Coronavirus: Tedros Ghebreyesus of WHO faces firestorm of criticism
Attacked from all sides, have the WHO and its leader, the Ethiopian national Tedros Adhanom Ghebreyesus, failed in their mission or, on the contrary, prevented the worst? An upcoming inquiry should provide some answers.
When he took to the podium to make closing remarks at the seventy-third World Health Assembly, held in Geneva on 18 and 19 May, Tedros Adhanom Ghebreyesus, 55, bore a wide grin.
The Director-General of the World Health Organisation (WHO) also wore a blue, tropical print shirt, setting aside his conservative grey suit.
A gesture meant as a tribute to nurses from the Polynesian state of Tonga who had planned to attend the meeting but were unable to due to the coronavirus pandemic, he explained, before thanking member countries for their “support” and reminding the audience (mostly in attendance virtually) that while “the COVID-19 pandemic has tested, strengthened and strained the bonds of fellowship between nations […] it has not broken them”.
The speech was a perfect show of unanimity and optimism. At least on the surface of it.
Behind the scenes, the virtual assembly was a fierce battlefield and ended on an unprecedented note with the adoption of a resolution, drafted largely by European representatives, calling for an “impartial, independent and comprehensive evaluation” of WHO’s coordination of the “international health response” to the worst crisis in its history: COVID-19.
In China’s grip?
The resolution is an attempt to respond to the mounting criticism – often American – directed at the organisation in recent weeks. In mid-April, the United States suspended their financial contributions to WHO.
More recently, the country has even contemplated the idea of leaving the organisation altogether on the grounds that it failed in its task and, probably an even greater crime in the Americans’ eyes, is fully in thrall to the Chinese authorities.
Made out to be the embodiment of the organisation’s every supposed shortcoming and shady action, “Dr Tedros” is naturally at the centre of the controversy.
Some people maintain that he was only elected because he is African, as he is the first non-medical doctor director-general (although he has public health qualifications).
Others claim he has been under the thumb of China (which backed his candidacy) for a long time and they back up their theory by noting that the party of which he was a member in Ethiopia, the Tigray People’s Liberation Front, is a communist movement. Others still say that he is timid. Or totally in the pay of “Big Pharma”.
The first African elected to head WHO has been spared no criticism, and malicious rumours about his private life have even begun spreading among the Ethiopian diaspora.
A lot of these attacks are unfounded, but some of them should be explored further – beginning with the WHO’s attitude towards China. As early as January, while the number of coronavirus cases was exploding in Hubei province, WHO was working with Beijing, which made sense.
On 20 January, the organisation sent a team to Wuhan and, on 22 January, a meeting to determine if the novel coronavirus outbreak constituted a Public Health Emergency of International Concern (PHEIC) ended on an inconclusive note.
On 28 January, Ghebreyesus met with the President of China, Xi Jinping, in Beijing, setting the stage for an unfortunate grovelling posture that has been interpreted ever since as a sign of the director-general’s submission.
On 30 January, WHO finally declared a PHEIC. On 30 March, the International Olympic Committee announced that the Olympic Games, originally scheduled to take place in Tokyo in summer 2020, would be postponed until 2021. Very upset about the decision, the Japanese vice prime minister called WHO the “Chinese Health Organisation”.
Other critics, not necessarily the same ones, rebuke the UN-backed institution for being overly cautious. It was out of caution that the WHO waited to declare a PHEIC and then to upgrade its status from an epidemic to a pandemic. It was also out of caution that it refused to approve the use of potentially effective treatments against COVID-19 or some of its symptoms, with chloroquine, artemisia and Madagascar’s Covid-Organics leading the pack.
Michel Yao, an Ivorian born doctor currently practicing medicine in Canada and responsible for coordinating the WHO operations in Africa, rejects this criticism: “Our role is to organise clinical trials in line with methodological approaches in order to verify treatment effectiveness and safety. But doctors have always had the option of using treatments that haven’t been approved if it was recognised that they could provide relief to patients. This is known as ‘compassionate use’, and WHO has never been against it.”
In Africa, some had nevertheless hoped that the election of Ghebreyesus in May 2017 would lead the WHO to take a greater interest in medicinal plants and traditional techniques. They claim that their calls have gone unheeded thus far.
Is this indifference a sign that pharmaceutical industry multinationals are trying to protect their profits? Whatever some people may claim, WHO has not necessarily made a habit of siding with “Big Pharma”, as the Geneva-based organisation points out.
In 2013, for example, the Chinese national Margaret Chan, the director-general of the organisation at the time, called out the behaviour of researchers who ran the risk of delaying the development of detection tests for certain strains of coronavirus because they wanted to register a patent.
Also, in 1985, the United States temporarily suspended its contribution to the organisation on the grounds that WHO was encouraging developing countries to create their own pharmaceutical industries.
Lastly, many believe that the WHO should have declared a PHEIC and the pandemic more rapidly, which would likely have encouraged some countries to order lockdowns and, in so doing, save lives.
