It was in this position that he played a key role in developing the concept of essential drugs, as Secretary of the first Expert Committee on the subject.

In January 1988 the WHO executive board selected Nakajima to become Director-General in a 17-to-14 vote over Carlyle Guerra de Macedo of Brazil.

His re-election was opposed by all major donor countries to the WHO including the United States.

[13] An audit was conducted that concluded in March and cleared Nakajima of misusing WHO's finances.

[15] In 1997, Nakajima announced that he was not seeking another re-election and that his term of office would end in July 1998.

He was replaced by Gro Harlem Brundtland of Norway, whose candidacy was supported by the United States and the European Union.