The doctor making Trump queasy
The head of the World Health Organization is feeling the squeeze from the US and China.
ADDIS ABABA, Ethiopia — As head of the World Health Organization, Tedros Adhanom Ghebreyesus has achieved what he set out to accomplish: injecting politics into public health and casting it as “a political choice.”
With the coronavirus crisis, the former Ethiopian foreign minister who took over the WHO in 2017 has got far more than he bargained for.
Now, as Tedros leads the global response to a worldwide pandemic in an age of rising nationalism and shifting world order, his message is: “Please don’t politicize this virus.”
With the death toll mounting and the economic costs of lockdowns beginning to bite, he finds himself caught between two of the United Nations health agency’s most powerful members.
One, the United States, is the WHO’s biggest single source of cash. The other, China, is a major supplier of the medical equipment and machinery that will be needed to bring economies back online. It’s also the original epicenter of the pandemic — and thus key to understanding the virus that’s brought the globe to its knees.
“Tedros has taken risks and has exposed himself” — Michel Kazatchkine, former chief of the Global Fund to Fight AIDS, Tuberculosis and Malaria
Donald Trump has accused the WHO of helping Beijing cover up the virus — allowing it to spread unchecked as the health organization heaped praise on the Communist Party and criticized American travel restrictions. The U.S. president has frozen payments as he deliberates whether to strip the WHO of about 14 percent of its annual budget.
Meanwhile, China has been pushing back aggressively against any attempt to imply that it mishandled the epidemic when it first broke out at the end of last year.
Interviews with diplomats, researchers, big money donors and development administrators reveal a global health establishment that has been baffled by Tedros’ obsequiousness to the secretive communist regime in Beijing.
While such people are generally supportive of the WHO’s mission and largely admiring of Tedros personally, they are split on whether he should have taken a harder line on China. They are united, however, in their concern that Tedros’ troubles with Trump will sink the global response to the coronavirus and undermine the long-term sustainability of the WHO.
“Tedros has taken risks and has exposed himself,” said Michel Kazatchkine, a former chief of the Global Fund to Fight AIDS, Tuberculosis and Malaria, who worked with Tedros in Ethiopia and in Geneva.
It’s not the first crisis Tedros has weathered, but it’s by far the biggest. The question is whether he has enough political acumen to ride out the pandemic with the WHO intact — or whether the backlash against him will harm an institution staffed by 7,000 experts in 150 offices around the world.
The stakes include not just the response to the coronavirus but also polio, Ebola and malaria, as well as whatever pandemic comes next.
“He has to reach out to much more powerful people, as we can see now, to get support and be protected,” said Ilona Kickbusch, an external WHO adviser and founder of the Global Health Centre at the Graduate Institute of Geneva. “You get attacks from all sides.”
Soft on China
In his dealings with China, Tedros stands accused of enabling — or at least not resisting — a Chinese cover-up during the early weeks of the pandemic, a period when authorities in the country were less focused on containing the virus than on preventing word about it from getting out.
Even some of Tedros’ allies confess they cringed at some of the praise he heaped on Beijing as the novel coronavirus spread.
On January 30, announcing the decision to declare “a public health emergency of international concern” — the WHO’s highest designation — Tedros said China’s speed in detecting the virus and sharing information was “beyond words.”
“So is China’s commitment to transparency and to supporting other countries,” he added.
Those words have not aged well, as reports pile up accusing China of hiding its knowledge for weeks and of hoarding medical equipment as it did so.
The WHO as a whole has also come under fire for a January 14 tweet citing Chinese studies that found “no clear evidence” of human-to-human transmission, after one of its own experts suggested such transmission was possible.
During an epidemic in which time is of the essence, such uncritical endorsements “risked undermining the credibility of the WHO,” said Lawrence O. Gostin, director of Georgetown University’s O’Neill Institute for National and Global Health Law. But, he added, “it’s utterly unfounded to say that he had some personal self-interest that guided him with respect to China.”
“’What he could have done is say, ‘These are the data coming out of China but we’re unable to independently verify it,’” he said. “That would have been what we would have liked to have seen in an ideal world.”
The WHO did not provide an on-the-record comment for this article.
It’s not the first time Tedros finds himself in risky diplomatic territory. The long-time civil servant rose through the ranks of a repressive regime in Ethiopia while staying distant enough from its abuses to remain acceptable on the global stage.
During his time as a public official back home, Ethiopia — and Tedros — proved skillful at balancing competing interests, be it Western donors, the Chinese government or international aid organizations.
In Ethiopia, the U.S. government is currently sending food aid to famine-hit regions near the Somali border. And women’s health clinics, some of which provide abortions under the many exceptions to the country’s ban, get a boost from American billionaires, including Bill Gates and Ted Turner.
