Tedros Adhanom
Tedros Adhanom Ghebreyesus (Ge'ez: ቴዎድሮስ አድሓኖም ገብረኢየሱስ; born 3 March 1965)[1] is an Ethiopian[1] microbiologist and internationally recognized malaria researcher[2] who currently serves as Director-General of the World Health Organization, a position he has held since 2017.[3][4] Tedros is the first non-physician and first African in the role.[5] Tedros has held two high level positions in the Government of Ethiopia: From 2005 to 2012, Tedros was Ethiopia's Minister of Health[6] and from 2012 to 2016, Tedros was Ethiopia's Minister of Foreign Affairs
Early life and education
Tedros was born in Asmara, which at that time was in Ethiopia – but is now the capital of Eritrea[9] – to Adhanom Gebreyesus and Melashu Weldegabir. The family originated from the Enderta awrajja of the province of Tigray. As a child, Tedros has discussed being very aware of the suffering and death caused by malaria.[10] His younger brother died at the age of 3 or 4 years old, possibly by a preventable disease like measles, which Tedros often discusses as a defining experience in regards to the need for global healthcare.[5][11]
In 1986, Tedros received a Bachelor of Science (BSc) degree in Biology from the University of Asmara.[12] In 1992, Tedros received a Master of Science (MSc) degree in Immunology of Infectious Diseases from the London School of Hygiene & Tropical Medicine at the University of London.[7] In 2000, he earned a PhD in community health from the University of Nottingham for research investigating the effects of dams on the transmission of malaria in the Tigray region of Ethiopia.[13]
Early career
After college, Tedros, joined the Ministry of Health of the Derg as a junior public health expert.[14] After the fall of Mengistu Haile Mariam, Tedros moved to London for graduate school.[7]
In 1986, Tedros joined the Ministry of Health as a Minister of Health where he received praise for a number of innovative and system-wide health reforms that substantially improved access to health services and key outcomes in Ethiopia.[15] Amongst them were hiring and training roughly 40,000 female health extension workers, cutting infant mortality from 123 deaths per 1,000 live births in 2006 to 88 in 2011, and increasing the hiring of health cadres including medical doctors and midwives.[16]
In 2001, Tedros was appointed head of the Tigray Regional Health Bureau.[7] As head of the bureau, Tedros was credited with making a 22.3% reduction in AIDS prevalence in the region, and a 68.5% reduction in meningitis cases. He oversaw a campaign to improve ICT access that installed computers and internet connectivity to most of the region's hospitals and clinics, whereas they had not been connected before.[17]
During his time in this position, health care staffing was increased by 50%. Immunization for measles was raised to 98% of all children and total immunisation for all children under 12 months was raised to 74%. The percentage of government funding for the Tigray Regional Health Bureau was increased to 65%, with foreign donors' percentage falling to 35%. Overall, 68.5% of the population was provided with health care services within 10 km.[17]
In late 2003, Tedros was appointed a State Minister (deputy minister) for Health and served for just over a year.[18]
Minister of Health of Ethiopia (2005–2012)
In October 2005, Tedros was appointed Minister of Health of Ethiopia by Prime Minister Meles Zenawi. Despite the many challenges faced by the health ministry in terms of poverty, poor infrastructure, and a declining global economic situation, progress in health indicators was considered "impressive" in Ethiopia.[15][16][19] During the period 2005–2008, the Ethiopian Ministry of Health built 4,000 health centres, trained and deployed more than 30,000 health extension workers, and developed a new cadre of hospital management professionals as part of a Health Extension Program (HEP).[6][19] Furthermore, in 2010, Ethiopia was chosen by the US State Department as one of the US Global Health Initiative Plus countries, where the US will support innovative global health efforts.[citation needed]
Tedros inherited a ministry with a strong vision but little capability to meet that vision.[19] The Ministry was somewhat beholden to a donor community that was focused on HIV/AIDS, Tuberculosis, and malaria programs when Tedros first assumed his leadership position with a diagonal, systems-based reform agenda. With little economic surplus, the country lacked capacity to build its own health systems, and much of the Ethiopian human resources for health had fled the country: for example, there are more Ethiopian doctors in the Chicago metropolitan area than in Ethiopia.[19][20] Tedros designed the health workforce "flooding" reform strategy that has resulted in the training and deployment of thousands of doctors, nurses, pharmacists, laboratory technologists and health officers.[21]
