I'm Paul Verschoor, and I'm speaking
with Annie Sparrow about the role of collaboration in public health.
Annie's commitment to public health is rooted in fieldwork conducted in response
to natural disasters as well as devastating combat zones.
She served as a UNICEF Global Fund Program Coordinator for Malaria in Somalia,
and is currently an Assistant Professor of Population Health and Policy at Eken
School of Medicine at Mount Sinai, New York.
So, Annie, welcome to our podcast.
So, before we really look and discuss around the topic of collaboration,
maybe you could give us a short biographical sketch of your career path to understand
from what perspective you look at these challenges around human collaboration.
This is the part I hate. This is the part when people ask me what I do,
and I'm more likely to say that I lap danced my way through medicine and met
my husband as an escort than actually tell people what I really do,
which is public health and pediatrics and working in various,
often more difficult places of the world, teaching and practicing medicine.
Listen, this is a super-industry field,
and perhaps as a pediatrician, it's
easier to even think about it or talk about it because it's not a profession
you can even go into without being able to get down on the ground and collaborate
to figure out what's going on with one's patients. It's a bit like veterinary
science in that respect.
You know, you have to be, I'm somebody who would much rather be on the ground
and working with the people that I know.
Often speak on behalf of, than managing people from afar.
What interests me in terms of background is, okay, so your lab dance,
your school, your time in the semester school, good.
But, and congratulations, but that still means that at some point you discovered
that what you really cared about was in these conflict zones to look at public health issues
So how did that transition really happen? Was it coincidence?
No, you're right. So that was a huge transition for me.
I spent the first 10 years of my career doing pediatric intensive care.
So in the UK, I did retrieval medicine at St. Mary's, at the Royal Brompton.
And that's kind of high intense work that takes place in kind of an ivory tower. hour.
And it's very fulfilling to do that kind of work.
In Australia, we think of it as Australian doctors, the flying doctors,
if you've heard of the flying doctors.
But then I was exposed to how the rest of the world lives.
My brother had spent 10 years or so in Afghanistan, and I put myself in a position in Australian,
going to work in Australian refugee camps to see what was going on there because
they were filled with people who were locked up as, you know,
as illegal Q jumpers and, you know, the type of people that we don't want here
and as criminals and as terrorists.
So I thought I should go and, and, and see for myself.
And that led to an extraordinary collaboration actually across,
across all the different fields of medicine.
So not just, you know, pediatrics, but psychiatrists, surgeons,
you know, family medicine, you know, all sorts of, you know,
every specialty that we have in Australia.
And normally we have quite a hard time talking to each other.
You know, we don't really talk to orthopedic surgeons or necessarily to plastic surgeons very much.
But this was an issue, like children in detention under these very punitive
circumstances in the middle of the, you know, the Australian desert was something
we could all get around, and we did.
And as a medical community, we managed to get children out of detention and
to sort of really change conditions in a way that goes, wow,
that is the power of collaboration.
That was a long time ago, but that was probably my starting point in terms of
moving away from simply paediatric intensive care and into public health more broadly,
figuring out how to effectively advocate and work on behalf of people who don't
necessarily have a voice and how to figure out how to be effective at that.
That was where I started, yeah. But you also feel today you're still in the
trenches of this kind of public health challenges,
or now you stand at a different position relative to those trenches with more
of an overview and more a link to, let's say, policy, policymaking, guidelines, and so on.
So where do you position yourself there today?
So my position is quite interesting and unusual because I'm one of those few
people who still practice medicine.
So I still can get down in those trenches. And I say that by,
you know, for example, pretty much every year,
except for, you know, since the pandemic began, I go to Eastern Congo and work
on an island called Idjwi,
where there's about 300,000 people and they have a life expectancy at birth of 26 years.
That's, you know, that's pretty much medieval. And there's only half a dozen
doctors on the entire island.
And to go there and work is something that is deeply fulfilling for me,
but also it's a way of every year helping to give kids the best way to start
the school year healthier and better off, like by deworming them,
treating them for malaria.
And that's just an ongoing collaboration, as it were, where it's effective because
of the ability to be both a doctor and to know how to treat people,
but also to then be able to make the case at the higher policy levels.
So it's interesting straddling those areas because not many people actually do it.
I mean, WHO, for example, is filled with doctors who haven't seen a patient for 20 or 30 years.
And that puts you in a very different position. There's not many of us who can
be both clinicians and academic and also understand how to write policy effectively
or to create the solutions that are necessary.
Right. Well, so thank you. This is very clear. Now we know where you're coming
from, which is multiple directions.
So to you, what is collaboration and what is it good for?
Collaboration means that you can get anything done,
and I think that is the lesson of the pandemic like that is the nut we have to crack.
If we're going to move forward globally I mean the pandemic has taught us that
of course we're never going to have international collaboration on the way that
we did post-world World War II, perhaps.
So we need to build global coalitions more effectively in order to get things done.
But what I've seen and experienced myself is that after a career in medicine
and public health, where I've always
been interested in other people's specialties and areas and so forth,
suddenly in the last 18 months, I've collaborated with more people with more
specialties within science and medicine,
but also across every other sector, across trade
across business across sport across education it's
like wow i mean you know it's
we really do know how to get things done and we can and i've that has also been
my experience trying to you know with the tokyo olympics for example where um
understanding how to and forgive me i don't I don't know how much you know about
what I've been doing recently,
but in my role as an advisor at the Centre for Sport and Human Rights,
then a lot of us have been concerned about the safety of the Olympics and not
just for athlete health, but for public and global health.
And although journalists have been key in driving some of the issues.
People don't tend to listen until you put something in an academic journal.
So with the help of the colleagues that I've developed over the last year,
for example, at the International Confederation of Trade Union.
Then I reached out to several colleagues, my co-authors in this piece in the
New England Journal of Medicine,
Lisa Brosseau, who is an industrial hygienist, Bob Harrison,
who is an occupational health and safety scientist and doctor,
and Mike Osterholm, who is an American public health heavyweight across so many areas.