But in Addis Ababa, a capital of proliferating skyscrapers, fading Art Deco apartment blocks and well-kept shantytowns, the brand-new commuter train connecting suburbs in the north and south was built by China. As was the space-age headquarters of the African Union, seated in Addis, a reflection of Beijing’s heavy economic and diplomatic investment in the continent.
“He is a very technical person, research-orientated” — Saba Kidanemariam, the country director for Ipas Ethiopia
As health minister from 2005 to 2012, Tedros simultaneously courted and stood up to donors from the West, leveraging cash for medicines to build a sweeping health network that’s the envy of Africa. In campaigning for his current job, he built a political support base outside the bloc of wealthy countries that usually pull the strings of U.N. agencies, while maintaining cordial relations with G20 leaders, including — until even a month or so ago — the U.S.
In Ethiopia, Tedros is viewed as a “mixed personality,” said Getnet Tadele, a professor specializing in the sociology of health at Addis Ababa University.
He’s credited with major improvements in access to basic health care, and his embrace of reproductive rights helped make Ethiopia a darling of rich Western countries and the humanitarian philanthropies that echo their interests.
On the other hand, he was a member in good standing of the Tigray People’s Liberation Front, the former ruling party, including serving as foreign minister from 2012 to 2016. The regime has been condemned by human rights organizations for torturing political dissidents, tossing journalists in jail and cutting off regions home to opposition factions.
“He was part of that coterie that was really creating a lot of fear in the country,” said Tadele.
Tedros has a world-famous health record — but it’s stained by accusations that he participated in a cover-up of his own.
There’s little dispute about Tedros’ pivotal role in improving access to basic care. Under Ethiopia’s so-called community health extension program, Tedros helped train and employ 38,000 health workers, providing better care for pregnant women and people suffering from HIV infections, tuberculosis and malaria.
Tedros was also a key figure in pushing through Ethiopia’s abortion law, which even today is credited with being one of the most progressive in Africa despite deep-rooted opposition from the Ethiopian Orthodox Tewahedo Church.
“He is a very technical person, research-orientated,” said Saba Kidanemariam, the country director for Ipas Ethiopia, an NGO working to offer access to abortions and contraception.
In her work on women’s health services, Kidanemariam was witness to Tedros’ rise through the ranks of the TPLF. She met him regularly while he was health minister and said that Tedros always put a lot of energy into equipping regional health bureaus with more resources and staff.
At the same time, “he is a very good PR agent for himself,” she added. “He can relate with anyone.”
Tedros proved especially adept at using different streams of development funding, such as the Global Fund and the U.S. AIDS program Pepfar, to bankroll his network of community health workers.
“I will follow your rules, your procedures, your processes, but at the end I will decide how all these programs come together,” Kazatchkine, who as Global Fund director first encountered Tedros around 2008, recalled hearing.
The vote was a secret one, but Beijing’s backing was seen as key for Tedros’ victory over his British opponent, David Nabarro.
While he was health minister, Tedros was accused of downplaying a series of cholera outbreaks, accusations that are reminiscent of those being hedged at China and its early stance during the coronavirus crisis.
Money was pouring into the Ethiopian health care system — from the U.S., the U.K. and the Bill and Melinda Gates Foundation. That meant Ethiopia had a reputation to maintain — and outbreaks of cholera, a potentially fatal intestinal infection fueled by poor sanitation, didn’t fit.
Unable to get the disease under control, Tedros is accused by watchdogs of trying to minimize the outbreaks by refusing to call them anything other than “acute watery diarrhea,” or AWD.
“If you can’t manage disease outbreaks then that’s in direct correlation to your legitimacy, not to mention implications for tourism,” said Edward Brown, Ethiopia’s country director for World Vision. “Trying to control the narrative rather than tell the truth, that was the stain of the AWD thing.”
Tedros’ time in the Ethiopian government was also a period in which China was emerging as another major donor. In 2012, the year the Chinese-built African Union headquarters was inaugurated, Tedros was appointed foreign minister.
The aim was to have him in “a position as a diplomat to leverage China,” said Tadele. “It was a deliberate move.”
During his time as foreign minister, Tedros regularly met senior officials from China, often traveling to Beijing to carry on the blueprint of leveraging financial aid and building headline projects, such as industrial parks, started by former Prime Minister Meles Zenawi.
It’s a relationship that would prove useful when he stood for president of the WHO.
Until Tedros’ election, the WHO chief had been selected by the organization’s 32-member executive board. The year of his candidacy marked the first time each member of the United Nations would have a chance to vote — offering a voice to a wide array of governments from developing countries such as Ethiopia.
The vote was a secret one, but Beijing’s backing was seen as key for Tedros’ victory over his British opponent, David Nabarro.