As Minister of Health, Tedros was able to form a close relationship with prominent figures including former American president Bill Clinton and the Clinton Foundation and the Bill and Melinda Gates Foundation.[19]
Global Health Initiatives
During his time as Minister of Health of Ethiopia, Tedros was very active in global health initiatives. Ethiopia was the first country to sign compact with the International Health Partnership. He was Chair of the Roll Back Malaria Partnership (2007–2009), Programme Coordinating Board of UNAIDS (2009–2010) and the Global Fund to fight AIDS, Tuberculosis and Malaria (2009–2011) and Co-Chair of The Partnership for Maternal, Newborn & Child Health (2005–2009). He also served as member of the Global Alliance for Vaccines and Immunization (GAVI) Board as well as the Institute of Health Metrics and Evaluation (IHME) and the Stop TB Partnership Coordinating Board. He was also member of several academic and global health think tanks including the Aspen Institute and Harvard School of Public Health.[citation needed] He served as vice-president of the 60th World Health Assembly that was held on 14–23 May 2007. From 2008 until 2009, he was a member of the High Level Taskforce on Innovative International Financing for Health Systems, co-chaired by Gordon Brown and Robert Zoellick.[22]
The Global Fund to Fight AIDS, Tuberculosis and Malaria
In July 2009, Tedros was elected Board Chair of The Global Fund to Fight AIDS, Tuberculosis and Malaria for a two-year term. In a profile published in April 2010, The Lancet reported that Tedros was "a household name at the Global Fund Secretariat" before his election as Board Chair where his leadership was regularly cited at the Global Fund that resulted in Ethiopia to be named as an exemplary high-performing country.[10]
Maternal and Child Health
The rate of child deaths fell by 30 percent between 2005 and 2011.[19] Infant mortality decreased by 23 percent, from 77 to 59 deaths per 1,000 births, while under-five mortality decreased by 28 percent, from 123 to 88 per 1,000 births.[23] The number of expectant mothers who delivered with the help of a skilled provider rose from 6 percent in 2005 to 10 percent in 2011, according to the 2011 Ethiopia Demographic and Health Survey.[23]
Tuberculosis
During Tedros' tenure, TB prevention and treatment services were included as one of the packages of the Health Extension Workers which has resulted in improvement of performance and the achievement of the TB MDG targets ahead of the target time.[citation needed]
Malaria
Deaths from malaria fell by more than 50% from 2005 to 2007.[19] The rate of new malaria admittances fell 54% in the country over the same period, while the number of childhood malaria cases reported at clinics fell by 60%.[23] The Health Ministry conducted the distribution of 20.5 million insecticide-treated bed nets to protect over 10 million families in malaria-prone areas between 2005 and 2008.[23]
According to the WHO Africa office (WHO-AFRO), in 2011 when Tedros was the minister of health, 75% of the land and 60% of the population was exposed to malaria in Ethiopia, although malaria admissions and deaths marginally fell in recent years.[citation needed]
The National Malaria Guideline (3rd Edition) prepared by the Ministry of Health of Ethiopia in 2012, before the departure of Tedros to the Ministry of Foreign Affairs, states that "52 million people (68%) live in Malaria-risk areas". The document further reveals that "Ethiopia is one of the most malaria-prone countries in Africa, with rates of morbidity and mortality increasing dramatically (i.e. 3.5-fold) during epidemics". The same document alleges serious policy failures of the Government of Tedros who was the Minister of Health until 2013. It argues "Ethiopia faces many challenges related to human resources for healthcare, including the shortage of skilled health workers, high turnover and lack of retention of health professionals". In addition to these challenges, the National Malaria Guideline stresses once again, "serious problems in coordinating health interventions and implementing partners".[citation needed]
