Dr Tedros Adhanom Ghebreyesus, the director-general of the World Health Organisation (WHO), is a man who likes to make appointments.
A few months after he became the first African elected to the position by United Nations member states in May 2017, he went on a solo run to announce the appointment of Zimbabwe’s authoritarian president Robert Mugabe as a “WHO goodwill ambassador for non-communicable diseases in Africa”.
As he had been warned by advisers, the pushback was immediate and Dr Tedros was forced to rescind the appointment of a man held responsible by many for reducing the health services in Zimbabwe to a shambles, not to mention his appalling record on human rights.
Better judgment was expected of a man who had been Ethiopian minister for health and foreign affairs and chairman of the board of the Global Fund to Fight Aids, TB and Malaria.
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Since he took up office in 2017 from his financially conservative predecessor, Dr Margaret Chan, the number of people appointed to very senior director posts (UN D-2 level) has almost doubled, from 39 in July 2017 to 75 in July 2024. In an organisation which is facing a salary gap of $500 million in 2025, this brought senior management costs including 215 directors and a 12-person senior management team to an estimated $92 million.
This week Dr Tedros told the programme, administration and budget committee of the executive board that there would need to be a 25 per cent reduction in the wages bill.
One long-time staffer who did not wish to be named told The Irish Times: “The situation is desperate. Everyone is rattled. A few staff have already been told that they are not going to be renewed. I feel physically sick about it every day.”
[ Dr Mike Ryan is dropped from WHO executive team amid ‘painful’ cost cutsOpens in new window ]
The cuts have started at the top of the 2,600-strong workforce, with Dr Tedros downsizing of his senior management team from 12 to seven effective from June 16th, following dismissals including that of his own deputy, Dr Mike Ryan, the Sligo-born epidemiologist and executive director for emergencies.
WHO’s profile rose during the Covid-19 pandemic because of its almost daily press conferences, broadcast live across all main social-media platforms and picked up by many national broadcasters too. They regularly featured Dr Tedros, flanked by Dr Ryan and Dr Maria Van Kerkhove, technical lead for Covid-19.
Dr Tedros embarked on his tenure with a promise of transformation and the arrival of the Covid-19 pandemic accelerated his inclination to grow the organisation, resulting in agreements to establish expensive outposts such as a pathogen lab in the Swiss alps, a training academy in Lyon and a pandemic surveillance hub in Berlin.
Some argue that the existing chain of six regional offices and their network of laboratories could have accommodated any of these functions, but retrenchment is certainly on the agenda now following the US withdrawal from membership and funding of WHO. Always slow to pay its membership fees, the US contributed $1.3 billion to the budget in 2022-2023 for specific projects. WHO now faces a funding gap of $1.7 billion in its $4.2 billion budget over the next two years.
Dr Tedros’s dropping of Dr Ryan from his senior executive team has raised eyebrows, given Dr Ryan was playing a leading role in the prioritisation exercise that has been ongoing in recent months and which is fundamental to the creation of a new structure which will see the number of divisions reduced from 10 to four, and a reduction in the number of departments from 76 to 34.
Dr Ryan has been replaced by his deputy executive director, Dr Chikwe Ihekweazu, a Nigerian German, who heads the pandemic hub in Berlin and was previously director-general of the Nigeria Centre for Disease Control.
One well-placed WHO source said the organisation could ill-afford to lose both Dr Ryan and Dr Bruce Aylward, the Canadian epidemiologist, a 30-year veteran, who was tasked with overseeing Dr Tedros’s stated top priority, universal health coverage. Dr Aylward also played a vital role in the Covid-19 response and led a WHO delegation to Wuhan in an unsuccessful search for the origins of the virus.
“There are excellent people on the new leadership team, but none have the experience of dealing with the kinds of political pressures that come when WHO is thrust into the limelight during a major health crisis like Covid-19. Ryan and Aylward have earned their spurs in the heat of battle against some of the worst disease epidemics of recent times,” said one organisational veteran.
There is a particular pathos about the fact that these veterans of the Covid-19 pandemic may choose not to attend next week’s World Health Assembly, considering their changed employment circumstances. After years of talks, and the decision of the US to opt out of the discussion, UN member states are finally scheduled to debate and adopt the WHO Pandemic Agreement in the coming days in Geneva.
The agreement is designed to ensure lessons from the Covid-19 pandemic are applied and there is equity in access to vaccines and healthcare come the next pandemic which both Dr Ryan and Dr Aylward would agree is not a question of if, but when.
