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The need for global systemic changes to protect humanity from future pandemics

April 20, 2020

Thomas Zeltner is a seasoned veteran of the healthcare industry, both in Switzerland and globally. Trained as a medical doctor and lawyer, Thomas built an outstanding career as a healthcare advisor and policy maker at the Federal Office of Public Health in Switzerland as well as the WHO. Thomas will serve as the Chairman of WHO Foundation, to be created with the mission to tackle the world's biggest healthcare challenges. FORM's Founding Partner Markus Okumus spoke to Thomas about the current COVID-19 crisis from the perspective of someone who has served in the higher echelons of healthcare. This is part II of our COVID-19 interview series with leading healthcare experts and advisors around the world.

Markus: Thank you for being with us Thomas. You've had a very successful career as a healthcare innovator and advisor. For those who don’t know you, why don’t you tell us a bit about what you’ve done in the healthcare space, both in Switzerland and globally

Thomas: Thank you for having me Markus. First of all, let me start with saying that I was trained both as a medical doctor and lawyer, which has certainly helped me understand the kind of societal and legal framework in which medicine and public health are practiced. I started off as a regular academic early in my career, and then took on the position of the Head of Medical Services at the University Hospital of Berne. From there, I moved to the Federal Office of Public Health, which is the executive arm of the Ministry of Health of Switzerland. And there we worked on a few really innovative projects. The first was the development of a highly innovative HIV and AIDS strategy, followed by a strategy concerning drug abuse and drug addiction in Switzerland. I suppose this shows that my colleagues and I had a strong interest in improving the lives of vulnerable groups and populations. My work at the Federal Office of Public Health then brought me to the World Health Organization, where I became a member of the highest executive board. In that capacity, I tried to help reform the organization, which is quite slow moving, and then became a special ambassador of the WHO to help them reform the financial side, specifically in terms of how to better collaborate with the global financial sector.

Markus: Very impressive, Thomas. Based on this incredible resume, you probably have a big-picture take on the current COVID-19 pandemic. Could you maybe tell us what you have found surprising about how the current crisis has unfolded?

Thomas: Well, a couple of things are certainly surprising. None of us really thought that the virus would jump over to Europe and then the US as fast as it did. The other surprise is the combination of a virus that can be deadly for some people but very mild for most. This is a true challenge for public health as it deeply complicates the crisis management efforts. The positive surprise, I would say, is that I’ve hardly seen anything like the current crisis in terms of mobilizing the global population and politics around the topic. In the past three weeks in Switzerland alone, hospitals have been able to accept more patients, more healthcare professionals are partaking in the fight against the virus, more beds and ventilators have come. These achievements are very surprising in a positive sense.

Markus: Indeed. But then again, many negatives remain. What about the current crisis worries you the most?

Thomas: That it will take much longer to settle the crisis and return to normal life than many people hope. I just read a paper which I very much recommend to you and your readers. It is written by Harvey V. Fineberg, M.D., Ph.D, one of the most prominent scientists globally, and published in the New England Journal of Medicine. He says it will take us at least ten weeks to flatten the curve. He’s referring to the US, but I think the same is true for Switzerland and Europe. Ten weeks is a long period, and it could of course be twelve weeks. Keeping everyone at home and practicing proper social distancing for such a long time will be very tough for people. It will be tough for the population, for families with children, but it will be especially difficult for the economy. And we’re already hearing some voices from the global economy say enough is enough, let’s get things going again. So I think we will need to find a balance between public health and the economy, and this will be a very difficult challenge. I worry that it will take a long time to find this consensus.

Markus: To follow up on that point, let's talk about global preventive measures that could facilitate a smoother handling of a future crisis. Given the current global response to COVID-19, what do you think should be done differently in the future when the next pandemic comes knocking on our doors?

