Dr Sunoor Verma’s interview Face to Face with The Himalayan Times. Published on 22nd April 2022
The Himalayan Times (THT) Question: In an interview with THT in March 2020, your predictions on how COVID-19 will play out came true. So, what has changed in the global health business in these two years?
Dr Sunoor: It seems to me that COVID-19 has shown countries, policymakers, technocrats, businesspersons, and the media the mirror. And the picture in the mirror was far from pretty. Years of under-investment in health as public service and health professionals have brought us to despair. We also saw that when there is strong cooperation between high-income countries and multilateral agencies like WHO, there can be accelerated solution-finding, as with vaccine development. At the same time, we saw that not much has changed on the axis- rich and poor. The rich controlled the allocation of essential Covid19 supplies. The helplessness of the poor, both as individuals and as countries and their dependency on acts of charity by rich countries is one strong memory of the last two years. I believe that what has also changed over the previous two years is the frivolous questioning of WHO‘s relevance. The UN’s health agency has long been the favourite punching bag of health stakeholders. With all the shortcomings of any membership organisation, WHO has shown that it is more than a normative and standards body. Its power of convening health actors has been hugely visible and effective these past two COVID-19 years. Low-income countries often vent on UN agencies for their miseries, especially the WHO. This is because they cannot box donor countries as they welcome the bilateral money that flows from them. Many member states ask WHO to be stronger, wiser, braver, etc. They must realise that WHO is the sum of the strength of its member states. Low-income countries can only contribute to WHO’s strengthening by making their health systems solid and practical for the commoner. All said and done; global health governance needs a rethink and recalibration. India, Brazil, Thailand and many others who until now were regarded at the periphery of global health governance architecture have unequivocally demonstrated their strength.
THT: What are the lessons for low-income countries from the last two years of COVID-19?
Dr Sunoor: Negotiation from a position of poverty is a non-starter. Least so during a global health crisis. While globalisation has been much celebrated, the poor have not benefitted proportionately. I hope that developing countries learn that health must transcend nationalism and regional alliances must be made as disease crosses borders quickly. Instead of each country reinventing institutions, regional health resources must be shared. They should be recognised and shared regionally by setting up laboratories, training facilities, stockpiling drug testing, and registration. It is a pity that regional fora such as SAARC have not developed to their potential and around the topic of health remain rudderless. Once again, with the facilitation of bodies like WHO, there was support for utilising the capacities of member states during COVID-19. However, these should be a reflex of countries and not the cajoling of international bodies. Regional global health alliances need to be forged now. These need to be regional in operations and financing yet learning from global systems.
Another vital lesson is the importance of activating existing emergency and disaster mechanisms over inventing new structures on the go. Some countries learned that emergencies are not the best time for adventure but rather for tested mechanisms.
THT: As you work closely with leaders and elected officials on strategy and leadership communication around the globe, what lessons are there from COVID-19 for leaders?
Dr Sunoor: COVID-19 has shown the importance of leaders exercising leadership. Occupying a leadership position is no guarantee of leadership. There is ample evidence and peer-reviewed research that countries where women have been in leadership positions on COVID-19, have fared better in their response. Power asymmetry against women in our countries in South Asia is a barrier to our emergency response, development, and prosperity. Excluding women from top-tier decision-making has been a blunder that should be corrected for future emergencies. An important message for leaders is that excluding women from decision-making is foolish and expensive. Donors should make grants available only subject to at least a fifty per cent representation of women in the steering committees of any project they fund in recipient countries.
Second, leaders have seen that undisciplined, unplanned, and unverified communication during health crises leads to the death of people. Third, communicating science and scientific messages to a broad and diverse audience is challenging and beyond the scope of many politicians and leaders. Either they should follow advice and scripts prepared by experts or appoint their own “Faucis” and let them do their job without interference. The top communicators on COVID-19 among leaders have been the former Chancellor of Germany and the Prime Minister of New Zealand. While Mrs Angela Merkel, a scientist, simplified complex data for her citizens in direct telecasts, Ms Jacinda Ardern showed unprecedented transparency in decision-making. If you don’t understand science, don’t deny it or twist it but appoint experts to communicate it and let them do their job.
Another lesson for leaders, I hope, is that they must be unifiers and not dividers in crisis. When people suffer, the last thing they want to see is their leaders’ bickering. The ability to transcend petty politics and create an environment of a unified national response is critical. Unfortunately, few leaders around the world have achieved this feat during COVID-19.
THT: In the post, COVID-19 world order, are multilateral agencies like WHO still relevant? Does their role need to evolve?
Dr Sunoor: Close your eyes for thirty seconds and visualize COVID-19 without WHO.
The question of relevance arises only if there is an alternative. In a world divided along the axis of income, gender, faith, ethnicity etc., the importance of a convener and facilitator is critical. WHO has outstandingly supported countries in their COVID-19 response, especially for an underfunded organisation. Do such agencies need to evolve or transform? Yes, of course, we all need to evolve constantly. High-income countries that fund much of the budget of WHO should want a transformed organisation and support that journey consistently and systematically. Low-income countries should better appreciate the rich-poor power asymmetry more realistically and temper their expectations accordingly.
I also feel that a new kind of expertise is needed in the global health arena. While countries need the norms and standards-setting from an apex body; however, their country-level implementation requires more than technical expertise. It requires coalition-building and diplomacy talent to help countries navigate their factions and mazes. Twenty years ago, people expected disease elimination from WHO; today, they expect WHO also to deliver health and well-being. This warrants an ability to look beyond WHO’s traditional matrimony to government health agencies and forge partnerships with national finance, policy planning, youth, education, and technology custodians. Finally, for any international agency, it is crucial to set clear criteria on when to exit a country, announce it, and adhere to that handover. How many flags you can pin on the world map should not matter in a Zoom world.
THT: Lastly, what conversations are essential now, drawing from the COVID-19 experiences as a society or global community?
Dr Sunoor: A core question that societies need to debate is what should remain in the public sphere and what in private? We have seen that countries with a robust public system of services have done much better in their emergency COVID-19 response. This is an important question, especially for low- and middle-income countries with an urgency to privatise public institutions and services in a call for greater efficiency. Some countries that advocate privatisation in aid-recipient countries have maintained solid public service systems in their own countries. So, this needs to be an organic debate in situ.
At the citizen level, I hope we will appreciate that Health is Politics. Voters would need to demand of their politicians the fundamental right to good quality health, education, and nutrition. And hopefully, this is what the ballot would be cast on in future.
About the Author
Dr Sunoor Verma is a global health practitioner. He has advised WHO, UNICEF, UNHCR, HUG-Geneva and Cambridge University on Strategy, Leadership Communication, Advocacy and Resource Mobilization. He has set up and led the country and regional operations for the European Centre for Minority Issues in the Balkans. He has supported track two peace processes in Macedonia, Kosovo and Sri Lanka and emergency response to the Tsunami, Avian Influenza and COVID-19. He has taught Global Health at Boston University. He has curated partnership initiatives with Macedonia, Kosovo, Germany, Switzerland, Australia, and Nepal parliamentarians. He divides his time between the foothills of the Jura Mountains in France and Buddhanilkantha in Nepal.