Science

The WHO boss: A doctor at his limits

In the middle of the worst Ebola outbreak the country has ever seen, Tedros Adhanom Ghebreyesus visits Bunia, a city in the east of the Democratic Republic of Congo, on 2 January. The Director General of the World Health Organization had spent New Year's Eve in the region, a sign of solidarity with the health workers who have not only been fighting a deadly virus there, but have also repeatedly been victims of violence. He should now fly to Uganda by helicopter to meet Prime Minister Ruhakana Rugunda. But there was a problem.

The day before, a group of vaccination workers had been attacked. A young Congolese from the group, Charles Lwanga-Kikwaya, had been hit on the head by a large stone. His condition was bad, says Jeremy Farrar, who accompanied Tedros on the trip. Farrar runs the Wellcome Trust, one of the largest foundations in the world, but he is a trained neurologist and had examined Lwanga-Kikwaya that morning. “It was clear that he would die if we didn't evacuate him,” he says.

But the helicopter pilot didn't want to take any detours in the crisis area. His instructions were clear: Tedros as a VIP had to be flown to Uganda for his state visit. After a tense discussion and numerous phone calls, the pilot finally gave in and agreed to fly Lwanga-Kikwaya and the three international visitors to the nearest hospital.

“He is stubborn”

“It was interesting to watch Tedros' style,” said Mike Ryan, who was in charge of the WHO health emergency program, who was also present. “He just kept saying calmly and firmly:” No, we have to take this man with us “. This ability to be persistent but respectful ”. “He is stubborn,” says Farrar. “Sometimes you need that with a leader.”

Lwanga-Kikwaya survived and returned to work a few weeks later. Tedros says he saw the confrontation as a test. “You can't worry about the wellbeing of millions of people if you don't worry about the wellbeing of someone who dies before your eyes,” he says.

Now Tedros is facing a much larger one Challenge: a deadly virus that is spreading rapidly from China. At the 30. In January Tedros declared the outbreak of the corona virus, now known as SARS-CoV-2, as an international health emergency. Back then there were fewer than 8000 confirmed cases, now there are more than 60000 in 25 countries. Flight connections have been canceled, cruise ships have been quarantined and everyday life has come to a standstill in large parts of China. Many researchers believe that the virus will spread around the world. It has the potential to infect millions of people with an impact on business and politics around the world.

China did not share all information

When Tedros took office on July 1 2017 did He did so with ambitious goals: reform WHO, strengthen the role of science in decision-making, highlight the effects of climate change on health, and provide healthcare to a billion more people. The new coronavirus epidemic will overshadow all of these priorities, says Ashish Jha, a world health expert at Harvard University.

How Tedros copes with the crisis will not only determine how he is judged, but also the organization he manages. “This is the moment. How things will develop in the coming weeks and months will have a massive impact on how the world looks at WHO. ”

But the crisis also puts Tedros in an“ almost impossible position ” says Lawrence Gostin, who runs the O'Neill Institute for National and Global Health Law at Georgetown University in Washington DC passes. If Tedros wants China to cooperate with the WHO, share data and seek advice, he cannot afford to overdo the sensitive Chinese government. It is now clear that the country did not share all of the information at the start of the outbreak – and may still not. “The WHO has never faced an epidemic that is developing so quickly and in a country that is so powerful and so closed in so many ways,” says Gostin.

“In the middle in a hurricane ”

And the epidemic comes at a time that is difficult for the WHO anyway. The organization's budget has not kept pace with its tasks, misinformation about vaccines is rapidly spreading online, and leading politicians are still denying climate change, which could have a massive impact on world health in the coming years. At the same time, multilateral organizations such as the WHO are criticized by nationalists and populists. “All the global trends stand against what the WHO was founded for,” says Gostin. “The WHO is in the middle of a hurricane.”

Tedros ’first memories of WHO come from a more hopeful time. He grew up in Asmara, which then belonged to Ethiopia and is now the capital of Eritrea. In the streets he saw posters for the WHO campaign to eradicate smallpox, which 1980 finally succeeded. Tedros studied biology, worked in healthcare, and eventually received a WHO scholarship to study at the London School of Hygiene and Tropical Medicine. He received his doctorate in malaria, returned to Ethiopia and quickly rose to the minister of health.

During his term from 2005 to 2012 he built up a network of more than 40000 health workers in rural areas, who spend malaria drugs, vaccinate children or care for pregnant women , The deaths from AIDS, malaria and tuberculosis decreased by half during this period. After four years as Foreign Minister of Ethiopia, Tedros 2017, with the support of the African Union, ran for the post of Director General of WHO and won significantly.

Ready to take risks

In December 2019, Tedros talks in his spacious office on the 7th floor of the WHO building in Geneva the first half of his term. The Ebola virus spreads again at the time and WHO employees are attacked in the Democratic Republic of the Congo. “The most important thing now is security,” says Tedros.

