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732 14 FEBRUARY 2020 • VOL 367 ISSUE 6479 sciencemag.org SCIENCE
came from African countries, where some
still revere Mugabe—who died in September
2019—as an anticolonial hero, and that he
had merely proposed him for the honor. “We
only started the process,” Tedros says. After
a massive backlash, he withdrew Mugabe’s
name. “He corrected it immediately and
that’s what leadership is about,” says Cana-
dian health researcher Peter Singer, one of
Tedros’s closest aides.
Fighting outbreaks is only one of WHO’s
tasks, and until recently, it did so primar-
ily by coordinating other organizations’
work. After the slow response to the West
African Ebola outbreak of 2013–16 trig-
gered outrage, the agency started to play a
more active role. But to achieve its stated
mission—“the attainment by all people of
the highest possible level of health”—WHO’s
primary job is to produce “norms and stan-
dards” that member states can implement,
such as guidelines for malaria treatment,
training materials for maternal health
workers, or policies on opioid use.
As part of his reform plan for the
organization—a top priority, he says—
Tedros has appointed more women, made
the top ranks more diverse, and created new
departments, including one for “healthy
populations.” As a former health minister,
he has a keen sense of the practical needs
of its member countries, says Bernhard
Schwartländer, his Cabinet chief. Tasks such
as updating WHO’s list of essential drugs
were prioritized; others, such as the “policy
framework on managing psychosocial con-
sequences of radio-nuclear emergencies,”
were dropped. “We are changing the DNA
of WHO itself,” Tedros says. But the 72-year-
old organization has a complicated structure
with six regional offices whose heads enjoy
considerable power. “WHO is a massive
tanker. You cannot turn it around easily,”
Schwartländer says.
To many in the ranks, the transformation
seems a never-ending process. “He has sig-
nificantly improved WHO’s core mission,”
Gostin says. “But he has not been able toconsistently bring WHO staff and partners
with him, sometimes resulting in unrest.”
Tedros acknowledges he has faced internal
resistance. “People get a bit nervous when
they see that you have this heavy change
agenda,” he says.
One move that gets universal praise, how-
ever, is the creation of the position of chief
scientist. “This is a really important signal,”
says Ilona Kickbusch, a global health ex-
pert at the Graduate Institute of Interna-
tional and Development Studies. “Science
is the bedrock of everything we do here,”
says Soumya Swaminathan, an Indian pe-
diatrician who has taken on the role. She
says her department will focus on identify-
ing research gaps; she has also launched
committees to look at the ethics of gene ed-iting and artificial intelligence in medicine
and public health.
To many outside observers, what matters
most is whether WHO will see an increase in
its $2.5 billion annual budget, most of which
does not come as “assessed contributions”—
essentially countries’ membership fees—
but as donations from countries or other
donors (see graphic, left). They often
earmark their contributions for specific
projects, such as eradicating polio, which
limits WHO’s ability to set its own priori-
ties. Tedros also acknowledges the risks of
depending on a few large donors. “If one
of them refuses to continue funding, WHO
could get into a serious shock,” he says.
“It’s like a country which is dependent on
oil.” So far, countries have resisted plans to
significantly raise the assessed contribu-
tions. “I’m very positive about the changes
that have happened, but a part of me won-
ders why that has not translated into a lot
more funding and a lot more support,” Jha
says. But Tedros points out that WHO has
just developed an “investment plan” to at-
tract new donors, and there have been some
small increases in donations.
In the December conversation with
Science, Tedros emphasized that disease out-
breaks are a constant concern. “If there is a
major outbreak, it’s not just a health prob-
lem. It can have economic, political, and so-
cial impact,” he warned. He did not know at
the time that the biggest emergency of his
career was already brewing in Wuhan, China.TWO MONTHS LATER, WHO is in full crisis
mode. Tedros and his top aides meet ev-
ery day to discuss the grim developments.
Journalists from around the word call into
daily press conferences, usually with Tedros
himself behind the microphone. The fight
against Ebola had taught him a clear strat-
egy, he said at one of these briefings: Fight
the disease at the source and try to keep it
from gaining a foothold elsewhere. “Focus
on the epicenter,” Tedros said. “If you have
several epicenters, it is chaos.”
But the fact that the epicenter is in China
complicates that task. Tedros has bent over
backward to stay on friendly terms with the
emerging superpower. He flew to Beijing to
meet with Chinese President Xi Jinping on
28 January and praised the Chinese govern-
ment for its efforts to fight the virus—even
though the country waited weeks before al-
lowing officials to inform the public about
the outbreak.
Tedros says his visit to China led to three
important agreements: to fight COVID-
hard at its source, to share data, and to let
an expert mission from WHO visit China.
On the evening of 9 February, he saw off the
mission’s advance team at the Geneva air- CREDITS: (GRAPHIC) N. DESAI/SCIENCE; (DATA)WORLD HEALTH ORGANIZATION’90–
’’92–
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’01234$5 billion
Donations Assessed contributionsWHO biennial budget
Assessed contributions Earmarked donations Non-earmarked donationsSources of the 2018–19 budget (%)*
17 81United States Bill & Melinda
Gates FoundationGAVIUnited
KingdomGermanyUnited Other
NationsWorld BankEuropean
CommissionRotary InternationalJapan15 13 8 7 45 4 333 35*data up to 7 January 2019
2Big job, modest budget
“Assessed contributions,” or fees from member countries, make up a small part of the World Health
Organization’s (WHO’s) budget and have remained mostly flat for 30 years. Donations have risen, but most
are earmarked for specific goals.
Published by AAAS