Tedros says he will work tirelessly to fulfill the promise of universal health coverage.

Valentin Flauraud/Keystone via AP

Former Ethiopian health minister becomes first African head of the World Health Organization

For the first time in its history, the World Health Organization (WHO) will be led by an African. In a secret ballot, the World Health Assembly today elected Tedros Adhanom Ghebreyesus, a physician and former health minister of Ethiopia, to be the agency's new director-general.

Many felt it was Africa’s turn to lead the agency, and the African Union, representing 54 WHO member states, supported the candidacy of Tedros, who goes by his first name. "This is a historic moment,“ says Ashish Jha, a global health expert at the Harvard T. H. Chan School of Public Health in Boston. "I think it is a good thing for WHO."

Tedros was health minister between 2005 and 2012 and served as Ethiopia’s foreign minister the past 4 years. His achievements for public health have been widely hailed; he built up a network of more than 40,000 female health workers, and deaths from AIDS, malaria, and tuberculosis were more than halved on his watch. But Tedros has been criticized for being part of the government that alledgedly committed human rights abuses. And just 10 days before the vote, Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University in Washington, D.C., claimed Tedros covered up cholera outbreaks in Ethiopia as health minister. Gostin supported and advised another candidate, physician and longtime United Nations operative David Nabarro from the United Kingdom.

In the end Tedros beat Nabarro in the third round of voting with 133 to 50 votes, according to journalists who reported the vote count. A third candidate, Sania Nishtar from Pakistan, was widely seen as a long shot and was eliminated in the first election round with 38 votes. Tedros will succeed Margaret Chan, who will step down on 1 July after leading the organization for 10 years.

Some observers suggest the attacks on Tedros may actually have helped him because countries felt they were unfair. Gostin admits that is a possibility. "It may have made a difference as his campaign turned it against Dr. Nabarro, accusing him [of] criticizing another candidate." But Gostin says as an academic he had to insist on the highest possible standards. He now wants Tedros to succeed, he adds. "But to do that he should make a clear statement of the importance of human rights and rapid reporting of outbreaks. And be clear that he will be willing to call out abuse wherever he sees it."

"I’m often astonished when I think of the path my life has taken," Tedros said in a short speech before the voting began. He recalled how a younger brother died "from one of the many child killers in Africa." It could just as easily have been him, Tedros said. "Coming from this background, knowing survival to adulthood cannot be taken for granted, and refusing to accept that people should die because they are poor, I have dedicated my life to improving health, to reducing inequalities, to helping people everywhere live more productive lives." He said he would work tirelessly to fulfill the promise of universal health coverage.

The change in leadership comes at a crucial time for WHO. The organization was widely criticized for its late response to the West African Ebola outbreak and is in the midst of reforms, while many fear that the Trump administration will significantly cut funding for international health. "This is a turning point for WHO," Gostin says. The new director-general will have to build up confidence in the organization and ramp up funding, he says. 

“The challenge is not really about one leader, but whether the World Health Organization can reform, become less bureaucratic, respond to threats more quickly, act more innovatively," Ron Klain, a lawyer in Washington, D.C., and U.S. Ebola response coordinator during the West African epidemic, wrote in an email to ScienceInsider. "The world is putting its faith in Dr. Tedros to do that, and the stakes could not be higher—now, we will see if he can deliver."

The election was unprecedented in many ways. In the past, WHO's executive committee, a body made up of 34 countries, chose one candidate who was then approved by the full assembly. This time, the board narrowed an initial field of six candidates down to three in January, leaving the final choice up to member states today.

The campaign received far more press attention than usual. Candidates traveled the world and vied for the job in speeches and on websites. "Campaigning is good," Jha says. "It forces you to articulate your vision, to make certain promises that you will be held accountable for. This is what we do in democracies." Having won after a hard-fought campaign also gives Tedros legitimacy, he adds. "I think it will make the [director-general] a more powerful position." But Jha criticizes the fact that countries voted secretly. "People have the right to know how their representatives voted," he says.

*Update, 23 May, 3:16 p.m.: This story has been updated with additional comments from Lawrence Gostin.