Earlier this year the World Health Organization created and filled a position that — if the advice in a raft of external Ebola response postmortems is correct — should help the UN agency rebuild its battered reputation.
The job: executive director of its new health emergencies program.
The successful applicant: Dr. Peter Salama.
Salama’s mission will be to help manage the response to health emergencies — and to forestall the types of bruising critiques the WHO got after the H1N1 pandemic (“an expensive over-reaction”) and the West African Ebola crisis (“a fatal under-reaction”).
Trained as a physician in his native Australia, Salama, 47, has worked for Doctors Without Borders, the Irish NGO Concern, and the Centers for Disease Control and Prevention, which lent him to the UN High Commissioner for Refugees after the Sept. 11 attacks.
He joined UNICEF — the UN Children’s Fund — in Afghanistan in 2002. Over the next 14 years, he held multiple posts with that agency, in New York, Zimbabwe, Ethiopia, and most recently, as regional director for UNICEF Middle East and North Africa, based in Amman, Jordan, where his responsibilities included for programs in war-torn Syria, Iraq, and Yemen.
STAT recently sat down with Salama at the WHO’s Geneva headquarters to ask about his background, his priorities, and how he handles stress.
This transcript has been edited for length and clarity.
You seem to go from conflict zone to conflict zone.
[Chuckles.] I spend a lot of time in humanitarian contexts, yeah.
What made you want this job?
I wasn’t actually looking for a move. But many people contacted me and asked me to apply.
And then when I looked into it and began to research, I realized that it was one of the most critical jobs at the most critical points in time in global health. So I decided to apply.
That suggests you think that you have something that the job needed. What was that?
I think the ability to manage very large programs with a proven track record of delivering results in those programs — both the people and the money and the other elements of that. And I think the ability to be strategic and anticipate issues and events and look ahead at what’s required.
I’ve always worked in partnership with other organizations. … I’ve got a pretty good picture of what it looks like to be on the inside of a lot of global health actors and partners. And of course that helps when you’re partnering with them to understand what they can bring to the table. Because WHO can’t do this job alone.
You speak very softly. Is that deliberate, or is that just you?
That’s just me. I’ve never had a loud voice.
It’s never stopped me from making clear my leadership role and my priorities. Leading teams, galvanizing teams, inspiring teams. It has never been a hindrance.
The press releases coming out of the health emergencies program aren’t just about diseases anymore. They are about diseases and refugee crises. Is that a reflection of your interests and experience?
One of the premises of the design of the new program was really to put together a number of key departments — the humanitarian emergencies side, the infectious hazards side, and then of course, also substantively, the emergency preparedness side.
I think that was very good thinking in terms of the design, because increasingly we see a real confluence of infectious diseases and vulnerabilities with humanitarian and political insecurity concerns.
And I think that confluence is going to challenge us more and more in terms of where we’re working but also how we work. It’s not just about sending the infectious disease experts in. They have to have access. They have to be protected from a security point of view. So it’s becoming extremely challenging and nowhere more so than of course the Middle East.
You’ve had to hit the ground running. What are your short-term priorities?
The first is to make sure WHO itself has the capacity required at the right level to deliver. And as you know WHO has suffered from budget cuts for over the course of more than a decade – and nowhere more so than some of the departments that I’m now responsible for. And we see the impact that that’s had.
There’s a mismatch between what’s expected of WHO — in this case to detect and do risk assessments of up to 200 to 300 events every year — and then the number and capacity of staff at all levels who are working on such an important issue. So we’ve already put a significant investment into the staffing and capacities in that area.
Also, WHO has had many gaps in the way it addresses partnerships. And I don’t think in this day and age that one can rely solely on a mandate. One has to earn the trust and respect of your partners, through strong technical expertise and also the ability to clearly see what other partners bring to the table and to utilize that effectively.
That’s kind of hypothetical. Give us an example.
So rather than coming to partners with an already full-fledged plan and saying, “Here’s the plan, and this is where we see you as our partner,” to actually start way before then. To start right at the beginning and say: “OK, there’s a new emergency, a new crisis. Let’s bring who we believe are the critical responders to this crisis around the table right at the outset and discuss what we think are the critical priorities and then agree, in real time and bring them on board from the outset.”
That hasn’t necessarily traditionally been done by WHO. We’re trying to really change that, to make sure partners understand that they really are respected for what they bring to the table.
Your experience at multiple other agencies must be helpful here.
I’ve heard the critiques from those agencies, whether they’re NGOs in civil society or the UN. And I’m really determined that WHO does this well. Because WHO is always going to be a relatively modestly sized organization compared to many others.
You mentioned the mismatch between expectations and capacity. WHO seems to be locked in a cycle where funding cuts hurt performance, which eroded confidence and is now hindering fundraising. Your program has raised about 56 percent of the $485 million it needs to function. How do you close that gap?
Some countries have made actual commitments. The US, for example, mentioned its $35 million commitment over three years. The Japanese government mentioned its $50 million commitment over 2016-17. And the UK, $40 million.
I was left fairly positive that we’re now starting to see the donors go back to their capitals and make some serious commitments.
This program is part of the core business of WHO. I firmly believe WHO will be judged on the success or failure of this program. But for this program to be successful, we’re going to have to find a sustainable model of financing, which is not just about us going every year with a begging bowl to donors and saying, “Look, here we are again. We’re about to run out of money.”
We have to be able to plan ahead. And if we’re doing more than reacting, but actually building capacity, that takes a multiyear commitment to our country programs and our member states.
It also takes a multiyear commitment to staff. To get the best possible expertise, which we really should be striving for — absolute excellence and technical experts on all of the high-threat pathogens — you can’t offer them a three-month contract.
And that’s the situation we’re in.
What about long-term goals?
Part of what I’ve really learned, especially in the last 10 years, was the countries that lag behind the most and where I think the global health community failed most dramatically were those countries that I would classify as fragile states.
This new program has a real obligation to work very closely with the other technical departments of WHO that can address this together.
What we know is that countries where they are delivering basic primary health care well have an enormous ability to detect and respond quickly to outbreaks and emergencies.
How do you handle the stress of this type of work?
Obviously it’s not new to me, having worked in the Middle East and in a range of other stressful settings. I guess the way I handle it is through family and friends — having a strong social network and through outside activities. I’m a squash player, for example; I love playing squash.
And having a very strong team around you is critical, in my view.
How are your children [three boys, aged 11, 10, and almost 3] adapting to life in Geneva?
They’re still in Amman. They’re waiting to get into schools in Geneva. That’s stressful!