WHO’s departing chief scientist regrets errors in debate over whether SARS-CoV-2 spreads through air | 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 on public health there.

Swaminathan, 63, joined WHO in 2017 and in March 2019 was named the agency’s first chief scientist, a position created by Director-General Tedros Adhanom Ghebreyesus to make sure “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 reporters’ questions at countless press conferences. Communicating about COVID-19 science “wasn’t really considered one of the functions of the chief scientist,” she says—but she embraced the role. Her biggest regret is not acknowledging early in the pandemic that SARS-CoV-2 could be spread by aerosols.

WHO has not yet named a successor for 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. 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 at the global level, I feel an urge to go 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 transform the way we approach health, with more focus on a systems approach, on prevention and health promotion, [and] attention to the determinants of health. For now, I’ll probably be based in Chennai with a research foundation. What else I’m going to do, I don’t know at the moment.

Q: Has being at WHO shown you the limitations of working on the international level?

A: It’s something we have been grappling with. WHO has a critical role in highlighting issues, in presenting data, based on the best available evidence, free of conflicts of interest and politics. But all the work is done in countries: the investment, the translation of policy, the actual implementation. So, a lot of the credit for advances will go to countries; at the same time, if they don’t do it, they also have to accept the responsibility.

Q: Can you give an example?

A: The majority of countries around the world do not have a good system to measure and report the causes of death. That’s a huge disadvantage. You can’t do proper policy planning if you don’t know what the burden of different diseases is and how that is evolving over time, and how interventions are helping.

Q: Before you arrived, the role of chief scientist did not exist at WHO. How has your understanding of that role evolved? What would you tell a successor about it?

A: It’s a multifaceted role. During the pandemic I became a spokesperson for WHO, which wasn’t really considered one of the functions of the chief scientist. When I set out in 2019, I had two or three big vision goals. The first one was to really work on our norms and standards. We want to develop what we call the living approach to guidelines, which means updating all our recommendations practically in real time, like we did for COVID-19 treatments. But also producing them in a format that’s easy for countries to adopt, so that somebody in a primary health care clinic does not have to go through these thick books, but can perhaps look on an app for the latest WHO guidance on a snake bite or some other problem that their patient has.

Sometimes, certain member states or interest groups are upset and want us to change the recommendation. So, the chief scientist has to stand very strong at that point.

Q: Can you give an example?

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

Q: It helps if you have support from the director-general, I assume.

A: Tedros has always stood by the scientific opinion, but he’s also willing to change his mind if we present him with different evidence. During COVID-19 there was a huge amount of attention for airborne transmission, a lot of research and a lot of people from other disciplines, such as engineers, who came into the field. So I was asked to convene both an internal and an external group to see if it’s time to change the definitions and the terms we use to describe this. I was hoping that this would be out before I leave, but it is likely to take a few more months.

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

A: We should have done it much earlier, based on the available evidence, and it is something that has cost the organization. You can argue that [the criticism of WHO] is unfair, because when it comes to mitigation, we did talk about all the methods, including ventilation and masking. But at the same time, we were not forcefully saying: “This is an airborne virus.” I regret that we didn’t do this much, much earlier.

Q: Why didn’t you? What went wrong?

A: I think it’s a mixture of things. I was very new in the role of chief scientist, and it had not been defined; what does the chief scientist do during a pandemic? I tried to do what I thought was best. What happens at WHO is that the technical departments do the guidelines, at the science division we just set the norms of how to do guidelines. So it was not my role and neither did anyone ask me to get involved at that stage. … The existing paradigm is based around flu, because most of our pandemic preparedness is flu. And similarly, SARS-1 was very different as a pathogen, so we couldn’t fully extrapolate from that. But in the beginning, we had to base it on some things. So, I think what I would say to the next chief scientist: If there’s any situation where there’s new evidence emerging, particularly from other disciplines, that’s challenging our understanding, get involved early on!

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

A: One is to be a bridge between the global scientific community and the health community. We are looking at areas where technology is moving rapidly, like gene editing, artificial intelligence, or 3D printing of organs. And another area is promoting norms and standards around research, data sharing—again, making sure there’s much more research being done in lower and middle-income countries, and that researchers there get the full credit they deserve.

Q: Where do you feel you’ve accomplished the most?

A: I think setting the science division on a path, giving it a lot of visibility globally and forging links with the big science communities. We signed a memorandum of understanding with the International Science Council last month that links us with 130 science academies around the world. Last year, we established the WHO Science Council, chaired by Harold Varmus, a Nobel laureate.

The other thing I am really proud of is the creation of the WHO mRNA vaccine technology hub, a facility based in Cape Town that aims to provide Africa with messenger RNA vaccines. Moderna and BioNTech-Pfizer refused to share any technical know-how or help us in any way, but the South African scientists were still able to create a vaccine. Of course, now that has to go through all the stages of clinical testing. So I can’t say that it’s been a complete success. But the early results are very encouraging. And finally, I’m proud of my role in WHO’s communication as well.

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

A: I’m not sure what’s going to 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 it doesn’t make sense to stay there, but it’s too early to judge.

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