• FACE-TO-FACE
Sunoor Verma, a global health practitioner who has advised WHO, UNICEF, UNHCR, HUG-Geneva, and Cambridge University on strategy, leadership communication, advocacy, and resource mobilisation, talks to The Himalayan Times about how COVID-19 has affected our lives, what lessons low income countries can draw from it, and the post-COVID world order. He divides his time between the foothills of the Jura Mountains in France and Budhanilkantha in Nepal.
Excerpts:
In an interview with THT in March 2020, your predictions on how COVID will play out came true. So in these two years, what has changed globally in the business of health?
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 is the case with vaccine development.
At the same time, we see that not much has changed on the axis- rich and poor. The rich controlled the allocation of essential COVID-19 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 that any membership organisation faces, 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 in these past two COVID-19 years. I often see low-income countries 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. For low-income countries, the only way they can contribute to WHO's strengthening is by making their health systems solid and practical for the commoner.
What are the lessons for low-income countries from the last two years of COVID-19?
Negotiation from a position of poverty is a non-starter. Least so during a global crisis. While globalisation has been much celebrated, the poor have not benefited proportionately. I hope 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 the topic of health remains 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.
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.
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?
COVID19 has shown the importance of leaders exercising leadership.
Occupying a leadership position is no guarantee of leadership.
There is ample evidence and peer-re- THT viewed 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 the top-tier decision making has been a blunder that ought to 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 a challenge and is 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 COV- ID-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.
In the post-COVID-19 world order, are multilateral agencies like WHO still relevant? Does their role need to evolve?
Close your eyes for thirty seconds and visualize COVID19 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 richpoor 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 do need the norms and standards-setting coming from an apex body, however, their country-level implementation requires more than technical expertise.
It requires coalition-building and diplomatic 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 the custodians of national finance, policy planning, youth, education, and technology.
Finally, for any international agency, it is crucial to set clear criteria on when to exit a country, announce it and try to adhere to that handover.
How many flags you can pin on the world map should not matter in a Zoom world.
Lastly, what conversations are essential now, drawing from the COVID-19 experiences as a society or global community?
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.
A version of this article appears in the print on April 22, 2022, of The Himalayan Times.
