The battle to get there was bruising but the end result was decisive: with 133 votes, compared with just 50 for his nearest challenger, Ethiopia’s Tedros Adhanom Ghebreyesus was elected this week as director general of the World Health Organisation (WHO).
In the process, he broke several barriers. Known by his first name, Ethiopian-style, Tedros is the first African to lead the global health body. He is the first since 1973 from the developing world. He is the first to be elected by the whole membership of the WHO, instead of a small executive board. He is the first non-medical doctor in charge (although he is often called “Dr Tedros”, the title comes from his PhD in community health).
Make no mistake: in choosing Tedros, the WHO has made a decisive break from the past. It was about time.
The WHO’s failings were exposed by the 2014 Ebola outbreak in Guinea, Liberia and Sierra Leone. The organisation was slow to respond and, when it did, it lacked the human resources and specialist knowledge necessary to make an immediate difference. It also communicated poorly, both in affected countries and to a global audience, failing to prevent wider panic.
The WHO has already promised to fix these failings. Margaret Chan, the outgoing director general, who has shouldered much of the blame for the poor Ebola response, has called for a series of wide-ranging reforms that would fundamentally change the way the organisation operates, making it much faster and more aggressive in responding to pandemics such as Ebola.
Tedros has promised to keep pushing for improvements. “We live in a changing world and the WHO must be able to change with it,” he said.
This will not be the first time Tedros has been entrusted to overhaul and modernise a lumbering, inefficient medical bureaucracy. As health minister for Ethiopia between 2005 and 2012, he spearheaded a healthcare revolution that included the creation of 3 500 new health centres and another 16 000 smaller clinics. He also oversaw the training and deployment of 38 000 all-female health extension workers, who advise on family planning, antenatal care, vaccinations and household hygiene.
The results are hard to argue with: according to the medical journal The Lancet, since 2003, this “highly successful” programme has brought down neonatal and maternal mortality rates by 38% and 43% respectively, and the prevalence of tuberculosis has more than halved.
The importance of Tedros’s record in Ethiopia cannot be overstated. On its website, the WHO claims that it wants “to build a better, healthier future for people all over the world”. Having delivered exactly this in one of Africa’s largest and poorest countries, Tedros has the practical, first-hand knowledge required to make good on this pledge.
Not that he is perfect. His campaign was dogged by two controversies. First, critics of the Ethiopian government — and there are many — said his appointment would legitimise Ethiopia’s poor human rights record. They have a point, but the same could have been said for the other candidates for the position: Sania Nishtar, from Pakistan, a country whose armed forces have been implicated repeatedly in human rights violations; and David Nabarro, from the United Kingdom, which is under preliminary investigation by the International Criminal Court for committing war crimes in Iraq.
Second, and even more seriously, Tedros was accused in the weeks leading up to the vote of covering up a cholera epidemic in Ethiopia while he was health minister. According to a senior public health expert with links to Nabarro, Tedros’s health ministry on three occasions deliberately misreported cholera cases as “acute watery diarrhoea” in an effort to avoid negative headlines.
This allegation might have derailed his bid for the top job, but the voting shows that it may have had the opposite effect, with Nabarro instead tainted by his association with this alleged “dirty tricks” campaign.
None of this matters now: after his triumphant election, Tedros is moving into Chan’s plush office at the WHO’s Geneva headquarters and must now make good on his ambitious campaign promises. It will be easier said than done: although the director general wields considerable power, the WHO must still answer to the whims of its member states, and it is hamstrung by funding concerns.
Tedros may or may not prove to be the cure the WHO needs. For now, however, the appointment of an experienced African to the world’s top health job is just what the doctor ordered.