Earlier this year, Dr Soumya Swaminathan – director of the Indian Council of Medical Research (ICMR) – was appointed Deputy Director General (DDG) of programmes at the World Health Organization (WHO). Health Issues India has interviewed Dr Swaminathan, about the progress made in public health, both in India and on the global level, and what she hopes to achieve during her tenure at the WHO.
Questions were arranged into three sections: one covering global health, one covering health in India and one on Dr Swaminathan’s work.
First of all, my congratulations on your appointment as the Deputy Director General (DDG) of programmes at the World Health Organization (WHO). What do you hope to achieve during your tenure?
Thank you very much. I think what I want is to set to work achieving the goals of the WHO and the leadership team. It’s a big organisation with a lot of member countries and it’s important we achieve the goals we have set for ourselves and achieve maximum impact.
What do you think is the major challenge or challenges facing the world today in terms of public health?
The biggest challenge is universal health coverage. We have large parts of the global population who lack access to quality health provision and I think access to good healthcare for all people, everywhere, no matter who they are is an important goal.
Health ministries in different countries do play a very important role and I think we need to do more inter-agency work at both the national and global agencies. There needs to be recognition that there are a great number of factors and determinants that one agency alone cannot solve; there must be dialogue and co-operation.
What do you think has hindered efforts to respond to these challenges thus far and what is needed to respond to and overcome these challenges?
I would say, in India, the population growth is a major challenge, in terms of limiting resources, and there is a lot of variation in capacity of health systems. Healthcare spending in particular fluctuates between states.
What do you consider to be the world’s major public health achievement of the past twenty years and what made it possible?
The major public health achievement is the eradication of smallpox and polio. We have also seen major successes with tetanus and measles. The number of vaccines children are on has gone up and will keep going up. Immunisation is the key.
We are also witnessing major advances in infectious disease – particularly neglected tropical diseases. There is still a lot of work to do on malaria, tuberculosis, and leprosy. All three remain significant threats.
Building on that, what further advancement in public health would you like to see in your lifetime and what do you think is needed to make that advancement possible?
A couple of things.
What we need are good global surveillance systems, which are needed so that we have enough information to respond to disease threats, particularly vaccine-preventable diseases but also others, such as noncommunicable diseases.
To achieve further advancements in health indicators, I would like to see a basic package of healthcare provision available to all. Nobody should have to travel long distances or incur large costs. Neonatal care, mental health, and care for the elderly – these things must be provided at the primary level. India is trying to do this by setting up sub-centres with well-trained primary healthcare providers and referral systems.
There have, of course, been many advances in global health in recent years. At the same time, however, there are a number of new challenges. The Ebola and Zika viruses are two of the most prominent examples which come to mind. On top of this, noncommunicable diseases are becoming increasingly prevalent, not only in more economically developed countries but also in the developing world. How does the WHO ensure that its efforts towards strengthening health systems and improving public health at the global level includes a cohesive response to these issues which, at face value, are rather disparate?
I think the priorities are changing as disease burdens change. Provision of diagnostics, drugs and treatment has to be a focus, especially in countries with large populations but with substandard facilities and shortages of resources. There must be drugs, there must be diagnostics, there must be treatment. It is the role of the WHO to ensure that there is this and that there is compliance with targets and guidelines and agreements that are set out, so that we meet our targets.
A core aim of the new WHO leadership team is universal healthcare. What do you think are the major obstacles to this at the global level and how can those obstacles be overcome?Universal healthcare can be only provided with good health systems. There are many building blocks to ensuring such systems – financing, human resources, governance, supply chain and logistics. Unless these pillars are in place, it’s difficult to create a quality health system. It is the role of the governments to ensure all this and this is why the WHO needs to work with countries on making sure their health systems are of a good standard.
During your career, you have worked extensively in tuberculosis research. Great strides have been made in reducing the burden of tuberculosis worldwide, but there is still work to be done. What are the steps which need to be taken to make tuberculosis a thing of the past?
Globally, lots of things.
I think that countries with maximum numbers of TB patients need to take leadership. Six countries account for 70% of the global TB burden. The world needs to come together as it did for polio – and everyone has to be involved. We need increased funding, research for new tools, private sector and community engagement. We are not going to eliminate TB any time soon without these.
You are the first Indian to hold the post of DDG within the WHO. Do you view this as a sign that India is gaining more recognition as a major player in healthcare on the world stage?
As well as appointing its first Indian DDG, the WHO appointed its first African Director General this year in Dr. Tedros Adhanom. Do you see this as a sign that low and middle income countries (LMICs are being given the chance to inform the debate on healthcare, rather than simply be beneficiaries of efforts by richer countries?
Yes, I would think so. It is a sign of a new impact LMICs are having – and it’s for the better.
