The global health community recently witnessed the first major test of the new WHO Director-General, Tedros Ghebreyesus’s nascent tenure. On October 22 2017, following several days of intense outrage and scrutiny, particularly in the news and on social media, the Director-General rescinded the appointment of Robert Mugabe, Zimbabwe’s longtime president, as a Goodwill Ambassador for Non-Communicable Diseases.

This episode was remarkable for several reasons. First and foremost, there is the fact that this was an incredibly odd and surprising selection given Mugabe’s role in ruining his country’s once strong health system (strongly articulated in the PHM Zimbabwe statement on the appointment). Second, the decibel level of the outrage in the media and on Twitter appeared to be far louder than anything we have seen so far in global health. And third, the WHO reacted swiftly, within a matter of days, to rescind the controversial appointment.

Our focus here is not on the decision itself, which we agree was inappropriate, but with the global response, and what the response tells us about the power dynamics flowing through global health governance, serving as another example of the intense power that the Global North (still) has in shaping discourse in global health.

A key question in this entire episode is whether the outcome would have been different if we, hypothetically, replace Mugabe with a different authoritarian leader. Mugabe might have been an ‘easier’ target, given his advanced age and diminishing role in geopolitics. But had the decision to revoke Mugabe’s appointment been made with a more powerful, globally ‘relevant’ (from the perspective of high-income countries), authoritarian-style leader, would the criticism have been as vociferous? Possibly not. Several countries with leaders with questionable human rights records have played and do play key roles in global health diplomacy (examples here and here). Keeping in mind the ideas of social justice and fairness that the global health community is meant to espouse, this begs the question about what we consider ‘tolerable’ behavior from a political standpoint.

Consider another example playing out in real time – the World Bank’s women’s entrepreneurship fund, launched in partnership with the Trump Administration, (represented by Ivanka Trump). The incongruity of this alliance (captured beautifully in Bill Easterly’s tweets) is underscored by the fact that the head of this Administration has a particularly dismal history with women’s empowerment – an example of which is the number of sexual harassment charges that have been brought against him.

When it comes to powerful international actors with less than stellar track records on issues ranging from muzzling civil society, to cracking down on free speech, to promoting ethno-nationalism, there appears to be a recognition that partnerships with those countries are warranted for political reasons, increasingly so in today’s climate where multilateralism is in crisis. But such an argument did not seem to have much traction in the backlash against the Mugabe decision. For example, many articles in the US media for example focused on the loss of ‘goodwill’ for the WHO more broadly, particularly in light of the negative coverage the institution received during the Ebola epidemic. What is interesting is that such discussions about the reputation of these institutions become far more nuanced when Northern actors are deeply involved. To our knowledge, few are challenging the World Bank’s legitimacy in light of the Trump partnership.

The episode also highlights whether we are more willing to turn a blind eye when considering certain political figures as global role models, in a similar vein as the Goodwill Ambassador position. For example, it is well accepted that politicians from the Global North, many of whom have been deeply connected to war and conflict in other parts of the world, can leave office and go on to have a second life as architects of world peace and development ( e.g. Tony Blair and his role as UN envoy). Why does our bandwidth for forgiveness and acceptance extend in the case of elite Northern actors? One explanation is that the power that Northern leaders wield, and the way in which we as society are conditioned to view them, strongly shapes what is tolerated, and what is not.

Finally, the nature of the response in both the news coverage and on social media reflects the continued dominance of Northern voices in shaping global health debate and discussion. The US media coverage for example was largely decontextualized and stripped of any views from Zimbabwe or the broader region. Such context is an essential part of understanding this decision, as put forward in a recent piece by Simukai Chigudu. The news coverage and heated social media debate also neglects the longstanding discontent amongst LMICs with Northern dominated global governance ‘discourses’ e.g in diplomatic relations with the African Union. There is a tendency that countries and regions withdraw from multilateralism partly because of its ‘capture’ by high-income countries.

Beyond the media narrative, views on social media appeared to focus on dominant Northern voices – even if the outrage had much broader and deeper roots. This matters, because as social media becomes a platform for protest in the global health community, some views will gain traction and visibility over others, perhaps due to their geographic locations (eg. in certain democracies people feel more comfortable voicing their views on Twitter) or the power of these individuals relative to other stakeholders in global health. Therefore, we need to think about whether these platforms will mimic other fora, including academic journals, where voices from low and middle income countries do not receive the same amount of attention. Compared with other, arguably more fraught areas of international diplomacy – trade, nuclear security, climate change – global health remains, for a part, a relatively ‘safe’ diplomatic space where post-colonial viewpoints, including a considerable role for philanthropy, still play out (McCoy and Singh, 2014). Therefore, we need to closely engage with the evolution of this new territory of social media activism.

One positive lesson from this entire experience is that there is a role for the broader global health community to play in shaping the trajectory of global health policy, perhaps in a way that we have not seen in the past. But we need to also reflect upon and question our own agency, norms and values in taking these stances, and ask whether we are in some ways contributing to existing power structures in global health, or whether we are trying to strengthen the legitimacy of diverse and alternate discourses to ensure further meaningful change for health, equity and social justice.