Tedros Adhanom Ghebreyesus has led the World Health Organization through the coronavirus pandemic, its toughest challenge since its founding more than 70 years ago. Under his leadership, the organization has faced criticism from all sides for its handling of the crisis and the political pressures surrounding it, with President Donald Trump last year accusing the WHO of being “a puppet of China.”

Despite all this, Tedros, who has been WHO director general since 2017, is now all but assured to stay in the job for five more years.

In a statement released Friday, the WHO announced that Tedros had been the only name proposed by multiple member states of the United Nations’ health body, and consequently was the sole nominee for the upcoming election. The formal appointment of the director general will take place in May 2022, during the World Health Assembly, with the term of office beginning on Aug. 16, 2022.

The news caused consternation among the critics of Tedros, who was the first African elected to the position. Some former members of the Trump administration who had clashed with WHO officials and moved to pull the United States out of the organization (a plan swiftly reversed by President Biden) said it was a mistake to grant Tedros a second term.

“This is a missed opportunity for the Biden administration to start anew at the World Health Organization,” said Anthony Ruggiero, a senior fellow at the Foundation for Defense of Democracies, who served on the staff of the Trump administration’s National Security Council.

But many public health experts welcomed the news that Tedros would remain in his position, arguing that despite mistakes, his leadership had helped calm some of the divisiveness seen throughout the pandemic.

“Tedros has been the moral conscience of the world,” said Lawrence Gostin, a professor of global health law at Georgetown University. “While the world’s been splintering and countries moving inwards with highly nationalistic responses, he’s urged global solidarity.”

Tedros also appears to have broad support among European leaders, who made up more than half the countries that nominated him. At a media appearance with Tedros on Thursday, Norwegian Prime Minister Jonas Gahr Store offered praise for the WHO leader.

“I wish you all luck in your endeavor, and I salute your staying power and your ability to keep focus on this agenda, servicing your broad membership and the whole world,” Store said.

The election process began in April when member states were invited to submit proposals for candidates, with 28 countries including Bahrain, France and Indonesia taking part. A director general can be reappointed once, according to the WHO, making Tedros eligible for another five-year term.

Tedros, who has steered the global response to a pandemic that has killed almost 5 million people across the world, has come under geopolitical pressure on all fronts. Early in the pandemic, he was widely criticized by the United States and other Western powers for being too soft on China.

Later, however, he faced a backlash from Beijing as he sought to push China harder on controversial issues, including a stalled and inconclusive joint WHO-China investigation into the origins of the coronavirus.

In the global health world, Tedros has won plaudits for consistently speaking out against vaccine inequity and calling for the fairer sharing of doses with poorer nations. Along with other top WHO officials, he has held regular briefings for the media, often speaking several times a week in appearances that called for remarkable stamina.

But even outside of geopolitical issues related to China and the United States, there have been problems. The WHO was criticized for its delayed guidance on masking, despite early signs that the virus was airborne. The WHO-backed vaccine-sharing program Covax has struggled, despite constant promotion by Tedros.

The organization also was hit by a devastating report detailing sexual abuse allegations against WHO staffers during an Ebola outbreak in the Democratic Republic of Congo. Tedros has pledged to overhaul policies on sexual abuse.

Despite all this, Tedros received strong endorsements from France and Germany for a second term. Of the 28 countries that nominated him, most were European. Only three were from Africa: Botswana, Kenya and Rwanda.

Ethiopia, which had nominated Tedros for selection the first time around, did not do so this year. Tedros, a former government minister, has criticized Ethiopian Prime Minister Abiy Ahmed over the conflict in the country’s Tigray region. Tedros is a high-ranking member of the Tigray People’s Liberation Front, the political party that rules Tigray and is in open conflict with Ethiopia’s central government.

Ruggiero, the Trump administration official, criticized Tedros for praising China “even in private” early in the pandemic and said he worried that Tedros’s team would become complacent in a second term.

“It’s really unclear to me why the Biden administration did not work with other countries to put forward a different candidate,” Ruggiero said.

The Trump administration began the process of leaving the WHO in July 2020, with an effective date of July 6, 2021. Members of that administration had planned to set up a new global health body, dubbed “America’s Response to Outbreaks,” but that effort faltered amid bureaucratic hurdles.

The Biden administration on Jan. 20, the president’s first day in office, announced that it was canceling the plan to leave the WHO. U.S. officials have been involved in deliberations about how to reform the global health body and strengthen international pandemic preparedness, with the topic up for discussion at a special session of the World Health Assembly, starting Nov. 29.