And then to write an article that had the legitimacy of a peer-reviewed journal
can suddenly start to move mountains that otherwise aren't movable.
So you can sort of realize that when you all come to the table with the same
agenda, which is not about self-interest but about the common good,
and you each have these valuable contributions, then it's much easier to move these mountains.
And I think the currency of collaboration is trust.
And I think that's the lesson I keep learning over and over again.
You can get anything done if you trust each other.
Okay. But now, so you had the last 18 months, you collaborated with many people
in many different contexts.
Actually, in some sense, if I understand it right, beyond what you had expected.
But in these different areas, what made that collaboration?
Is it common objectives and trust? Was that the common feature of all these
processes or were they also different?
Are there other features that we should consider?
Well, public health per se always involves, you know, you can't really get public
health done unless it's a collaborative effort.
It. I find it perhaps easier in my capacity as an independent clinician to work
behind the scenes to build the kind of collaborations.
And perhaps because it's a criteria for being a pediatrician, really,
that you're not really allowed to have an awful lot of ego or bothered it about
being wrong because lives are at stake.
So we learned that lesson very early on. And if I don't know the answer,
the most important thing is to ask somebody who does.
And so I think that's how I operate where I think I don't know,
but I can know how to find somebody or I'll ask somebody who does know,
and that way you establish the connections to get things done.
I found myself far more effective outside the UN than within it.
And I think part of that is because the UN
doesn't have this kind of institutional inertia that makes it very difficult
to create an ethos or a sense of purpose amongst staff that actually fulfills
the organisational mandate. And I think...
It is so easy to work with people when your common agenda is more important
than your personal ambition or financial interest because those things can really get in the way.
And that is a really difficult issue, I think.
But that's also where collaborations might face challenges.
But let's focus on the ones you build. As you said explicitly,
I go out and build collaboration.
Right? So if you go out and build collaboration, how do you do that?
What are the steps? Do you follow if you want a specific approach there?
Do you have certain benchmarks that you then set yourself in building collaboration?
Well i think that depends what needs
to be done so in my work in uh in
syria for example on something as specific as a polio outbreak well then i know
the limits of my own expertise so then i reach out to people who i know more
than who know more than i do and i ask them and that's That's sort of the thing that's so fundamental.
Like no one has to know everything. You just have to know who to ask.
And in doing so, that's engaging in itself because I think most of us want to
be able to do the right thing or help or participate in achieving a greater good.
And when you all bring a different thing to the table, then you, it's just,
there's a natural energy, I think, towards moving forward.
It's like, so this is what we, and I found that that process in itself is a
way to then build upon a strategy.
So, for example, with Syria, my aim with polio was to, which is a small part
of the war, the first outbreak in 2013,
when polio re-emerged after not having been there since 1995,
but it was a way to get a much bigger interest in conflict and to re-humanise conflict.
It was also a way to help accelerate getting the borders open and to remind
people that health is a way which requires every other sector to collaborate.
You can't get health done unless you actually get everything else right too.
Health requires nutrition, it requires water, it requires safety,
it requires communication, it requires a place to do things,
It requires, you know, the shelter.
It requires, you know, pretty much every other, you know, piece of the cluster
that the humanitarian organization draws out.
But it requires, you know, it's just, and I think that's what the COVID has shown too.
It's fundamental to getting anything done, but you can't have,
you know, there's no such thing as a right to health per se.
It depends on the right, you know, to educate, you know, education.
It depends on getting to work. It depends on food and communication and providing
people with the tools to look after themselves.
So when you show people that this is how we actually are going to move this particular mountain,
then I think it's much easier to see, okay, this is my area of expertise and
this is what I can contribute and this is how we'll then build upon it to say, oh, and by the way,
now you can like not only this strategy to get the border open,
but have you thought about the G7
and because, you know, at that stage, for example.
In 2014, Russia had to provide a state of the world where we were at with polio,
which was another way to then put pressure on Assad to stop the bombing,
for example, to create humanitarian pauses, to then allow polio vaccination,
but also many other things.
But that wasn't my idea. That was Ron Moldman's idea, who's a guru at the Milken Institute.
And I think that's that, you know, when you have these conversations, then they have amazing,
you know, they can go amazing places when you're not invested and you're open
to other people's ideas.
For me, there are several things that stand out now.
On the one hand, your definition of health, of getting health done,
actually then only a tiny fraction of the world population lives in an environment
where we get health done.
Because you see it more as an integrated process pertaining to the whole of,
let's say, the sustainable development goals.
All of that has to work together constructively before we can really speak of
health. So this really defines it at a very global integrative perspective.
But then you also said, well, earlier you said, look, I do believe everybody
has an interest in serving the common good of health. Now, do you really believe that?
That i think when you show people
how they can actually contribute people can
be deeply interested and invested in in in doing
so you know the mistake with the sdgs is that
you know 17 goals paul i mean that's either adorable to think that we could
do 17 things at once or just play nuts and and unfortunately people are you
know invested of course in that at each of their goals and while sort of paying
lip service to the fact that,
of course, they're all connected, you know.
And the one thing that, you know, think about this time two years ago,
we were all, you know, it was all about climate change, which,
of course, is an enormously important global problem, but that was it.
And then suddenly in the space of a few months, we were laser focused on a single
common health agenda, stopping COVID.
And it showed you know like oh we can't actually get anything done without actually
having a foundation of health but we didn't really understand and we still don't
really understand how to do that and what that actually means we we even talk
about you know the importance of nutrition or controlling diseases and and you know.
You know sanitation and safe water and we don't actually realize that,
One of the most, perhaps the single most important determinant of our health is our work.
And for children, it's their education. And I don't mean like online, but the schools.
And investing in education, investing in actual work.
Is incredibly important at a time when education per se is one of the vanishingly
few ways out of poverty and the gigantic recession.
