When nominations for the next World Health Organisation (WHO) director-general closed last week, only one African country publicly pledged to support the re-election of Ethiopian Tedros Ghebreyesus.
Kenya supports his return for another term, saying the former Ethiopian foreign minister will bring continuity of exemplary African leadership to an organisation that has been crucial in dealing with emerging health crises on the continent.
The WHO, the UN’s specialised health agency, has yet to make public the list of other contenders. Dr Tedros himself had dodged the question of whether he would seek a second term in his weekly virtual press conferences.
Nairobi, diplomats say, will support him if he seeks to complete his maximum tour of two five-year terms because it is “Africa’s turn”. Having served under two critical disease outbreaks - Ebola epidemic in the DRC in 2018 and the Covid-19 pandemic since late 2019 - Dr Tedros has passed his toughest test yet, Kenya says.
Born in March 1965 in Asmara, Eritrea, the Ethiopian biologist was minister for health and later foreign affairs in his country under the former prime minister Meles Zenawi and later Hailemariam Desalegn.
He is credited for lowering new HIV infections in his country at the time and pioneering a universal healthcare system Ethiopia has tried to implement. But he has also been criticised for helping cover up cholera epidemics during his tenure.
First African boss
When he took over at the WHO in 2017, he became the first African to do so, the first person to be elected from multiple candidates and the only non-medic to hold the seat. His campaign was fronted by both Ethiopia and Kenya, and he received an endorsement from the African Union. He was also widely supported by China against the US, the UK and Canada, which had backed a British medic, Dr David Nabarro, for the job.
At the WHO, his vision has been for everyone to access health services affordably and in time.
“Our vision is not health for some. It’s not health for most,” he argued in one speech. “It’s health for all: rich and poor, able and disabled, old and young, urban and rural, citizen and refugee. Everyone, everywhere.”
The WHO says he has helped deliver most of its targets and enabled the organisation to better respond to outbreaks based on lessons from the first Ebola epidemic in 2013.
He is also credited with raising gender parity in the WHO’s top management and enhancing collaboration between its headquarters and regional offices, countries and other international agencies involved in public health.
The WHO now has the Division of Science, the Division of Data and Delivery for Impact and the Division of Emergency Preparedness, seen as gaps when Ebola hit Sierra Leone, Liberia and Guinea, killing more than 11,300 people.
His fortunes, nonetheless, seem higher this time than when he first launched his campaigns in 2016 for his first term. On September 23, the German Mission to the UN in Geneva, where the WHO is based, tweeted the first endorsement by a European country, indicating it was pooling support in the entire European Union bloc for the Ethiopian.
“Today September 23rd, France and Germany, in coordination with a group of EU states, nominated Dr Tedros Adhanom Ghebreyesus for the election of the WHO director-general to be held in May 2022,” the German Mission said.
As is the norm, the WHO rules require disclosure of any public endorsements, funding and other support for candidates.
Suspicion at home
While he is liked abroad, Dr Tedros, however, carries a tag of suspicion in his home country. He had the support of the Ethiopian government before but now, it remains unclear whether that will be the case should he decide to seek a second term.
As the conflict erupted in northern Ethiopia, Dr Tedros, an ethnic Tigrayan and former Cabinet minister under TPLF (Tigray People’s Liberation Front) when it was in power, had to issue a public denial after officials in Addis Ababa claimed he had tried to acquire arms and diplomatic backing for the group.
TPLF, once part of the ruling coalition in Ethiopia, is now considered a terror group by Prime Minister Abiy Ahmed’s government.
TPLF has been fighting the Ethiopian military since November.
Dr Tedros, somehow dragged into the political drama back home, has denied siding with the TPLF, and claimed his own family had been hurt in the conflict.
Ethiopia has yet to make a public endorsement, but it will be curious if they chose to undercut him at the WHO.
Last year, Dr Tedros’ public support for Beijing’s narratives on the origins of Covid-19 and how the Asian country handled the pandemic earned him the ire of former US President Donald Trump, who had initially announced he would withdraw the country from the WHO.
His successor, Joe Biden, has since rescinded the decision, but it has not stopped US lobbyists from coming after the WHO boss.
“The Biden administration pledged it would fix the WHO when it reversed the Trump administration’s withdrawal from the organisation. The director-general race is the time to put this promise into action,” argued Anthony Ruggiero, a former senior director for counter-proliferation and biodefence on the US National Security Council during Trump’s time.
“We’ll never know for sure, but it’s safe to say that many people might still be alive had Tedros acted more forcefully against the virus instead of working so hard to please Beijing,” he argued in a commentary published in Foreign Policy magazine.
The WHO secretariat will announce the names of candidates in early November, according to the election schedule released in April, after the executive board makes formal nominations.
According to the WHO, delegates from member states, who form the organisation’s assembly will vote for the director-general during the 75th World Health Assembly.
They normally vote via secret ballot and the winner must garner a two-thirds majority to be declared the outright winner, if there are more than three candidates. Otherwise the vote can go into several rounds until a winner emerges.
Since April, member states have been encouraged to send in nominees, often in sealed envelopes including their CVs and an endorsement statement from the nominating country, which does not have to be the country the candidate is a citizen of.
A candidate often needs a member state to nominate them to contest. Those nominations are sent to the chair of the executive board, currently Kenyan gynaecologist Patrick Amoth, the acting director-general for Health.
Once the names are received by the board of 34 members, they may sift through the list and eliminate those who garner less than 10 per cent of the vote.
Once the list is trimmed, the remaining names are then forwarded to the assembly for election and appointment. That should happen between January and March next year.