As Ethiopian Seeks to Head WHO, Outbreak at Home Raises Questions

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FILE – Former Ethiopian health minister, Tedros Adhanom Ghebreyesus, seen here speaking in Geneva, Switzerland, May 24, 2016, if elected, would be the first African to lead the World Health Organization.
By Salem Solomon
VOA

WASHINGTON — Ethiopia is battling an outbreak of acute watery diarrhea (AWD) that has affected more than 32,000 people. At the same time, Ethiopia’s former minister of health, Tedros Adhanom Ghebreyesus, is a candidate to lead the World Health Organization.

The two facts are linked in that critics of Tedros say he has tried to minimize the outbreak by refusing to classify it as cholera, a label that could harm Ethiopia’s economic growth.

The WHO’s 194 member states will gather in Geneva for a 10-day assembly starting Monday. One of their first tasks is to choose the organization’s next director-general.

Tedros is one of three top contenders for the position, along with candidates from Britain and Pakistan.

Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, told The New York Times that Ethiopia has a long history of downplaying cholera outbreaks, and the WHO could “lose its legitimacy” if Tedros, who is also a former Ethiopian minister of foreign affairs, takes over the leadership of the organization.

“Dr. Tedros is a compassionate and highly competent public health official,” he told the Times. “But he had a duty to speak truth to power and to honestly identify and report verified cholera outbreaks over an extended period.”

But others have risen to Tedros’ defense. Tom Frieden, the former director of the Centers for Disease Control and Prevention, said the controversy over naming the outbreak is overblown. “During the time that Tedros was health minister, it would have not made any difference,” Frieden told VOA.

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Cholera vs. acute watery diarrhea

Ethiopia has been accused of covering up three cholera outbreaks during Tedros’ tenure as health minister.

Declaring cholera would not have changed Ethiopia’s response to past AWD outbreaks, according to Frieden. In fact, he says, avoiding the cholera label has not been irresponsible but rather a necessary compromise.

“It allowed public health to respond rapidly,” Frieden said.

The literature on AWD and cholera shows that treatment is the same. It calls for hydrating the patient, chlorinating water and improving sanitation. In fact, the WHO uses the terms interchangeably in their teaching materials on how to deal with an outbreak.

FILE – People wait for food and water in the Warder district in the Somali region of Ethiopia, Jan. 28, 2017. The consumption of contaminated water from shallow wells and ponds meant for cattle, poor nutrition and unsafe hygiene practices have led to outbreaks of cholera and acute watery diarrhea in the impoverished African country.
FILE – People wait for food and water in the Warder district in the Somali region of Ethiopia, Jan. 28, 2017. The consumption of contaminated water from shallow wells and ponds meant for cattle, poor nutrition and unsafe hygiene practices have led to outbreaks of cholera and acute watery diarrhea in the impoverished African country.
Lately, the development of cholera vaccines has brought the value of identifying the bacterial disease to the fore, said Frieden. “At this time, all African countries that report acute watery diarrhea should be rapidly doing lab confirmation and, if it’s cholera, considering the use of cholera vaccine in the response,” he said.

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In the current outbreak, Ethiopia’s Somali region has been hit the hardest, with 768 deaths since January, according to a WHO report published May 12. Almost 99 percent of the deaths and 91 percent of cases are in the same region.

The WHO representative to Ethiopia, Dr. Akpaka Kalu, says the government is right to call it AWD because regional health centers do not have the capacity to test every case.

If all cases are treated as cholera, the disease has the potential to spread more quickly when children who do not have it are brought into cholera treatment centers, Kalu said.

“We know, biologically, malnutrition causes diarrhea. Now, if you admit that child into a cholera treatment center, you’ve actually turned that center into a cholera transmission center,” he said, speaking by phone from Addis Ababa.

Current response

Over the past six weeks, the response to AWD in Ethiopia appears to have been effective.

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Kalu said his team, along with regional leadership and government officials, have focused on prevention and intervention. They have instituted community-based surveillance to monitor the regional drought in general and AWD in particular, and there has been a drop in reported cases.

“We have evidence the average number of cases [dropped] from over 600 a day to about 54 a day,” he said.

Kalu argues that early interventions are getting results and doesn’t think that vaccinating 6 million people in the Somali region is feasible.

He says Ethiopia is now preparing to prevent outbreaks from spreading to other parts of the country such as the Afar and Amhara regions as the rainy season approaches.

“We need to enhance preparedness because, as the rains come, usually what happens is the rains wash and enter the water bodies including where there is open defecation,” he said. “That’s how water bodies get contaminated and people use the water and become sick. So there is a need, our focus is to build capacity to be able to detect and contain so that it doesn’t spread.”

