EP. 63: LEADING THROUGH CRISIS AT THE WHO

May 23

WITH SOUMYA SWAMINATHAN, MBBS, MD

The former Chief Scientist of the World Health Organization traces her early career as a pediatrician treating children with infectious diseases and shares the ethical and communications challenges she faced during the COVID-19 pandemic.

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Episode Summary

When COVID-19 rapidly emerged, the World Health Organization (WHO) was thrust into an unprecedented challenge. The global pandemic response was in disarray; health care resources were limited and inequitably distributed; and misinformation burgeoned. At the center of this maelstrom was Dr. Soumya Swaminathan, who served as the WHO’s first Chief Scientist, from 2019 until 2022. Dr. Swaminathan not only spearheaded efforts to disseminate the latest scientific findings about the coronavirus and vaccine development, but also became one of the major public faces of the WHO. In this episode, we discuss Dr. Swaminathan's formative years becoming a pediatrician in India, specializing in treating children with tuberculosis and HIV, as well as the challenges she faced as a leader at the WHO in a time of eroding public trust.

Dr. Soumya Swaminathan is Chief Scientist at the World Health Organization (WHO). She previous served as WHO's Deputy Director-General for Programs. A pediatrician from India and a globally recognized researcher on tuberculosis and HIV, she brings with her 30 years of experience in clinical care and research and has worked throughout her career to translate research into impactful programs. Dr Swaminathan was Secretary to the Government of India for Health Research and Director General of the Indian Council of Medical Research from 2015 to 2017. In that position, she focused on bringing science and evidence into health policy making, building research capacity in Indian medical schools and forging south-south partnerships in health sciences. From 2009 to 2011, she also served as Coordinator of the UNICEF/UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases in Geneva.
She received her academic training in India, the UK, and the US, and has published more than 350 peer-reviewed publications and book chapters. She is an elected Foreign Fellow of the US National Academy of Medicine and a Fellow of all three science academies in India. She has previously been on several WHO and global advisory bodies and committees, including the WHO Expert Panel to Review Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property, the Strategic and Technical Advisory Group of the Global TB Department at WHO, and most recently was Co-Chair of the Lancet Commission on TB.
In this episode, you will hear about:
• Dr. Swaminathan’s experiences training to become a doctor in India - 2:05
• How Dr. Swaminathan discovered the balance between her interests in clinical medicine and research - 6:00
• Dr. Swaminathan’s reflections on the challenges of caring for children with tuberculosis and HIV - 9:38
• A discussion of global research funding disparity - 14:08
• How Dr. Swaminathan joined the WHO and eventually came to fill such a critical leadership role there - 19:04
• Dr. Swaminathan’s recollections of the arrival of COVID-19 from her perspective as the WHO’s first Chief Scientist - 21:28
• Lessons learned in health communication from the pandemic - 27:46
• The experience of being a lightning rod for online harassment and misinformation - 35:07
• Dr. Swaminathan’s advice to new clinicians who are considering pursuing a career in global health - 39:25
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to the Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and health care executives, those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:03] When COVID 19 rapidly emerged, the World Health Organization, or the WHO, was suddenly thrust into an unprecedented challenge. The global pandemic response was in disarray. Health care resources were limited and inequitably distributed and misinformation burgeoned. At the center of this maelstrom was Dr. Soumya Swaminathan, who served as the show's first chief scientist from 2019 until 2022. Dr. Swaminathan not only spearheaded efforts to disseminate the latest scientific findings about the coronavirus and vaccine development, but also became one of the major public faces of the WHO. In this episode, we discuss Dr. Swaminathan's formative years becoming a pediatrician in India, specializing in treating children with tuberculosis and HIV, as well as the challenges she faced as a leader at the WHO in a time of eroding public trust. Dr. Swaminathan, thank you for taking the time to join us and welcome to the show.
Soumya Swaminathan: [00:02:05] Thank you so much. Pleasure to be with you.
Henry Bair: [00:02:09] To kick us off, can you tell us before you became a leader in global health, before your involvement in the WHO, what first drew you to a medical career?
