The global health community is struggling to make sense of a blunder that has shaken confidence in the new director-general of the World Health Organization and given rise to concerns — both outside and within the WHO — about the impact the episode will have on the credibility of the agency he leads.
Mere days after hitting the 100-day mark of his first term in the office, Tedros Adhanom Ghebreyesus appointed Zimbabwean President Robert Mugabe to a ceremonial position of honor, naming the longtime authoritarian as a WHO goodwill ambassador for noncommunicable diseases.
Four days later, under intense international pressure, Tedros — who goes by his first name — withdrew the appointment.
“I have listened carefully to all who have expressed their concerns, and heard the different issues that they have raised,” he said in a statement issued Sunday.
There were sighs of relief and calls from some global health heavyweights to rally round a new leader who had the courage to publicly acknowledge a major mistake, and to swiftly correct it.
We have to allow leaders to admit mistakes listen reflect & when needed change decision.Brave leadership something we can all learn from.
— Jeremy Farrar (@JeremyFarrar) October 22, 2017
But within the broad community of people who work with and for the WHO, the stunning incident has created a sense of deep unease about why Tedros made the sure-to-be-challenged appointment in the first place and how a man who had been Ethiopia’s foreign minister — his country’s top diplomat — for four years did not anticipate the firestorm the Mugabe appointment would ignite.
The episode has raised questions about the new director-general’s judgment and what damage this lapse could inflict on the WHO, which faces major challenges during his tenure. Criticism of the appointment came from a multitude of sources, including many of the countries that provide much of the WHO’s funding.
“I think some of the arguments for his candidacy were that he’d been both a health minister and a foreign minister, and merging the technical and diplomatic aspects should have been his strength,” noted Jimmy Kolker, a retired U.S. diplomat who served as assistant secretary for global affairs at the Department of Health and Human Services during the Obama administration.
“I think he fell down on both sides … and certainly he underestimated the political or diplomatic liability this would be for WHO.”
Tedros has not publicly explained why he thought the 93-year-old Mugabe — a leader who has clung to power for decades by suppressing political opposition and trampling human rights in his country — was the right person to task with promoting the fight against cancer and heart disease to other African nations.
Even if you put aside Mugabe’s political track record — and no critic of the appointment would willingly do so — he was an unusual choice as a champion in the fight against chronic diseases. Zimbabwe is Africa’s largest tobacco producer and exporter. And under Mugabe, its health system has been beggared; the president himself leaves the country when he needs care.
Tedros had initially agreed to speak with STAT about the issue, but declined on Sunday, saying he felt his statement was enough and he was busy with other issues. A spokesperson for his office reaffirmed Monday that he would not give interviews about the matter.
In the absence of insights into his thinking, observers are drawing conclusions. They don’t find them reassuring, even as they support the WHO and want the agency to become stronger under Tedros.
Some have questioned whether the move was an attempt by Tedros to reward those who supported him in the race for director-general. Though balloting during the May election was secret and there’s no way to be certain who voted for whom, the 55-member African Union had unanimously endorsed his candidacy.
The road to that endorsement was paved by a vote by the union’s executive council in January 2016, which came just as Mugabe ended a year’s term as the African Union’s chair. Mugabe chaired the meeting.
Tedros himself credited “the unity of Africa” for his victory in a speech to the WHO regional committee for Africa in Zimbabwe in late August — an event Mugabe attended. In the address Tedros heaped praise on Mugabe, noting his “strong commitment to health.”
David Fidler, professor of international health law at Indiana University, said there’s currently no evidence the ambassadorship was payback for the African Union’s endorsement. “But the appointment of Mugabe was so bizarre that this explanation has to remain on the table until DG Tedros and WHO explain … why and how the appointment was made,” he told STAT on Sunday in an email.
Kolker said there has been a tradition at the WHO of directors-general rewarding countries that supported their candidacies. (Tedros is the first WHO leader to be elected by all member states; previously the director-general was selected by the WHO’s executive board.)
Still, the international community had been looking to Tedros to change the way the WHO operates and to restore the agency’s credibility, damaged in recent years by a perceived over-response to the mild 2009 H1N1 flu pandemic, a tragically slow response to the 2014 Ebola outbreak in West Africa, as well as reports of questionable travel expenditures. Restoring the WHO’s credibility is key, observers say, to getting countries to increase the agency’s funding, which has not kept pace with inflation for at least the last decade.
“It’s disappointing, the misstep of falling into an old pattern of making this about political support and that kind of sort of payback for political support, to me is a worrying sign,” said Kolker, who went on to stress, though, that he and many others want Tedros to succeed as director-general.
“I don’t want to make it too much just about him but it does seem as though the mandate that he has to make WHO a different and better kind of organization will be hurt by this. Because it was a misstep and it misjudged, I think, what the rest of the world was looking to him to do.”
It is also being seen as a serious miscalculation by dismayed WHO staff, many of whom first learned about the appointment through news coverage.
Dr. Ashish Jha, director of the Harvard Global Health Institute, is among those who have publicly applauded Tedros for reversing the Mugabe appointment. But he worried the “terrible decision” will feed into a cynical narrative — that the WHO doesn’t really care about human rights or global health.
The agency has gone through a bruising time, and it seemed like the election of the new director-general was an opportunity to hit the reset button, Jha suggested. Tedros, who handily beat five competitors for the job, seemed to get off to a solid start, recently appointing a strong and diverse senior management team.
“He was building a lot of goodwill and I think there was a sense that maybe this was a turning of the chapter at WHO,” said Jha, who added the appointment of Mugabe had let the air out of the balloon.
So what happens now? The cautious optimism that was the prevailing mood among WHO supporters has been replaced with anxious concern. And how much pause will this miscalculation give member countries, the folks who write the checks? “I honestly don’t know,” said Kolker.
There will be a price, Fidler predicted. “After this debacle, the leadership of DG Tedros will be under intense scrutiny, meaning he has wasted goodwill and political capital in making such a terrible decision and then admitting it was a terrible decision.”
“This intense scrutiny, and the impact of it on his director-generalship, might alter the agenda DG Tedros intended to pursue in order to placate the many government and non-governmental critics of his Mugabe decision,” he said.
Meanwhile some critics have signaled the issue hasn’t yet been put to rest.
The U.N. watchdog organization U.N. Watch called for a full and independent inquiry into the episode, demanding to know “what deals were made?”
Though he didn’t call for a formal inquiry, Fidler said it will be important to explore what the event says about Tedros’s leadership style, to find out how the decision was made, and what steps were taken to help the agency respond to “the utterly foreseeable outcry about this decision.”