8 Comments

  1. Selam,

    Please think first before you write.

    “As Ethiopian Seeks to Head WHO, Outbreak at Home Raises Questions” looks a fancy title to your story. Fancy, maybe; but it is not Ethiopia that seeks to head the WHO. The WHO directorship is not held by a country; it is a an office held by a candidiate form one of the WHO member countries.

    The guy who gets appointed by WHO member states gets employed by the WHO, travels as UN – WHO staff with UN – WHO special docuaments (he does not need his country’s passport) with immunity from arrest while on UN – WHO duty.

    In case of Dr. Tedros, except the government that backed his appointment for the job and some in Ethiopia who will be proud of an Ethiopian heading one of the most important offices in the world, once Tedros is employed, he is international person.

    Given the controversy Tedros has generated between supporters and opposers of his possible appointment and eventual employment by the WHO, please do not try to blurr the glaring divide by confusing his seeking office with something else.

    Tedros is seeking office and not Ethiopia.

    The rest of the report is fine.

  2. Corrigendum

    The paragraph from my comment above which starts with “As Ethiopian Seeks to Head WHO . . .” should have read:

    “As Ethiopian Seeks to Head WHO, Outbreak at Home Raises Questions” looks a fancy title to your story. Fancy, maybe; but it is not Ethiopia that seeks to head the WHO. The WHO directorship is not held by a country; it is a an office held by a candidiate elected form one of the WHO member countries.”

    Thanks!

  3. I have said this many times before. It would be a futile effort to stop this man from being chosen as the leader of WHO. He has a unanimous backing of the AU as he is the first such candidate as an African. In light of this strong support behind his candidacy, the state of the opposition is dismal. When I read the news that one such opponent sneaked in the meeting hall of the WHO and began shouting that nobody understood him, I knew then and there that this candidate’s election is sealed. That is not a dignified way of expressing opposing opinion. The other thing the electors might have looked at might have been the fact that this candidate is a late comer to the regime back home. So it is done now and he is the director of WHO. There is nothing that can be done about it. That is what happens when the opposition remains in disarray. A longtime friend in Europe was telling me the other day that even among the demonstrators there were some individuals who came almost to blows over the display of some kind of a flag. That is not funny at all except to the goons at Arat Kilo and their bosom buddy in Asmara. I have this strange hunch about the next battleground. I will not be surprised that if one of the officials in the inner circle of the regime back home throws his lot for a high profile position in another UN agency or even IMF or The World Bank. You watch!!!

  4. Why is that TPLFites are succsesful again and The Opposition camp is falling again ????
    Its beyond Just Tedros and WHO…The ineffective and repeatedly failure Opposition camp need soul search and look inward for overhaul change if strategy and improvements

  5. TPLF is an Ethno- FASCIST group i got that,i also got that the PRO-DEMOCRACY leaderships ineffectiveness
    NEED SERIOUS DEEP AND THOROUGHLY STUDY AND SUGGESTIVE PRACTICAL RECOMMENDATIONS FOR CHANGE IF STRATEGIES…..THE YOUTH AND WOMAN MUST JOIN THE STRUGGLE …AND NOW

  6. So Dr Tedros is now WHO DG-does this translate to he will continue to cover up outbreaks occurring in sovereign countries? Doesn’t make sense. More convincing would be if he delayed emergency help to the victims-whether you name it AWD or cholera!

  7. Often diaspora politics is blind like a bat. Opposing or supporting the candidate is not by itself bad. But the way we go about to justify our thinking process is in question. Yes, the Doctor was and is part of the TPLF establishment. Based on your view you can support and not support his candidacy. To simply insult individuals and ethnic groups as whole defeats the very reason the person is attempting to relay to the public.
    Here is what (Tigray Online) put in their web site in red ink after the Dr. is elected to the position of WHO director. “The Ethiopian extremist group’s unprecedented attack only exposed their fake cry of unity. Racists you lost in Gonder and you lost now!!!” Pretty rubbish to put it mildly. Racism and ethnic grouping is the hallmark of the TPLF, not the Ethiopian people. To foment hate, division and fighting among peaceful people is the objective of the TPLF from the get go. The idea to think if you are not with me you are against me is rubbish. We can think for ourselves and still respect the outcome of any election. And that is what is lacking in the diaspora and within TPLF circles. I say to Dr. Tedros Adhanom Ghebreyesus congratulations. That does not mean, I agree with his past dealings and his present view. Yet, as an Ethiopian I share his success in this endeavor.

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