Are We Prepared? An Exclusive Interview with WHO Director-General Margaret Chan

Margaret Chan has led the World Health Organization for the last nine years. During her leadership, the world has suffered an onslaught of infectious disease outbreaks—avian influenza, H1N1 (swine flu), cholera, and MERS, to name a few. Then Ebola hit. If the Director-General of the WHO was not a well-known figure before Ebola, the epidemic that began in 2014 and sharply exposed the shortcomings of the world’s premiere health agency has put her name—and the WHO—front and center.

Margaret Chan discussing universal healthcare.

Over the last year, the WHO has been widely criticized for taking too long to recognize and address the seriousness of the Ebola outbreak. Independent reports have pointed to its inadequate response and called for major changes in how the agency does its work. Chan herself has acknowledged that the WHO was “ill-prepared” for the Ebola epidemic. She has proposed a number of agency reforms and carefully suggested that WHO needs more institutional power to respond to disease outbreaks.

As global leaders fill the hotels, restaurants, and meeting rooms of midtown Manhattan during the United Nations General Assembly, Chan is hoping to make the case for better solutions to preventing and responding to the next outbreak.

On the heels of the United Nations adopting new global development goals for 2030, Chan today spoke before heads of state and public health advocates at UN headquarters. There she stressed the importance of building universal health coverage and resilient national public health systems.

In an earlier interview with The GroundTruth Project and NOVA Next, Chan discussed how WHO should deal with emerging infectious diseases and drug resistance—and how the world should prepare itself for future pandemics.

Joanne Silberner: Are we prepared for the next outbreak of infectious disease?

Margaret Chan: We are better prepared than we were a year ago, but we still need to do more. And we are currently doing this via our internal revamping of our emergency work and a review and retooling, where necessary, of the International Health Regulations, which will help all member states to build the skills and capacities necessary to help the world be better prepared.

Everyone needs to remember that Ebola was not a worst-case scenario. Preparedness for the future means preparedness for a very severe disease that spreads via the airborne route or can be transmitted during the incubation period, before an infected person shows telltale signs of illness. A severe disease that transmits easily will leave very little international surge capacity as most countries will need their own staff and resources to combat the outbreak in their territories.

Silberner: With 70% or more of emerging infectious diseases coming from animals, what can we do to prevent these from jumping to humans?

Chan: Managing the global regime for controlling the international spread of disease is a central and historical responsibility of the World Health Organization. We work closely with our animal health partners, the Food and Agriculture Organization and the World Organisation for Animal Health, to strengthen the monitoring, assessment, control of, and response to diseases of animals which have crossed or potentially can cross the species barrier and infect humans and to identify and implement coordinated strategies to reduce the risks to human health.

Silberner: What can the World Health Organization do to strengthen the monitoring of infectious disease outbreaks?

Chan: At the 68th World Health Assembly in May 2015, member states agreed to have a review committee look at the effectiveness of International Health Regulations—the legally binding agreements around global health for all member states—in the prevention, preparedness and response to the Ebola outbreak. A significant part of these regulations is about the surveillance capacity of countries to identify disease outbreaks early.

The committee will be recommending steps to improve the functioning, transparency, effectiveness, and efficiency of the regulations and to strengthen preparedness and response for future emergencies with health consequences.

I am personally overseeing changes that include the establishment of a global health emergency workforce, a new emergency program with an operational platform that can shift into high gear quickly, performance benchmarks that show exactly what is meant by “high gear,” and the funding needed to make this happen.

Silberner: Early in your career, you were faced with SARS. Other new viruses followed, and now there’s MERS. What from your SARS experience will help when it comes to addressing MERS?

Chan: One of the similarities that most immediately comes to mind is the hospital-based nature of both outbreaks, where poor infection control practices have led to outbreaks and large numbers of cases. We have seen how good infection control practices can stop or immediately shut down hospital transmission, and ensuring that all good practices are replicated and instituted across the world’s hospitals is a priority for WHO and public health.

Silberner: How is the WHO helping to increase and maintain the number of trained nurses and doctors in the public health system in under-resourced places like Sierra Leone?

Chan: Health system development is a key to effective detection, response, and control of any outbreak. We recognized this early in the Ebola outbreak and even before. We are spearheading efforts by the international community to rebuild and make health systems in Ebola-affected countries more effective and resilient.

Silberner: What is needed to simulate the development and production of drugs and vaccines for emerging pandemic threats?

Chan: WHO is preparing a blueprint for research and development preparedness during health emergencies and for epidemic prone diseases for which there is little or no R&D.

The idea springs from the Ebola R&D experience—the way many of the relevant players came together and accelerated the testing of hundreds of products to find technologies to address the disease. Only this time we would want to set the rules of engagement and the best tools to carry out the research in a rational framework and blueprint document so that we can act faster and more effectively the next time something like Ebola hits.

Silberner: Drug resistance, while not an infectious disease, is an emerging threat. What is the WHO doing to stem the spread of resistance to frontline drugs for diseases such as malaria?

Chan: In 2014, WHO initiated a plan to combat antimicrobial resistance. The Global Action Plan, which represents the collective work of countries, organizations, multiple sectors—including key partners such as the Food and Agriculture Organization of the United Nations and the World Organisation for Animal Health—and civil society, was adopted by member states at the World Health Assembly in May 2015.

The goal is to improve awareness and understanding of antimicrobial resistance, to strengthen surveillance and research, to reduce the incidence of infection; to optimize the use of antimicrobial medicines, and to ensure sustainable investment in countering antimicrobial resistance. Only about one-quarter of countries currently have national plans.

WHO is focusing on supporting countries to develop national action plans on antimicrobial resistance.

Silberner: Does more than $1.6 billion now going towards Ebola response and recovery put other existing public health programs—and progress—in jeopardy?

Chan: The funding currently going to the three most-affected countries does not come from other programs. It is a sign of solidarity by the international community and will have the benefit of strengthening the health systems in these three countries.

Silberner: As international leaders gather in New York this month, what are your hopes for action on the world’s outbreak preparedness?

Chan: We have begun a review process to strengthen the International Health Regulations and WHO’s organizational ability to respond quickly and effectively to health emergencies. We would hope that leaders in New York will give both political and financial support to these efforts.

This article is part of the “Next Outbreak” series, a collaboration between NOVA Next and The GroundTruth Project in association with WGBH Boston.