WHO Director-General Tedros Adhanom Ghebreyesus was reappointed to a second five-year term on Tuesday by the U.N. health agency's member countries.
No other candidate challenged Tedros for the post amid the ongoing difficulties of responding to the devastating coronavirus pandemic.
This is overwhelming, Tedros said, after another World Health Organisation official asked everyone in the room to stand and applaud him.
Fighting back tears, Tedros described himself as a child of war after signing the contract for his extension. He said that after witnessing his younger brother's death at an early age, it was luck (that) brought me all the way here."
Tedros, a former government minister from Ethiopia, has directed WHO throughout its management of the global response to COVID-19 and withstood occasionally withering criticism over its multiple missteps.
He is the first African to lead the agency and the only director-general not qualified as a medical doctor.
He is also the first WHO leader not to be supported by their home country; Ethiopia has previously accused Tedros of misconduct after his sharp criticism of the war and humanitarian crisis there and raised concerns about his leadership on Tuesday.
Under Tedros, the U.N. health agency failed to call out countries including China for blunders that WHO officials grumbled about privately, advised against mask-wearing for months, and said initially that the coronavirus wasn't likely to mutate rapidly.
Scientists drafted by WHO to investigate the coronavirus' origins in China said the critical probe was stalled last year, after issuing a report that even Tedros acknowledged had prematurely ruled out the possibility of a laboratory leak.
There have been some mishaps, but Tedros has also been a steady voice throughout the pandemic, advocating for an equitable response, said Javier Guzman, director of global health policy at the Center for Global Development in Washington.
He said despite reservations about Tedros' leadership, some countries weren't willing to push for change.
We are in the middle of the pandemic and there is some pressure for consistent leadership to take us through this difficult moment, Guzman said.
Tedros has frequently railed against rich countries for hoarding the world's limited supply of vaccines and insisted that pharmaceuticals aren't doing enough to make their medicines available to the poor.
Amid the near-universal focus on Ukraine after the Russian invasion, Tedros slammed the global community for not doing enough to solve crises elsewhere, including Yemen, Syria and Afghanistan, arguing that it was possibly because those suffering weren't white.
Still, critics say Tedros has failed on some fundamental issues, like holding staff accountable after allegations that dozens of outbreak workers managed by WHO sexually abused young women in Congo during an Ebola outbreak that began in 2018, in one of the biggest sex scandals in U.N. history.
None of the senior WHO managers alerted to the abuse allegations and who did little to stop the exploitation, have been fired.
In January, The Associated Press reported that staffers in WHO's Western Pacific office filed an internal complaint accusing regional director Dr. Takeshi Kasai of abusive, racist and other misconduct, undermining efforts to stem the spread of COVID-19. In response, Tedros said an investigation into the allegations had been launched and promised to act with urgency.
But last week, several WHO staffers wrote to the agency's Executive Board complaining that Kasai has been able to continue his unethical, abusive and racist conduct without any form of restriction. In an email to staff, Kasai disputed the charges.
Public health expert Guzman said the apparent culture of impunity at WHO was problematic.
We do need to see a stronger (WHO) director-general going forward, where misconduct is not tolerated, he said, calling for extensive reforms to make the agency accountable.
As Tedros begins his second term, some experts have also raised concerns that WHO isn't fulfilling its primary role as a technical agency providing science-based guidance to countries.
Dr. David Tomlinson, a cardiologist who has campaigned for better protective equipment for health workers in Britain's health system, says he has been appalled by WHO advice, most notably their reluctance to acknowledge that COVID-19 is widely spread in the air.
In July 2020, more than 230 scientists published a paper appealing to WHO to recognise the coronavirus was airborne; that later prompted the organisation to alter some of its recommendations.
Tomlinson and others say Tedros should ensure WHO's top priority during future health emergencies is evaluating the science.
They have perpetuated untruths that have ultimately led to the deaths of millions of people, he said, citing the estimated 15 million people who have died during the pandemic.
We need an agency that's unafraid to tell the truth, but that's unfortunately not what we have.