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This WHO handout picture shows chief of operations, support and logistics Paul Molinaro, WHO director-general Tedros Adhanom Ghebreyesus and WHO technical lead Maria Van Kerkhove during a COVID-19 virtual press conference at the WHO headquaters in Geneva on March 16, 2020.CHRISTOPHER BLACK/AFP/Getty Images

For many years, health experts in Ethiopia noticed a strange phenomenon: The government was refusing to acknowledge cholera outbreaks.

Instead, the authorities labelled the outbreaks as “acute watery diarrhea” – a broader term that includes milder diseases. Research by Human Rights Watch found that the Ethiopian government was pressuring its health workers to avoid any mention of cholera, which could damage the country’s image and deter tourists.

Throughout this period, one of the most powerful officials in Ethiopia’s authoritarian government was Tedros Adhanom Ghebreyesus, first as health minister and then foreign minister. In 2017, he was elected to a new post: director-general of the World Health Organization.

Critics say the cholera saga in Ethiopia is a sign that Dr. Tedros is comfortable with the secrecy of autocratic states – a tendency that may have led him to accept China’s earliest reports on the novel coronavirus outbreak in December and January without challenging its officials with tough questions.

“Dr. Tedros is the product of a deeply authoritarian regime,” said Jeffrey Smith, director of Vanguard Africa, a U.S.-based consultancy that lobbies for democracy in Africa.

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Tedros Adhanom Ghebreyesus has been criticized for his performance during the cholera epidemic in in Ethiopia during which he appeared to condone the secrecy of autocratic states.FABRICE COFFRINI/AFP/Getty Images

“Dictatorships are bad for public health, both inside their borders and globally.”

Ethiopia has become more democratic under its new prime minister, Abiy Ahmed, who took power in 2018. But before that, Mr. Smith said, it was a “highly repressive surveillance state in which a lack of government transparency was a hallmark.” And Dr. Tedros played a role in helping construct and maintain that state.

Ethiopia also had close relations with China, obtaining much of its surveillance technology from Chinese state suppliers, which allows it to monitor and punish dissidents.

With the WHO facing growing criticism for praising China’s pandemic response, there is fresh scrutiny of Dr. Tedros and his role at that organization and in Ethiopia.

In his current position, Dr. Tedros is constrained by the WHO bylaws, which make the agency dependent on the information provided by its member states. The issue is whether his leadership set a tone that tended to accept China’s reports without sufficient questioning.

He has denied that he helped to cover up cholera outbreaks in Ethiopia during his term as health minister from 2005 to 2012, calling it a “smear campaign.” In an interview with Foreign Affairs in 2017, he said: “It doesn’t even make any difference whether you call it ‘cholera’ because the management is the same.”

Dr. Tedros, 55, made history in 2017 when he became the first African to lead the global health agency, defeating the British health expert David Nabarro in the first-ever election for the WHO’s top job. He won by a margin of 133-50 in a secret ballot among the world’s health ministers, with strong support from African ministers and the African Union.

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File photo shows then-foreign minister of Ethiopia Tedros Adhanom, center, in Addis Ababa, Ethiopia on Jan. 23, 2014.The Associated Press

A few months later, Dr. Tedros was again facing criticism – this time for the WHO’s decision to award the title of “goodwill ambassador” to Robert Mugabe, then the Zimbabwean dictator. After several days of outraged protests by world leaders and health organizations, Dr. Tedros cancelled the appointment – but did not apologize or explain it.

Dr. Tedros was born and educated in Eritrea, then a region of Ethiopia, and later earned graduate degrees in infectious diseases and community health in Britain. As a child, his younger brother died of a suspected case of measles, a preventable illness that helped motivate his support for universal health care in his campaign for the WHO’s leadership.

As health minister in Ethiopia, he was praised for building thousands of health clinics, opening dozens of new medical schools, training 40,000 female health workers and drastically cutting the maternal mortality rate and the death rate from malaria, tuberculosis and AIDS.

As head of the WHO, he and the global agency have continued to be strongly supported across the developing world, especially after U.S. President Donald Trump announced that he would cut the organization’s funding.

African leaders have rallied around WHO and its leader. “Lives are saved because of the work they do,” said Chikwe Ihekweazu, director-general of the Nigeria Centre for Disease Control, at a briefing this week.

“The organization is critical to our collective survival.”

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