Soumya Swaminathan: [00:02:20] So when I was growing up, I actually never wanted to be a physician or a doctor. I wanted to be a veterinarian because I was very interested in animals and was fascinated by animals. I also did grow up in a research institute where I had the opportunity to explore different labs and departments, and I always had in our house we had a lot of students coming to see my father. These were master's students, PhD students. So it was quite commonplace as I was growing up as a child to be hearing a lot of science being discussed and things like PhD theses. And so I think my interest in science was there from early on. It was only when I went when I finished school and went into my first year of what we called pre-medical that I found a lot of my peers were going to try to get into medical school. And it occurred to me then that what I was interested in doing that is science or genetics or research could also be well served after a medical degree. And so it was quite serendipitous that I decided to take the medical entrance exams, which, as you know, are highly competitive in India. Knowing that I had less than a 50/50 chance of getting into medical school. And I thought that would determine which path my career took. As it turned out, I did get in to the Armed Forces Medical College in Pune and decided to go ahead and join the medical school and started enjoying the course very much. And through the first 4 or 5 years of medical training, I found myself being drawn to the pediatric ward because again, I think of my love for animals and love for children.
Soumya Swaminathan: [00:04:22] I was instinctively drawn towards children and by the time I had passed out of medical school, I knew that I wanted to do a postgraduate degree in pediatrics. And so that's what I then aimed for. Of course, one has to again go through the whole round of entrance exams to get into a postgraduate program. But I was lucky to again get into one of the best schools in India, the All India Institute of Medical Sciences in New Delhi, which is where I ended up finishing off my MD in pediatrics. And as I was doing that, I got interested in respiratory diseases of children. Of course, one of the commonest problems that children come into hospital with. And so I then applied and got into a fellowship program at the University of Southern California in Los Angeles to do a program in pediatric pulmonology and and neonatology. So that was where I did my fellowship and where I also learned really the basics of research, research methods and how to how to go through the whole process end to end from thinking about a research idea, how to conceptualize it, how to undertake that research, how to problem solve and troubleshoot, and then ultimately how to analyze the data as well as publish it and present it at conferences. So I would say in the two years I spent in Los Angeles was really the shaping of whatever innate research interests I had into something that was much more concrete.
Henry Bair: [00:05:59] I know that when I speak to attending physicians, I know who were trained in India, I get the sense that, you know, as you alluded to, medical school admissions in India is insanely competitive, probably the most competitive of of any country in the world. So I always have a lot of respect and admiration for for Indian trained physicians. I'm curious, since you spent so much time while you were in California learning how to be a scientist, was that something that you came in knowing that you wanted to do in the sense that, you know, how did you conceptualize balancing clinical care, providing care for children versus time conducting research?
Soumya Swaminathan: [00:06:44] So as I mentioned, I was always interested in research. I. Don't think I ever imagined myself doing only pure clinical medicine at any time. I was always interested in asking questions Why and how can we do better? And why is something happening? And so when I decided to go to the US for a fellowship. One of my goals was to improve my research skills, which I thought were not very good at that point of time. So even though I had a great interest in research, I didn't think that I was well equipped with the knowledge and the tools. And this is why I enjoyed my time in Los Angeles so much, because my teachers and mentors there were excellent researchers, apart from being excellent clinicians. And so not only did I learn a lot going on ward rounds with them, and then of course, I was also managing patients myself, but also really learned to think about clinical problems that needed solving through more research. An example is the control of breathing, which at that point in the late 80s, we understood very little about, even though we saw a number of children with breathing disorders that were related to central control of breathing. And so a colleague and I designed equipments on our own and built them from scratch so we could actually study the hypoxic and hypercapnic responses to ventilation and published a series of papers which I think were quite seminal at that time, trying to understand how breathing is controlled and going further actually to look at the genetic influences.
Soumya Swaminathan: [00:08:31] Looking at twins to see how much of the control of breathing is genetic versus environmental. So it was delving into areas like that. Maybe this was like pure physiology for some, but trying to answer things which had not been well understood and doing it from starting from a problem, a child actually has a problem and and then you're trying to solve that. So this is why when I came back to India. After my fellowship, I really wanted to focus on children's respiratory diseases, including tuberculosis. It's very different from adult diseases, and very often people don't appreciate the difference between illnesses and children. Illnesses and adult children are often treated as little adults, and that's a mistake that's made repeatedly. So this is why I was fascinated. Of course, it's much more challenging to do the research in children because you have to get the cooperation, you have to get their trust. You have to get them, get them interested and wanting to cooperate with what you're doing. But, you know, that's all part of the fun.