Session and you know we can't weight all these goals equally and it's but it i'm not sure that,
you know saying to people oh you know we have to focus on
health first is going to have a lot of buying on the other hand um you know
health provides a way to overcome a lot of the other barriers because it is
universal you know it's one of the things that we can all experience in different
ways whether you need a hip replacement or a you know a pacemaker or you know
and now Now we're all frightened of some COVID,
but that doesn't apply equally in all countries.
But it is something that we all understand.
You can use it as a way to not talk about the political issues that are otherwise barriers.
But there are two things here. So on the one hand, you're saying,
look, you go out under the assumption that other people want to collaborate,
because also they care, as you do, about these health issues.
So you said earlier, look, if I don't know it, I'm going to ask someone.
But it must have happened to you as well. I'm sure that that someone doesn't
want to give you the answer because they're not necessarily sharing that overall objective with you.
Take the Syrian situation, right?
There were people who indeed were weaponizing health, so they would not give you the answer.
So how do you deal with that in your model of collaboration?
You're right i mean that that's where you know that that's a
huge problem because i mean you know
to a large extent when you find people you know you find your
co-collaborators because you have the same common purpose so you sort of naturally
attract each other and you introduce to each other and that's how you know you
enter into other people's circles of trust so you know there's any number of
people that i can point to and ring up and say you know i need your help and
And they'll just say, yes, Annie, what do you need?
And vice versa, without having to go through the, what is it for?
How much? What does it mean in terms of time, investment, money,
blah, blah, blah? It's just a yes.
And that's the value of trust.
And those people then, with those, you can move mountains, or at least to a certain extent.
Of course, I mean, this is the problem with the political agenda. And yeah.
And those that are invested in the status quo or those that,
you know, or the institutional inertia that characterises the United Nations.
And it's the same with, like, the Tokyo Olympics. I mean, the International
Olympics Committee, you know, President Bach makes, you know,
Seth Blatter, the ex-president of FIFA, look like Mother Teresa.
There's absolutely no interest in health, public health or global health of any kind.
I mean, that's an organisation that's characterised by, you know,
maximizing its revenue streams and maintaining its feudal control system.
So, no, there's no openness there, despite what we have worked so hard to do.
But at least we can try and shine a light to create greater accountability going
forward so that we don't repeat this five-star fiasco.
Yeah, but this is interesting, right? Because now you start to speak first of first.
It means we have to qualify successful collaboration because, as you describe it now,
it depends actually very much on a subset set of all possible collaborations
among people who do share these common, more idealistic goals and who share trust on that basis.
So that means successful collaboration also for you was very much within those networks.
But now if you step outside of the networks, now you mentioned the National
Olympic Committee as an example, and you mentioned also Russia in case of the
polio campaign, vaccination Nation campaign, then you see it is also an opposition.
Now you have multiple collaborative systems in opposition, and there apparently
another approach is required.
You mentioned someone who then proposed to use more diplomatic economic power,
if you want, to change the approach of such an opponent.
So is that then a natural collateral of the collaborative system?
Like within there are shared values, there are shared goals, there's trust.
But between such systems, we speak about power relations.
And is that and also the role of the United Nations, for instance,
to manage those power relations between multiple, partially exclusive collaborative systems?
Well, it's certainly in their role to broker those relations and to provide a platform.
It's not something they're clearly very successful at doing so,
and we all know that. I don't think there's been that natural trajectory towards
self-interest, nationalism, retreat from multilateralism, which doesn't help.
Historically, there's always been a commercial interest, particularly for public health.
And I say that where 150 years ago,
the nations started meeting and arguing over the cholera pandemics because they
didn't want Europe and America and the UK infected by those Asiatics or those
Muslims bringing cholera across the Mediterranean. Right.
But they argued about it for like four decades' worth of sanitary conventions and conferences.
And the only reason that they then became to a consensus was when the British
lost control of the Suez Canal in 1898 or so.
And when it opened up, then there was a commercial, you know,
common incentive to actually standardise quarantine measures.
So that drove that standardisation.
And that then became the sort of international sanitary regulations,
which was a forerunner of today's international health regulations,
which countries are meant to adhere to, you know, particularly to control pandemic threats.
You know, that's, but that only goes so far.
You know, we can say the same thing, I married in New York and New Yorkers are
very famous for talking about their tap water, which is, you know,
which is delightful, but it wasn't always like that.
You know, we all know the history now, courtesy of Hamilton,
and how, you know, the famous fight between Hamilton and Ehrenberg was altered
in, you know, Ehrenberg took the money, you know, created a bank,
you know, forgot about the water,
you know, invested, I don't know, you know, like a few thousand relative to
the 200,000 that was meant to be put into it. And it took another six years.
And it wasn't until people started complaining about the taste of their beer
that the water source became cleaner.
And so it was, again a sort of a profit-driven incentive but
i don't think that's enough anymore you know because
without trust you know that you know a commercial
incentive also is not enough we have seen the fact that there's
a commercial incentive to vaccinate everybody for companies to transfer tech
to you know to to waive the ip it's not happening and and just saying that you
know we would make their world would be you know you know more profitable if
we did so well that is not a sufficient argument argument.
And, you know, that's, you know, it's, it's not enough,
anymore I think without figuring out the ways where we reconnect to each other so,
that is that's when it comes back down to this global shortage
of trust which should not be a surprise I mean investing in
a vaccine is amazing we can see the power of scientific collaboration to produce
these vaccines but if you don't invest the same amount in figuring out how to
get people to roll up their sleeves you know the best vaccines won't work without
social traction and trust and quite apart from the misinformation that is deliberately
sown or the conspiracy theories,
I have found time and time again that showing up and listening and building
those relationships of trust, that's what pays dividends.
But you can't do it with that aim.
It has to be an agenda with an integrity that is without intention and that
I learned that it took me a long time to even learn that lesson and I'd say that with.
