María Neira: “If companies like MAPFRE are offering to vaccinate, we should accept those resources”
On World Health Day, one year after the COVID-19 pandemic was declared, we interviewed María Neira, director of the Department of Public Health and Environment at the World Health Organization (WHO), by video conference. We discussed the global crisis, challenges for the future and threats such as protecting solidarity, the health of climate change and combating inequalities. We also addressed the offer from MAPFRE’s Chairman & CEO to provide resources to speed up the vaccination process.
What assessment would you make of the situation? Where are the WHO’s concerns currently focused?
The consequences of this epidemic are devastating, both at the health level and at the social and economic level, in terms of a setback in the achievements combating poverty, education or human rights… For us, that’s a great concern. The bottom line is that we must have universal and free public health, we must be adequately prepared to respond to epidemics, we must have well-trained and protected health professionals, and international solidarity must work, which has served scientific solidarity. Everything can be improved and we will have to see not only how to prepare for an emergency, but what brought us here. What are the causes[i] and how can we reduce them… It’s clear that there will never be zero risk, but we have to analyze what we can do to reduce this human and health-related weakness as much as possible. I believe that many of these issues have already been identified.
You lead an area linking public health and the environment. What can you tell us about the connection between the destruction of nature and the outbreak of deadly viruses such as SARS-Cov2 or Ebola? Do you see a growing awareness of the need to protect our environment and meet the goals of the Paris Summit now that COVID-19 has made us rethink how we live?
I think that it’s no longer a matter of raising awareness, but of speeding up the processes to stop this destruction, to let everyone know that we cannot fight against nature, because we will lose. This is clear and has already been demonstrated by AIDS: the virus was detected in areas where the barriers between human health and animal health had been broken. We have already had many warnings from other pandemics, which were due to stressful environmental conditions that again created the perfect conditions for the virus to be spread to humans. At this point we could see that global warming was the crisis we were facing. As soon as we have dealt with the pandemic, we will have to focus on this crisis much more. It’s no coincidence that the places where there have been more and more severe cases of COVID-19 are those where the population had long been exposed to air pollution, which had made their lungs more vulnerable, adding an additional risk factor.
We must repair our relationship with the entity that gives us food, drink and air, and that’s the environment. Now, it’s no longer just a matter of awareness and environmental education: it’s a matter of being able to survive. The next pressing matter is that we are eating the plastic that we throw into the ocean. We’re destroying it, it’s like after a harvest, what farmer would think of throwing on bleach and burning and destroying the land that feeds him? This is something we’re doing in every production process we have in place.
“We must repair our relationship with the entity that gives us food, drink and air, and that’s the environment.”
With the role of international bodies and the reinvention of multilateralism, it is possible that, since the creation of the United Nations 75 years ago, there has never been a moment of truth as important and of such global risk as this one, with the exception of wars. Are they prepared? In the face of national populism and selfishness, for example in the vaccine race, is cooperation and multilateralism the answer?
There’s no doubt that [multilateralism] must be reinvented, but it is the answer. If it had not been for international cooperation between the scientific world, in which all scientists responded in a completely altruistic way to all the work groups we set up to issue scientific recommendations based on science, if it had not been for how knowledge was exchanged between different researchers, between different clinicians who were treating patients, exchanging data, we would not have discovered what treatment worked best in record time.
It’s clear that we aren’t going to make much progress if we put measures in place in the richer world and let the others drown. We need it to keep the virus at bay, because if we keep it alive elsewhere it will still threaten us, we need it as a market and above all to live in a peaceful and stable world. It’s clear that if we support some and not others, peace and stability will be jeopardized, and violence and the struggle for survival will resurface… I hope that the next fight will not be for water, it’s one of those hidden realities, buying land to extract water. The scarcity of water resources is going to be a problem. So of course, cooperation with major organizations, a United Nations that responds to the needs we have and where politics are a factor, but in the sense of dealing with the common good.
“We aren’t going to make much progress if we put measures in place in the richer world and let the others drown.”
…In the sense of everyone being united as well. Because the WHO is specifically warning of “a grotesque problem in the vaccination process.”
Yes, it was expected. It’s a free-for-all, but it’s going to have to be stronger together. That’s why we launched the COVAX program to at least allocate some resources to countries that would not be able to finance vaccination campaigns. Somehow, it reminds me of when we started with anti-retroviral drugs against AIDS when there was a trend of absolutely absurd prices for treatment that the rich world could afford, although there was also a very big bill for the health system. And when prices were negotiated, when the market “opened,” obviously everything progressed much more and we were able to reduce the prevalence of AIDS deaths and serious illnesses, which also consume a lot of resources.