Tyler Johnson: [00:09:38] You know, Dr. Swaminathan. So I'm a medical oncologist and have colleagues, of course, who are pediatric oncologists. And oftentimes people will say to me when they find out that I'm a cancer doctor, they'll say, oh my gosh, that must be such a hard thing to take care of people with cancer. And, you know, I have various things that I can say in response to that. But I have to say that to whatever degree that is true, it seems like it would be true 100 or 1000 fold to take care of children with cancer, which is just to say that I feel like on the one hand, there's this I think many doctors feel a, you know, something of an intuitive draw towards caring for children. We're sort of primed. The way that we're wired is to care for children anyway. And so I think in some ways it could seem natural for us to want to also include them in our medical care. But by the same token, I have to imagine that caring for children with respiratory diseases also has to bring with it its own unique burden, and that sometimes as beautiful as it can be to care for children and see them get better, it must be equally as difficult when they don't do well and when they have problems, especially because, as you were sort of alluding to a moment ago, you know, there's an entire other dynamic, which is that oftentimes children are not capable of getting the treatment that they may need unless the adults who are in their lives are responsible and reliable enough and their social situation is such that they can, you know, get there reliably and whatever. You know, for instance, if you were to think about TB treatment, that has to be given over a long period of time or what have you. Can you talk a little bit about the burden of caring for children that comes along with with the privilege that I imagine it also is?
Soumya Swaminathan: [00:11:24] Yes. I mean, you're absolutely right. I mean, some of the memories that I can never erase from my brain are those of children who've struggled and children whom we haven't been able to help as much as we would have liked to. And I'm thinking of children with leukemia that took care of during my training days when the management of leukemia was much more primitive and the outcomes were not so good as they are today. And I saw many. Young children die after we had become very close to each other. Because after all, you take care of these children for prolonged period of time. Similarly, I've seen with tuberculosis the terrible impact of a disease like TB meningitis on a young child, you know, really causing that child to have a lot of cognitive impairment. And the struggle that parents then have to constantly deal with, particularly if they come from low income families and they don't have a lot of resources. So I think that sort of experience is very painful, of course, but motivates me to. Keep throwing light on areas which people may not be that well aware of, including the sometimes the social and economic environment that actually is responsible for the inequities and access to care. And that's something that I've been very sensitive to because I worked in diseases like tuberculosis and HIV and in other infectious diseases of poverty. And I've seen that the determinants of health and the determinants of disease are often not something that medical professionals are taught or are sensitive to or know how to deal with. So through my career, I've now I'm convinced that a lot of our. Problems in medicine actually come from the social, economic, environmental determinants of health, and we just need to address those much more than we have done so far. So I think, yes, it's a mixed feeling always. There's a lot of joy working with children and seeing them get better and improve and the kind of love that they give you. But even the children who are suffering from disease, they give you so much love unconditionally that it kind of sustains you and wants you to keep working.
Tyler Johnson: [00:14:08] Can you talk a little bit You sort of came right up to the edge of of mentioning this. It felt like in that answer. But I think it's an important thing to draw out. Again, I you know, it's hard not to compare to my own experience, but as a medical oncologist for adults in the United States, I see that billions of dollars are sometimes spent to develop medications that then on average by people for five, six extra weeks of at the end of their lives as they are struggling with metastatic cancer. And I don't mean to question the value of those kinds of medicines. Sometimes I've seen them, you know, people go much beyond the average and do really well with them. But at the same time, it is really striking to think about that. On the one hand, we have that to care for adults in the United States, while at the same time there are other diseases like tuberculosis or HIV or even things like cholera or whatever, which in countries that are not as well resourced in the United States, you have even children who are often suffering and sometimes dying from these diseases, and in which there have not been, in some cases, new relevant medications in many years or even decades, and which in some ways is not surprising because the research and development budget for those diseases that are not as prominent in wealthy countries like the United States is just not there. Can you talk a little bit from someone who has one of the more prominent global health perches in the world? Can you talk a little bit about sort of how you see that research funding disparity and its impacts on the global population?
