With the election on 29 June 2018 of Portugal’s Antonio Vitorino as new Director General of the International Organisation for Migration (IOM), the traditional lead of the organisation by the Unites States (US) will come to an end. In light of the European Union’s efforts for a common approach to migration, the election of Mr Vitorino might have been a strategic choice for European countries. The voting process, characterised by a secret ballot, also contributed to limit US pressure: although secrecy is sometimes put into question – as for example in the context of the last WHO election, in which calls for greater transparency aimed to avoid decisions and deals based on considerations unrelated to health – in this case, it might have contributed to protect individual member states from fears of direct US financial retaliation.

However, as the US constitutes IOM’s largest contributor, concerns on the Organization’s future funding remain. Even if the level of funding is maintained, the structure of the budget which is largely project based opens the possibility for the US to shift its funding to initiatives more in line with its priorities, with the risk of leaving some of the current programmes underfunded.

Even if indirectly, what is happening in the IOM and other multilateral arenas also has implications for health. With the US leaving the negotiations on the global compact on migration and pulling out of the Paris Agreement and the Human Rights Council, the risk is not only that of weakening multilateral diplomacy, but also to undermine efforts for greater policy coherence and inter-sectorality. Migration, human rights and climate change are closely interlinked with health, and it will not be possible to make sustainable health progress without concerted action in all related sectors.

The next IOM Director General, who will take office on 1st October, already stressed the importance of achieving concrete action on the interlinkages between migration and the Sustainable Development Goals (SDGs). He also envisions a decentralised organisation to answer the needs of its member states on migration. However, a major challenge will be to ensure that negotiations in this field, including in the context of the European Union and the Global Compact on Migration, are not guided by security and economic interests but integrate strong health and human rights components. As multilateral diplomacy and transformative approaches to development are being challenged at different levels, this change in IOM leadership should be an opportunity to reiterate a strong engagement of multilateral institutions for people-centred approaches and for the rights of the most vulnerable.