AIDS
Under Tedros, the Ministry of Health was able to turn around Ethiopia's record of the highest number of new HIV infections in Africa, bringing the number down dramatically.[23] The prevalence was reduced from its double digit record to 4.2 in cities and 0.6 in rural areas.[23] According to the HIV/AIDS Prevention and Control Office (HAPCO) said the rate of HIV infection in Ethiopia has declined by 90% between 2002 and 2012, while the rate AIDS-related death has dropped by 53%.[23] The number of people starting HIV treatment increased more than 150-fold during 2005–2008.[19]
The decline in the infection rate has been attributed to the concerted effort of the Ministry of Health in providing medicines and organizing various awareness-raising programs.[23] The office has managed to integrate the people in HIV prevention and control activities. The wide range of media campaigns to inform the public about the disease has definitely paid off as it has helped achieve behavioral change. Prevention measures like the use of condoms have shot up starkly with increased awareness on the disease and advertising urging safe sex practices and condom use.[23] The government's collaboration with local and international governmental and nongovernmental organizations has also positively influenced access to HIV/AIDS related service centers.[23]
Family planning
Under Tedros' tenure, the unmet need for family planning in Ethiopia has declined, and the contraceptive prevalence rate has doubled in 5 years. Based on the current trends, contraceptive prevalence rates will reach 65% by 2015 by reaching additional 6.2 million women and adolescent girls.[24] Recognising that early childrearing is a major factor in infant mortality, the Ministry of Health is targeting its efforts on adolescent girls (15 to 19 years) who have the highest unmet need for family planning.[24]
Minister of Foreign Affairs of Ethiopia (2012–2016)
In November 2012, Tedros became Ethiopia's Minister of Foreign Affairs.[7][8] He held this position from November 2012 until 2016, as part of Hailemariam Desalegn's cabinet reshuffle after he was approved by the EPRDF as party leader (and thus Prime Minister).
Financing for Development Conference (FfD3)
Tedros was instrumental in the successful outcome of Third International Conference for Financing for Development, which was held in Addis Ababa, Ethiopia, on 13–16 July 2015 demonstrating his negotiation and consensus building skills. Tedros was responsible for the organization of the Addis Ababa Action Agenda (AAAA) document in which the attending countries committed to financing for the Sustainable Development Goals.[25][26] He played key role in saving the Forum from collapse by bringing polarized positions closer.[according to whom?] The outcome document, called the Addis Ababa Action Agenda (AAAA), set policy actions by Member States, which draw upon all sources of finance, technology, innovation, trade, and data in order to support the implementation of the Sustainable Development Goals.[27] The Conference, however, was criticized by a few observers for failing to come up with new money for implementing the SDGs during its process[28] while a follow up report by the Economic and Social Council Forum in April 2016 was much more optimistic and provided the framework to monitor the commitments.[29] Tedros served as a member of the High Level Task Force for innovative financing for Health Systems chaired by former World Bank President and Prime Minister of UK, Gordon Brown.[30]
Agenda 2063 of Africa Union
As Chair of the Executive Council of the AU in 2014, Tedros highlighted the need for a paradigm shift in Africa's political and socio-economic governance and development in order to realize the continent's long-term agendas. He emphasized the need for Africa to focus on issues of economic emancipation, peace and stability, the acceleration of rapid economic growth, governance and democratization. During his tenure, the AU adopted its First Ten Year Implementation Plan for Agenda 2063 – a roadmap for achieving a prosperous Africa based on inclusive growth and sustainable growth, which has placed health as its centerpiece.[citation needed] His leadership and skills in conflict resolution have also helped resolve regional disputes—such as the agreement between the Federal Government of Somalia and Jubaland Political Actors—which was critical to improving the delivery of health services and protecting the safety and security of Somali citizens.
