Expectations are growing over the expected move of the WHO’s top leadership

Soumya Swaminathan, WHO chief scientist, at a press briefing at the height of the COVID pandemic in September 2020.

World Health Organization chief scientist Dr Soumya Swaminathan, a respected voice in the WHO’s senior leadership, is expected to resign within the next month – in the first major leadership shakeup by Director-General Dr Tedros Adhanom Ghebreyesus since the start of the pandemic COVID-19, Watch the health policy has learned.

Conversely, Dr. Mike Ryan, executive director of the WHO’s Health Emergencies Programme, who he was previously expected to leave the organizationappears set to remain, confirmed several WHO insiders familiar with the upcoming reshuffle.

Sources said Swaminathan, who at 63 is still two years short of the WHO’s mandatory retirement age, wanted to stay another year in the office she built from scratch.

However, Tedros is reportedly keen to make changes to his leadership, senior staff are acting at the CEO’s behest – and there are also hints that Swaminathan’s style is too independent for the CEO.

The upcoming reshuffle will likely include the departure of the deputy Director Dr. Zsuzsanna Jakabsources said Watch the health policy.

Jacob the Hungarian health professional born in 1951, is already well above the WHO’s mandatory retirement age of 65 – which can exceptionally be extended by just three years. She was previously the Regional Director of the WHO European Office.

Left to right: WHO’s Mike Ryan, Tedros Adhanom Ghebreyesus and Sylvie Briand at a press briefing on COVID in February 2020 – just after the WHO declared an international public health emergency.

Ryan, who looks set to stay for the time being, is highly regarded in emergency circles. However, he is also someone who remains consistently deferential to Tedros’ own political authority and direction throughout more than two withering years of WHO’s response to the COVID pandemic.

Ryan was appointed executive director of health emergencies in 2019 following Tedros’ decision to remove renowned Australian epidemiologist Dr Peter Salama. Salama has held the post since 2016 – when he was appointed at the end of the Ebola outbreak in West Africa, which caught the WHO off guard and prompted a major reorganization of the agency’s emergency response team.

But in Tedros’ first major internal reshuffle, the director-general nimbly moved Salama from Health Emergencies to the newly created position of executive director of Universal Health Coverage.

Salama accepted the new role with grace. But internally, the reshuffle is seen as a frontman role and a demotion of sorts by Tedros, who reportedly harbors a grudge against Salama, a former WHO official said Watch the health policy. It dates back to Salama’s reported criticism of Ethiopia’s poor handling of a series of cholera outbreaks during Tedros’ tenure as the country’s health minister from 2005-2012. The mismanagement scandal that rocked the WHO emergency team led by Salama in 2018-19 nevertheless created the political opportunity for Tedros to act.

In January 2020, shortly after Salama assumed his new role at UHC, he died of a heart attack.

Tedros’ centralized leadership style

Tedros at a WHO press conference in January 2022.

The question now is who will replace the departing Jakab and Swaminathan – both known as strong, experienced leaders – along with other, lesser-known names that may also be swept up in the coming shuffle.

Tedros’ tenure at WHO has been marked by a centralized leadership style, such as a Lancet editorial observation at the end of August. And it left less room for senior officials to express themselves independently than had typically been the case under previous CEOs—a concern for a science-based organization.

“Power is increasingly centralized around the office of the director-general under Tedros. This strategy can be advantageous in a crisis that requires a commander. But the lack of depth in wider leadership leaves gaps in the organisation, they said The lancetin an August editorial marking the beginning of the second term of Tedros Adhanom Ghebreyesus.

“It’s a very lonely, authoritarian way of ruling – that much is clear,” said one diplomatic source who has known and admired Tedros since his days as Ethiopia’s health minister (2005-2012). Watch the health policy.

Speaks out publicly on sensitive topics – including treatment for COVID

Swaminathan is one of the few senior WHO officials who speaks publicly and independently on often controversial issues. During the COVID crisis, she appeared very frequently not only at WHO’s global media briefings, but also on international and Indian television.

She has distinguished herself in particular by her willingness to speak openly about the emerging evidence surrounding new COVID treatments – in cases where the WHO has bucked trends of politically popular but scientifically unsound therapies – including remdesivir, ivermectin and hydroxychloroquine.

Specifically for remdesivir, WHO recommended not to use the drug in November 2020opposing the US Food and Drug Administration’s approval of the drug developed by the pharmaceutical company Gilead.

At the time, Swaminathan told reporters bluntly at a WHO global briefing that the FDA had ignored evidence presented by the WHO in a multinational “Solidarity Study” to the effect that the drug failed to reduce mortality or bring other measurable benefits. The fact that she dared to reveal such information to the powerful FDA so openly was an unusual move for a WHO official.

An independent voice in Indian academia

Swaminathan’s statements also stirred popular political positions in India. Her statements about the lack of evidence for ivermectin as a treatment for COVID earned her the ire of the politically aggressive Indian Bar Association – which went so far as to file legal complaints against some of her comments in 2021

IBA, Indian insiders said Watch the health policy at the time it tended to echo the positions of Prime Minister Narendra Modi’s government,

Swaminathan, however, fully subscribed to the evidence-based guidelines not only of the WHO, but also of India’s own Ministry of Health and Family Welfare – which had just recently dropped ivermectin from its own list of recommended treatments for COVID. Swaminathan welcomed the move, saying the revised national guidelines were “simple, rational and clear guidelines for doctors.

When Tedros was first elected WHO director-general in 2017, he appointed Swaminathan as his deputy director-general. However, in a 2019 reshuffle, he moved her from the post of DDG to the newly formed Office of Chief Scientist. It was something some WHO watchers also interpreted as a kind of political distancing on Tedros’ part – although Swaminathan was also eminently suited to her new role, which put her in charge of the WHO’s evidence base.

WHO watchers will now be watching closely to see if Tedros appoints a new chief scientist with the authority to speak, as Swaminathan did. A renowned Indian pediatrician and tuberculosis researcher, she previously served as the Director of the Indian National Tuberculosis Research Institute in Chennai and later as the Director General of the Indian Council of Medical Research from 2015-2017.

From 2009-2011, Swaminathan was also Coordinator at TDR, the UNICEF/UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases based in Geneva.

A montage of anticipation

Anticipation of the upcoming senior staff reshuffle grew this week as Tedros announced several new WHO director-level appointments, as well as 11 new country representatives, in an internal WHO staff announcement released on Friday.

New appointments include Gaya Gamhewage, a Sri Lankan physician as Director, Prevention and Response to Sexual Exploitation, Abuse and Harassment.

Gamhewage has already served in this critical position, where she led much of WHO’s response to the sexual exploitation and abuse scandal that broke out in the Democratic Republic of Congo in September 2020 – and has since subject to an ongoing internal investigation.

Tedros also announced the appointment of Dr. Alian Labric, a Belgian researcher, as director of the WHO’s relatively new digital health intelligence unit. Labrick is a former professor and associate chair for research at Johns Hopkins University.

At the same time, Tedros announced a new WHO representative in the Democratic Republic of the Congo, Dr Bureima Hama Sambo, as well as new heads of offices in Mauritius, Barbados, Panama, Qatar, Romania, Albania, Belarus and the Solomon Islands Korea (North Korea) and Myanmar.

Image credits: WHO, Fletcher/HPW.

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