Outgoing WHO chief scientist regrets mistakes in debate over whether SARS-CoV-2 is airborne | Science

Last week Indian pediatrician Soumya Swaminathan announced on Twitter that she is leaving her post as chief scientist at the World Health Organization (WHO) at the end of this month. She plans to return to India to work in public health.

Swaminathan, 63, joined the WHO in 2017 and in March 2019 was appointed the agency’s first chief scientist, a position created by the director-general Tedros Adhanom Ghebreyesus to ensure that “WHO anticipates and stays on top of the latest scientific developments”. During the COVID-19 pandemic, Swaminathan became one of the faces of the agency’s global response, fielding questions from journalists at countless press conferences. Communicating the science of COVID-19 “wasn’t really considered one of the functions of a chief scientist,” she says — but she embraced the role. Her biggest regret is that she did not admit at the beginning of the pandemic that SARS-CoV-2 could be spread by aerosols.

The WHO has not yet named a successor to Swaminathan, whose departure is part of a larger exodus from the agency’s top leadership.

ScienceInsider caught up with Swaminathan to talk about her time at WHO, her plans for the future and the advice she would give to her successor. The questions and answers have been edited for brevity and clarity.

Q: Why are you leaving?

AND: The most important reason is that after 5 years of working at the global level, I feel compelled to come back and work at the national level. As India and many other countries have made health a priority, I think there is probably a once-in-a-century opportunity to really change the way we approach health, with more emphasis on a systems approach, prevention and health promotion, [and] attention to determinants of health. For now I will probably be based in Chennai with a research foundation. I don’t know what else I’m going to do at this point.

Q: Has working at WHO shown you the limitations of working internationally?

AND: It’s something we’ve struggled with. WHO plays a key role in raising awareness of issues, presenting data based on the best available evidence, free from conflicts of interest and politics. But all the work is done in the countries: investment, policy translation, actual implementation. Much of the credit for advances therefore goes to countries; at the same time, if they do not, they must also accept responsibility.

Q: Can you give an example?

AND: Most countries around the world do not have a good system for measuring and reporting causes of death. This is a huge disadvantage. You can’t do good policy planning if you don’t know what the burden of different diseases is and how it evolves over time and how interventions help.

Q: Before you arrived, the role of Chief Scientist did not exist at WHO. How did your understanding of the role evolve? What would you say about him to the successor?

AND: It’s a multifaceted role. During the pandemic, I became the spokesperson for the WHO, which was not really considered one of the functions of a chief scientist. When I set out in 2019, I had two or three big visions. The first was to really work on our norms and standards. We want to develop what we call a live approach to guidelines, which means updating all of our recommendations virtually in real time, as we did with the treatment of COVID-19. But also to produce them in a format that countries can easily adopt, so someone in a primary care clinic doesn’t have to go through these thick books, but can maybe look at an app for the latest WHO guidelines on snake bites or stings. some other problem their patient has.

Sometimes some member states or interest groups are angry and want us to change the recommendations. So the chief scientist has to stand very firm on this point.

Q: Can you give an example?

AND: A few years ago we issued a guideline that strongly states that antibiotics should not be used for growth promotion or disease prevention in animals, as this contributes to antimicrobial resistance. Several member states were very upset. They didn’t want this recommendation to come out because it affects their industry. We stuck to our guideline, we didn’t change it.

Q: I suppose it helps to have the support of the CEO.

AND: Tedros has always stood by the scientific opinion, but he is also willing to change his mind if we present him with different evidence. During COVID-19, there was a lot of focus on airborne transmission, a lot of research, and a lot of people from other fields, like engineers, coming 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 terms we use to describe this problem. I was hoping it would be out before I left, but it will probably be a few more months.

Q: Was that your biggest mistake as chief scientist – not calling SARS-CoV-2 airborne?

AND: We should have done this much earlier, based on the available evidence, and it is something that has cost the organization. You may object [the criticism of WHO] it’s unfair because when it comes to mitigation we’ve talked about all methods, including ventilation and masking. But at the same time, we didn’t say emphatically, “This is an airborne virus.” I regret that we didn’t do it much sooner.

Q: Why didn’t you do that? What went wrong?

AND: I think it’s a mixture of things. I was very new to the Chief Scientist role and it wasn’t defined; what does a chief scientist do during a pandemic? I tried to do what I thought was best. What happens in WHO is that the technical divisions make the guidelines, in the scientific division we just set the standards for how to make the guidelines. So it wasn’t my role, nor was anyone asking me to be involved at that stage. … The current paradigm is based on influenza because most of our pandemic preparedness is influenza. And similarly, SARS-1 was very different as a pathogen, so we couldn’t fully extrapolate from that. But at the beginning we had to assume some things. So I think what I would say to the next chief scientist: If there is any situation where new evidence comes out, especially from other fields, that challenges our understanding, get involved as soon as possible!

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

AND: One is to be a bridge between the global scientific community and the health community. We look at areas where technology is advancing rapidly, such as gene editing, artificial intelligence or 3D organ printing. And another area is promoting norms and standards in research, sharing data – again making sure that much more research is done in low- and middle-income countries and that researchers there get the full credit they deserve.

Q: Where do you think you have achieved the most?

AND: I think to set the scientific division on a path, to make it visible globally and to establish connections with large scientific communities. Last month, we signed a memorandum of understanding with the International Council of Science, which connects us with 130 science academies around the world. Last year, we established the WHO Scientific Council, which is chaired by Nobel Prize winner Harold Varmus.

Another thing I’m really proud of is the creation of the WHO Technology Center for mRNA Vaccines, a facility based in Cape Town to provide messenger RNA vaccines to Africa. Moderna and BioNTech-Pfizer refused to share any technical know-how or help us in any way, but South African scientists were still able to create a vaccine. Of course, it now has to go through all the stages of clinical testing. So I can’t say it was a complete success. But the first results are very encouraging. And finally, I am also proud of my role in WHO communication.

Q: You’ve occasionally used Twitter to communicate. How do you see the future of this platform?

AND: I’m not sure what will happen. I’m just waiting and watching. But I’m not very optimistic that it will continue to be a good platform. If a lot of public health people start leaving Twitter, then there’s no point in staying there, but it’s too early to judge.

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