Tedros Adhanom

Head of the Tigray Regional Health Bureau

In 2001, Tedros was appointed head of the Tigray Regional Health Bureau.^[4] 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.^[12] Health care staffing was increased by 50%.^[12] 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.^[12]

State Minister for Health

In late 2003 he was appointed a State Minister (deputy minister) for Health and served for just over a year.^[13] It was during this time he started crafting his ambitious health reform agenda.

Global Health Initiatives

During his time as Minister of Health of Ethiopia Tedros has been very active in global health initiatives and left a print of his influence in the wider area of the global health architecture. Ethiopia was the first country to sign compact with the International Health Partnership. He has served as 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 . He has also served as vice-president of the 60th World Health Assembly that was held on 14–23 May 2007.

The Global Fund to Fight AIDS, Tuberculosis and Malaria and its reform

Tedros was elected as Board Chair of the Global Fund in July 2009 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.

In his acceptance speech, he said ’The honor of this overwhelming vote of support belongs to my country, Ethiopia, which I am very privileged to represent. I am deeply humbled by this election and recognize well the weight of the responsibilities that come with it. The Global Fund faces big challenges ahead. But I am also optimistic about the great opportunities we now have for ensuring that this unique and innovative organization continues to be a success over the coming years”.

During his tenure, Dr. Tedros has guided the Global Fund to address significant challenges and to make important decisions that has led to the development of a comprehensive reform agenda and a more efficient and effective Global Fund. The Board has acknowledged his outstanding leadership role in its decision point at the end of his tenure saying " He has served the Global Fund with high degree of commitment and Passion. He has led with commitment and determination a comprehensive reform agenda".^[16]

Millennium Development Goals

Ethiopia has been noted by the UN as one of the "success stories" in terms of achieving the Millennium Development Goals (MDGs).^[17] Three of the eight MDGs, goals four through six, deal directly with health:

• Reducing child mortality rates,
• Improving maternal health,
• Combating HIV/AIDS, malaria, and other diseases

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.^[19] 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.^[19]

Criticism and scandal

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.^[20][21] 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.^[21] 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."^[22] Tedros Adhanom 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."^[21] Tedros Adhanom has also been criticised for exaggerated achievements and curriculum vitae, which is in contradiction with a statement by WHO about the health status of Ethiopia: “The health status of Ethiopia is poor, even when related to other low-income countries including those in sub-Saharan Africa. The population suffers from a huge burden of potentially preventable diseases such as HIV, malaria, tuberculosis, intestinal parasites, acute respiratory infections and diarrhoea diseases ^[23]

The third Financing for Development Conference (FfD3)

Tedros was instrumental in the successful outcome of the Conference which was held in Addis Ababa, Ethiopia, on 13–16 July 2015 demonstrating his negotiation and consensus building skills. He played key role in saving the Forum from collapse by bringing polarized positions closer. 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.^[24] The Conference, however, was criticized by a few observers for failing to come up with new money for implementing the SDGs during its process ^[25] 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.^[26] Dr 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.^[27]

Agenda 2063 of Africa Union

As Chair of the Executive Council of the AU in 2014, Dr. 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. 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 Ebola 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. 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.^[28] He also promptly mobilised 200 Ethiopian health workers highly trained in management of public health emergencies and surveillance (by an initiative he has created when he was the Minister of Health) to join the African Union response team.^[29]

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. By that time it was more than 22 percent complete, and the dam is expected to produce 6,000 megawatts, which will make it Africa’s largest hydroelectric power plant. The dam is expected to have a reservoir of around 70 billion cubic meters, which is scheduled to start filling in 2014. Egypt, Ethiopia and Sudan established an International Panel of Experts to review and assess the study reports of the dam. The panel consists 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.^[30] 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.^[31] 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.^[30][32]

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.^[33][34] The discussion was televised live without those present at meeting aware.^[33] Ethiopia requested that the Egyptian Ambassador explain the meeting.^[35] 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.^[33] 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.^[36] 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.^[37] 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".^[38] 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.^[38]

Candidacy and election

On May 24, 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, wi^[39]th 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.^[40] During the launch, it was stressed that the nomination of Dr Tedros was based on merit and his prolific national and global credentials. His campaign tagline was "Together for a Healthier World."^[41] 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.^[42] She later led his transition team.^[43] Negash Kebret Botora, Ethiopia’s ambassador to the UN and international organisations in Geneva, also played a critical role in the campaign.^[44] The campaign was supported in part by a Fund created by East African countries.^[45] Tedros also hired Mercury Public Affairs, a US-based lobbying company, to help him with his bid.^[46]

During its 140th meeting in January 2017, the Executive Board of the WHO shortlisted Dr Tedros as the front runner out of six candidates through two rounds of secret voting. He collected the most votes during both rounds. On May 23, 2017, Dr. Tedros was elected as the next Director-General for the World Health Organization with an overwhelming 133 votes out of 185.^[47][48] 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.^[49][50]

Tenure

Tedror with Houlin Zhao in 2017

Tedros has identified universal health coverage as his top priority at WHO.^[51] 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.^[52][53][54] In October 2017, he announced his senior leadership team, with women representing 60% of appointments.^[55][56] 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 WHO’s 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.^[57][58]

Mugabe Goodwill Ambassador controversy

On 18 October 2017, Tedros Adhanom 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.^[59] 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.^[60][61] 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 didn't consider the equally (some say more)qualified Michel Sidibe of Mali and Awa Marie Coll-Seck of Senegal.^[62] His judgement was widely questioned on social media. The editor-in-chief of Lancet,the prominent medical journal called Tedros Dictator-General.^[63] After a widespread condemnation, on 22 October 2017 Tedros Adhanom rescinded Mugabe's goodwill ambassador role.^[64][65]

One of 50 people who will change the world in 2012

Tedros was named as one of the 50 people who will change the world in 2012 by the UK Wired Magazine. The Magazine wrote "Tedros has used innovative techniques to save the lives of millions of Ethiopians. Rather than building expensive hospitals, he has set up programmes to train 35,000 health workers. The workers then go on to provide care in nearly every community across Ethiopia -- especially for women and children, who are often the most vulnerable and underserved. As a result of this, women have access to family planning and are now able to plan the timing and spacing of their children. And children now receive life-saving vaccines and treatment for deadly illnesses such as pneumonia, malaria and diarrhoea. In five years, his work has reduced the death rate of Ethiopian children under five by 28 per cent. Does it get more inspiring than that?" ^[66]

One of the 100 most influential Africans for 2015

The New African Magazine, a best-selling pan-African magazine published in the UK, listed Tedros as one of the 100 most influential Africans for 2015 in the category of politics and public service. The magazine named him as " the trailblazer" and signified his reformist agenda as Minister of Health of Ethiopia where he transformed the health sector of the country through massive deployment of health extension workers which has resulted in massive gains. The magazine said Tedros put people at the center of his policies again as Minister of Foreign Affairs and mentioned his massive social media followers. His role as a key player in Ethiopia′s strategic regional interventions and mediation in Sudan and Somalia also contributed for his naming as one of Africa′s influential people for 2015.