First WHO chief scientist to successor: ‘Speak truth to power’

When Dr. Soumya Swaminathan leaves the World Health Organization this week, it will be very different from when she joined in 2017.

There’s now a science division at WHO that she built from scratch in 2019 when she became the global health agency’s first chief scientist, and a science council advising the director-general on high-priority scientific issues. WHO’s scientific work has also become more prominent over the past three years during the COVID-19 pandemic, when it provided living guidelines on the latest treatments and launched global trials for existing drugs’ potential to treat the disease.

But there are things she hoped to have accomplished sooner during her time at WHO such as setting up a global research and development network for tuberculosis vaccine research and expanding WHO’s genomic platform data sharing for other diseases. A process is also underway to standardize the terminology around airborne diseases — which became a contentious issue for COVID-19.

“I think it's all going to happen. And it could have happened sooner, but … these things take time,” she said.

When she goes back to India, Swaminathan’s focus will be more local and will look at the many factors affecting health — from food systems to climate change. She also hopes to engage children to cultivate their interest in science and help them differentiate fact from fiction.

“I hope that I can work with school children to improve their understanding of science, to create more curiosity, to ask the right questions, to not believe everything that they see on social media,” she said, adding that her new role will be more local compared to her role at WHO, but “Hopefully, that work could then have some impact in the future, both on national and global policy.”

In a broad interview, Swaminathan shared with Devex the challenges of serving as WHO’s first chief scientist, the worst science misinformation she had to deal with, and what she thinks could address health inequities that became prominent during the COVID-19 pandemic. She also had advice for her successor.

This conversation has been edited for length and clarity.

Equity and access really came up over the last three years during the COVID-19 pandemic. How frustrating is it to see it playing out before you, with low- and middle-income countries not really getting vaccines and other health products? And in what way do you think the current processes that are in place to develop a new pandemic accord would help fix this?

I was genuinely shocked and sort of disappointed at the way that things played out. But I wasn't entirely surprised. I think many of us were not because we've experienced this in the past. I come from a background of working on TB and HIV. And in both of those fields, working in India, having a lot of collaborators in Africa, I know the struggle that we had to access anti-HIV drugs, but also to advance the science in TB, for example. It's so slow-moving.

So to me, it's very concerning that the world is still not serious about the fact that there are huge inequities. I think the pandemic exacerbated that inequity. It didn't create the inequities; they just became very obvious.

The pandemic accord that's being negotiated now, I think, is a good opportunity to address this issue. But, again, it's during pandemics that accord would apply. I would like to see a broader and wider debate on this beyond pandemics because there are other huge public health problems today, which need to be addressed. And I think the way I see it could happen is a new model of R&D innovation that is led by low- and middle-income countries, where there's from the beginning the philosophies around open sharing of data, knowledge collaborations, and building things together with a view to make affordable products, which can then be widely accessible.

I think countries do have to invest more. I think perhaps the paradigm of donor-driven research and innovation has to be now supplemented by countries actually putting more money into research and development and innovation. I think that is the only way to drive this type of movement that will result in an equitable access where you're not depending on just a few companies and high-income countries to do all the innovation.

Science misinformation really took off during COVID-19. What's the worst misinformation you've had to deal with?

I think it started with the drugs. We had hydroxychloroquine, and then we had ivermectin in particular. … There was a very big group or lobby that was promoting these drugs, and particularly in high-income countries. And this message was of course going around the world. But the fact is that it was not evidence-based, and … trial after trial kept showing that it was not effective. But that was a time when I was being personally attacked also on social media for having said that some drugs are not effective, that there's no evidence, and that we should rather be focusing on things that we know work.

That I think was the first big controversial thing. And also we had seen at that time that the U.S. [Food and Drug Administration] was actually giving emergency use listening to some of these drugs without a lot of evidence. And so we were often asked in the pressers, “So you agree or disagree with the FDA?” So again, we had to stick with the evidence that we had, and we had groups working on it constantly.

Then came the vaccine misinformation and that continues to be a challenge.

What they do is very clever, because they will take something that is a fact, but then distort that fact. So for example, myocarditis with [messenger] RNA vaccines. Yes, it occurs. It's a rare side effect that occurs in young men. It's maybe four or five per million or something like that, and most of them recover. But they will take that, and basically turn the story into something that makes it so dangerous. And we kept trying to communicate that if you look at benefits versus risks, there's absolutely no question that all of these vaccines that we have approved had a huge positive benefit-risk ratio. And there are rare side effects with everything, but they're extremely rare.

It was difficult. It continues to be so. And, unfortunately, there are even medical doctors and groups of doctors that promote these. [And] the credibility, obviously, coming from doctors is higher, and that's very difficult.

There was this whole debate early on about whether COVID is airborne. How hard is it to communicate very clearly to the public when WHO and other public health experts were saying different things?

Especially with social media today, it's very hard, because there are a lot of voices, and scientists were debating and criticizing each other publicly. So, when scientists start doing that, the public could get confused, right?

So what we tried to do is really bring people together. We've always done that. And in fact, now we have a process ongoing, where we have a very broad group of experts who are actually discussing the terminology that we should be using for airborne pathogens, not just viruses. Now that our understanding of airborne transmission has improved over the last two years … we want to create some standard terminology that can be used by all groups around the world so that we don't fight about things like, “Is it aerosol?”

The word “airborne” in the past has been used only for aerosolized particles that can spread at long distance. And I think we want to change that paradigm and say airborne is anything that is spread through the air — large or small particles, short or long distance. Different diseases may have preferentially different ways of spreading, but they're all spreading through the air, like waterborne or bloodborne diseases. So that's now the process that we're actually in … trying to revise the terminology and put it out to the public. That will be useful for the future, and it will also be useful, I think, for the other disease areas to update the way in which they describe transmission.

There has been a lot of public debate. And I think it's taken away perhaps from the important issues of mitigation. WHO has always advocated for do-it-all, like hand-washing, wearing masks, physical distancing, ventilation, so all of them, plus vaccines [when they] came along. So we've always said [to] use all the tools and … use your risk assessment to decide which ones are most appropriate for you.

Is there anything that you wanted to do and accomplish, but weren't able to?

I think I'm satisfied that I started many of these processes, which hopefully will get stronger and be built on by the next chief scientist. So I don't think there's one thing that I wish I could have done.

There are many things that I wish we'd move faster on. … The way we do research, for example, I would have loved to set up a global R&D network for TB vaccine research, which would work with the same urgency that we've shown for COVID vaccines. I wish we could have expanded the genomics platform data-sharing mechanisms for other diseases. I think it's all going to happen. And it could have happened sooner, but … these things take time.

What piece of advice do you have for the next person taking on your work?

I think for the next chief scientist, I would say that we need to continue to be outspoken and not be afraid of either personal attacks or pressures that come from different places … [and] stick with the science. I'm not saying that you can't change … science is always evolving. And so you have to be willing to say, well, this is what I know today. But then, six months from now, this could change, and I'm willing to then change that. And be humble.

And I think … listening to voices from the countries, voices from outside, listening to both criticism as well as praise and incorporating that into the work that we do. And finally not being afraid to speak truth to power. I think sometimes it is quite challenging and difficult for anyone who has to do that. But I think that is the role of the chief scientist. … If the chief scientist sees that things are going in a particular direction that's not quite aligned with what the data is telling us, then I think it's their duty to point it out.