With the world and India entering the middle phase in a two-pronged fight against the COVID-19 pandemic, including public health measures to curb the spread of the Wuhan coronavirus and the race to develop a viable vaccine solution, global and regional cooperation between nations has never before been as important as it is today. Poonam Khetrapal Singh, Regional Director, World Health Organisation South-East Asia Region, discussed the big questions on institutional learnings, transnational collaboration, and challenges for India with Narayan Lakshman. Edited excerpts:
How has the departure of the U.S. from WHO impact the organisation’s functioning and what measures can it take to shore up its finances?
WHO’s relationship with the United States is much broader and goes well beyond funding. It is about working together. The U.S. has been a vital partner to WHO since its creation in 1948. Over the years U.S. funds have supported programmes like polio eradication, health emergencies, TB, maternal health, immunisation etc. Together, we have worked to save the lives and improve the health of hundreds of millions of people around the world. WHO is reviewing the impact of the withdrawal of U.S. membership and will collaborate with partners for work to continue.
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What are the big learnings for WHO from this crisis?
The pandemic has demonstrated that indeed health is central to the overall well-being of a country. We clearly need to invest more in strengthening our health systems and making them resilient to emergencies of pandemic proportion. A multi-sectoral approach is needed in pandemic preparedness and response.
Like in the past following the H1N1 pandemic and Ebola outbreak, WHO would conduct detailed evaluation post-COVID-19 pandemic which would help the organisation take measures to effectively respond to such events in future.
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What role is there for regional public health cooperation in the recovery from this pandemic, for instance relating to (a) vaccine development (b) case tracing, monitoring and surveillance?
From sharing lessons learnt; best practices; joint reviews; to technical, financial and material support to responding to health emergencies, there is a strong culture of cooperation in the Region, facilitated by WHO.
The Regional Strategic Preparedness and Response Plan for WHO South-East Asia, developed in February, in line with the global plan, has been guiding WHO’s outbreak response in the Region. Based on this framework, WHO has been supporting the COVID-19 response in the Region.
A meeting with vaccine manufacturers and national regulatory authorities of vaccine manufacturing countries like India, Indonesia and Thailand was organised by WHO South-East Asia Regional Office on April 29 to facilitate information sharing on COVID-19 development.
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There is concern, given the past and present record, that more such viral pandemics could originate in China. What can the WHO do about it?
The International Health Regulations (2005), which 196 countries across the globe have agreed to implement, lists out core capacities that countries must have and the measures that they need to take in response to emergence and re-emergence of international disease threats and other health risks.
The post-pandemic evaluation would determine further advice to the world, including WHO, to be better prepared for future.
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Turning to the case of India and the lockdown strategy: how can India balance the need to slow the virus’ spread with the imperative of resuming economic activity?
As countries ease lockdowns and work towards finding the right balance to save lives as well as livelihood, the focus should be on local epidemiology to adjust and implement public health and social measures. A national risk assessment should be supported and implemented through subnational or even community level risk assessment, as the transmission of COVID-19 is not typically homogenous within any country.
The risk assessment should be based on epidemiological factors, healthcare capacities and public health capacities. Protection of vulnerable populations should be central in the decision to maintain or lift a measure.
Areas that are now witnessing plateauing of cases or a downward trend, have achieved this with aggressive implementation of core public health measures — detect, isolate, trace contacts and treat cases — complemented by protective measures like physical distancing, covering coughs and sneezes, and frequent handwashing.
This “new normal” does not mean “business as usual”. We must continue with the core public health and physical distancing measures and stay vigilant. India is already doing so. It is heartening to see India demonstrating unwavering commitment in its fight against the pandemic.
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What would you describe as India’s biggest challenge in tackling the pandemic?
India took early and decisive measures since the start of the outbreak and has since been scaling up capacities — ramping up testing, building and readying hospitals, training health workers, procuring medical needs etc, However, we are aware of the varying capacities at the national and State levels. Also, it’s not unusual in a country as big as India and its population size, that the measures taken may often not be uniformly sufficient across all areas. Scaling up capacities and response is dynamic in a country like India and remains a constant need and challenge.