Soumya Swaminathan: [00:15:52] Well, I think you've put your finger on what's wrong today with the incentives that drive R&D for new products. And we saw very well during the pandemic that a lot of the time the innovations were coming out of the private sector, of course, but that the basic research underlying those innovations were all funded through taxpayer money, through public funds, through the NIH, for example, billions of dollars the NIH spends on basic research. But then the intellectual property is used by companies and sold at whatever price they feel is the right price. Now, this type of model, which is profit driven. Will only serve very high income countries and within those countries, only people who can afford. We know, for example, that insulin is unaffordable in the United States. And of course, now President Biden is doing something to fix that. But it just tells you that a drug that was developed over 100 years ago without a patent by Banting and best today is because of the control by a few companies unaffordable to the majority of people who need it. So I think we have to change the way that research and development is done, particularly when we're talking about life saving products, drugs, vaccines. These are global public goods. People's lives should not be measured against profits.
Soumya Swaminathan: [00:17:31] And so there is a new movement now, and I feel optimistic that low and middle income countries who suffered during the pandemic today have woken up to the fact that they cannot depend on charity, that they cannot depend on something trickling down, that they need to really get much more proactive. And so a good example is the mRNA technology transfer program that I set up when I was at the W.H.O., which basically tries to democratize knowledge, puts the technology, new technology in the hands of scientists around the world, and then leaves it up to them really to take it forward in whatever way they think is most relevant for their own populations. And so I think there is now growing understanding. There is, of course, the negotiations going on at the World Health Assembly around the pandemic treaty and what equity should look like in terms of the sharing of knowledge, sharing of data, sharing of technology. I don't expect suddenly overnight that there will be big changes happening globally in the way that IP is handled, for example. But I do think that governments, people, scientists and companies in the global South will now be taking much more, I think, proactive approach to solving our own problems with affordable technologies.
Henry Bair: [00:19:04] Thank you so much for laying all of that out for us. This leads me to the next thing I wanted to talk about, which is your involvement with the WHO. Can you tell us what drew you to the work of public health and then specifically to the WHO? How did you first get involved?
Soumya Swaminathan: [00:19:22] So actually, it's funny, but I had no intentions of of working at the WHO at any stage of my career except for two years that I had done at TDR, which is a special program for research and training in tropical diseases because I wanted to work diseases beyond tuberculosis. But it was Dr. Tedros who, after he took over as director general in 2017, actually invited me to join his senior leadership team. And that's how I got there, first as his deputy director general and then as chief scientist, which was a new position that had been created 2019. So of course I'm very grateful for this opportunity that I had. I think I learned a great amount and hopefully did contribute as well, particularly in setting up the science division, which was a very exciting thing to do. Of course, we had to do it in the middle of a pandemic, which was challenging, but it also gave the opportunity to really show why and how the WHO is so key, is so central to global health and why the coordinating role, the convening role of WHO was so important in the pandemic, both in terms of furthering the understanding of the virus and putting out recommendations, but also in terms of bringing scientists together from around the world who were working on different aspects of the virus or the countermeasures. We helped to shape and drive the research agenda and also specifically, you know, vaccine and drug development in a way in which, You know, there could be equitable access. So I was proud to have been associated with some of those initiatives. I think we learned a lot of lessons during the pandemic. There were some obviously good successes, but a lot of things which could have been done better. And those are lessons I hope that we will learn and and not repeat those mistakes.
Tyler Johnson: [00:21:28] You know, we we've had a chance on the podcast to talk to. Various people who were involved in different aspects of responding to the onset of the pandemic. So, for example, we've spoken to a person who is an emergency room doctor, during that time. We spoke to the person who was the commissioner of the New York City public health system during much of the pandemic and have had a chance to sort of reflect with them on their experiences. At the same time, you, as I understand, you took the office that you just mentioned as the chief scientific officer of the W.H.O. in 2019. So just before the pandemic started. And I remember for myself personally in February of 2020, when the reports started to come out of Italy of hospitals filling up with patients who were sick with the virus. And then it started to become clear that if it was not already in the United States, it would be soon. I just remember, even as, you know, I mean, as I say, I was an oncologist. I was not going to have any role in the, you know, driving the even statewide, let alone nation or world wide effort to battle the pandemic.