Humility and probably the
arrogance of thinking that you know I knew what I
was doing but I got I went back to Syria with my
son um who made me
go back at a time when I felt I had nothing more to give that
I you know I was kidding myself if I was doing anything
more than a drop in the the ocean and i was what who did
i think i was you know a white australian showing up you
know treating a few people with typhoid or diagnosing a
few cases of polio and he said mom there are friends we have
to go back and it was that that taught me you know the true value of solidarity
and hanging out and it's you know it's years later when we need each other and
and that trust is there because it's built on a foundation of that is you know
there's really literally built on the ground,
being together, eating together, sharing together,
laughing together, and crying together.
But now can you describe in more detail then how you build up this polio initiative in Syria?
Because it's one thing to decide to do it and to create the conditions that
can be done, but then you need a huge network of participants who actually are
out in the different clinics or the shelters or whatever to inoculate people,
plus you must convince the population to also participate in this.
So how was that process structured?
That's where the syrians you know the syrians
did that not me i mean i was somebody who
was simply started going there uh to explore this
relationship between health and human rights because i think that when you violate
people's human rights it comes out in health both individually and at the population
level but because i was there and as a pediatrician i you know i gradually became
involved you know increasingly involved in in and you know,
and open to you know providing advice
and help and clinical services and
training wherever and whenever it was asked with me and
because I kept going back and back you know I started going to the border
first in Lebanon and then in Turkey and then you
develop these relationships of trust and access to those networks but the Syrians
were amazing at managing the polio piece which the government in Damascus was
busy trying to cover up and had no interest of course and vaccinating the northern
politically unsympathetic areas which had been neglected for years.
That was, I think that's the power of a civilization which has enormous reach
within its networks and enormous trust within itself because that can't happen.
Unless that has been there for a long time.
I mean, they're a very civilised people to be able to pull off these amazing,
you know, massive campaigns and get 92% of the population vaccinated at a time of conflict.
I mean, we couldn't do that in the States. I mean, look at what we're,
you know, so it's, you know, this is the thing about trust, of course,
it's a long-term investment.
And I was sort of able to be the person who conveyed it at a policy level and
could write about it and hold the argument.
And, of course, as an advantage, it sounds really precious, but I have a lot
of degrees off my name because every time I change countries, I have to re-qualify.
So I qualified in Australia and the UK and the US, but it's helpful when you
need to have the argument.
And I spent some time at Human Rights Watch learning the law as well so I could understand the law.
But it's then, you know, I can then take the heat,
as it were, so that 2Ns could receive some funding and support to be able to
do these things and to protect their population.
But I can only take my hat off and kneel thinking, I've never seen a population
withstand so much and still get so much done.
How did they do it? How did they do it? Was it top-down leadership?
Was it bottom-up trust and a shared set of values and goals?
How did they do it? Can you explain it?
It was certainly driven from the ground. It's the people who stayed and made
that choice to keep working,
to volunteer, you know, I'm not just talking about the doctors or the nurses, the pharmacists.
I mean, and honestly, like the pharmacists and the dentists are absolutely fundamental
in that kind of situation because they're super good at managing both the logistics
and understanding the patients and the drugs and so forth,
where doctors alone, like I can manage a cholera camp or an ER,
but you really need a dentist or a pharmacist to do all of the supply chains
and get those things done. That's a huge feat.
But the process of...
It still is remarkable to me, and it's a very good question,
and I would need to come back to you more about that.
I feel that they demonstrated solidarity in the face of such brutal oppression
and determination that,
you know, they would do it for their children.
Like, you know, they didn't go out, you know, they didn't decide to stand up
and to figure out all the different ways of dying, you know,
being shot at, being starved, being tortured, being, you know,
gassed, you know, being bombed, being incinerated.
You know they came out to figure out all these different ways of living for
their children and you think that you know we will all do
anything for our children and they would figure that out too but the
the the the masses of
people who who became you
know um you know volunteers or paramedics who
educated themselves and they shared their sort of skills in
a way that is counter um you know
contradicts what we understand of medical ethics you're
not allowed to operate in anybody else's field but you have to do
that you know in war zones and in these settings and to
share skills and they i think
that you know when when people can see the length to which you will go to help
protect you know children from being paralyzed and needlessly suffering then
that also it helps then you know at receiving end but it is also a lot of work
and you can imagine Imagine two-way.
Western, like say the children, for example, would come and do a cultural sensitivity exercise.
So then you have to get everyone in the village and you have a lunch together
and you say, this is what we're going to do. This is why we need to do it.
We're going to want your help in planning, whether it's a polo campaign or Mises campaign.
Oh, and then we need all your signatures to sign so that we can get reimbursed for the lunch.
It's like, seriously, I mean, it is like, It's just so insulting in a way that
you think, I mean, I cannot believe that you would do these things.
It's so counterintuitive to what we would really call cultural competence.
And especially in such a population that is so generous and hospitable and is
suffering such tragedies.
But in the polio campaign, would you also see people collaborating across the lines of conflict?
So people who were supporters of the government would still work together with
the revolutionaries, so the people who want to build a new nation,
they would still work together across these lines of conflict in order to advance
the polio vaccination campaign.
As far as possible, absolutely. Absolutely. I mean, it's more,
it's much more so from the, you know, from the North, you know,
who would, you know, with, you know, the Northern ethic was like,
we will help people everywhere insofar as possible.
So, for example, yes, they would, you know, they would hide the polio canisters
in milk, you know, in what you call the big canisters of milk,
you know, hold the polio vials in milk canisters and, you know, disguise themselves,
disguise them so that they could cross into villages that were under government
control and then vaccinate, you know, kids.
And they would then not, like, do the usual marking of the finger with purple
ink because otherwise, you know, then retaliation could be expected.
But certainly, you know, some government people would, you know,
look the other way in order that this could happen because there is some,
you know, common understanding.
But, you know, I mean, that also was deeply impressive.
