BY LENA H. SUN | WASHINGTON POST
The governing body of the World Health Organization on Tuesday elected Tedros Adhanom Ghebreyesus, a former Ethiopian health minister, to head the global health agency responsible for marshaling the international response to infectious disease epidemics such as Ebola and Zika.
During the third and final round of balloting in Geneva, members of the World Health Assembly voted 133 to 50 to pick Tedros, as he is known, to be the next director-general, according to unofficial tallies.
Cheers broke out, observers said, as he beat out David Nabarro, a 67-year-old physician and longtime U.N. official from Britain, and Sania Nishtar, a 54-year-old cardiologist from Pakistan. It was the first time member states took part in a secret ballot that gave each member state an equal vote.
In the past, leaders were chosen by an executive board and voting took place behind closed doors. Nishtar was eliminated during the first round of voting.
There were 186 member states who were eligible to cast ballots. Eight others had not paid their dues in time or were not represented at the 10-day gathering. In the final round of voting, there were two abstentions, observers said.
Tedros told the delegates that it was “pure luck” that he was competing to lead WHO, noting that when he was growing up in Ethiopia, his 7-year-old brother was killed by a common childhood disease, and that it could easily have been him. Observers tweeted that Ethiopian delegates could be seen hugging and high-fiving each other after their countryman made it to the second round, which Tedros went on to win with 121 votes vs. Nabarro’s 62.
The election comes at a critical time for the WHO. It has experienced huge budget cuts over the years, lost many talented staff, and was heavily criticized for its slow and ineffective response to the 2014 Ebola epidemic in three West African countries that killed more than 11,000 people.
A recent editorial in the Lancet said the election comes at a time of “unparalleled uncertainty” for the organization. It said: “Vastly more is expected of WHO while its role is contested and constrained.”
All three candidates had pledged deep changes to the U.N. agency, promising greater accountability and transparency. The winner, who will serve a five-year term, takes office July 1, succeeding Margaret Chan, who has held the post since November 2006.
As the cash-strapped agency seeks more money to fund responses to worldwide crises, it has also been struggling to control its own travel costs. The WHO, with a $2 billion annual budget, routinely spends about $200 million a year on travel, far more than what it spends to fight some of its biggest problems in public health, according to the Associated Press. The WHO said nearly 60 percent of the cost is for travel of external experts to support countries and for representatives of member states to travel to technical meetings and sessions of WHO governing bodies.
Dealing with epidemics is only part of the responsibilities of the WHO. It has considerable influence in setting medical priorities that affect billions of people. Its mission includes tackling antimicrobial resistance, confronting the growing problem of obesity, diabetes, and reducing maternal and infant mortality during childbirth.
Public health experts say one of the biggest challenges facing the WHO is getting rid of the deeply entrenched politics that affects the selection, promotion and support of its staff. One of the primary reasons that the WHO’s initial response to the Ebola outbreak was “not competent” is that “they didn’t have the right people in the right places,” said Tom Frieden, former director of the Centers for Disease Control and Prevention. Highly competent representatives were later appointed in the three West African countries, and with good representatives, the “WHO can accomplish amazing things,” he said in an interview before the election.
But senior positions, such as the WHO assistant director-generals, are appointed on a “geographic quota system,” Frieden said. “Many have little technical expertise in the area they are overseeing. Whoever becomes the next will only succeed if they make their key human resource decisions on the basis of technical and operational excellence.”
Success requires strong management experience and savvy political skills to challenge the status quo and persuade governments to relinquish some of their sovereignty for the greater good, experts said.
Jeremy Farrar, who heads the Wellcome Trust, a London-based global biomedical research charity, which did not endorse a candidate, said the WHO needs a leader who can lay out “this is what the organization needs and then persuades the member states to go in that direction” instead of someone “who tries to reach consensus with everybody.”
In the run-up to the vote, the battle seemed to narrow to a race between Tedros and Nabarro, who has wide experience on the front lines of global health and in the United Nations system, where he has spent much of his career. Tedros, 52, was Ethiopia’s health minister from 2005 to 2012 and foreign minister until 2016. The only nonmedical doctor among the three candidates, he would be the first WHO director-general from Africa. He was backed by the African Union as well as countries in the Pacific and the Caribbean. He presided over a dramatic expansion of Ethiopia’s health system and reductions in infant and maternal mortality as well as deaths from malaria. He also extended the reach of the health system deep into remote rural areas.
But just before the election, he and the Ethiopian government were accused of covering up cholera outbreaks going back to 2006 despite international regulations requiring countries to report outbreaks of the bacterial disease. Ethiopia referred to the disease as “acute watery diarrhea,” essentially a symptom of the disease, rather than naming it. It is not clear whether Tedros had any input in the government’s decision, but the change occurred during his tenure as health minister. He has denied any coverup.
The accusation against Tedros prompted Frieden to point out last week that while “not optimal,” many countries report cholera to the WHO as acute watery diarrhea. “This allows reporting and response without laboratory confirmation, but in no way indicates that Tedros Adhanom Ghebreyesus, a former health minister of Ethiopia, is any less qualified to become director general of the WHO,” Frieden wrote in a letter to the New York Times.
Success requires strong management experience and savvy political skills to challenge the status quo and persuade governments to relinquish some of their sovereignty for the greater good, experts said.
Jeremy Farrar, who heads the Wellcome Trust, a London-based global biomedical research charity, which did not endorse a candidate, said the WHO needs a leader who can lay out “this is what the organization needs and then persuades the member states to go in that direction” instead of someone “who tries to reach consensus with everybody.”
In the run-up to the vote, the battle seemed to narrow to a race between Tedros and Nabarro, who has wide experience on the front lines of global health and in the United Nations system, where he has spent much of his career. Tedros, 52, was Ethiopia’s health minister from 2005 to 2012 and foreign minister until 2016. The only nonmedical doctor among the three candidates, he would be the first WHO director-general from Africa. He was backed by the African Union as well as countries in the Pacific and the Caribbean. He presided over a dramatic expansion of Ethiopia’s health system and reductions in infant and maternal mortality as well as deaths from malaria. He also extended the reach of the health system deep into remote rural areas.
But just before the election, he and the Ethiopian government were accused of covering up cholera outbreaks going back to 2006 despite international regulations requiring countries to report outbreaks of the bacterial disease. Ethiopia referred to the disease as “acute watery diarrhea,” essentially a symptom of the disease, rather than naming it. It is not clear whether Tedros had any input in the government’s decision, but the change occurred during his tenure as health minister. He has denied any coverup.
The accusation against Tedros prompted Frieden to point out last week that while “not optimal,” many countries report cholera to the WHO as acute watery diarrhea. “This allows reporting and response without laboratory confirmation, but in no way indicates that Tedros Adhanom Ghebreyesus, a former health minister of Ethiopia, is any less qualified to become director general of the WHO,” Frieden wrote in a letter to the New York Times.
Tedros has also been criticized by human rights groups because of his ties to a government known for its poor human rights record.
Nabarro has had years of experience dealing with outbreaks and crises for the United Nations, including avian flu, the 2004 Indian Ocean tsunami, and Ebola. But critics say that as a longtime insider, he would have difficulty introducing the radical change needed to overhaul the agency.
Nishtar, the Pakistani doctor, has the least amount of management experience and experience with outbreaks. She served briefly as health minister, and has worked on noncommunicable diseases for years as head of a nongovernmental organization. She is the only candidate who promised to serve a single five-year term.
