of disciplines, Global Health Delivery Science will create the new tools required to analyze and overcome implementation gaps so we can deliver interventions to the people who need them most.”

With the same passion he’d brought to DOTS+ and the 3-by-5 Initiative, Kim threw his weight behind the idea of applying principles of performance assessment generated in the Harvard Business School to programs for child vaccination, HIV treatment and other health initiatives in poor countries.

In 2009 he left the FXB Center to serve as President of Dartmouth University in New Hampshire.

Though Kim’s nomination has received rave reviews, he will have to travel the world, campaigning for election.  And he could be the first American nominee defeated in election for President of the World Bank since 1944. Or another way of looking at it is either Dr. Ngozi Okonjo-Iweala or Jose Antonio Ocampo could be the first President of the World Bank nominated and promoted by a nation that has been a major recipient of the Bank’s financial support.

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