[Ip-health] Scroll.in - Interview: WHO's new deputy director general Soumya Swaminathan spells out her priorities

Thiru Balasubramaniam thiru at keionline.org
Sun Oct 8 22:57:51 PDT 2017


Interview: WHO's new deputy director general Soumya Swaminathan spells out
her priorities

Swaminathan has been appointed deputy director general of the World Health
Organisation and will be the first Indian to hold such a high post.

Oct 04, 2017 · 07:30 am
Menaka Rao

Dr Soumya Swaminathan, the current head of the Indian Council for Medical
Research, will soon take over as as deputy director general of the World
Health Organisation, the second highest position at the international
public health body.

Swaminathan is a paediatrician and has nearly 30 years of clinical research
experience. Much of her research has been on paediatric and adult
tuberculosis exploring epidemiology and pathogenesis of the disease as well
as the the role of nutrition and HIV infections.

Swaminathan’s appointment to the WHO comes only months after Dr Tedros
Adhanom Ghebreyesus, a former health minister of Ethiopia, took over as
director general – move that public health watchers have cheeredas one that
will push the health interests of developing countries forward.

Shortly after the announcement of her appointment, Swaminathan spoke to
Scroll.in about a new direction for the WHO, providing universal health
coverage, improving access to medicines and dealing with pandemics. Here
are edited extracts of the interview.

Dr Tedros Adhanom Ghebreyesus, the director general of WHO, is from
Ethiopia. You have worked extensively in India. Before this, most of the
senior positions in the WHO were held by experts from developed countries.
How do you think your experience in a developing country can help you
prepare for this new role?

I think the main difference is that I have seen the health system at very
close quarters in India. Having worked on a disease like tuberculosis,
which is a disease of poverty, I have closely observed the health systems
and the social determinants of the disease, both of which are equally
important. We will go with a more pragmatic and practical approach.

Could you give me an example on how your approach could be different?

A lot of work at the WHO is normative, which involves setting standards and
guidelines for countries to follow. Our approach will be different from a
experts who only have theoretical knowledge about certain subjects. There
is no point in making guidelines which will not work. Knowing how health
systems work in developing countries will help make guidelines that could
be followed.

We are seeing new pandemic health threats in recent years - from Ebola to
Zika to a new malaria strain discovered recently in Cambodia. How might the
WHO prepare countries and international health networks to contain and
combat these?

In such situations, the WHO will need to convene countries. We need to
improve the provision of emergency care. How to introduce a new drug or
vaccine and how to get everyone together on it is key to this process. We
need to get everyone including industry to ethics committees together to
help tackle a disease. In case of Ebola, by the time the approvals for the
trials were sought, and the trials were completed for the vaccine, the
outbreak was on the wane. We need to be prepared to immediately act on such
outbreaks and have a research and development plan backed up. We will look
at forming global consortiums in developing treatment programmes for
diseases such as the Global Antibiotic Research and Development
Partnership. These are the programmes I would be interested in. I want the
WHO to bring in more research and evidence. So far, the WHO has been
providing support for research. I feel there will be an advantage if WHO
can conduct the research itself.

Dr Ghebreyesus has said that the focus of WHO will be on universal health
coverage. What will be the challenges to try realise this goal?

The challenge will be reach everyone with quality care that is both
preventive and curative with health systems strengthening including
infrastructure, human resources, and financing. The reason that poor
countries find universal health coverage difficult is that they either do
not have the finances or human resources. How to address that will be a
very challenging thing to do. But some countries have been able to do it.
In our own region, Thailand has done it. This vision is achievable but not
easy. Globally one has to come together on this issue. The poor do not have
access to so many medicines.

How do we improve access to medicines?

That is a tough one. This issue involves commercial interests as well as
intellectual property rights. It is not purely in the realm of health
ministries and the WHO. It needs a lot of negotiation and international
advocacy as well. There have been many successful programmes that have
helped improve access to medicines like, for instance, the Medicines Patent
Pool. There are lots of diseases for which we need to develop medicines or
improve access to medicines. This will be very challenging.

(The Medicines Patent Pool is a United Nations backed public health
organisation that works with drug manufacturers to improve access to HIV,
hepatitis C and tuberculosis treatments in low and middle income countries.)

Your research has by and large been in tuberculosis. How will the WHO work
towards controlling the spread of TB?

TB is a global priority and will continue to be a priority. India has a big
role to play in the elimination goals. We need to increase access to drugs
and improve private sector engagement more. In South East Asia
particularly, engaging private sector is a big challenge.

We now know non communicable diseases are not just a problem of the rich,
but a more widespread problem. What are your plans on tackling non
communicable diseases?

Non communicable diseases need a multi-pronged, multi-sectoral approach.
Air pollution is a major determinant of non communicable diseases. This
problem can be handled less by the health ministry. We need to involve
other ministries more, such as the environment ministry.

To handle the excess fat, sugar and salt in foods, we need to work on food
labelling and increase food taxes. This will need involving finance
ministries and other sectors. Preventive health care will be another major

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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