Thomas: Every country needs to take the threat of pandemics so seriously that we go from talking about the threats to moving forward with protective measures. Let’s stop talking and start walking. For Switzerland at least, we have excellent policy papers on how to prepare, and the same goes for all the other countries I’ve looked into. By now, it's clear that those countries that had been affected by similar crises in the past, like Singapore, Hong Kong, and South Korea, were better prepared this time around, because they know what a real crisis looks like. And now it's our turn to realise what's at stake and better prepare on the national level. In terms of international response, the key point is to see how to get to medications and vaccines more quickly, and there again there's a need for concerted action between the public and private sector.

Markus: Thank you, Thomas. You have had extensive experience in the higher echelons of healthcare, and of course that gives you a bird’s eye view of the systemic changes needed to deal with future pandemics. But certainly the individual has a role to play as well. What are some preventive measures that people can take against infection-associated diseases generally?

Thomas: Well, each pandemic and virus is different. In the current situation, and this can't be stated enough, you can’t get infected if you are at 2.5-3 meters distance from people. So social distancing is extremely important. And although we don’t know to what extent viruses survive on surfaces, the recommendation is pretty simple. You can touch whatever you want, as long as you don’t touch your face afterwards, and that you wash or disinfect your hands if you do touch something. Then you’re pretty safe. These measures on the individual level helps us in pandemics related to oro-pharyngeal viruses, meaning viruses related to the mouth and nose. But of course, we shouldn't forget that one of the biggest pandemics we had is the HIV / AIDS pandemic, which is very different than the current one. With respect to HIV, we had to adapt in terms of our sexual behavior and how we relate to blood, because blood was infectious. So you have to look at the differences between different types of pandemic. But it’s clear that individual behavior can make a huge difference. And with new digital technologies, there are enormous potentials to facilitate all kinds of protective measures.

Markus: Great. Thank you so much for that clarification. It's obviously very important for people to understand their individual roles. I would like to go back to global prevention. You are the first designated chairman of the WHO Foundation, which will only be established this year in Geneva. Its goal is to tackle the biggest health challenges globally, and it comes at a time when we are experiencing a global challenge on a grand scale. Please tell us a little bit about the foundation. How will it protect global communities against disease outbreaks, including future pandemics?

Thomas: Thanks for that question, Markus. Well, we all sometimes complain about the WHO and the UN. On the other hand, we all know that we need these organizations. We need the WHO as a norm-setting body, as the center of knowledge when it comes to health. Unfortunately, member states have always been reluctant and continue to be reluctant to fund the WHO appropriately, if I may say so. You know, this is a world organization whose budget is actually smaller than the budget of the University Hospital in Zurich. So you see that there's a real lack of funding. That’s one part of the answer. The other part is that there are more and more extremely wealthy people who are willing to donate large sums for good causes. The WHO was not in a position to accept that wish until now. So the Foundation will be a tool where the public and high net worth individuals can contribute to the cause of the WHO. The Foundation will be shaped such that the donors have a say in what they want to invest in. Two-thirds of the money will go to the WHO directly, and one-third will go to implementing partners in countries where the fund seeds a need for strong changes in local healthcare policy.

Markus: Wonderful. And this brings us to the last question. We all know that the current crisis will end at a certain point and normal life will return. What are some of the positive lessons that we can learn from the past few months? What do you hope that the post-crisis world will look like?

Thomas: Well, I hope that the post-crisis world will basically look like it did in mid-2019. Borders are open again, people enjoy traveling, businesses are running. But that will only happen if we have a vaccine and the virus disappears. I assume that the virus will continue to create trouble here and there for the next 2 years or so, but we can overcome that. The second positive thing is that we probably got this wake up call now, and that we will hopefully agree that we need to be better prepared, and that means investing in a few things to make sure we're in a position to react swiftly and effectively in the future. And finally, I hope that we learn and agree that the world is a global village, that we are all part of this village, and that we need to help each other to make this village a better place to live.

Markus: Talk about ending on a positive note. Thank you for taking the time to join us, Thomas. It has been an honor and a delight to speak with you.

Thomas: It was a pleasure to be with you, Markus.

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