Will Ghebreyesus’ pandemic report card earn him a second WHO term?

Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, plans to seek a second term, as first reported by STAT news this past spring. 

He’s been a mainstay face of the COVID-19 pandemic response over the past year.

Ghebreyesus leads near-daily briefings on the status of the pandemic, outlining guidance and best practices and issuing calls for greater cooperation and solidarity. 

At the annual World Health Assembly meeting, he called on wealthier countries to do more to respond to vaccine inequities around the world. COVAX, the WHO-led initiative to distribute vaccines, is experiencing massive shortages and delays. 

Meanwhile, the United States and The European Council and other countries are pushing for greater independence and transparency in the next phase of the WHO-led investigation into the origins of the coronavirus virus.

Related: WHO draft report says animals likely source of COVID-19

If elected, his new term would begin in a year. The director-general position is capped at two five-year terms. It requires a nomination, and all 194 member states now have a vote. Members must nominate candidates for the next term by this fall.

More than anything, Ghebreyesus’ legacy and future come down to his handling of the pandemic, said Thomas Bollyky, director of global health at the Council on Foreign Relations.

Related: A future pandemic is ‘almost guaranteed,’ Fauci says

As director-general, Ghebreyesus has tried to guide the world through the biggest health crisis of the century. His position is required to manage a massive global health operation, which includes disease control, logistics and guidance, budgeting and steering the world through choppy political waters. 

“I think this is important to recognize it’s an impossible job — but a really essential one,” said Suerie Moon, co-director of the Global Health Center at the Graduate Institute in Geneva.

“I think this is important to recognize it’s an impossible job — but a really essential one.”

Before becoming director, Ghebreyesus was a longtime health minister, and then foreign minister of Ethiopia. He often talks about how his own upbringing drives his work: As a child, he saw his younger brother die of an illness that could have been cured if the region had had better health care.

He ran for the WHO post in 2016 against an initial pool of six candidates. He became the first director-general to get elected in a process where all member states had a vote, and his victory was an especially big deal across Africa.

“There is the level of connection and the level of excitement knowing that he is the first African WHO [director-general].”

“There is the level of connection and the level of excitement knowing that he is the first African WHO [director-general],” said Dr. Githinji Gitahi, group chief executive officer of Amref Health Africa, a large nongovernmental organization based in Nairobi, Kenya.

Ghebreyesus represented a hope that more would be done to improve health throughout the continent. Gitahi said that Ghebreyesus delivered, pushing hard, for example, for governments around the world to commit to universal health care through a United Nations declaration.

“He made it his singular mandate,” Gitahi said. “And I remember him saying, ‘All roads lead to universal health coverage.’ And I think that pushing that agenda, and also the agenda that universal health coverage is not different from global health security, it had never been seen before.”

In 2018, Ghebreyesus faced some pushback for the WHO’s handling of the Ebola outbreak in Democratic Republic of Congo, which took years to contain. He has pushed for more involvement from the private sector and civil society groups.

Related: What does the WHO Ebola emergency declaration mean for DR Congo?

A recent independent assessment gave the WHO mixed reviews about its early COVID-19 response and found the organization could have declared a pandemic sooner than it did.

“Ultimately, the decision on declaring a public health emergency of international concern is [Ghebreyesus’] alone to make,” said Bollyky of CFR. 

Also under scrutiny is Ghebreyesus’ response to individual countries.

“There also will be critiques that as a general matter, moving throughout this pandemic, Dr. Tedros has been deferential to member states, including China, and some people, particularly in the United States, would have liked to see him be more aggressive in that regard.”

“There also will be critiques that as a general matter, moving throughout this pandemic, Dr. Tedros has been deferential to member states, including China, and some people, particularly in the United States, would have liked to see him be more aggressive in that regard,” Bollyky said. 

Behind the scenes, Ghebreyesus has given critical guidance and support to low- and middle-income countries. Directors tend to avoid confrontation with member states and work under the radar to coordinate. 

Moon, of the Graduate Institute, said that Ghebreyesus stands out with his charisma and political savviness, which she said is important during a highly charged pandemic.

“I think you see it in COVID-19, the fact that Tedros is comfortable with foreign ministers and heads of state to [a] degree that health ministers are not often comfortable at that level of power,” Moon said.

Ghebreyesus stood out when he called on nations to support the lifting of patents on COVID-19 vaccines and products — a move that many higher-income countries didn’t back. 

Related: WTO rep says patent waiver ‘strikes the right balance’

In general, Ghebreyesus’ reviews have been positive, and despite some criticism, it’s unlikely that the world would want to shake up global leadership amid a pandemic, Bollyky said.

Moon added that Ghebreyesus will still need a solid vision of what must happen to prevent future outbreaks as the pandemic enters new phases.

“What kinds of reforms can we make at the global level, given the world we’re in today, [that is] highly fragmented, you know, [with a] rise of nationalist populism, anti-science backlash, an ongoing COVID pandemic in many parts of the world — it’s going to be a huge, huge challenge,” Moon said.

How this unfolds in the weeks and months ahead will be a referendum not just for Ghebreyesus, but for the WHO itself — and its future.