Do you think a leadership more broadly drawn from developing economies will utilise a different approach to global healthcare, having viewed the challenges of beleaguered health systems such as those in India and in a number of African countries at first hand?
Yes. I think if you have lived and worked in a developing country your experiences inform your way of thinking and gives you the chance to bring that experience to global policy making. DG Dr Tedros is looking at a new approach and making the WHO a lot more responsive and impactful to what is happening at country level. Not just Africa or India but persons from number of countries with broad collective experience are now in the leadership team. This way, we can make a difference.
In India, you have occupied a number of high-level positions – most recently as the director general of the Indian Council of Medical Research. As such, you have been at the forefront of the strides India has made in health in recent years: cutting rates of most infectious disease, increasing life expectancy, reducing maternal mortality, infant mortality. What are you most proud of in terms of what India has achieved in terms of public health?
I am very proud of the reduction in child mortality and the strides we have taken towards achievement of the Millennium Development Goals. The eradication of polio is another achievement I am very proud of and we are very close to eradicating other infectious diseases, such as kala-azar and leprosy. We have demonstrated we are committed and able to deliver. It gives me confidence we can respond to other challenges like TB.
Do you have anything else to add about global healthcare and/or healthcare in India?
There is a need for looking at traditional medicines such as ayurveda becoming more globally recognised. Many of these have proven benefits and have come through the ages. A holistic approach to health is needed.
Modern systems do not pay enough attention paid to prevention. We need to be looking at behaviour like tobacco, eating habits, activity levels. We must make these points very clear and we’re coming out with these disease burdens. We need to look past simple post-active care and start looking at getting preventive.
What made you want to be a doctor?
I never actually wanted to be a doctor. I wanted to be a scientist, then a vet. I was interested in genetics and basic science.
Did you grow up in a household where science was part of everyday conversation? Did that drive your interest in medical research?
Yes, my father was an agricultural scientist so I did grow up in a very scientific household. I was partly raised in a research institute and there were a lot of students, so science certainly did dominate everyday conversation and it definitely influenced and helped develop my interest.
Which aspect of your work do you enjoy the most and which aspect do you enjoy the least?
I was grateful for the opportunity to treat patients with HIV, who often are neglected and stigmatised. I’ve seen firsthand what HIV can do to families. More broadly, I enjoy having the kind of doctor-patient relationship. I’ve been away from that: I want to go back when I am finished at the WHO.
What I enjoy the least is dealing with bureaucracy and people who because of their own arrogance or ego are unwilling to take sufficient steps. If you don’t take the right steps, it can be very costly.
What might someone be surprised to know about you?
I learnt South Indian classical music and played the violin on radio.
Dr Swaminathan’s life and career at a glance
Soumya Swaminathan is an Indian paediatrician and clinical scientist whose work spans several decades in the medical and research sectors, both in India and internationally. Born in Chennai, Dr Swaminathan studied zoology at the University of Delhi, before earning an MBBS from Armed Forces Medical College in Pune; an M.D. from the All India Institute of Medical Sciences (AIIMS) in New Delhi; and a Diploma of National Board from the National Board of Examinations. She followed this with a post-doctoral fellowship in neonatology and pediatric pulmonology at the Children’s Hospital Los Angeles University of Southern California, U.S. and a research fellowship with the Department of Pediatric Respiratory Diseases at the University of Leicester in the United Kingdom.
In 1992, Dr Swaminathan joined the Tuberculosis Research Centre in Chennai, where she worked as a research scientist for more than 20 years. Her work focused on adult and pediatric tuberculosis, with interests in epidemiology, pathogenesis, the role of nutrition and HIV-associated tuberculosis.Dr Swaminathan’s many professional memberships during this period included the International Union Against Tuberculosis and Lung Diseaes, where she chaired its HIV section from 2009 to 2011; the International Scientific Advisory Expert Group for the All-Party Parliamentary Group on Global Tuberculosis (APPG TB); and committees and groups under the banner of the United Nations, the WHO, the AIIMS, the Indian Institute of Science, and the Indian health ministry, the Department of Biotechnology and the Department of Science and Technology. She also served as co-ordinator for neglected tropical diseases at the WHO’s Special Programme for Research and Training in Neglected Tropical Diseases (TDR) and is a life member of the Indian Academy of Paediatrics.
In 2012, Dr Swaminathan became director of the National Institute for Research in Tuberculosis (NIRT) and, in 2015, was appointed Director-General of the Indian Council of Medical Research (ICMR) and Secretary for the Department of Health Research. In 2017, she was appointed Deputy Director General of Programmes for the World Health Organization (WHO) by Director General Dr Tedros Adhanom. She is the first Indian person to hold this position.