I mean, the polio vaccination campaign was so successful that in the end,
you know, UNICEF even encouraged and supported the Syrians to cross the border through Iraq.
And vaccinate those in Iraq as well because we know, too, that Poland actually is fed into it.
And so that was the extent of the trust and the reach that they could actually do that.
And that was only because people stayed and they stayed and they –,
They demonstrated, I suppose, every single day that they were going to do the
right thing, no matter what. What's the vaccination rate?
What was the end result there? How big a fraction of the population got vaccinated?
Well, the first round alone was 92%, which was just massive.
I mean, Apollo doesn't, you wouldn't expect to have that high in a conflict
zone. And you have to do several rounds, of course, multiple rounds,
six, seven, eight, nine.
And certainly that's what stopped the polio outbreak.
And it took several months, but that was successful.
I think by the end of it, then 93, 94% of the population was vaccinated.
And then, you know, then it then, despite government undertakings,
of course, it then came back in 2017.
But this time it was vaccine-derived polio, which shows too that there had not
been a serious effort to vaccinate the population.
You know, by that stage, Darazor was under government control because vaccine-derived
polio only comes back when you haven't vaccinated people for a long time.
Right. So this is a massive public health effort.
It's collaborative, right? As you described it, they reached 94% more or less vaccination rates.
Now in the US, in response to COVID, where we have infinite resources basically
to get the population vaccinated, for the last seven months or more,
we have reached about 50% vaccination rate.
What's the difference between these two collaborative systems.
Well,
You know, it's been a very long time since we've actually paid any attention
to the importance of trust.
And we have adopted a model that is disease-driven and subordinates people to
the virus and to the vaccine.
So as long as you do that, it's very hard to see how we will get sufficient
social traction to get people to roll up their sleeves.
Because we are effectively saying this is all we need to solve the pandemic.
Everybody has to get vaccinated.
Well, that's not true. I mean, that is absolutely not true. And we see that right now.
I mean, you know, more broadly, you know, across the world,
you know, the effort that has gone into sort of this, you know,
let's keep those nasty diseases there in the, you know, in what we would used
to call the global south.
Will make every effort to make sure that Ebola or SARS or whatever the threat is doesn't come here.
But we won't address these Canadian killers like malaria or the other ones that
kill your children much faster and at a much higher rate on a daily basis because
they're no longer a threat to the West.
And that is not an ethos that can last very long. And across America,
we can see that people who have been.
Whose health has been neglected, they don't have services, they don't have access
to a decent standard of living, a great job, their kids are not going to school.
I mean, if you ignore what we would call the social or the political or the
economic, the environmental determinants of health, and all that we say is you
just need to be vaccinated, well, that's not true.
It's a very negative approach to public health. and ignores the positive issues
like, if we want you to stay home, let's give you some social protection.
Let's give you some financial protection to actually allow yourself to withstand this.
Let's give you the tools to look after your own health. Let's give you everybody
rapid tests so that you can test yourself every day and have some agency.
These are measures that actually build trust so that when the vaccine comes,
you are much more likely to accept it because you're actually part of the solution.
Solution but you know this paternalistic prescriptive approach
which has you know ignored the
importance of communication and says do this do this
do this and hasn't explained along the way you know and takes a long time to
update their priors so you know telling people to wash hands and wash services
when it's an airborne viruses and then when you finally say okay in may okay
it's airborne but you feel still fail to actually say okay now this is what
we need to do not very helpful.
And it's, you know, saying mask up everybody at a time when masks are even probably
becoming less effective as Delta virus and Delta variant and the others become more infectious.
What are people going to do? It's like, you know, a year ago,
we watched the world lay down their tools willingly.
To control this we've never seen that kind of paradigm before
of course governments you know think we'll have to shut down
but people did it willingly and we shut down and now
of course people are fed up not only
just fed up with the economic you know cost but because
where is the truth where's the trust we're not
going to do something unless we can see why we have to do it and where
are the tools now give us a time but then your description in some sense what
you are than saying is that the COVID-19 crisis also shows how healthcare systems
are not working anymore as collaborative systems.
Absolutely. And in that way have lost effectivity from a public health perspective.
Well, we commoditized health. And the minute we made it into a commodity,
then it stops being held in healthcare. healthcare, you know,
the real global public good here is not vaccines, it's care.
And that's what, you know, the Syrians demonstrate in spades.
They know how to care for each other. They have an architecture of care that
is just so obvious and so deep that it cuts across, you know,
racial, ethnic lines in a way that is, you know, we need to learn from that.
And we need to remember that even investing in healthcare workers,
which we obviously need to do of every kind,
not just called doctors and nurses, but the janitors, the porters who push the
trolleys, everyone who's in the line.
But in itself, it's hard to see how that will work unless we also invest in
caring for each other, and that theory of care, is that what it's called?
But it's that how, and, and, but part of that is,
Part of that, of course, is finding the tools which help us reconnect at a time
where we're already disconnected and digitally living.
And some of those tools include things like rapid tests, which can help us then
look after our own health, our family's health, our community's health.
Right. Those are the building blocks for collaboration.
But this is what we see here as well, is that with that, we've reached the end
of the sustainability of healthcare systems, right?
By commoditizing health, especially in the U.S., It also is at the point of
just not being sustainable anymore.
So is the current system future-proof or are you arguing for a complete reorientation
here of the approach towards health that is based on collaboration and different
values? How do you see that?
I think it's essential. And this is the opportunity because we've seen,
we've gone as far as we can with this biomedical approach that there is an antibiotic
or a drug or a treatment for everything.
It's not. I mean, Pasteur was
a PR genius and he really knew how to market the germ model and he did.
And and that really um that
really was the the point at which people diverged
from burkoff and who was you know
fully recognized the importance of of social justice of shelter of decent living
of a decent standard of living of a decent job of all these other things that
that the building blocks of health and we simply went down the biomedical model
as if there's every Every disease has one single cause,
and there's a drug or an antibiotic for all of this. That's just not true.