West Africa Ebola Crises
As Minister of Foreign Affairs, Tedros played a pivotal leadership role in the Africa Union's response to the 2013–2016 Western African Ebola virus epidemic. He particularly facilitated greater country ownership and urging countries to adhere to the WHO guidelines including the full implementation of the International Health Regulations.[citation needed] He also advocated that the Ebola crises offer a unique opportunity to strengthen primary health care and highlight the importance of health as a critical security issue. In an interview he conducted with Devex in November 2014, Tedros discusses what "disappointed" him in the global response to Ebola, the importance of solidarity in overcoming the outbreak, and how the deadly virus has transformed to a crisis beyond health.[31] He also promptly mobilised 200 Ethiopian health workers highly trained in management of public health emergencies and surveillance (by an initiative he created when he was the Minister of Health) to join the African Union response team.[32]
Hidase Dam controversy
In May 2013, controversy intensified over the under-construction Hidase Dam in the Benishangul-Gumuz near Sudan as Ethiopia began diverting the Blue Nile for the dam's construction. At that time, the dam was more than 22 percent complete, and expected to produce 6,000 megawatts, making it Africa's largest hydroelectric power plant. The dam was expected to have a reservoir of around 70 billion cubic meters, which was scheduled to start filling in 2014. Egypt, Ethiopia and Sudan established an International Panel of Experts to review and assess the study reports on the dam. The panel consisted of 10 members; 6 from the three countries and 4 international in the fields of water resources and hydrologic modelling, dam engineering, socioeconomic, and environmental.[33] The panel held its fourth meeting in Addis Ababa in November 2012. It reviewed documents about the environmental impact of the dam and visited the dam site.[34] The panel submitted its preliminary report to the respective governments at the end of May 2013. Although the full report has not been made public, and will not be until it is reviewed by the governments, Egypt and Ethiopia both released details. The Ethiopian government stated that, according to the report, the dam meets international standards and will be beneficial to Egypt, Sudan and Ethiopia. According to Egyptian government, the report found that the dimensions and size of the dam should be changed.[33][35]
On 3 June 2013, while discussing the International Panel of Experts report with President Mohammad Morsi, Egyptian political leaders suggested methods to destroy the dam, including support for anti-government rebels.[36][37] The discussion was televised live without those present at meeting aware.[36] Ethiopia requested that the Egyptian Ambassador explain the meeting.[38] Morsi's top aide apologized for the "unintended embarrassment" and his cabinet released a statement promoting "good neighborliness, mutual respect and the pursuit of joint interests without either party harming the other." Morsi reportedly believes that is better to engage Ethiopia rather than attempt to force them.[36] However, on 10 June 2013, he said that "all options are open" because "Egypt's water security cannot be violated at all," clarifying that he was "not calling for war," but that he would not allow Egypt's water supply to be endangered.[39] Tedros said the dam will be used exclusively for power generation and is being constructed in a way that takes Egypt's water security concerns into account.[40] On 18 June, Tedros and Egyptian Foreign Minister Mohamed Kamel Amr issued a joint statement reiterating "their commitment to strengthen their bilateral relations and coordinate their efforts to reach an understanding regarding all outstanding issues between both countries in a manner of trust and openness building on the positive developments of their relations".[41] Both agreed to review the report of the International Panel of Experts and implement their recommendations, working to defuse the tensions and ease the crisis.[41]
Director-General of World Health Organization (2017-present)
On 24 May 2016, on the margins of the 69th World Health Assembly, Tedros officially announced his candidacy for the post of the Director-General of the World Health Organization as the sole African candidate,[42] with endorsement from the African Union and Ministers of Health of the continent. His official launch of candidacy in Geneva was attended by the chairperson of the African Union Commission, Nkosazana Dlamini-Zuma, the Ministers of Foreign Affairs of Rwanda and Kenya, and the Minister of Health of Algeria.[43] During the launch, it was stressed that the nomination of Tedros was based on merit and his prolific national and global credentials. His campaign tagline was "Together for a Healthier World."[44] His Campaign Chair was Senait Fisseha, an Ethio-American lawyer and a Professor of Gynaecology and Obstetrics from University of Michigan. During this period she was also Director of International Programmes at the Susan Thompson Buffett Foundation, a post she hold since 2015 to advance women's health and reproductive rights globally.[45] She later led his transition team.[46] Negash Kebret Botora, Ethiopia's ambassador to the UN and international organisations in Geneva, also played a critical role in the campaign.[47] The campaign was supported in part by a Fund created by East African countries.[48] Tedros also hired Mercury Public Affairs, a US-based lobbying company, to help him with his bid.[49]
During its 140th meeting in January 2017, the Executive Board of the WHO shortlisted Tedros as the front runner out of six candidates through two rounds of secret voting. He collected the most votes during both rounds.
