Global health today: Tedros, COVID in Indonesia, and a million more COVID cases by 2022?

This is the first in a series of newsletters, offering the expert insight of Lalita Panicker – consulting editor, views, Hindustan Times, New Delhi – into some of the most pressing health issues of the day.

Another term for Tedros?

To use a well-worn cliché, the Director-General (DG) of the World Health Organization (WHO) is an enigma wrapped in a mystery, a contradictory figure raising as many questions as providing answers. Tedros Adhanom Ghebreyesus has maintained an enigmatic silence over whether he plans to run for a second term as DG (the position is capped at two five-year terms). However, in early May this year, the authoritative Stat News, citing a person “familiar with his thinking,” reported that he planned to do so.   

It is unclear at this point whether others will emerge to challenge the 56-year-old Ethiopian who made history in 2017 when he became the first African elected to the global health agency’s top job. Nominations close in September.

Looked at any which way, contested or unanimous, it will become a referendum on the WHO’s handling of the COVID-19 pandemic under Tedros’s leadership. After all, he’s been the face of the world’s COVID-19 pandemic response ever since the new virus emerged in the central Chinese city of Wuhan in late 2019 – and a lightning rod in political spheres when talking about whether or not the agency mishandled the pandemic. 

A recent independent assessment gave WHO mixed reviews about its early COVID-19 response and found the organisation could have declared a pandemic sooner than it did. His defenders have said the delay was slight and eventually inconsequential.

Also under scrutiny is Tedros’s response to China, where it all began. Critics feel that he has been deferential to that country. Tedros, whose global profile has risen dramatically during the pandemic, flew to Beijing in January 2020 for talks with China’s President Xi Jinping to ensure its cooperation and sharing of information, before declaring a worldwide health emergency.

The Trump administration accused Tedros and the WHO of being “China-centric” and halted US contributions (the US is WHO’s largest donor) while starting the process of leaving the agency. In April last year even as Donald Trump blustered and threatened, Tedros had a quiet response to Science Insider: “Please quarantine politicising COVID. We will have many body bags in front of us if we don’t behave.”

The Joe Biden administration that succeeded Trump’s in the U. S. announced immediately after taking office in January this year that it would remain a member and fulfil its financial obligations while working on reforms.

Tedros distanced himself from the findings of a WHO-led mission written jointly with Chinese scientists, that investigated the origins of the virus. The report issued on March 30th this year said the virus had probably been transmitted from bats to humans through another animal, and that a lab leak was “extremely unlikely” as a cause. This is being seen in some quarters as a convenient Chinese bailout. Treading cautiously but firmly, Tedros said that data had been withheld from the team and that the lab issue required further investigation. 

A year after Tedros took office, Ebola exploded in the Democratic Republic of the Congo; the outbreak, the second largest on record, took two years to contain. Tedros faced some pushback for the WHO’s handling of the outbreak. He ended up traveling to the region at least ten times to meet with people working to contain the outbreak. Before it could be fully extinguished, the COVID-19 pandemic began.

Before becoming director, Tedros was a long-time health minister, and then foreign minister of Ethiopia. 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 race in which he handily beat out five other candidates, shored up by support from the African Union, a bloc of 55 nations.

Now, however, it is doubtful that Tedros can count on support from his home country which nominated him last time. Ethiopia’s military accused him in November of supporting and trying to procure arms and diplomatic backing for Tigray state’s dominant political party, which is fighting federal forces. Tedros has denied taking sides in the conflict.

When he took office in 2017, Tedros represented a hope that more would be done to improve health throughout the continent and indeed low-income countries worldwide. To some extent he has delivered, pushing hard for governments around the world to commit to universal health care through a United Nations declaration. He has stood out calling on nations to support the lifting of patents on Covid-19 vaccines and products — a move that the US has surprisingly backed, but other higher-income countries have not. 

As DG of the WHO, Tedros has tried to guide the world through the biggest health crisis of the century. A who’s who of world leaders have joined him, virtually, at his meetings starting last year – France’s president Emmanuel Macron, Germany’s outgoing Chancellor Angela Merkel, and South Africa’s president Cyril Ramaphosa – all pledging support for the WHO’s efforts to end the pandemic. Even pop star Lady Gaga announced an online music festival One World Together at Home – with a host of big names from Billie Eilish, to Elton John, to the Rolling Stones – in support of the WHO. No other senior UN official, not even the UN Secretary General himself, has ever received so much attention.

Tedros’s 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. There are some who have described it as an “impossible” job but an “essential” one.

Indonesia: COVID and beyond

Tackling a huge resurgence of COVID-19 and stepping up its anti-COVID vaccination drive, Indonesia has managed to refocus on endemic health issues as well. In a far-sighted move to protect children against pneumonia, Indonesia has launched the Pneumococcal Conjugate Vaccine (PCV) towards the end of June. Like other Southeast Asian nations, Indonesia has seen its immunisation and other health services being impacted by the pandemic. Data released by Unicef in 2020 has shown that 84 per cent of health facilities experienced an interruption of immunisation services at the ground-level. Despite this, the government’s action to introduce PCV comes as a much-needed boost for child health efforts in Indonesia.

The launch comes after a statement made by the Minister of Health in April 2021, resolving to introduce three new vaccines (PCV, HPV and Rotavirus) in the national immunisation programme by 2022. It marks a significant step as the country has been losing at least 20,000 lives every year due to childhood pneumonia. According to experts, Indonesia is on the path to preventing 500,000 cases of childhood pneumonia annually by including PCV in its immunisation programme.

COVID: A million more?

The World Health Organization says Covid cases could shoot past 300 million by early next year if the pandemic continues in its current direction, calling on world leaders to slow the spread by providing more testing supplies, treatment and vaccines to poorer nations.

The projection came just a week after WHO reported 200 million Covid cases worldwide and six months after the globe surpassed 100 million cases. With four variants of concern on WHO’s radar — including the surging, highly transmissible Delta variant — WHO DG Tedros Adhanom Ghebreyesus said the total amount of unreported Covid cases makes the real tally “much higher” than what’s reported.

WHO officials expressed an urgent need on Tuesday, August 10th, for US$7.7 billion in funding to help distribute vaccines, oxygen and medical care in low-income countries. “We are all in this together,” Tedros said. “But the world is not acting like it.”

In early August, the WHO announced a moratorium on COVID vaccine booster shots, asking wealthy countries to stop using their extra doses so developing nations could start receiving a majority of the inoculations. Tedros previously issued a target to vaccinate ten percent of the world’s population by the end of September and forty per cent by December.

WHO has estimated that under two per cent of Africa’s population is fully vaccinated, and some nations on the continent have yet to begin administering vaccinations. Comparatively, more than half of the U.S.’s population is fully vaccinated, according to the Centers for Disease Control and Prevention.

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(Lalita Panicker is consulting editor, views, Hindustan Times, New Delhi)