A resounding silence surrounds an event to take place at the end of this month that, in theory at least, has great significance for the health of the people of Africa. Dr Ebrahim Samba is to step down after serving his maximum two terms of office as Director of WHO's Africa Region (WHO/AFRO). Such disinterest in a new UN health leader in the continent with the world's most pressing disease burden seems at first glance astonishing. However, a little familiarity with WHO and its African Office makes the lack of debate more understandable.