The Ethiopian head of the World Health Organization, Tedros Adhanom Ghebreyesus, was confirmed as the only candidate Friday for the world’s top health job and now looks certain to serve a second term as its director-general. No nation put up a candidate against him despite his controversial handling of the COVID-19 pandemic and close relationship to China.

Observers say the U.S. lack of activism in the election process means it has lost a major opportunity to wield influence over the future of the organization. The nomination deadline ended at the end of September. 

Craig Singleton, adjunct fellow at the Foundation for the Defense of Democracies, told Fox News, "The WHO Director General election stood as one of the first multilateral tests for the Biden administration, which has prioritized multilateralism and the United Nations in particular as a vehicle to promote U.S. interests on the world stage. The administration has put forward candidates for other international organization elections, such as the International Telecommunications Union, but has yet to provide an explanation for its decision to not challenge Tedros."

Singleton continued, "This misstep raises serious questions about Washington’s efforts to push back against China’s growing U.N. activism, which includes Beijing’s efforts to promote leadership candidates throughout the UN system which are deferential to China’s interests."

Fox News has reached out the State Department but has yet to hear back on its rationale for not putting up an alternative candidate for the post. 

In this Monday, March 9, 2020 file photo, Tedros Adhanom Ghebreyesus, Director General of the World Health Organization speaks during a news conference, at the WHO headquarters in Geneva, Switzerland. 

In this Monday, March 9, 2020 file photo, Tedros Adhanom Ghebreyesus, Director General of the World Health Organization speaks during a news conference, at the WHO headquarters in Geneva, Switzerland.  ((Salvatore Di Nolfi/Keystone via AP, file))

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President Biden reengaged with the WHO early in his presidency following the Trump administration’s announcement that it would be terminating the U.S. relationship with the organization.  At the time, Trump cited the WHO’s handling of the pandemic, its purported pro-China bias and subsequent failure to enact reforms.

When the Biden administration rejoined in January,  Dr. Anthony Fauci said that Tedros was his "dear friend." Tedros reportedly referred to Fauci as "my brother Tony."

(From L) World Health Organization (WHO) Health Emergencies Programme Director Michael Ryan, WHO Director-General Tedros Adhanom Ghebreyesus and WHO Technical Lead Maria Van Kerkhove attend attend a daily press briefing on COVID-19 at the WHO headquarters on March 6, 2020 in Geneva.  (Photo by FABRICE COFFRINI/AFP via Getty Images)

(From L) World Health Organization (WHO) Health Emergencies Programme Director Michael Ryan, WHO Director-General Tedros Adhanom Ghebreyesus and WHO Technical Lead Maria Van Kerkhove attend attend a daily press briefing on COVID-19 at the WHO headquarters on March 6, 2020 in Geneva.  (Photo by FABRICE COFFRINI/AFP via Getty Images)

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While the U.S. didn’t nominate Tedros, 28 countries including France and Germany did. Unusually, his home country did not back him. Ethiopia was unwilling to give him its blessing due to accusations of him taking sides against the sitting government as the threat of a civil war grows in the African country. Tedros, who is not a medical doctor, had previously served as the Ethiopian health and foreign minister.

The United States is the single-biggest contributor to the WHO, spending roughly $2 billion over the last five years. The U.S. funds 22% of the organization's budget, while China picks up almost half of the tab.

Hugh Dugan, who was the senior director for international organization affairs at the National Security Council during the Trump administration and had briefed the Biden administration on the WHO during the transition, expressed his concern that needed reforms may fall by the wayside .

"In standing for another five years as WHO chief, Tedros was due a White House grilling over COVID-19.  But Biden forgot to seize that opportunity for improved accountability and transparency concerning Wuhan," Dugan said. "Instead, he rubber-stamped Tedros like a mildly overdue library book. The status quo should have been a status no, and only the United States has the heft to call out China's guy. But Biden's team … continued to show little interest in creating leverage for needed change at WHO's helm."

Singleton, a former U.S. official with expertise on China and international organizations, shared concerns over Tedros’ perceived China bias. 

"There is little doubt that Tedros lacks credibility, not only because he allowed Beijing to undermine the investigation into COVID-19’s origins, but also because a number of serious scandals have occurred on his watch." he said. "These include reports about sexual assault allegations involving WHO employees in his inner circle, as well as a recent audit which revealed that the WHO spent millions of donor dollars procuring faulty Chinese PPE during the height of the pandemic."  

He noted that there is scant evidence that "his affinity for China has lessened since the pandemic’s outset. This is unsurprising given Tedros' history of championing Beijing’s interests, first as Ethiopia’s health minister and later as foreign minister." China was not one of the countries who nominated Tedros.

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A diplomat with knowledge of the inner workings at the organization who asked to remain anonymous told Fox that the WHO is deeply troubled under Tedros. The diplomat observed that the WHO was "entirely focused on promoting his personal political agenda. He is not a scientist, and his rule is authoritarian and patriarchal. With repeated mishaps on scientific guidance … WHO has lost all credibility."

WHO is the middle of a serious sex abuse scandal following revelations from a report by independent experts that found 21 WHO employees stand accused of sexually abusing people during Ebola outbreaks in Congo in 2018 and 2010. The Associated Press quoted, The Code Blue Campaign, a group that campaigns to end sexual exploitation and abuse by UN peacekeepers and other staff members as, "the largest finding ever of sexual abuse in a single U.N. initiative in a single country or time period." 

A spokesman for the World Health Organization didn’t respond to emailed questions regarding criticism of Tedros. 

Fox News’ Adam Shaw and the Associated Press contributed to this article.