Interview: WHO's new deputy director general Soumya Swaminathan spells out her priorities

Swaminathan has been appointed deputy director general of the World Health Organisation and will be the first Indian to hold such a high post.

Dr Soumya Swaminathan, the current head of the Indian Council for Medical Research, will soon take over as as deputy director general of the World Health Organisation, the second highest position at the international public health body.

Swaminathan is a paediatrician and has nearly 30 years of clinical research experience. Much of her research has been on paediatric and adult tuberculosis exploring epidemiology and pathogenesis of the disease as well as the the role of nutrition and HIV infections.

Swaminathan’s appointment to the WHO comes only months after Dr Tedros Adhanom Ghebreyesus, a former health minister of Ethiopia, took over as director general – move that public health watchers have cheered as one that will push the health interests of developing countries forward.

Shortly after the announcement of her appointment, Swaminathan spoke to about a new direction for the WHO, providing universal health coverage, improving access to medicines and dealing with pandemics. Here are edited extracts of the interview.

Dr Tedros Adhanom Ghebreyesus, the director general of WHO, is from Ethiopia. You have worked extensively in India. Before this, most of the senior positions in the WHO were held by experts from developed countries. How do you think your experience in a developing country can help you prepare for this new role?

I think the main difference is that I have seen the health system at very close quarters in India. Having worked on a disease like tuberculosis, which is a disease of poverty, I have closely observed the health systems and the social determinants of the disease, both of which are equally important. We will go with a more pragmatic and practical approach.

Could you give me an example on how your approach could be different?
A lot of work at the WHO is normative, which involves setting standards and guidelines for countries to follow. Our approach will be different from a experts who only have theoretical knowledge about certain subjects. There is no point in making guidelines which will not work. Knowing how health systems work in developing countries will help make guidelines that could be followed.

We are seeing new pandemic health threats in recent years - from Ebola to Zika to a new malaria strain discovered recently in Cambodia. How might the WHO prepare countries and international health networks to contain and combat these?
In such situations, the WHO will need to convene countries. We need to improve the provision of emergency care. How to introduce a new drug or vaccine and how to get everyone together on it is key to this process. We need to get everyone including industry to ethics committees together to help tackle a disease. In case of Ebola, by the time the approvals for the trials were sought, and the trials were completed for the vaccine, the outbreak was on the wane. We need to be prepared to immediately act on such outbreaks and have a research and development plan backed up. We will look at forming global consortiums in developing treatment programmes for diseases such as the Global Antibiotic Research and Development Partnership. These are the programmes I would be interested in. I want the WHO to bring in more research and evidence. So far, the WHO has been providing support for research. I feel there will be an advantage if WHO can conduct the research itself.

Dr Soumya Swaminathan. (Photo: Twitter/@doctorsoumya)
Dr Soumya Swaminathan. (Photo: Twitter/@doctorsoumya)

Dr Ghebreyesus has said that the focus of WHO will be on universal health coverage. What will be the challenges to try realise this goal?

The challenge will be reach everyone with quality care that is both preventive and curative with health systems strengthening including infrastructure, human resources, and financing. The reason that poor countries find universal health coverage difficult is that they either do not have the finances or human resources. How to address that will be a very challenging thing to do. But some countries have been able to do it. In our own region, Thailand has done it. This vision is achievable but not easy. Globally one has to come together on this issue. The poor do not have access to so many medicines.

How do we improve access to medicines?
That is a tough one. This issue involves commercial interests as well as intellectual property rights. It is not purely in the realm of health ministries and the WHO. It needs a lot of negotiation and international advocacy as well. There have been many successful programmes that have helped improve access to medicines like, for instance, the Medicines Patent Pool. There are lots of diseases for which we need to develop medicines or improve access to medicines. This will be very challenging.

(The Medicines Patent Pool is a United Nations backed public health organisation that works with drug manufacturers to improve access to HIV, hepatitis C and tuberculosis treatments in low and middle income countries.)

Your research has by and large been in tuberculosis. How will the WHO work towards controlling the spread of TB?
TB is a global priority and will continue to be a priority. India has a big role to play in the elimination goals. We need to increase access to drugs and improve private sector engagement more. In South East Asia particularly, engaging private sector is a big challenge.

We now know non communicable diseases are not just a problem of the rich, but a more widespread problem. What are your plans on tackling non communicable diseases?
Non communicable diseases need a multi-pronged, multi-sectoral approach. Air pollution is a major determinant of non communicable diseases. This problem can be handled less by the health ministry. We need to involve other ministries more, such as the environment ministry.

To handle the excess fat, sugar and salt in foods, we need to work on food labelling and increase food taxes. This will need involving finance ministries and other sectors. Preventive health care will be another major challenge.

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Relying on the power of habits to solve India’s mammoth sanitation problem

Adopting three simple habits can help maximise the benefits of existing sanitation infrastructure.