Tedros was elected as Director-General of the World Health Organization by the World Health Assembly on 23 May 2017,[4][50][51] becoming the first director-general who is not a medical doctor,[52][53] with an overwhelming 133 votes out of 185.[54][55] His election was historic, as he became the first African to lead the WHO, as well as the first Director-General elected in a vote open to all Member States.[56][57] He took office for a five-year term on 1 July 2017.[4]
Tedros has overseen the WHO management of the Kivu Ebola epidemic.[58] He made early trips to both the Democratic Republic of Congo and China during the Kivu Ebola epidemic.[59]
Tedros has identified universal health coverage as his top priority at WHO.[11][60] He campaigned on the issue and reiterated this focus in his first speech as Director-General and throughout the 72nd Session of the UN General Assembly.[61]\[62] In October 2017, he announced his senior leadership team, with women representing 60% of appointments.[63][64] While Tedros received praise for his commitment to gender equality, he also received criticism for a lack of transparency. He appointed Dr. Tereza Kasaeva of the Russian Ministry of Health to lead the WHO Global Tuberculosis Program without soliciting civil society input; days before the appointment, civil society organizations had published an open letter calling for a competitive, open process to identify the Program's new director.[65][66]
2019–20 coronavirus pandemic
In early 2020, Tedros oversaw the world's management of the 2019–20 coronavirus pandemic (COVID-19).[67]
Criticism
WHO election
In May 2017, just prior to the WHO election, stories surfaced about an alleged cover-up of three possible cholera epidemics in Ethiopia in 2006, 2009 and 2011. The outbreaks were allegedly wrongly labelled as "acute watery diarrhea" (AWD)—a symptom of cholera—in the absence of laboratory confirmation of Vibrio cholerae in an attempt to play down the significance of the epidemics.[68][69] UN officials said more aid and vaccines could have been delivered to Ethiopia if the outbreaks had been confirmed as cholera. The allegations were made by Larry Gostin, an American law professor who was acting as an adviser to rival candidate David Nabarro from the UK.[69] The African Union delegation to the UN dismissed the report, published in The New York Times, as "an unfounded and unverified defamation campaign, conveniently coming out only days before the election."[70] Tedros denied the allegation of a cover-up and said he was "not surprised at all but quite disappointed" by what he called a "last-minute smear campaign."[69]
Tedros's candidacy for WHO director general was opposed vigorously by several Ethiopian parties, due to his career in the violent Communist Tigray People’s Liberation Front. The TPLF provided millions of dollars in financial support for Tedros's candidacy in WHO.[71][72][73]
Robert Mugabe
On 18 October 2017, Tedros announced that he had chosen President Robert Mugabe of Zimbabwe to serve as a WHO Goodwill Ambassador to help tackle non-communicable diseases for Africa.[74] He said Zimbabwe was "a country that places universal health coverage and health promotion at the centre of its policies to provide health care to all". Mugabe's appointment was severely criticised, with WHO member states and international organisations saying that Zimbabwe's healthcare system had in fact gone backwards under his regime, as well as pointing out Mugabe's many human rights abuses. It was also noted that Mugabe himself does not use his own country's health system, instead travelling to Singapore for treatment.[75][76] Observers said Tedros was returning a campaign favour. Mugabe was chair of the African Union when Tedros was endorsed as a sole African Union candidate in a murky process that did not consider qualified alternatives like Michel Sidibé of Mali and Awa Marie Coll-Seck of Senegal.[77] His judgement was widely questioned on social media. The editor-in-chief of Lancet, a prominent medical journal, called Tedros "Dictator-General".[78] After a widespread condemnation, on 22 October 2017 Tedros rescinded Mugabe's goodwill ambassador role.[79][80]