Other governments, particularly in Africa, were also enthusiastic. While no other region of the world relies on international organizations like the WHO more than Africa, those institutions have generally been run by officials from richer parts of the world.
The continent’s lack of voice had been highlighted by the devastating 2014 Ebola outbreak in West Africa, in which the WHO, under then Director General Margaret Chan (of China), was accused of moving too slow to stem the virus.
As one Geneva-based diplomat put it, there was “a clear, tacit understanding that if the African continent produced a good candidate, then that candidate would be the next DG.”
Tedros also had the backing of the African Union. Even before the 2014 Ebola outbreak, he’d spearheaded the idea of a pan-African equivalent of the U.S. Centers for Disease Control and Prevention. As Ethiopian foreign minister, he got the item on the agenda at the AU, said a senior official of the now operational African CDC.
During the campaign, Tedros was able to brush off questions about Ethiopia’s human rights abuses without much resistance. The country, he argued, distancing himself from direct allegations of violence, was a new democracy, not a perfect one.
When Gostin, an informal adviser to Nabarro, in a last-ditch effort to turn the campaign around, resurrected the charges of a cholera coverup, the accusation only seemed to help Tedros.
Tedros accused Nabarro’s campaign of a “colonialist mindset” and 10 days later won the election.
He would go on to vindicate one of the central rationales of his candidacy: Improving the WHO’s response to Ebola. Lost amid the COVID-19 crisis has been a quiet victory in the Democratic Republic of Congo, where a seemingly intractable outbreak of the hemorrhagic fever, coursing through remote war zones, has largely been quelled.
“Here you had an African director general, leading a major global emergency on the continent itself, in a country that was and is fragile, misgoverned and fraught with political violence and massive public distrust,” Gostin said.
But while a few new cases have cropped up, the outbreak is nearly extinguished. It’s among the reasons, Gostin said, that “overall he’s won me over.”
Since taking office, Tedros has sometimes courted controversies with moves that seem to confirm Western misgivings that he’s a little too comfortable with strongmen.
Less than four months into the job, he named the Zimbabwean dictator Robert Mugabe a WHO goodwill ambassador for noncommunicable diseases.
Tedros’ argument was that anyone who wants to join the fight against obesity and cancer should be welcome. After all, Mugabe, who died two years later, still had a following among some Africans who revered him as the liberator he once was rather than the despot he became.
Tedros withdrew the honor amid forceful backlash. But it revealed a political style that values bringing as many into the fold as possible — even when there are strong reasons to keep them out.
His subsequent staffing moves also drew critics: In a bid to keep a campaign promise to shake up the overrepresentation of white men in the WHO’s ranks, he fast-tracked some key appointments. He named eight new directors, all but one women, flipping the gender balance in the top ranks.
“Before Tedros it was the G7, now it is more like the G20” — Mathias Bonk, chairman of the Berlin Institute of Global Health
But one of those women, his new tuberculosis boss Tereza Kasaeva, became emblematic of critics’ concerns that he was blowing off conventional qualifications to score political points: The appointment of the Russian health ministry official seemed like a sop to Moscow, which has a terrible record on the disease, after Vladimir Putin pledged $15 million to the WHO’s efforts in that area.
Civil society groups and the prestigious medical journal The Lancet worried Tedros was putting the WHO’s legitimacy (and funding) at risk. It was an early warning for Tedros about the risks of getting too friendly with global pariahs.
Yet the Kasaeva controversy proved to be short-lived — her work hasn’t attracted criticism. And Tedros and his allies contend that the old power players are just struggling to adjust to the new world order.
They note too that officials from powerful donor countries still have plenty of opportunities in his WHO. Two of Tedros’ earliest hires, for example, still hold key spots on his leadership team: Bernhard Schwartländer, a longtime WHO staffer handpicked by the German government, is his chef de Cabinet, and the Brit Jane Ellison, a former Tory MP, is executive director for governance.
“At that level, it’s still not a ‘world’ health organization,” said Mathias Bonk, chairman of the Berlin Institute of Global Health. “Before Tedros it was the G7, now it is more like the G20.”
Tedros’ former opponent, Nabarro, is now an adviser on the coronavirus fight, recently appearing on the American Sunday political show “Meet the Press” to plead the WHO’s case in the face of Trump’s attacks.
At a press conference last month, Tedros told reporters he believes that “talent is universal, opportunity is not.”
He compared the criticism he received for being too close to China with the disapproval he got when he nominated the health secretary of the Cook Islands, a tiny South Pacific archipelago, as the WHO’s chief nurse.
“What is this Cook Island?,” he recounted hearing. “Is it Thomas Cook the company or what Cook?”