And it's pretty lazy, actually. I mean, it's low-hanging fruit, right? It's not.
And that was the, you know, when WHO, the World Health Organization,
actually was created out of the ashes of World War II and the...
The health office that was in Geneva, it recognized this shift that health wasn't
just the absence of disease, but the presence of physical and mental and emotional health.
I mean, mental health, we know is like a prerequisite for physical health,
but we still just pay lip service to it.
But, you know, even having recognized that, and it was given the mandate to
get beyond these negative approaches to public health, which is like vectors and vaccination.
Vaccination, of course, we love
it. It's our preferred tool of mass salvation, But it can only go so far.
But that approach didn't last very long because Cold War starts,
Iron Curtain comes down, and the superpowers prefer the model of disease diplomacy
and sharing vaccines because it's much easier than actually putting in place these other measures.
Governments like short-term solutions. They don't want to invest in it.
Well, but maybe it goes actually deeper, right?
Because also if you look at the scientific models, the epistemology of it,
reductionism is the way in which we often end up looking at the world,
even though what we try to understand are multi-scale integrated systems.
And with collaboration, we, of course, face a similar challenge.
But it also means that the way you described collaboration in public health
is actually a very tiny minority of all our activities within health systems and in public health.
The majority sits more in this incentive-driven, highly fragmented,
commoditizing of health.
And then, of course, we have enormous artifacts that are very costly for society.
Take the opioid crisis that the US is facing.
But are you fighting a rearguard battle here?
Are you the left of the Mohicans of how things could have been?
And we're off just in this direction and there's no return because of course
the power behind it is enormous health as a non-collaborative if you want neoliberal
exercise do you still have a chance to change that and if so where would you start.
Well out,
I am, we are, I suspect you are too. We are condemned by hope.
And we didn't always have this homo economicus approach to health,
nor did, you know, when you look at what Rockefeller did,
at the turn of last century, they did basically what Mackenzie Scott is doing
now, where there's a willingness to actually put money into areas that,
you know, with a high degree of trust.
And because we have to actually find a different way. I mean,
it's very clear now with the variants that this here-there approach isn't working anymore.
We can't keep things there and all we're doing, I mean, we did it before with
HIV and while we won the battle in terms of making HIV drugs accessible,
we certainly lost the war with big pharma and patents.
But the idea was or the rationale was that we can't,
you know they can't have them in the global south because people aren't literate they
won't be able to read you know the label they won't take them on time and
will create drug resistance that's not true
at all of course and that was disproven because africans and are much
much better more compliant you know and and than
many you know people across america you know
the rationale but you know 20 years later have we conquered hiv no because it's
much more than about making drugs cheap you know we have to address all the
other issues that go into to why people have AIDS and get AIDS and the agency
and all of the human rights and the issues that, you know, it's like giving a woman,
a woman's ability to inherit property will protect her, you know,
not just from AIDS, but from poverty and from domestic abuse and provide their
children with a much greater ability to go to school, et cetera, et cetera.
There's an importance of actually recognizing the linkages that.
Mean that you can do a normal, enormous amount if you put in the legal framework
and uphold it, for example, and you understand those connections.
More deeply, but, you know, looking at the variants, you know,
we have created, you know, the equivalent, the viral equivalent of the Hydra,
you know, the nine-headed monster.
Every time we like, you know, create a new vaccine, it doesn't matter.
You know, more heads will keep appearing.
And if we can't learn this lesson now, then yes, we pretty much are doomed because
the next pathogen is almost certainly here already.
We haven't identified it yet and but an approach
to public health that is limited to vaccines and doesn't
actually take you know start with people as as
part of the solution and figure out how to produce this you know this groundswell
of collaboration i mean we can do that and that's actually the only way you
can defeat that's the only way that we can defeat the virus i mean human collaboration
is formidable but as you say the monsters that are lined up against that are also So considerable.
Right. But in some sense, the medical professionals are one of the big obstacles
in the way of building a true integrated health system.
Or would you not agree with that? Go on.
Well, look, they are the ones who are representing also a part of these power
structures that have been following this route of the commoditization of health.
They have been selected into that system.
The ones who have more idealistic goals are not part of it because they wouldn't
survive in that environment. It's highly competitive.
It's very much about the monetization of health.
The guys who are good in that game will protect that game because this is how
they actually are important, have status, and make lots of money.
And of course, usually they're guys.
So are they not one of the big obstacles we face?
Because in parallel, as you also indicate yourself, actually,
for many pathologies, we see very little progress on actually curing anything
because people are just climbing up the wrong tree and they think they're getting to the moon, right?
So is this actually not one of our biggest obstacles that the way we have currently
implemented health as a non-collaborative system is the first thing we have
to dismantle to make progress? Yes.
Yes, everything you said is true. I think dismantling something is very difficult,
and it's probably easier to provide a way forward that enables people to start
to collaborate positively so that they don't have to necessarily detach or declare
their attachment to that model.
So what's the way forward if people are so conditioned around their incentives?
So, so can you, can you sketch that way forward?
Well, perhaps it's easier to start with places where there's conditionality
or these conditions aren't already cemented.
And I say that where across Africa, for example, people are really tired of
looking to the West for solutions.
And we see this hypocrisy where Gates, on the one hand, forces,
you know, Oxford University, which are providing the only open source vaccine
to partner with AstraZeneca, which, hello, has never produced a vaccine before.
And, you know, because Gates actually perceives IP as the lifeblood of the universe,
which of course is nonsense and is toxic and is,
and then, you know, by contributing also to COVAX, you know,
the, you know, the, you know, which is aiming to supply the world that doesn't
have access to vaccines.
And that's just hypocrisy of the first order.
Meanwhile Boris of course withdraws 95% of
development on developmental aid which so
much to Africa including 100%
of family planning because of course the US's attitude and the global gag rule
but then says but we will put a billion into vaccines this is nonsense and there's
no accountability of these kind of pledges but meanwhile Africans are.
