Departing WHO chief scientist regrets errors in arguing whether SARS-CoV-2 spread through the air | Sciences

Last week, Indian pediatrician Soumya Swaminathan Advertise on Twitter She will leave her position as chief scientist at the World Health Organization at the end of this month. She plans to return to India to work in public health there.

Swaminathan, 63, joined the WHO in 2017 and in March 2019 was appointed as the agency’s first chief scientist, a position created by the director-general. Tedros Adhanom Ghebreyesus To ensure that “the World Health Organization anticipates and remains abreast of the latest scientific developments”. During the COVID-19 pandemic, Swaminathan has become one of the faces of the agency’s global response, fielding reporters’ questions at countless press conferences. Communicating about the science of COVID-19, she says, “wasn’t really considered a chief scientist’s job,” but she has embraced the role. Its biggest regret is not recognizing early in the pandemic that SARS-CoV-2 could be spread by aerosols.

The WHO has not yet identified a successor for Swaminathan, whose departure is part of a larger exodus from the agency’s senior leadership.

SciencesInsider caught up with Swaminathan to talk about her time at the WHO, her plans for the future, and the advice she’d give for her successor. Questions and answers have been edited for brevity and clarity.

Q: Why are you leaving?

a: The most important reason is that after 5 years of working on a global level, I feel the need to go back and work on a national level. As India and many other countries have made health a priority, I believe there is potentially a once in a century opportunity to change the way we approach health, with more focus on systems approach, prevention and health promotion, [and] Pay attention to the determinants of health. For now, I will probably be based in Chennai with a research institution. What else am I going to do, I don’t know at the moment.

Q: Did being in the World Health Organization show you the limits of working at the international level?

a: It’s something we’ve been grappling with. WHO has a critical role in shedding light on issues, in presenting data, on the basis of the best available evidence, free from conflicts of interest and politics. But all the work is done in the countries: the investment, the translation of policies, the actual implementation. So, much of the credit for the predecessors will go to the countries; At the same time, if they don’t, they also have to accept responsibility.

Q: Can you give an example?

a: The majority of countries around the world do not have a good system for measuring and reporting causes of death. This is a big drawback. You cannot do adequate policy planning if you do not know the burden of different diseases and how that evolves over time, and how interventions help.

Q: Prior to your arrival, the role of chief scientist did not exist at WHO. How did your understanding of this role develop? What will you tell your successors about?

a: It is a multifaceted role. During the pandemic, I became the official spokesperson for the World Health Organization, which wasn’t really considered one of the chief scientist’s jobs. When I launched in 2019, I had two or three big goals. The first is to really work on our rules and standards. We want to develop what we call the Living Approach to Guidelines, which means updating practically all of our recommendations in real time, as we have done with COVID-19 treatments. But also that they are produced in a format that is easy for countries to adopt, so that someone in a primary health care clinic doesn’t have to look through these thick books, but maybe they can look up an app for the latest WHO guidance on a snake bite or some other problem they have. their patient.

Sometimes, some Member States or interest groups get upset and want us to change the recommendation. So, the chief scientist must stand very strong at that point.

Q: Can you give an example?

a: A few years ago, we released guidelines that firmly said that antibiotics should not be used to promote growth or prevent disease in animals because they contribute to antimicrobial resistance. Two of the member states were very upset. They did not want this recommendation to appear because it affected their industry. We stuck to our guidelines, and didn’t change them.

Q: I suppose it would be useful to have the support of the Director General.

a: Tedros has always stuck to scientific opinion, but he’s also willing to change his mind if we give him different evidence. During COVID-19, there has been a great deal of interest in airborne transmission, a lot of research and a lot of people from other disciplines, like engineers, getting into the field. So I was asked to convene an internal and external group to see if it was time to change the definitions and the terms we use to describe it. I was hoping this would be over before I left, but it will probably take a few more months.

Q: Was that the biggest mistake you made as chief scientist, not calling SARS-CoV-2 into the air?

a: We should have done it earlier, based on the available evidence, which is something that cost the organization. You can argue with that [the criticism of WHO] Unfair, because when it comes to thinning, we’ve already talked about all methods, including ventilation and masking. But at the same time, we weren’t forcefully saying, “This is an airborne virus.” I regret we didn’t do this much, much earlier.

Q: Why didn’t you? what happened?

a: I think it’s a combination of things. I was very new to the role of Chief Scientist, and that was not decided upon; What does a chief scientist do during a pandemic? I tried to do what I thought was best. What happens in the WHO is the technical departments do the guidance, in the science department we just set the standards for how the guidelines should work. So it was not my turn and no one asked me to participate at that stage. … The current model is based on influenza, because most of our preparation for a pandemic is influenza. Likewise, SARS-CoV-1 was very different as a pathogen, so we couldn’t extrapolate that completely. But in the beginning, we had to base it on a few things. So, I guess what I would say to the next chief scientist is: If there is ever a situation where new evidence emerges, particularly from other disciplines, that challenges our understanding, get involved early!

Q: You said earlier that you started with two or three priorities. What is the rest?

a: The first is to be a bridge between the global scientific community and the health community. We’re looking at areas where technology is moving quickly, like gene editing, artificial intelligence, or 3D printing of organs. Another area is strengthening norms and standards around research and data sharing – again, making sure that more research is done in low- and middle-income countries, and that researchers there get the full credit they deserve.

Q: Where do you feel you have accomplished the most?

a: I think setting the science department on a trajectory, giving it a lot of visibility globally and establishing links with the major science communities. We signed a Memorandum of Understanding with the International Science Council last month that connects us with 130 science academies around the world. Last year, we set up the Science Council for the World Health Organization, chaired by Harold Varmus, the Nobel Prize winner.

The other thing I’m really proud of is the establishment of the WHO RNA Vaccine Technology Center, a facility based in Cape Town that aims to provide Africa with mRNA vaccines. Moderna and BioNTech-Pfizer refused to share any technical knowledge or help us in any way, but the South African scientists were still able to create a vaccine. Of course, this must now go through all stages of clinical testing. So I can’t say it was a complete success. But the early results are very encouraging. Finally, I am proud of my role in WHO communications as well.

Q: I sometimes use Twitter to communicate. How do you see the future of this platform?

a: I’m not sure what will happen. I just wait and watch. But I’m not very optimistic that it will continue to be a good platform. If so many public health workers start leaving Twitter, it makes no sense to stay there, but it’s too early to judge.

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