India’s sanitation problem is well documented – the country was recently declared as having the highest number of people living without basic sanitation facilities. Sanitation encompasses all conditions relating to public health - especially sewage disposal and access to clean drinking water. Due to associated losses in productivity caused by sickness, increased healthcare costs and increased mortality, India recorded a loss of 5.2% of its GDP to poor sanitation in 2015. As tremendous as the economic losses are, the on-ground, human consequences of poor sanitation are grim - about one in 10 deaths, according to the World Bank.

Poor sanitation contributes to about 10% of the world’s disease burden and is linked to even those diseases that may not present any correlation at first. For example, while lack of nutrition is a direct cause of anaemia, poor sanitation can contribute to the problem by causing intestinal diseases which prevent people from absorbing nutrition from their food. In fact, a study found a correlation between improved sanitation and reduced prevalence of anaemia in 14 Indian states. Diarrhoeal diseases, the most well-known consequence of poor sanitation, are the third largest cause of child mortality in India. They are also linked to undernutrition and stunting in children - 38% of Indian children exhibit stunted growth. Improved sanitation can also help reduce prevalence of neglected tropical diseases (NTDs). Though not a cause of high mortality rate, NTDs impair physical and cognitive development, contribute to mother and child illness and death and affect overall productivity. NTDs caused by parasitic worms - such as hookworms, whipworms etc. - infect millions every year and spread through open defecation. Improving toilet access and access to clean drinking water can significantly boost disease control programmes for diarrhoea, NTDs and other correlated conditions.

Unfortunately, with about 732 million people who have no access to toilets, India currently accounts for more than half of the world population that defecates in the open. India also accounts for the largest rural population living without access to clean water. Only 16% of India’s rural population is currently served by piped water.

However, there is cause for optimism. In the three years of Swachh Bharat Abhiyan, the country’s sanitation coverage has risen from 39% to 65% and eight states and Union Territories have been declared open defecation free. But lasting change cannot be ensured by the proliferation of sanitation infrastructure alone. Ensuring the usage of toilets is as important as building them, more so due to the cultural preference for open defecation in rural India.

According to the World Bank, hygiene promotion is essential to realise the potential of infrastructure investments in sanitation. Behavioural intervention is most successful when it targets few behaviours with the most potential for impact. An area of public health where behavioural training has made an impact is WASH - water, sanitation and hygiene - a key issue of UN Sustainable Development Goal 6. Compliance to WASH practices has the potential to reduce illness and death, poverty and improve overall socio-economic development. The UN has even marked observance days for each - World Water Day for water (22 March), World Toilet Day for sanitation (19 November) and Global Handwashing Day for hygiene (15 October).

At its simplest, the benefits of WASH can be availed through three simple habits that safeguard against disease - washing hands before eating, drinking clean water and using a clean toilet. Handwashing and use of toilets are some of the most important behavioural interventions that keep diarrhoeal diseases from spreading, while clean drinking water is essential to prevent water-borne diseases and adverse health effects of toxic contaminants. In India, Hindustan Unilever Limited launched the Swachh Aadat Swachh Bharat initiative, a WASH behaviour change programme, to complement the Swachh Bharat Abhiyan. Through its on-ground behaviour change model, SASB seeks to promote the three basic WASH habits to create long-lasting personal hygiene compliance among the populations it serves.

This touching film made as a part of SASB’s awareness campaign shows how lack of knowledge of basic hygiene practices means children miss out on developmental milestones due to preventable diseases.


SASB created the Swachhata curriculum, a textbook to encourage adoption of personal hygiene among school going children. It makes use of conceptual learning to teach primary school students about cleanliness, germs and clean habits in an engaging manner. Swachh Basti is an extensive urban outreach programme for sensitising urban slum residents about WASH habits through demos, skits and etc. in partnership with key local stakeholders such as doctors, anganwadi workers and support groups. In Ghatkopar, Mumbai, HUL built the first-of-its-kind Suvidha Centre - an urban water, hygiene and sanitation community centre. It provides toilets, handwashing and shower facilities, safe drinking water and state-of-the-art laundry operations at an affordable cost to about 1,500 residents of the area.

HUL’s factory workers also act as Swachhata Doots, or messengers of change who teach the three habits of WASH in their own villages. This mobile-led rural behaviour change communication model also provides a volunteering opportunity to those who are busy but wish to make a difference. A toolkit especially designed for this purpose helps volunteers approach, explain and teach people in their immediate vicinity - their drivers, cooks, domestic helps etc. - about the three simple habits for better hygiene. This helps cast the net of awareness wider as regular interaction is conducive to habit formation. To learn more about their volunteering programme, click here. To learn more about the Swachh Aadat Swachh Bharat initiative, click here.

This article was produced by the Scroll marketing team on behalf of Hindustan Unilever and not by the Scroll editorial team.