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730 14 FEBRUARY 2020 • VOL 367 ISSUE 6479 sciencemag.org SCIENCE

PHOTO: WORLD HEALTH ORGANIZATION/LINDSAY MACKENZIE

O

n 2 January 2019, Tedros Adhanom

Ghebreyesus faced a life-or-death

decision. The director-general of

the World Health Organization

(WHO) had spent New Year’s Eve in

Bunia, Democratic Republic of the

Congo (DRC), to boost the morale

of staff fighting the second biggest

Ebola epidemic ever. As he was get-

ting ready to board a helicopter to Uganda,

where he was scheduled to meet Prime

Minister Ruhakana Rugunda, Tedros had to

decide whether to bring along a young Con-

golese man named Charles Lwanga-Kikwaya.

The day before, a group of Ebola vac-

cinators was attacked by a group of young

men and women—one of many assaults

WHO staff has had to endure—and Lwanga-

Kikwaya had been hit on the head with a

large stone. His injury was serious, says

Jeremy Farrar, head of the Wellcome Trust,

who accompanied Tedros and examined the

patient. “We quickly decided we either had

to evacuate him or he was going to die,” says

Farrar, who trained as a neurologist.

But the pilot refused to make a detour

in a conflict zone; protocol dictated that

Tedros, as a VIP, had to be flown to his state

visit first. After a tense standoff with Tedros

and several phone calls, the pilot relented

and agreed to fly Lwanga-Kikwaya and the

three international visitors to the near-

est hospital. “It was interesting to watch

Tedros’s style,” says Mike Ryan, head of

WHO’s Health Emergencies Programme,

who was also present. “Just quietly, deter-

minedly saying, ‘No, we must leave with this

man.’ Just that ability to be persistent but

respectful.” “He’s stubborn, he won’t take no

for an answer,” Farrar says. “You need that

sometimes in a leader.”

Lwanga-Kikwaya survived and went back

to work a few weeks later. Tedros, who is

Ethiopian and the first African to head

WHO, says he saw the confrontation as a

test. “You cannot care about millions if you

don’t care about a poor human being dying

in front of you,” he says.

Today, Tedros is facing a far bigger chal-

lenge: a deadly virus that’s spreading from

China around the world at an astonishing

speed. On 30 January, Tedros officially de-

clared the outbreak of the new coronavirus

an international health emergency. Just the

week before, the number of confirmed cases

had exploded from 830 to almost 8000.

Twelve days later, as Science went to press,

it had gone up to more than 43,000 cases in

25 countries. Flights had been suspended,

cruise ships quarantined, and daily life in

large parts of China brought to a standstill.

Many scientists now assume the outbreak

will develop into a full-fledged pandemic

that could result in millions of infections and

global disruption.

Tedros took office on 1 July 2017 with

an ambitious to-do list: Reform WHO,

strengthen evidence-based decision-making,

highlight the health impact of climate

change, and provide 1 billion more people

with health coverage. But the epidemic of

COVID-19, as the new disease was chris-

tened on 11 February, will overshadow all of

his stated priorities, says Ashish Jha, a re-

searcher at the Harvard T.H. Chan School of

Public Health. How Tedros handles the crisis

will shape not just his legacy, but the future

of his organization, Jha says. “This is the mo-

ment! How things go over the next weeks and

months will end up having a very big impact

on how much the world values WHO.”

Yet the crisis has put Tedros “in a near-

impossible situation,” says Lawrence

Gostin, director of the O’Neill Institute for

National and Global Health Law at George-

town University. If Tedros wants WHO to stay

informed about what’s happening in China

and influence how the country handles the

epidemic, he cannot afford to antagonize the

touchy Chinese government—even though

the country has been less than fully trans-

parent about the outbreak’s early stages,

and perhaps still is. Critics say that stance

puts WHO’s moral authority at risk. “WHO

has never faced such a fast-moving epi-

demic in a country that is quite that power-

ful and, in many ways, closed,” Gostin says.

And the epidemic comes on top of other

challenges inside and outside WHO. Its

budget hasn’t kept up with its tasks; mis-

information about vaccines is spreading like

wildfire; and leading politicians remain in

denial about climate change, which could

WHO’s empathetic head confronts

the threat of a new virus—

and the tricky diplomacy it brings

By Kai Kupferschmidt, in Geneva

FEATURES

WHO Director-General

Tedros Adhanom

Ghebreyesus (center)

helped save a critically

injured health worker in

the Democratic Republic

of the Congo last year.

THE HEALTH

CARER

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