At that point where I think, okay, let's start here where we can divest ourselves
of this Western, the West being addicted to developing us, as it were.
There's enough, I think, across Africa, there's enough innovators,
enough tech, enough people, enough,
there's a rising middle class and wealth that means they can invest in their
own health without having to go down that Western model of a biomedical model
and putting the disease first.
I think they can see much more clearly that the only way to actually stamp out
these diseases is by making people healthier.
And that starts with the actual conditions in which people live.
And it starts with exploring, you know, I mean, it's not that there aren't,
you know, there are certain tools which we think could make people a whole lot healthier.
You know, we know that fecal transplants are
incredibly successful for making our biome healthier and protecting us
from all sorts of diseases we know that viruses are responsible
for at least 25 of all of our cancers so how
about we invest in more live vaccines you know which we use anyway like you
know bcg measles oral polio you know which we're all familiar with and you know
and especially are well used across africa and southeast asia as tools which
might actually protect us against a lot of these uh expensive diseases so we
don't and get them in the first place.
So I think that, you know, we suffer from a global failure of imagination.
And when we, you know, it's going to be very hard to get people to detach from
our addiction to this biomedical model. I fully agree.
So I think it's easier to start where it's possible.
So, but then before we go for the final few questions, I would like to go back
to your involvement in the Olympics that are running right now,
where overall the situation is not great, right?
There's also lots of debate about the actual quarantine measures taken,
about the testing and so on.
So you wrote a paper and published in May where you were urging also the International
Olympic Committee and the local organizers in Japan to rethink the measures they took.
So in that sense, that's also an invitation for a collaborative effort to find the best way forward.
So did your paper have that impact?
No. Okay. And why not? Because they don't want to collaborate.
And that was very clear right from the beginning.
You know, obviously the natural people to collaborate with are the athletes
or the athletes' associations themselves.
They're the ones who have gained all the wealth of knowledge,
of expertise, best practice over the last year and a half.
And I say that as somebody who was involved in, you know, counselling the Women's
National Basketball Association, you know, last year. and they had a really
successful season, 87 games without a single positive COVID case.
But instead of actually inviting the people who know what they're talking about,
the World Players Associations, for example, and the experts that,
you know, like, I mean, I am not an expert around sport.
I've known people who are far more informed than I am, but I know who to ask.
Task and it's like the center of support and human
rights is full of experts where you think okay why don't
we just find out where the experts are and ask them but instead there's this
ethos of hand-picking experts who the IOC know will tow the party line and there's
also a fear that if they step out of line they'll be excommunicated and even
though we were myself and Mike Osterholm home,
who was such an amazing man,
an American public health heavyweight who has no fear and is such an expert.
Instead of actually really listening to what we're talking about,
they're just really paying lip service. And we can see that.
Relying on vaccination is a nonsense strategy when you could already see vaccine breakthrough.
And we know that vaccines were fundamentally just, their primary purpose is
to stop severe disease. It's not to stop spread.
So instead of taking a science-based approach or a risk-based approach,
they sort of created this charade and then how can we be surprised when it doesn't work out?
So, I mean, the good thing is that because of that paper, we have raised the stakes,
you know, to a much higher level and created a lot more awareness about what's
really going on because there's a huge lack of transparency.
I mean, how do we know what's going on? How do we know what their real testing protocols are?
How do we know you know um how people
are living eating sleeping i mean the athletes themselves that
we did the mental health they have a hotline paul
they have a hotline for mental health and for women or for anyone you know who's
who gets uh sexually assaulted which which shows you a lot about this approach
it's like no one is going to report so that's a great way of saying it didn't
happen who's at the end of the line i'm not you know that's a bit of a uh it's
not meant to be a a diversion or digression,
but it sort of epitomizes their whole approach where they're not taking it seriously,
but they are investing measures that look like they take it seriously.
And meanwhile, there's this.
Disregard of athlete, public, and global health movements.
But there's an interesting aspect to this, right?
Because there are two ways to interpret the International Olympic Committee's
response and the Japanese organizers.
On the one hand, it could be that they have just alternative objectives.
Their goals are different.
Their goals are essentially in collision with the ones of public health.
They're not telling you what these goals are, but that's why they're not listening.
This is one possible interpretation.
The other interpretation is it's sort of plain stupidity and mediocrity,
that people are following in a sort of habitual perspective on how public health
should be organized, how these kinds of events should be organized.
And they just march along that habit. it and if you deviate,
if you challenge them to deviate it is just rejected because the world looks
just fine from their habitual world model.
So which of the two sides would you take as your interpretation of this lack of response?
You're right. It's one of the most frightening things is colleagues that I respect
deeply who are utterly convinced or who have been up until the game started that,
Everything was absolutely fine, that we were drama queens who were banging on
about nothing, that vaccination would protect everyone, and it's not a big deal.
And you think, wow, I'm not sure where you're standing.
The world looks very different to me and to my colleagues.
But I agree that there is this combination, this fairly lethal combination of
mediocrity and complacency, where we have forgotten the importance of public health.
And we have had the pandemics of the 21st century before, SARS and H1N1,
which should have been dress rehearsals for this, have been really interpreted
as that, oh, well, it's never going to get that bad.
And, you know, the last century, we, you know, people talked about the death
of infectious diseases, which is, of course, is deeply arrogant.
I mean, we are facing, you know, pandemics and climate change and antimicrobial resistance.
Those are the three global narratives that affect us all.
You know, and once our antibiotics go, you know, we are really… Well,
you know, humans have declared victory over many natural phenomena on many occasions
that can get bitten in their backside very rapidly.
So the time capsule we're going to send to one of the possible inhabited planets
in the future will just say, look, we killed this planet out of stupidity.
This is our main opponent in building collaboration?
Well, certainly where the IOC
is concerned, they have a long tradition of rising above the rule of law.
I think that we can see now that, you know, you can only rise above the laws
of nature for so long. But, you know, we don't.
