"Science appears calm and triumphant when it is completed; but science in the process of being done is only contradiction and torment, hope and disappointment." These are the words of Pierre Paul Émile Roux, French bacteriologist and creator of the first effective treatment for diphtheria. While Soumya Swaminathan is no bacteriologist, she can relate well to what Roux implied, in her role as the chief scientist at the World Health Organization (WHO).
The 62-year-old sounds surprised though at making it to the list of Fortune India's Most Powerful Women. "To be on a list that has CEOs and heads of big businesses is a humbling experience because as a scientist you are generally not in the public eye at all," she says.
While Swaminathan is not from the world of business, her actions mean business as they have been influencing economic outcomes and, more importantly, saving lives. Worldwide, Covid-19 deaths have surpassed the five-million mark, with the US, Russia, Brazil, Mexico and India being the worst affected. The severity of the crisis can be gauged from the fact that while it took over a year for the death toll to hit 2.5 million, the next 2.5 million fatalities came in less than eight months, thanks to the virulent Delta strain.
"The pressure and the tension came from the realisation that you could not afford to be wrong as many millions of people and countries depended on your advice. That meant striking the right balance between waiting for the evidence to be generated, but not so long enough that it's too late. You have to do your best to save lives. So, it's always a judgement call and one needs to adopt a no-regrets policy," points out the daughter of India's famous agricultural scientist M.S. Swaminathan.
It's been a long and fulfilling journey from Chennai to Geneva. Though Swaminathan completed her degree in medicine by specialising in paediatrics, in the over 30 years of experience across clinical care and research, she has been instrumental in the launch of several impactful programmes. While she spent a solid 23 years researching tuberculosis and HIV at the National Institute for Research in Tuberculosis in Tamil Nadu, as the director general of the Indian Council of Medical Research (ICMR), she ensured more funding for India's apex governing body for biomedical research that oversees 30 institutions. So, it came as no surprise when she made to the WHO as the deputy director general in 2017, giving her the platform to expound her knowledge in clinical research, infectious disease and public health management. Two years later, she was appointed as WHO's first chief scientist — a post specially created to consolidate all health-related research into clear guidelines for all nations — till the pandemic changed it all.
Back from a short Christmas break, Swaminathan heard the alarm bells ring in early 2020. Unlike SARS-1, which could be controlled since a person had to be sick in order to spread the disease, the new coronavirus was a silent killer as it had the ability to spread from an asymptomatic person as well. "That changed everything. We were successful in putting out the guidelines for the first diagnostic test within 48 to 72 hours of the whole genome sequence being publicly available, thanks to our network of collaborating centres," says Swaminathan.
At the same time, as a clinical researcher and scientist, it was also exhilarating for Swaminathan to see the pace at which science moved, and the role WHO played in convening, in priority setting and in being able to synthesise all the data into guidelines.
But what was emotionally draining for the scientist and her team was the abuse that they were subjected to at the peak of the crisis. "Scientists can disagree and argue as that's part of scientific discourse, but being attacked by lay people on social media was all so new and difficult to deal with," she recalls. There were groups that specifically targeted Swaminathan for saying that certain drugs lacked evidence that they work. "Some took it very personally as they believed in those things as cures. The common man (woman) does not always understand that science is an iterative process, that new knowledge means giving up on earlier beliefs and that one has to make a distinction between studies of varying quality, and that there is a scientific process of evaluating the data and evidence to form conclusions," rues Swaminathan. Hydroxychloroquine was a good example of a drug that got so politicised in the beginning of the crisis as political leaders without any scientific evidence were claiming that these drugs could act as a saviour. US President Donald Trump set the ball rolling, prompting the US Food and Drug Administration (FDA) to give an emergency use listing.
"Politics in many countries was overriding science. I did not anticipate polarisation around something as simple as whether a drug works for a disease or not. That's purely something you decide based on data from well-conducted clinical trials. It should have nothing to do with personal beliefs or ideology," says Swaminathan.
However, dealing with big pharma came with its own set of challenges. "I felt some companies were trying to push their own product. Of course, they did studies, but they were not always the best-designed studies, or were done in small numbers of patients. Also, their marketing was out of proportion with what the drug could actually do," mentions Swaminathan.
Despite all the challenges, the WHO managed to kick off Solidarity, a clinical trial platform that allowed drugs to be tested very quickly in large multi-country studies. "From the beginning, we advocated for a process whereby we run these large, multi-country trials with good study designs where people collaborate as it's a lot more efficient," explains Swaminathan.
But the big players chose to keep off the initiative. "We have not had much success in convincing many of the multinational Pharma companies to work with us, to transfer their knowhow and intellectual property to companies which could have manufactured these products and made access wider," says Swaminathan. But the WHO did manage to keep its Soldiarity initiative going and is now testing three new therapies — artesunate, imatinib and infliximab — to examine their potential in reducing the risk of death in hospitalised Covid-19 patients. These drugs were donated for trial by their respective manufacturers.
Even as progress is being made, the virus continues to be as virulent as ever. The Delta variant is the most infectious and dominant strain given its efficiency in transmission, and constitutes about 98% of all viruses globally. But Swaminathan is not too worried. "While the Delta variant has shown that it is partially resistant to antibodies, vaccines are proving to be very effective in preventing hospitalisation and death. What we want is a break in the link between infection and serious disease."
It is unlikely though that the virus is leaving planet earth anytime soon. The WHO expects the disease to convert from a pandemic to an endemic — circulate within a restricted community or geography where most people would get a mild infection like a common cough or cold.
"Today, even influenza kills thousands across the world and we still don't have a good vaccine for it. So, it [Covid-19] could be an infection that people get. Most will recover, few will fall sick, some will die, but we need to manage it the way we deal with other infections. We need to be prepared to diagnose, treat and isolate the infected individuals as well as continue with surveillance in the community. Effective oral antivirals will make Covid a more manageable disease," opines Swaminathan.
While the pandemic has been the most challenging phase in her career, Swaminathan does not find it as painful as the fight against HIV. "It was not just the fear of dying that an infected person had to face, it was the stigma of being rejected by your own family. As a caregiver and a doctor I found myself helpless in that situation," she recalls.
Even as she battles the virus, living away from the family can be tough. But Swaminathan has found her peace in nature. "It's very beautiful here in Geneva and nature is a healing balm for me. So whenever possible, I am out walking." But what also keeps her going is the realisation that she is inspiring GenNext. "I have school and college students writing to me not just from India but other countries saying that if you can do it, so can we." That's indeed a powerful antidote to keep Swaminathan going in these testing times. — V. Keshavdev