He mused to reporters about whether it was “arrogance or ignorance.” Ignorance could be fixed, he said. But arrogant people “didn’t want to have a chief nursing officer of the whole wide world from a small country like Cook Island.”
He continued: “So we work with Cook Island, 10,000 population. We work with China, 1.4 billion population. We were criticized for the 10,000. Is it because Cook Island influenced us? Using what? And China, using what?”
Tedros told reporters he’s personally weathered racist attacks and death threats, since controversy erupted over his handling of the coronavirus outbreak in China.
“I don’t give a damn,” he said.
‘Imagine it’s you’
The WHO will no doubt be subject to both internal and external reviews of how it’s handled this crisis when it’s all over.
That the agency is too beholden to one of its more powerful members is not a new charge — what’s different is that the country usually accused of throwing its weight around is the U.S.
The WHO has attracted “significant criticism from many countries that it has seemed to be beholden to the United States for decades,” said Adam Kamradt-Scott, a University of Sydney specialist in the WHO and in responses to disease outbreaks. The idea that it “switched its loyalties to China is really quite comical,” he added.
It’s also not the first time that world leaders have called on the WHO to take a more aggressive stance on countries that seem to be concealing outbreaks.
Tedros’ stance on China draws frequent comparisons to that of Gro Harlem Brundtland, a former Norwegian prime minister who served as head of the WHO from 1998 to 2003.
In 2003, Brundtland publicly called China out for hiding the SARS outbreak, a major shift in the agency’s traditional approach.
The WHO “has not historically criticized governments when they do the wrong thing,” said Kamradt-Scott.
Initially, countries applauded Brundtland’s assertiveness. The initial impulse was to give the WHO more power to investigate how countries were dealing with outbreaks. (There’s a similar campaign afoot today, led by Australia, likely to be a hot topic at the WHO’s annual assembly of member countries starting May 17.)
But then it dawned on the diplomats: “Imagine if it’s you next time,” said Kamradt-Scott.
The final result was to do just the opposite, and prevent WHO presidents from unilaterally taking action against a country.
The International Health Regulation, adopted in 2005, put new limits on the WHO chief’s authority. Instead, an emergencies committee offers recommendations about whether to issue travel restrictions or declare a public health emergency.
It’s with this precedent in mind that Tedros has taken his softer approach on Beijing.
“His view is if you publicly criticize China, they’re going to become less transparent,” said Gostin.
How the WHO comes out of this crisis will depend primarily on who is elected U.S. president in November.
For now, the most visible change is to the organization’s PR footing, complete with shows of diplomatic force. The WHO and EU leaders teamed up twice in recent weeks for high-profile extravaganzas of global solidarity.
Tedros didn’t need to mention Trump. “He plays things in this more roundabout way,” said Kickbusch, the external WHO adviser. “Anybody who reads the list” of supporters — from which the U.S. is absent — “will know what it’s all about.”
Kickbusch described this technique as “encircling,” bringing allies into the fold without directly calling anyone out. Tedros’ face-time and phone calls with the likes of German Chancellor Angela Merkel and French President Emmanuel Macron over the years have also paid off in support, especially when the choice is framed as one between him and Trump.
“He wasn’t the candidate of a significant number of European countries,” Kickbusch said. But leaders who’ve appeared at pledging events have taken the view that “nobody’s perfect, but they have a respect for what he’s trying to do and what he’s trying to navigate.”
Tedros is also in good standing with the WHO’s second biggest donor: The Bill and Melinda Gates Foundation.
“I don’t care who is the head of WHO right now, that is just a tough spot given the politics between China and the United States. So I think he’s doing the very best he could do,” Melinda Gates told POLITICO. “I think his leadership has been quite strong on this, quite frankly.”
Tedros has also been refining his defense, highlighting what he did do during the early weeks of the outbreak.
After a split decision from the committee about whether to declare an international emergency on January 23, Tedros flew to Beijing and personally met with President Xi Jinping.
As a result, the Chinese allowed a WHO-led group of experts to enter the country, though there’s debate about whether that should have happened earlier — and whether those experts really got an unvarnished look.
“At the end of the day, each country takes its own responsibility. We don’t have any power… to enforce our own advice” — Tedros, WHO chief
When the WHO did finally declare an emergency on January 30, Tedros noted in a press conference in late April, there were still no deaths outside of China.
“So, the world should have listened to the WHO then carefully,” he said. “It’s up to countries to take our advice or reject it. But we give our advice based on the best science and evidence.”
“At the end of the day, each country takes its own responsibility,” he added, “We don’t have any power… to enforce our own advice.”
Whether he can make that defense stick will determine whether he, and the WHO, come out of the crisis stronger — or far weaker.
Carmen Paun, Jillian Deutsch, David M. Herszenhorn and Rym Momtaz contributed reporting.