Q&A: WHO head of emergencies

Dr. Peter Salama speaks with Roman Abebe (far left) and mother, Bancheyalew Tegen at the Selam Center in Ethiopia. Photo by: Mulugeta / UNICEF Ethiopia / CC BY-NC-ND

Global health issues featured more prominently on the agenda of the recently-concluded G-20 summit than at any previous meeting of the rich country grouping. Country chair Germany prioritized discussions about preparedness for pandemics and antimicrobial resistance.

Universal health care also figured into discussions, thanks in part to the first-ever participation of a delegation from the World Health Organization, led by newly-elected director-general Dr. Tedros Adhanom Ghebreyesus. During his address to the G-20, Tedros called UHC “the strategic solution actually, to prevent epidemics and provide quality care to our people by strengthening health systems of countries, especially in the most fragile and vulnerable parts of our world.”

Also in WHO’s delegation was Dr. Peter Salama, who took over as the first head of WHO’s new Health Emergencies Program in 2016. The initiative was at the forefront of the reforms WHO unveiled in response to criticism of the agency’s slow response to the West Africa Ebola outbreak. The program is designed to coordinate with countries and international partners to both prepare for and respond to emergencies, while also weighing in on broader efforts to contain disease outbreaks and provide relief.

After the summit, Salama spoke to Devex about the significance of the WHO’s involvement in the summit, and how that could translate into future policies and actions. The interview has been edited for length and clarity.

What is the significance of health being featured so prominently on the G-20 agenda this year? 

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It’s not the first time health has been on the agenda of the G-20, of course, but it’s the first time that there’s been a whole session on health and WHO was officially invited to participate in it. I think that reflects the increasing support from G-20 leaders to broaden the agenda beyond economic issues to the issues around health, education and social development.

There were three major aspects of that focus. A focus on health systems and universal health coverage, a focus on health emergencies, and a focus on antimicrobial resistance. All of those got more time than I’m sure they’ve ever had. That reflects at least the political commitment of the leaders on those issues. And now it’s up to all of us to follow through and make sure those commitments are met.

What specific discussions stood out to you as most significant?

One particularly focused around the need to comprehensively implement the international health regulations. What we find globally is that everyone wants everybody else to report an outbreak as early as possible. When it comes to an epidemic in their own country, there’s often a lot of reluctance. And the reluctance is sometimes for a very rational reason, which is that other countries might levy unnecessary travel and trade bans on the countries that report. There was a really good discussion around mutual obligations in health to report early whenever there’s a serious outbreak, but also to ensure that the system catches those other countries that are levying unnecessary travel and trade barriers.

Another thing that came out strongly was the need to ensure we’re not just reactive, but proactive in terms of building countries’ capacities around the world to ensure that much earlier on in the cycle we’re investing in national core capacities — around surveillance, around emergency response, around laboratory networks — so that we’re much better prepared.

What was not discussed that should have gotten more attention?

There was a lot of reference and discussion in some of the other sessions around security issues. There was a whole session on counterterrorism and a lot of discussions on economic issues. I think people related very much the climate change aspects to both those issues. But I would have liked to see more linkages directly made between other health agendas, to both climate change and also the economic and security issues. On climate change, especially, it’s a major health issue, and that didn’t get enough airtime.

Though health got a lot of attention, not a lot of specific funding commitments emerged. What comes next?

“We’ve finally got health as a major issue on the G-20 agenda, so we need to keep it there. But we also need to keep it there for a purpose.”

It was really about people’s readiness and willingness, and around the political commitment at this point. The G-20’s not a pledging summit, but of course it’s important once you’ve got the political commitment, usually the financial commitments can follow.

What’s really important is we’ve finally got health as a major issue on the G-20 agenda, so we need to keep it there. But we also need to keep it there for a purpose. There’s no point in keeping it on the agenda if there’s no action. We have these commitments from the G-20. How do we translate that into an action plan that does see more financial commitments to these issues? Not just for WHO — certainly for WHO, which does need a different financing model to be more fit for purpose — but for all of the global health partners that are contributing to this agenda.

Several other initiatives were discussed that go beyond WHO. We focused on those issues, including funding for our contingency fund for emergencies, which has really been quite critical for improving our response in the last year or two. But also the World Bank discussed its pandemic financing facility for outbreaks and emergencies. There was also a discussion around reproductive health and other issues. All of those issues will need to be supported and financed.

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