Tyler Johnson: [00:22:36] But I still remember feeling this sense of dread and weight settling onto my shoulders over the course of that month, feeling like we were sort of, you know, getting ready for this thing that nobody really knew what it was going to look like. But it was becoming clear that it was really going to be a world historic and very difficult thing. But as someone who, in effect, was one of the people who was charged with directing that global effort more than what the global effort looked like per se. Can you just talk to us a little bit about what was the personal experience of being in that position at that time like for you? Like, how did it feel to be one of the people who was trying to figure out how to do this thing that really had not been done in at least a hundred years and in a world that was, you know, completely different than what it was during the flu epidemic of 1918.
Soumya Swaminathan: [00:23:30] So it was an unprecedented time, obviously. And now looking back, it's very hard really to, you know, picture what those first few days were like. I do remember that it was full of anxiety, a lot of questions, not really knowing what was going on, wanting to find out more. In the early days, of course, there wasn't much information coming out of China that that changed after mid-January. And, you know, we started getting more and more information coming out. But also then what we saw was the major problem is that the rest of the world was not taking this seriously or at least many high income countries, particularly in North America and Europe, were not taking this seriously. They thought it was something happening in some other part of the world that would that would go away. And despite warnings by people who knew about these things, and certainly the W.H.O. had started warning right from the end of January or so, even before there were any deaths outside China, that this could be very serious. You know, the highest level of alarm, the public health emergency of international concern that had been raised. And we found it very frustrating to meet with this type of refusal to accept. Of course, things also got very political. That was making life much more complicated because rather than focusing on the science and what needed to get done, a lot of time was spent, you know, being distracted by these kind of political accusations and counter-accusations and having to deal with that.
Soumya Swaminathan: [00:25:13] But as far as I was concerned, luckily I was a bit protected from a lot of the politics and I focused on the research and innovation and decided that we would convene scientists from around the world, try and focus on what the major gaps were, what needed to get done, and, you know, give the kind of advice and normative guidance that developers were looking for in terms of what should be the benchmarks, what should be the target product profiles, what the regulators should be doing, how do we harmonize things? How are we going to make scarce products accessible? How do we scale up diagnostics? At that time, Africa had only two labs that could do PCR, so there was an urgent need to scale diagnostics. So of course there were many, many people working on all of these things. But I found myself at the center of this kind of activity that was all quite positive in the sense that it was trying to solve the problem. And so I'm grateful that I didn't have to deal with the politics, that I could focus on the science and the data and really informing people.
Soumya Swaminathan: [00:26:26] I, of course, started taking a much bigger role in communications a few months into the into the pandemic. But again, that was something that evolved as we started learning more and more and people wanted to know more and more. We realized that these press conferences that he was having were keenly watched and were very important ways of communicating the latest science to people around the world. So I think all of that gave me the energy to keep going without becoming completely despondent. Of course, throughout one, you know, worried about family, we worried about friends. We worried about what was going to happen, particularly looking at the impact on low income countries. That's what really, really upset me a lot when I saw the impact that it was having on lives and livelihoods of people not directly impacted by COVID infection so much, but really losing everything they had because of the impacts of the massive lockdowns, the impact on children, for example, of school closures. And as time went on, you could see the difference in response between high income and low income countries getting wider and wider. That was very painful to watch.
Henry Bair: [00:27:46] Earlier you mentioned that as the pandemic went along, your role eventually expanded to include some degree of health communication with the public. And as we've seen, health communication became such a massive shaping force on the public's perception of the pandemic and how the pandemic actually unfolded. Can you share with us some of the lessons you've learned over the course of the pandemic about effective health communication?
Soumya Swaminathan: [00:28:18] Yes. So I'd had a bit of experience with health communication in India when I was head of the Indian Council of Medical Research, and I realized that very few scientists actually spoke to the media or to the lay public about the work that we did in our labs or in our clinics. In a way in which the research could be made accessible and understandable to people. So I decided that as head of the Medical Research Council, that it was my responsibility to convey some of that great work. The research that was being done, after all, are all being funded again by taxpayer money. People deserve to know what research agencies are doing.