COVID-19 and relationship with China
During the COVID-19 pandemic, Tedros was widely criticised by the public and was perceived to have acted slowly in his efforts to stem the epidemic, and as having a too close relationship with the government of China (where the pandemic originated).[81][82] In January 2020, Tedros met with Chinese leaders including Chinese Communist Party general secretary Xi Jinping about COVID-19.[83] In the first week of February 2020, he stated that there was no need for the world to take measures that "unnecessarily interfere with international travel and trade" such as worldwide travel restrictions. This was interpreted to have contributed to the spread of the virus.[84]
Tedros and the WHO were also criticised for the delay in declaring COVID a Public Health Emergency of International Concern[59][85] and a pandemic, which was seen as political and was criticized by world leaders[81][86] as well as conservative media.[87] According to Georgetown University professor Lawrence Gostin, Tedros' strategy on China was a more politically strategic one, rather than a critical approach. Tedros praised China for its containment measures, describing them as a "new standard for outbreak control",[59] a position which was criticised in light of China's efforts to suppress information.[88] A petition on change.org demanding the resignation of Tedros for his perceived capitulation to Chinese authorities[89] received over 772,000 signatures.[90] Observers also contrasted Tedros' praise for China with the concerns voiced by several countries and organizations over China's slow initial response and its resistance to cooperate with international disease-tracking efforts.[82]
On 8 April 2020, during a regular COVID-19 press briefing, Tedros responded to a question from a journalist asking for a response to remarks by President Donald Trump where he threatened to cut U.S. funding to the WHO, the three complaints Trump had: (1) WHO criticized the U.S. travel ban to China, (2) the WHO was delayed in responding to and characterizing COVID as a pandemic, and (3) that the WHO is China-centric.[91][92] Tedros gave an impassioned response, with a key point being a plea to not politicize the virus, referring to grave consequences of body bags if the world didn't approach this from a global perspective of unity at national levels.[93]
Tedros claimed that he received death threats and racist remarks that were made about him that he attributes to Taiwan, which Taiwan vehemently rejected.[94] Tedros said that he believed the Foreign Ministry of Taiwan knew about the racist insults and did not proactively act to address them, complicitly endorsing them.[95] Tseng Ho-Jen, Ambassador Taipei Representative Office in the European Union and Belgium, said that Foreign Minister of Taiwan Joseph Wu and the Taiwanese government had never launched an offensive against Tedros. He criticized Tedros' accusations as being unfounded and fabricated.[96] Taiwan’s foreign ministry also demanded an apology for what it called unnecessary and slanderous comments from Tedros. President of Taiwan Tsai Ing-wen expressed “strong protest” against Tedros’s allegation that it was behind racist attacks. She said Taiwan's people know how it feels to be discriminated against and isolated more than anyone else as Taiwanese have been excluded from global organizations for years. She also invited him to visit Taiwan.[97]
The Washington Post related Tedros' outburst to the criticism Taiwan previously leveled at the WHO for ignoring early warnings about COVID-19 (notifying the organization in late December about human-to-human transmission of a new form of pneumonia in Wuhan), and to Taiwan's general exclusion from the "increasingly China-friendly" WHO
