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When COVID-19 rapidly emerged, the World Health Organization (WHO) was thrust into an unprecedented challenge. The global pandemic response was in disarray; healthcare resources were limited and inequitably distributed, and misinformation burgeoned.
At the center of this maelstrom was Soumya Swaminathan, MD, who served as the WHO's first chief scientist, from 2019 until 2022. Swaminathan not only spearheaded efforts to disseminate the latest scientific findings about the coronavirus and vaccine development, she also became one of the major public faces of the WHO.
In this episode, Henry Bair and Tyler Johnson, MD, talk with Swaminathan about her formative years becoming a pediatrician in India, and specializing in the treatment of children with tuberculosis and HIV, as well as the challenges she faced as a leader at the WHO during a time of eroding public trust.
In this episode, you will hear about:
- 2:05 Swaminathan's experiences training to become a doctor in India
- 6:00 How Swaminathan discovered the balance between her interests in clinical medicine and research
- 9:38 Swaminathan's reflections on the challenges of caring for children with tuberculosis and HIV
- 14:08 A discussion of global research funding disparity
- 19:04 How Swaminathan joined the WHO and eventually came to fill such a critical leadership role there
- 21:28 Swaminathan's recollections of the arrival of COVID-19 from her perspective as the WHO's first chief scientist
- 27:46 Lessons learned in health communication from the pandemic
- 35:07 The experience of being a lightning rod for online harassment and misinformation
- 39:25 Swaminathan's advice to new clinicians who are considering pursuing a career in global health
The following is a partial transcript (note errors are possible):
Bair: To kick us off, can you tell us before you became a leader in global health, before your involvement in the WHO, what first drew you to a medical career?
Swaminathan: So when I was growing up, I actually never wanted to be a physician or a doctor. I wanted to be a veterinarian because I was very interested in animals and was fascinated by animals. I also did grow up in a research institute where I had the opportunity to explore different labs and departments, and I always had in our house, we had a lot of students coming to see my father. These were master's students, PhD students. So it was quite commonplace as I was growing up as a child to be hearing a lot of science being discussed and things like PhD theses.
And so I think my interest in science was there from early on. It was only when I finished school and went into my first year of what we called pre-medical that I found a lot of my peers were going to try to get into medical school. And it occurred to me then that what I was interested in doing -- that is, science or genetics or research -- could also be well served after a medical degree.
And so it was quite serendipitous that I decided to take the medical entrance exams, which, as you know, are highly competitive in India. Knowing that I had less than a 50/50 chance of getting into medical school. And I thought that would determine which path my career took. As it turned out, I did get in to the Armed Forces Medical College in Pune and decided to go ahead and join the medical school and started enjoying the course very much. And through the first 4 or 5 years of medical training, I found myself being drawn to the pediatric ward because, again, I think of my love for animals and love for children.
I was instinctively drawn towards children and by the time I had passed out of medical school, I knew that I wanted to do a postgraduate degree in pediatrics. And so that's what I then aimed for. Of course, one has to again go through the whole round of entrance exams to get into a postgraduate program. But I was lucky to again get into one of the best schools in India, the All India Institute of Medical Sciences in New Delhi, which is where I ended up finishing off my MD in pediatrics.
And as I was doing that, I got interested in respiratory diseases of children -- of course, one of the commonest problems that children come into hospital with. And so I then applied and got into a fellowship program at the University of Southern California in Los Angeles to do a program in pediatric pulmonology and and neonatology. So that was where I did my fellowship and where I also learned really the basics of research, research methods, and how to go through the whole process end to end, from thinking about a research idea, how to conceptualize it, how to undertake that research, how to problem solve and troubleshoot, and then ultimately how to analyze the data, as well as publish it and present it at conferences. So I would say the 2 years I spent in Los Angeles was really the shaping of whatever innate research interests I had into something that was much more concrete.
Bair: I know that when I speak to attending physicians I know who were trained in India, I get the sense that, you know, as you alluded to, medical school admissions in India is insanely competitive, probably the most competitive of any country in the world. So I always have a lot of respect and admiration for India-trained physicians. I'm curious, since you spent so much time while you were in California learning how to be a scientist, was that something that you came in knowing that you wanted to do, in the sense that, you know, how did you conceptualize balancing clinical care, providing care for children versus time conducting research?
Swaminathan: So, as I mentioned, I was always interested in research. I don't think I ever imagined myself doing only pure clinical medicine at any time. I was always interested in asking questions. Why and how can we do better? And why is something happening? And so when I decided to go to the U.S. for a fellowship, one of my goals was to improve my research skills, which I thought were not very good at that point of time. So even though I had a great interest in research, I didn't think that I was well-equipped with the knowledge and the tools.
And this is why I enjoyed my time in Los Angeles so much, because my teachers and mentors there were excellent researchers, apart from being excellent clinicians. And so not only did I learn a lot going on ward rounds with them, and then, of course, I was also managing patients myself, but also really learned to think about clinical problems that needed solving through more research.
An example is the control of breathing, which at that point in the late 80s, we understood very little about, even though we saw a number of children with breathing disorders that were related to central control of breathing. And so a colleague and I designed equipment on our own and built them from scratch so we could actually study the hypoxic and hypercapnic responses to ventilation and published a series of papers, which I think were quite seminal at that time, trying to understand how breathing is controlled and going further actually to look at the genetic influences. Looking at twins to see how much of the control of breathing is genetic versus environmental. So it was delving into areas like that.
Maybe this was like pure physiology for some, but trying to answer things which had not been well understood and doing it from starting from a problem, a child actually has a problem and and then you're trying to solve that. So this is why when I came back to India after my fellowship, I really wanted to focus on children's respiratory diseases, including tuberculosis. It's very different from adult diseases, and very often people don't appreciate the difference between [adult] illnesses and children [illnesses].
Children are often treated as little adults, and that's a mistake that's made repeatedly. So this is why I was fascinated. Of course, it's much more challenging to do the research in children because you have to get the cooperation, you have to get their trust. You have to get them interested and wanting to cooperate with what you're doing. But, you know, that's all part of the fun.
For the full transcript, visit The Doctor's Art.
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