We should take a cue from the virus and understand that we have to,
this is the opportunity for change.
And the Olympics work a whole lot better. People perform better,
you know, higher, faster, stronger together when we actually
can actually create the best environment and
it's all you know one that when you
do that right and when from the right intentions then it's a
more profitable environment as well then work everybody it's a global win-win
which is one of the most tragic things because that's where I let's you know
you know instead of having a you know these bilaterals which are non-transparent
let's have the kind of conversation where we can all say the advantage right Right,
but there's another thing that worries me about your paper.
Look, it's published with some real experts in one of the leading medical journals in the world.
We have our mouths full continuously about evidence-based medicine.
Well, here's the evidence delivered in a highly credible, high-authority journal.
It has absolutely zero impact. So, is it actually just a pretense that evidence
matters in these debates on global health?
Well, that is probably the real question, isn't it?
The evidence from the very beginning of this pandemic has been that it was airborne,
microscopic, asymptomatic. We could see that right from the beginning where
the Chinese doctors that were infected were not, you know, were not the ones
in the ER or the ICU like we saw in SARS.
It was the family physicians, the ophthalmologists, the elective,
you know, people on elective surgery wards and the surgeons that were not,
that showed us that it was being transmitted asymptomatically and it had to be airborne.
And of course, the Chinese cover up, you know, and governments always cover up epidemics.
We know that, that is, that's, you know, that's pandemic 101. Public Health 101.
But, you know, the problem for...
The World Health Organization is that the countries, because they all adopt
this stance of you're not going to come in and cross our boundaries or interfere
with our sovereignty unless we say so.
They have no independent ability
or financial clout to be able to figure out what's really going on.
And so despite the obvious airborne and the evidence, and a lot of the scientists
put a lot of serious effort into getting this out there.
It took an enormous amount of time for both the CDC and the WHO to update their
priors, and we didn't see that till May this year.
And you think, wow, I mean, this comes back to the importance of communications.
And even well before evidence, that's the precautionary principle.
After all, it's like, this is what the evidence looks like.
And we know that for a disease that's operating like this, let's adopt airborne precautions.
Let's mask up. Let's look to our ventilation. Let's look to air filtration.
Let's figure out. And we can see that that is part of the problem now.
We didn't do that. People haven't been honest about saying, okay, we screwed up here.
You know what I mean? Fauci himself said, I'm sorry, I got it wrong.
It makes it much easier then to listen to him the next time around.
There's a real issue here, right? Because if you put in this effort to write
this paper, put all the arguments together, together, and there's subsequently
no response from your target audience, the IOC and the Japanese organizers,
it erodes trust in public health measures.
It erodes trust in the science behind it because the general public says,
well, these people make all this noise, but the guys in power are not impressed.
So are you now obliged to keep on hammering on this message until they give
in just to safeguard the trust in medical knowledge?
Well, certainly I'm not going to give up my position or my importance of evidence or my standpoint.
And when I say that there's no impact, I mean, I'm probably saying far too binary.
You know, it certainly has created a...
You know, a much more potential even moving forward to hold the IOC accountable
for this five-star fiasco.
And that's super important because this cannot be the global standard going forward.
You know, I mean, and that's, you know, we have the opportunity at a moment
in time where we can actually see the importance of science.
And, you know, then let's hold on to that ribbon.
Let's hold on to that quality and hold that line and use it to inform,
you know, our events, whether it's the Olympics or the football or the Beijing
or the World Cups going forward or the Dubai Expo or whatever it is,
you know, going and getting back to school.
I mean, let's use that evidence and let's hold the line on the quality and the rigour that we know.
And let's, you know, it is important to actually, you know, stop,
you know, call a spade a spade.
Like all the big winners of this pandemic have been the tech guys who,
you know, continue to churn out these, you know, but ridiculous contact tracing
apps that do nothing, haven't shifted the level, the dial one iota,
and yet there's all this pretense and lack of evidence that they do.
It's like there's no app for public health. It's not easy. You have to go out there and do the work.
And it is work, and it is harder in the face of all of this.
People's addiction to easy wins.
But achieving is just that, and it's not even a win, But with an opportunity
to actually put people first, we have to do that.
And we know what that looks like. It's not rocket science. We have to invest in it.
Otherwise, we don't. So, Annie, my last two questions. So, on the one hand…,
You're not demanding, are you, Paul?
No, not at all. I love the questions. Okay.
So, look, do you believe humans will ever succeed in building sustainable collaborations,
in this domain of global health?
Is it even possible? Will we be able to?
Yes, I do. Okay. That is my experience from the pandemic.
I do believe, I mean, I look around and I see all these different connections
and I'm grateful to them all.
All these new colleagues and collaborations that have enabled,
mood certainly have enabled me to try and do my best to help advance, to take part,
in this endeavor. So I think it is possible.
And maybe I am condemned by hope. But now, if you could change one thing in
humans, let's say we give you the most advanced technology, you can change one trait of humans.
What would it be so that they could achieve sustainable and sustainable collaboration.
Well, I think this is the collision of homo economicus and, you know,
very fundamental, you know.
What is the other, you know, the human beings that can,
that are able to cooperate and to overcome these global challenges is have to
be able to put people before profit.
So we have to give up our addiction to this money.
I mean, recognising that there's a limit to capitalism and to this model of
home economics, that means we can go so far down this model.
If you carry that model to the natural end, well, then I'm sorry,
you're going to kill so many people that you're not going to be able to make those profits anymore.
We're not going to see big pharma
change because drugs are the most profitable industry on the planet.
So that's maybe why that's one trait that I think has to change if I could actually change anything.
Okay. Annie Sparrow, thank you very much for this conversation.
It's a pleasure. That was a pretty tough conversation, Paul.
You're pretty demanding.
Hi. You listened to one of our podcasts in the series on collaboration produced
by the Ernst Trommel Forum and the Convergent Science Network.
You can find more episodes on our website.