Soumya Swaminathan: [00:29:07] So I also realized, that sometimes it's a double edged sword and you can be quoted out of context. You can have a headline appearing that's next day. That's misleading. It's not exactly what you said. And, you know, sometimes things could could boomerang on you. But on the whole, I believe that it was positive. And so during the pandemic, as I began to take more of a role in communications, both live media as well as social media, I realized that it is best to be as honest and transparent and open as possible, to not to obfuscate, not to avoid or evade questions, but give as honest an answer as possible. To say if you don't know or if you're still learning to say you don't know. If you need to apologize or say you made a mistake previously and that you wanted to correct yourself to actually do that. To try to be mindful of the kind of language that one uses and not use too much of technical jargon.
Soumya Swaminathan: [00:30:18] And also to put things in a way in which it would make sense, you Know, to ordinary people realize that, you know, every time we spoke that millions of lay people, ordinary people, were listening to what we were saying. And so it was a very powerful position to be in. Because you could communicate so much, but you could also do a lot of harm if you weren't careful. And so I decided that while panicking people is not necessarily the best approach, you need to be quite balanced in the messaging that you're giving in terms of. What people can do. Actually, I think giving practical and pragmatic advice is always appreciated rather than a theoretical lecture and and also why certain things were being advised. Explain the rationale behind them. And as vaccines became available, actually, if you remember, there was a lot of anxiety about the speed at which vaccines had been developed and whether they were safe enough. And so we had to repeatedly explain how these things are done, how clinical trials are done, what the safety parameters are, what the efficacy parameters are, how who actually approves certain products based on the data that we see, how we are constantly reviewing it, how there are rare side effects, but the benefits outweigh the risks. And we had to get into a lot of details and this had to be kept up for many, many, many months because people continued to have questions, rightly so which needed to be answered. And I think the final lesson is perhaps for me is, you know, don't talk down to people. Talk with people, explain, have a dialog and be willing, you know, to repeatedly address the same issues, perhaps in different ways if it's not going through.
Soumya Swaminathan: [00:32:21] What was very concerning was the misinformation that was floating around and that kept getting worse and worse. And also the personal attacks that my colleagues and I had to face, particularly on social media. And that wasn't something that I was prepared for or was expecting, and it was upsetting. But then again, I decided that the advantages of being on social media, of being out there, outweighed some of these disadvantages of being attacked and quite viciously at times, I must say. But overall, I think that it was the right thing for me to have done.
Henry Bair: [00:33:00] I certainly find it a very courageous thing to do, to have all these attacks on you publicly available for all to see. And then still, despite all of that, continue with your work. To your point about the lessons learned on effective communication. I think one thing that I so strongly agree with is knowing when to say you don't know. Which I understand can be very challenging for scientists, experts and doctors to admit.
Tyler Johnson: [00:33:36] Yeah, I was sort of going to make a similar point. I mean, I think as I look back, I spent a lot of time during the pandemic. You know, we were all sort of quarantined in our houses, especially here in California. And so I spent much more time online in digital communities, Facebook and whatever, than I previously had. And one of the things that I learned from my time doing that is it often felt like it wasn't so much that the vaccines or masking or whatever public health measure were on trial so much as the very idea of expertise itself was on trial or the medical community itself was on trial. And in retrospect, it often felt like the thing that was actually the most damaging to the public confidence in the medical community were the times when we pretended to know things that we didn't or we refused to acknowledge where we had changed our opinion from previously. And to your point, I think it's so much more helpful to just say either we got this wrong and now we're trying to put it right, or we thought this before and now we have better evidence and this is why we think this other different thing now. And I think that when we fail to do those two things, when we fail to, you know, marshal full candor, it really does damage the public's confidence in in the public health communication apparatus in a way that can quite literally be deadly in the age of the Internet and misinformation.
Henry Bair: [00:35:07] You know, you mentioned that you had to deal with these personal attacks. And I realized if you're willing to share. Can you tell us, like, what did it feel like to to be the recipient of these personal attacks? And how did you, you know, muster up the will to continue? How did you mentally overcome that?
Soumya Swaminathan: [00:35:35] I don't know if I can fully explain how and why I was able to overcome that. But I think when I looked at the balance of the feedback that I got the negative sometimes can look very large because, you know, it gets amplified in your feed in your social media feed, for example. So I think it's important to take a step back and recognize that it's not just social media that's important. And I would obviously get feedback from a large number of colleagues and friends and acquaintances. I did a lot of television media in India. As well in different languages. Apart from the global media. I would hear feedback coming back to me about, you know, the clarity of of my communications or, you know, the important messages that had gone through and the kind of impact that it might be having on the ground. So on the one hand, there was all of that. On the other hand, of course, then there's this very limited social media sort of amplifying cycle. And there were a few very, very unpleasant attacks which again, to me were very surprising because they were about things where I thought the evidence and data should speak for itself. It's about the efficacy of drugs. And you remember there was a lot of noise about hydroxychloroquine and then about Ivermectin.
