Conflict in Ethiopia creates opening for WHO reform

The upcoming election of the Director-General of the World Health Organization (WHO) will not be business as usual. Current Director-General Dr. Tedros Adhanom Ghebreyesus is expected to stand for re-election at the 75th World Health Assembly in May 2022. Normally, Directors-General who choose to run for re-election do not have to worry about receiving the endorsement of their home governments. But for Tedros, this may not be the case.

Since November 2020, the government of Ethiopia has been at war with the regional government of Tigray, the Tigray People’s Liberation Front (TPLF). Though large-scale military campaigns appear to have ended, there are signs that this conflict will continue.

Tedros comes from Tigray and served as Ethiopia’s health minister and foreign minister when the TPLF was Ethiopia’s dominant political party. Because of this, key members within the Ethiopian government have accused him of supporting the rebellious faction. It is therefore unlikely that Ethiopia will nominate Tedros for re-election. This puts the future of the first African Director-General in jeopardy.

WHO Member States are left with three options: a) find a government willing to nominate Tedros, b) find an alternate African candidate in consultation with the AU, or c) find an electable non-African candidate.

This decision comes at a time of crisis for the WHO.

It is widely agreed that the WHO was overwhelmed by the COVID-19 pandemic. This is not the first time the WHO has failed to adequately address dangerous outbreaks. Under Tedros’s predecessor Dr. Margaret Chan, the WHO’s handling of the Ebola epidemic was criticized as an “egregious failure.” The WHO has yet again failed in its responsibility to protect the world from deadly diseases. COVID-19 will not be the last global health crisis. Moving forward, there is a desperate need for fundamental WHO reform.

There may be a few shareholders that argue that Tedros is the best candidate for WHO reform. He was praised for his efforts to revitalize the Ethiopian health system. He has been supportive of opening up the WHO to civil society and the private sector. With support from the Trump administration in 2017, winning his first election by a wide margin, Tedros was seen as having a mandate for reform.

Tedros also benefits from having the right adversaries. Former President Trump heaped criticism on him for his handling of the pandemic. In an attempt to exert pressure, the Trump administration suspended payments to the WHO and began the process of leaving in the middle of the pandemic. This was a grave mistake. No other country followed, and the United States suffered a significant loss to its moral leadership. Given the former president’s irresponsible behavior, Tedros could be seen by some in a sympathetic light.

The geopolitical situation in Ethiopia may also play to his favor. The Ethiopian national government has been accused of ethnic cleansing in the Tigray region. WHO Member States might rally behind Tedros as a way of expressing their opposition to the actions of the Ethiopian government. A supportive Member State could choose to nominate Tedros in this context.

But a far larger number of stakeholders will point towards the many errors made by the WHO during the pandemic as a sign that a different Director-General is needed. The Independent Panel for Pandemic Preparedness and Response identified a series of dangerous missteps on the part of WHO leadership. Their Second Report on Progress criticized the WHO for failing to issue “more timely and stronger warnings of the potential for human-to-human transmission.” Recently, National Security Advisor Jake Sullivan expressed “deep concerns” about Chinese interference in the WHO’s investigation into the origins of the pandemic in Wuhan, the draft report of which peremptorily rejected the possibility of the pandemic originating in a Chinese lab. The U.S. has joined more than a dozen countries in calling for an independent investigation.

Responsibility for these failures ultimately rests with the organization’s head, Director-General Tedros. There are good reasons to believe that he is not the right candidate to reform the WHO. A top priority during his first term as Director-General was improving the WHO’s public health emergency response system. Those efforts were clearly inadequate. Many have criticized his effusive praise of China’s “transparency” during the early days of the pandemic despite widespread evidence that China repeatedly violated International Health Regulations by covering up information related to the outbreak. If this is not enough to deny Tedros his second term, then under what circumstances would a Director-General of the WHO not be re-elected?

Assuming Tedros loses the support of Ethiopia, the Biden administration has a choice to make. This election is an opportunity for the new administration to make good on its promise to return to engaging with multilateral organizations. In order to secure authentic WHO reform, the Biden administration should distance itself from a Tedros candidacy. That leaves two options: supporting a consensus candidate from the African Union or finding an electable non-African candidate.

The AU has a clear stake in this election. Tedros was the first African Director-General of the WHO. The AU supported Tedros, reiterating this during Trump’s attacks. However, given the union’s support for the Ethiopian national government during the conflict in Tigray, it would likely follow Ethiopia’s lead in disavowing Tedros.

At the same time, there is an implicit understanding that the region is still “entitled” to a second term in the office of Director-General. There are many qualified, alternate African candidates that the AU could choose to nominate. A consensus among Ethiopia, an African member state offering an alternate candidate, the AU and the United States would create unique momentum behind a new African candidate.

It is also possible that the AU will not be able to agree on an alternate nominee, particularly since this year’s assembly has already taken place. This might create an opportunity for a viable non-African candidate. If not Africa, it is the turn of the Americas, which have not held the WHO’s top post since 1973. A nominee from a country in the region that handled the pandemic relatively well could very well win the election. 

In either case, the Biden administration must begin to engage with this process now given the approximate deadline of September 2021 for Director-General nominations.

As the world continues to address the COVID-19 pandemic, the WHO must be led by a Director-General who is capable of achieving serious reform, not one who has shown an unwillingness to correct mistakes. Ideally, Africa, led by the AU, would identify an alternate candidate quickly. Now is the time for the United States to return to its multilateral commitments and publicly support such a candidate.

Daniel F. Runde is a senior vice president and William A. Schreyer chair in Global Analysis at the Center for Strategic and International Studies. He previously worked for the U.S. Agency for International Development, the World Bank Group, and in investment banking, with experience in Africa, Asia, Europe, Latin America, and the Middle East.