Leaders at the WHO challenge this idea of a delayed response, often attributed to supposed pressure from China. For instance, Yao recalls that “even before the first cases in Africa were detected in Egypt and Algeria, our teams were providing African authorities with tools to analyse their level of preparedness”.
Senegal-born Ibrahima Socé Fall, Assistant Director-General of the institution, stresses that “we declared a PHEIC on 30 January, and a lot of countries – especially the most developed ones – were slow to react, despite the fact that we warned everyone in very clear terms and were holding meetings every day”.
Other WHO officials comment somewhat bitterly that the bulk of the criticism comes from countries – the United States, the UK, France, etc. – which stand out for their chaotic management of the first few weeks of the pandemic. What’s more, it took two months to gather the $675m needed to fund the coronavirus preparedness and response plan after WHO called on countries to contribute to it on 5 February.
Despite these problems, material assistance has already been provided to 135 low- and middle-income countries, and, in Africa, Yao says that “most health development plans are based in part on WHO protocols, research and recommendations”. According to Matshidiso Moeti, WHO Regional Director for Africa, “Namibia and the Seychelles, which closely followed our precautionary advice, have reported no new cases over the past month.”
Defenders of the organisation are not solely made up of Ghebreyesus’s subordinates: while Donald Trump was ranting and raving against WHO on the small screen, Bill Gates, whose foundation is the second largest financial contributor to WHO after the United States, sided with the organisation and its leader on Twitter.
In an editorial published at the end of April, several NGO executives and public health leaders reiterated that now, more than ever, was the time to come together and to take multilateral action, and that the WHO was struggling first and foremost due to a lack of resources and that it was merely implementing the procedures defined by its member states, summarised in the International Health Regulations (IHR).
To confront the wave of “Tedros bashing”, Tedros’s supporters launched a counteroffensive. It began in his home country, Ethiopia, where several voices, including that of the Minister of Health Amir Aman, spoke out to remind people that when Ghebreyesus was leading the country’s health ministry, he built a solid community health programme suited to the context and whose positive effects have been observed.
For some of his supporters, the attacks targeting the WHO director-general are also likely, if not especially, due to plain old racism.
An underfunded organisation
Should we reach the conclusion that the WHO’s management of the crisis is – and was – beyond reproach? Of course not. However, the countries attacking the Geneva-based institution would do well not to forget that it only has the means and powers that they wish to grant it.
With 194 member states, 7,000 employees and 150 regional offices worldwide, the organisation seems at times too modest in size and, above all, underfunded. Its annual budget ($5.6bn) is even smaller than that of the Paris hospital system. In addition, mandatory contributions account for barely 20% of the budget, while the rest comes from payments made by countries at their discretion.
As Professor Marc Gentilini, an infectious disease expert and former president of the French Red Cross, underscores, budget cuts are not rare and “the work impacted by these cuts in the 2010s includes that of researchers studying coronavirus-type pandemics”.
Forced to be more cautious, Ghebreyesus told reporters in 2017, shortly after his election, that following the Ebola epidemics in Africa, the idea of establishing “simulation exercises at the regional level” was on the table. But, he added, “such programmes are very costly, so we need to obtain special funding”.
Aside from these financial aspects, it’s also important to note that ever since its creation in 1948, the WHO has been the site of never-ending power struggles between superpowers. In 1949, the Soviet Union and several of its satellite nations withdrew from the organisation, criticising it for refusing to make the connection between health and socio-economic conditions, and for being dominated by the United States.
In 1978, liberal countries protested against the Declaration of Alma-Ata, which highlighted the inacceptable health inequalities between the world’s regions. Some denounced the declaration as a “communist vision of health”.
In 2005, the United States prevented the WHO’s then director-general, the South Korean national Lee Jong-wook, from making a speech about the public health consequences of Hurricane Katrina. Today, Beijing is suspected of controlling the organisation. Essentially, no matter what it does, the WHO is always accused of being either lax or alarmist.
So, should the WHO be scrapped and Tedros along with it? Let’s remember that up until the beginning of 2020, the former Ethiopian health minister had unanimous support, especially compared to Chan, his predecessor, who was rebuked for unnecessarily stoking global panic when the H1N1 flu struck in 2009.
The upcoming “impartial and independent inquiry” will likely reveal more information about any failures or errors of assessment on the part of the organisation. Its conclusions will weigh heavily on Ghebreyesus’s possible desire to seek a new five-year term in 2022.
Pending the results of the inquiry, it would probably be worthwhile to consider reforms that could give WHO the resources and powers it needs to accomplish its difficult mission. Some experts suggest creating a permanent steering committee which would be transparently run with guaranteed independence, while others recommend extending the term of office of the director-general and changing the organisation’s funding model.
The problem is that once the pandemic is under control, no one – or almost no one – will want to hear about these topics anymore. Until the next crisis comes.