It turns out that a week is a long time in international health leadership. At a on non-communicable diseases, Tedros Adhanom Ghebreyesus, director general of the World Health Organization, named Zimbabwe鈥檚 president as the WHO鈥檚 latest 鈥溾��.
Following international uproar, the accolade 鈥� granted to promote the tackling of non-communicable diseases (NCDs) in Africa 鈥� was revoked five days later. The debacle showed both misguided good intention and the importance of internal communication.
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, the first non-medic and African to hold the WHO鈥檚 top job, is generally well-regarded. Elected in May, he has a strong record of global health leadership, working in the fight against AIDS, tuberculosis and malaria, and championing infant and child health.
From 2005 to 2012, he was minister of health in Ethiopia, winning plaudits for reforming the country鈥檚 health system, improving outcomes and widening access to care. While detractors point out that he served in a senior position in a government for human rights abuses, there is no evidence of wrongdoing on his part.
In contrast, Mugabe is not well-regarded. The 93-year-old has ruled with an iron fist for 37 years. The US imposed against him for his human rights abuses, and the UK of an honorary knighthood in 2008 for violently repressing political opposition.
accuses his government of corruption, ruining the economy, crushing democratic opposition, and of illegally detaining and torturing journalists and political activists. Under his watch, rampant hyperinflation and gross mismanagement have in a country once referred to as the breadbasket of Africa.
On paper, the health system there is well-designed 鈥� built on the principles of universal access, health promotion, and strong primary care 鈥� but it collapsed under his rule. By the WHO鈥檚 own assessment, chronic underfunding has led to poor outcomes (Zimbabwe comes near the bottom among countries for life expectancy 鈥� a dismal for men). Mugabe doesn鈥檛 seem to trust his own hospitals, flying to Singapore for medical care since January.
Behind the decision
So what was Tedros thinking? It does not seem that Tedros shared his intention to announce Mugabe鈥檚 ambassador role with senior WHO staff, and my global health colleagues from all sectors expressed disbelief on social media.
There is also no evidence to suggest that the decision was anything more than a terrible and uncharacteristic political misstep. But there is precedent to help explain what he might have been thinking.
Tedros built his platform on 鈥� encouraging countries to extend an increasing range of health services to more of the population while improving protection for people when they fall ill, for example through health insurance.
His focus on universal health coverage is only one layer of his strategy; he has also championed a more universal vision of global health and has put real effort into inviting all members of the worldwide community to support his goals. During his candidacy, he visited many member states, and an for China Daily is indicative of his efforts to court all countries regardless of their political record.
His years of experience in pragmatically overseeing significant health improvements within an oppressive government may explain his willingness to engage with unsavoury regimes. This is a difficult line to tread: those in the non-communicable diseases arena sympathise with his inclusive inclinations, but have drawn the line at having Mugabe as their figurehead.
Some positive results
A few good things have come out of this. The international uproar has applied fresh diplomatic pressure on Mugabe and served to highlight the plight of his people. The episode also put non-communicable diseases into the headlines; they are the leading cause of death and disability worldwide, but they are misunderstood, underfunded and . The swift cancellation of the appointment was also a victory for , and a rare example of a leader who is willing to listen and change their mind when wrong.
The initial error tarnished the WHO鈥檚 reputation, undermined its credibility and raised questions about the new director鈥檚 judgement. Seen in the context of his laudable efforts to 鈥渟eek broad support鈥� and 鈥渉igh-level political leadership for health鈥�, his mistake is perhaps more understandable.
However, commendable efforts to include everyone on the journey to truly universal healthcare cannot come at the cost of condoning and legitimising despots and oppressive regimes. Violence, political oppression and corruption are anathema to the founding principles of the WHO: promoting the highest standards of mental, physical and social well-being for all.
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