He is also concerned with another virus. The day before the estimate of measles death for 2018 appeared: 144 000 dead, an increase of 14 percent versus 2017. And this for a disease for which there is a cheap, effective vaccine. Tedros is mainly responsible for the misinformation that spreads on social networks. “This is a crisis and Facebook and Twitter and other social media companies really need to understand this.”

Tedros was willing to take risks in the first half of his term. And not only on his 12 trips to the Ebola outbreak. But that didn't just give him success. Shortly after taking office, he announced that Robert Mugabe, long-time dictator of Zimbabwe, should become a health ambassador for WHO. The proposal came from African countries, says Tedros, where Mugabe, who died in September 2019, is still venerated by some as a freedom fighter. It was just a suggestion. But after an international outcry, Tedros withdrew the proposal.

“The question is not whether but when”

His reform of the organization is also met with a lot of criticism internally. One step that is praised, however, is the appointment of a chief scientist.

“This is a really important signal,” said Ilona Kickbusch, a global health expert at the Graduate Institute of International and Development Studies in Geneva. “Science is the foundation of everything we do here,” says Soumya Swaminathan, an Indian pediatrician who has taken on this role. She says her department will focus on identifying research gaps. It has set up committees to deal with the ethics of new genome editing and the role of artificial intelligence in medicine.

In the conversation in December, Tedros emphasized that there was always a danger in the background hovers that there is an outbreak of an infectious disease. “The question is not whether, but when,” he says. He has no idea that a virus is already multiplying and spreading from person to person in southern China, which will become the greatest challenge of his term in office.

WHO is in crisis mode two months later. Tedros and his key advisors meet daily to discuss the latest developments. Journalists from all over the world dial into the press conferences, mostly with tedros themselves behind the microphone. The fight against Ebola taught him a clear strategy, he says in one of these briefings: contain the disease, fight it at source and prevent it from spreading elsewhere. “We have to focus on the epicenter,” says Tedros.

He is showering praise on the Chinese government

But the epicenter is in China, which makes it difficult the task of the WHO. Tedros has made every effort not to criticize the Chinese government. At the 28. In January, he flew to Beijing to meet President Xi Jinping and praised the government for its efforts to fight the disease, even though it had waited weeks before the authorities were allowed to tell the public about the outbreak.

Tedros said his visit to China had three important results: fighting the virus at its source with all severity, sharing data and letting a WHO expert group into the country.

Am Last Sunday evening, after saying goodbye to a first group of three experts at Geneva Airport, Tedros speaks on the phone and defends his praise from China. “We are grateful for what they do,” he says. “They are not only doing this for their own country, but for the rest of the world.” It would be time later to investigate whether everything the government had done was appropriate. “We don't want to start blaming now. We can only tell China that all measures should be appropriate to the problem and they have assured us that. ”

Not everyone agrees. In the meantime, China has sealed off entire cities and effectively quarantined millions of people, a measure that many experts believe does little to combat the virus and violates human rights.

Tedros herself warns for patience

“I am absolutely convinced that the measures should be denounced, both for their human rights violations and for their very manageable benefits,” says Alexandra Phelan, a human rights lawyer at the center for Global Health Science and Security at Georgetown University. The cooperation with China is so crucial that she understands why Tedros does not want to publicly address this. “But I'm worried about what that means for the future.”

Some go further. An online petition asking Tedros to withdraw has collected more than 300000 signatures. Jha disagrees with the criticism. “I don't think it would have been helpful to act aggressively against China on this issue,” he says. “I think Tedros pushed China pretty well and dealt with China. Farrar says China has done well in a difficult situation so far, but the country should quickly release more epidemiological data and virus sequences. “For me, these are the two big gaps, because these two make it possible to follow the epidemic,” he says.

Tedros himself urges patience. The situation in China overwhelmed the country. “We get some information, we may not get other information,” he says. “But we understand that.”

His brother died. He believes: in measles

In October 2018 Tedros became the third of the

on the stage of the World Health Summit in Berlin Surveyed sustainable development goals that the United Nations spent on 2030: “A healthy life guarantee for all people of all ages and promote their well-being ”. Tedros started talking about Hassab al Karim, a boy he had met a few days earlier in a clinic in Khartoum, Sudan.

Hassab had had an operation there for rheumatic heart disease. “This 13 year old boy couldn't even have survived a few years, but I think he's hopeful now he will survive into adulthood and beyond, ”said Tedros. When he described how Hassab had smiled at him, his voice wavered and he paused for a few moments. “For me,” he said, wiping away the tears, “for me, Hassab al Karim is SDG-3.”

It was not the first time that Tedros cried in public, and some observers mock these outbursts of feeling. For others, this is exactly his strength: that he, as head of an international bureaucracy that touches billions of lives, is aware of the individual fate. It is as easy for him to speak to medical students or patients as to heads of state. He often mentions his brother, who died young. Tedros believes in measles. This loss taught him to see individuals when he reads death statistics, he says.

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