Talking pandemics and power with Australia's global health wunderkind

What does Australia’s global health ambassador do? For Lucas de Toca, appointed to the position last November, it is one of many hats he wears. He is also the head of the global health division at the Department of Foreign Affairs and Trade. But it’s the ambassador job that makes him, at just 36 years old, the face of Australia’s global health policy. Aside from administration and strategic policy, he says his job is to represent Australia’s interest in global health — from the board of Gavi, the Vaccine Alliance to the Global Fund to Fight AIDS, Tuberculosis and Malaria to the World Health Organization. That means advising on Australia’s bilateral health investments overseas as well as offering technical assistance to partner governments. “The main mandate for me is to make sure that the global health system, the global health architecture, works for the Pacific and Southeast Asia,” he told Devex last month. “There's something about pandemics that people want to move on from. How many stories or silent films do we see on the 1918 pandemic? None.” --— Lucas de Toca, Australia’s global health ambassador After our interview at the World Health Summit regional meeting in Melbourne, Saia Ma’u Piukala, WHO’s regional director for the Western Pacific, was one of the officials queuing up for de Toca’s next bilateral. Not bad for the Spanish-born doctor who could not speak English before coming to Australia in 2005. Fast-forward to 2024 and our conversation covered pandemic treaty negotiations, how to balance the demands of climate, poverty and health in official development assistance budgets, and how to get young people like himself into real positions of power. The text has been edited for length and clarity. One speaker at this conference said governments are reluctant to conduct a review of what happened during the COVID-19 pandemic and to learn the appropriate lessons for next time. Do you agree? On a very human side, I find it fascinating how people just want to move on from disease. If you look at history, we always talk about wars and changes of government and sovereigns and the Roman Republic. But we don't spend nearly as much time on plagues and disease events that actually have much more life-changing impact on societies. There's something about pandemics that people want to move on from. How many stories or silent films do we see on the 1918 pandemic? None. So I think there's a bit of wanting to move on from that that is very human. On the other hand, we have a formal official inquiry going on at the moment. There is a review of the COVID-19 federal response that the Department of the Prime Minister and Cabinet commissioned, that has taken thousands of submissions, and we’ll have their findings published later in the year. At Davos this year, Bill Gates called for an event equivalent to the COP climate summits but for global health. How do you see the relationship between climate finance, poverty eradication, and global health, in an era of dwindling aid budgets? It's very tricky. We have a number of replenishments coming up at the same time, and you're right, aid budgets are stretched from every direction. “The conditions for emergence of new zoonotic jumps and a new pandemic keep getting worse. The chances of a new pandemic increase every year.” --—- There's also a sense — and I'm speaking very broadly — from a lot of finance ministries around the world that health had its heyday with the pandemic and now it's time to move on to another thing. So we are being very realistic and very honest as donors with these global health initiatives. We absolutely recognize the importance of this. Gavi contributes to vaccinating half the kids in the world, and the Global Fund has done amazing strides in trying to maintain its focus and clear reporting on the three diseases that it treats, but then horizontal approaches through health system strengthening. So I think both organizations are doing a significant effort to make sure that taxpayer dollars that are put into them are well used. But we are also conscious that the growth that we've seen in the past is probably not realistic in this context. There's a few initiatives like the Lusaka Agenda that try to streamline secretariat, back office support, and make sure that the plans of all the large global health initiatives are complementary, there's no duplication. I think there's an onus on these initiatives to come back to donors and demonstrate that what they're doing has an impact, and it's measurable, and it's hitting the targets that we're seeking. From our perspective, we want to see these organizations succeed globally. But we are razor-sharp on making sure that they're delivering in our region. And your impression is that they are? There's always tweaks, but that is part of the reason why we engage. If we're not in the room, often Pacific voices are not heard. On the pandemic treaty, do you think the timing is important? Some people are saying, “what's the rush”? I think the timing is important. People around the world have already moved on from the pandemic, governments are ready to move on. We can't lose the momentum that the post-pandemic environment created. And also we can't imagine we've got 10 years to get this right, because pandemics only happen once in a generation. The conditions for emergence of new zoonotic jumps and a new pandemic keep getting worse. The chances of a new pandemic increase every year. So while there's still political will and modicum of attention in health, we need to get this right. There is a preponderance of youth ambassadors in global health and global development. But at 36, you have a “real” job. How do we avoid young energy being channeled into a sideshow, rather than actually participating at the main negotiating table? That's a tricky balance, I agree. But I must say I was very involved in med student politics and the International Federation of Medical Student Association. And I think one of the reasons why I ended up in public health and having a real job in leadership relatively early in my career was because of that training ground. We shouldn't use youth parliaments and youth organizations as an excuse to funnel young people into a side table where they provide advice. But those initiatives are important, both to get the perspective into older tables that may not be ready to cede some of their power, but also as a training ground for the leaders of the future. I've benefited enormously from initiatives like that.