The race to elect the next Director General (DG) of the World Health Organization (WHO) has already begun. At the same time, somewhere a district surveillance officer recently flagged an unusual cluster of fevers, a pharmacist worried about a delayed vaccine consignment, and a mother sat in a clinic hoping the system would simply work. None of them will vote in the contest for the WHO chief; they will simply live with the result. The question, however, is what the winner should do with a shrunken budget, and how.That contest to elect the WHO chief is not hypothetical. The formal process began in April 2026, nominations close on September 24, 2026, and the World Health Assembly is expected to appoint the next DG in May 2027, for a term beginning on August 16, 2027. In an earlier essay, I argued that the world needs preparedness, trust, scientific integrity and courage to act before certainty is perfect. However, the arithmetic is sobering. Member States approved a 2026-27 budget of US $4.2 billion in May 2025, roughly a fifth smaller than first proposed, even as external health aid is shrinking. WHO’s own rapid stock-take across 108 country offices found widespread disruption to health workforces, surveillance, and information systems, with further projected fall in development assistance of up to 17% in 2025. The next leader won’t trim a stable system but will be cut into one already under strain. And the in-tray is crowded. The next DG must manage pandemics that travel faster than diplomacy while confronting an expanding epidemic of noncommunicable diseases (NCDs), a warming climate that is redrawing the map of infection, antimicrobial resistance, and a corrosive, erosive public trust in science. Scarcity can lead to firefighting, delaying attention to chronic, structural threats that cause most deaths. A credible agenda must address both immediate crises and long-term issues.The instinct in a financial crisis is to defend everything. The wiser course is the opposite. The organising principle for the next era should be simple: protect the global public goods that only the WHO can supply, target country support where it is genuinely needed, and delegate routine delivery to others. Every activity should answer one question: Is this something only the WHO can do? If not, who should the WHO partner with or delegate to? What belongs in the “only WHO” column is reasonably clear, and the agency’s own realignment plan says as much. Norms, standards, and guidelines carry a legitimacy no national agency or company can match. Surveillance and early warning are an explicit obligation under the International Health Regulations and the foundation of outbreak prevention. Emergency coordination, incident management, surge capacity and health cluster leadership are irreplaceable. And convening power, the ability to align nearly 200 governments around a shared threat, exists nowhere else. These functions should be ring-fenced even as budgets fall.Just as important is naming what the WHO can stop doing, ending legacy platforms, cutting stand-alone technical products, handing over some logistics, and stepping back from humanitarian work where UNICEF and UNFPA are better placed. That is more honest than shaving posts evenly across the board. The hardest call is country presence. The WHO cannot abandon it, MOPAN found that demand for country support has risen since the pandemic, but it can differentiate intensive help in fragile, high-burden settings, lighter brokerage elsewhere.How can a the next DG do more with less?Several levers are within the next DG’s reach. The first is governance. An organisation cannot focus if its mandate keeps expanding. The Health Assembly passed 28 resolutions in 2025, up from 17 the year before, and its agendas have swelled. Every new mandate should pass through a hard gate: a costed business case, a comparative-advantage test, and a sunset clause. The second is financing. In 2022-23, only about an eighth of WHO’s voluntary contributions were flexible or thematic; the rest were tightly earmarked, starving agreed priorities. The next leader should ask donors to fund functions such as surveillance, norm-setting, and emergency coordination rather than narrow projects, and to pool results-linked windows. The remaining levers include consolidating guidance products and practicing smart decentralisation, such as moving pandemic work to Berlin and operations to Dubai, only if it reduces duplication. A true division of labour would utilise the WHO’s 842 collaborating centres and UN partners for delivery, with the health watchdog setting standards, ensuring quality and serving as the last resort. The lessons are blunt – austerity without a target operating model is not a strategy, whether it was how PAHO handled it in 2021, or when UNAIDS forcibly cut its budget and slashed country envelopes by 30% only to watch morale and leadership capacity to suffer. It is drift. That is why the approach matters as much as the architecture. The next DG will need to be a crisis manager, coalition builder, systems reformer, guardian of trust, a transparent communicator, and a leader who revises course in public when the evidence changes. Making equity operational instead of ceremonial, and turning fine words into allocation rules and accountability, will require effort beyond health ministries, involving finance ministers, development banks, and climate negotiators. And above all, they will need to be an institutional operator who can convert principles into budgets, staffing, and priorities.The existential questionThe more crucial question is not financial but existential. The WHO was born in 1948 from the rubble of a war. Nearly eight decades on, the question now whispered in capital letters in its name has outlived its purpose, and mistakes age for obsolescence. The pathogens have not retreated. Chasing down the diseases that crossed borders while the ruins are still smoldering – they once arrived as smallpox and cholera, and now arrive as NCDs, claiming roughly three-quarters of the world’s deaths. A warming climate could further cause a quarter million additional deaths a year between 2030-2050, as antimicrobial resistance is the quieter contagion of distrust. But an institution does not become irrelevant because the world changes around it. It becomes irrelevant only if it refuses to change with it.So, the question that the WHO’s candidates should ponder upon before they ever stand at a podium is not how to win Geneva but what they would do with it. It is time to repurpose WHO, leaner, sharper, re-pointed at the dangers that stalk us, this decade and the next. The case is not sentimental. With its budget cut by roughly a fifth and global health aid in retreat, the world cannot afford to lose this agency, and it will not save it by building a bigger one, but by demanding a smarter and stronger one. The next DG will be measured not by the budget they command, but by the judgment they bring: whether a dangerous pathogen is caught early and stopped before it spreads, whether a frightened country finds trusted guidance in the dark, and whether evidence outlasts politics when lives hang in the balance. That is the introspection this moment asks of anyone who would lead such a global watchdog – not how to make WHO larger, but how to make it indispensable. If they choose the few things only WHO can do and pour their energy into doing them better than anyone else, the world will not be asking again in 2029 whether WHO still matters. It will be grateful it endured.Giridhara R. Babu is a professor of Population Medicine, College of Medicine, QU Health, Qatar University.