Soumya Swaminathan: [00:37:09] And both actually had large clinical trials done, which showed that neither of these drugs was effective either in prevention or in treatment of COVID. And yet there's a group of people that continue to advocate for the use of these drugs. This included physicians, surprisingly, from different countries, and they got very agitated when myself and my colleagues at the W.H.O. would clearly say that there was no evidence for the use of these drugs. And so this was one of those very strange cases where it was actually around the use of a medicine that I was being attacked as having some sort of vested interests in not promoting these these medications, when all I was saying is we should not be spending our resources on. Unproven treatments. Let's focus on what works. Particularly when we're talking about low income countries and governments spending their resources. So it also I think was very helpful that we were a team. We were a group. I was not in this alone. Of course, it would have made it so much more difficult if I was alone and I could see that allo f us that were communicating, whether it was WHO or whether it was other prominent public health experts and scientists in different countries were facing similar challenges. And very often again, very, very perverse attacks on themselves and their characters. So that also gave me some strength and courage to carry on. And finally, I think it was like we cannot allow this type of bullying to let us to be quiet because in public health it is our responsibility to speak. I think as a scientist, I've realized more and more that we don't do enough of it and that we cannot afford to be bullied and cowed down because there are going to be many pressures in life. And so I think this was a good test, actually, to see if one could withstand those pressures.
Tyler Johnson: [00:39:25] Well, Dr. Swaminathan, you've been so generous with your time. We wanted to ask, as a final question, we'd like to ask all of our guests. If you had the chance to talk to physicians in training, especially physicians in training who are interested in working global health, what are some of the things that you think are are most important for those physicians or nurses or physician assistants, nurse practitioners? Any health care workers who want to go into a global health career? What what advice would you have for them that you think would be most important?
Soumya Swaminathan: [00:39:59] It's a great time, actually, to to be in global health. There's a lot that needs to be done. There's a lot that needs to be fixed in terms of the lack of equity and the lack of access to resources, but also the lack of access to knowledge. And therefore, I think for a young person starting out today, firstly I would say be as good as possible in your own area of work. You know, you have to be technically very competent. So pick an area that you're passionate about that you love and study it well and get to know it as well as possible. That's the best way to contribute. Secondly, if you really want to be in global health and I think you have to spend a significant amount of time working in places and in communities which are very different from where you've been yourself. And you have to approach it with a sense of humility, with a sense of openness and a sense of wonder and wanting to learn. I've learned so much from communities Eeen though I grew up and worked all my life in India, I still learn a lot when I go and speak to communities and they completely change my perception, you know, of a solution that I thought was the right solution. But actually it's something very different when you look at it from a different perspective. So I think that is really important. Having mentors, friends, connections, networks around the world is extremely important. I think it's a diversity of views is what I enjoyed most at W.H.O. is really the diversity, you know, just the background that people come from and the way they see things.And when you speak with each other, then you really can come up with much better solutions than if you all came from the same exact background and way of thinking. So that's what's so exciting about global health. But I think one has to be a student all one's life. You can never say that you are the expert now and you're going to teach others what to do. And I think if you come from a place of privilege and position, then it becomes responsibility to help others. And particularly when you see bright people who don't have the same opportunities that you might have had in your life, then, you know, doing something to help those people get a step up, get that visibility, get that next opportunity, I think is is what actually gives you a lot of satisfaction as you go on in your own career.
Henry Bair: [00:42:29] Well, with that, we want to thank you again for taking the time to join us in conversation. And of course, thank you for your incredible work with the W.H.O. through a really, really challenging time. It's been a true privilege talking to you.
Soumya Swaminathan: [00:42:44] Thank you.
Henry Bair: [00:42:47] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at www.thedoctorsart.com. If you enjoyed the episode, please subscribe rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.
Tyler Johnson: [00:43:06] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:43:20] I'm Henry Bair.
Tyler Johnson: [00:43:21] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.