You have to be very strategic and the truth is that protecting nature has a lot to do with protecting yourself, especially in a selfish way, and solidarity with others is also very strategic. If you don’t see the argument for solidarity and equity, you have to use the economic and risk argument, and perhaps you get a better response there. But whatever the argument used, we need to be supportive, strategic, visionary and we need to save everyone and learn some very basic lessons. It bothers me when people say: save the planet. I find it very arrogant! We aren’t going to save the planet, we have to try to keep the planet from destroying us. To do that, we must stop attacking it so outrageously. Then we’ll all be better off.
Speaking of generosity… as a Spaniard, you will have seen the urgent messages about the damage that lockdown has done to the economy and to life in society. Were there other options? What worked best: tracking, bubbles, lockdowns limited to restricted healthcare areas, masks?
We’ve long recommended five measures, which have been scientifically proven to have an impact. Obviously whether we use all five at once or whether we use only one, you have to figure out what risk you are exposing yourself to and what risk you are exposing others to. It’s clear that in a rational and proportionate manner the best things are ventilation, because we know that this is where the highest transmission occurs, in enclosed, crowded spaces and where there is closer contact, because aerosols accumulate and obviously transmission is much easier. If we know that this is happening somewhere, we’ll take action: we’ll increase ventilation, the use of masks and of course hand washing, which I believe is one of the most basic public health measures but also more effective and not costly. We should do so very naturally. It’s one of those measures we call logical investment and common sense, without any downside, because it certainly works. Another is using your arm as a barrier, sneezing into your bent elbow, because in the end it’s not only that. You, as an insurance company, will know very well that until recently, before the pandemic, it was socially accepted that a person with flu or cold symptoms would come to work. It was even encouraged! “I feel terrible, but I’m here and sneezing, coughing”… We saw it as something that almost deserved recognition and thanks. Fortunately, that will no longer will happen. No person with symptoms of an infectious illness will presume to be so good a worker that they put themselves in a position where they can pass it on to others. I think that has benefited us in terms of flu transmission, which has not been so strong this year. These are fundamental measures. Others have a smaller impact and a lot is still being spent on them. I would recommend those five, to do a risk assessment and to have each of us act as a risk manager and assessor, and from there be aware of the risks you are taking and what risks you pose to other people.
“We aren’t going to save the planet, we have to try to keep the planet from destroying us. To do that, we must stop attacking it so outrageously. Then we’ll all be better off.”
MAPFRE president Antonio Huertas launched a very clear appeal in February offering all the company’s resources to accelerate the vaccination process, once the priority groups had been immunized. What does this initiative suggest and what do you think of public-private collaboration at such a crucial time?
I have no doubts whatsoever. This type of collaboration is necessary. It’s already very necessary in normal situations, all the more so in exceptional situations such as this. We rely on this a lot, because sometimes those who work in public health, trying to push the agenda, know that the private sector can have a lot of influence. We work with the private sector a lot to, with all due respect, influence. A company like MAPFRE can promote very important prevention policies, of course avoiding the use of tobacco, promoting a much healthier lifestyle, with balanced menus and education on nutrition, it can propose and promote environmentally friendly practices, reduce the carbon footprint, introduce much greener, sustainable corporate practices… I know it does. Reducing cardboard or plastic used in packaging processes, promoting sustainable transportation for employees, making it easier than ever to travel without a vehicle. There are so many ideas that the public sector can put in place… I always say that I would negotiate, talk with all sectors, even with those who produce products with high calories, with a high sugar index… It’s the only way to move forward together, to somehow create positive pressure, positive competition. This type of collaboration is essential, necessary, it stimulates creativity, generates positive competition between different sectors and in some way allows us to monitor and observe the level of compliance publicly. I see many advantages, obviously without the private sector having any kind of pernicious influence… we already put all the barriers in place so that this is not the case.
“I believe that we can vaccinate and effectively achieve herd immunity here in the summer. We need to have this goal, and not accept another scenario”
I know you will not be able to draw a particular scenario, but to give us some hope. When do you think we’ll be able to return to normal, similar to what we can remember, remove our masks, hug each other, travel?
We need to be very positive, because among other things we need a goal, hope that will encourage us, because otherwise the next pandemic will be a mental health crisis and we cannot afford that.
I’ve organized vaccination campaigns in Africa, one of which I remember well, for cholera in a refugee camp, and we vaccinated an incredible number of people in three days. If we can do that in Africa, I believe that we can vaccinate and effectively achieve herd immunity here in the summer. We need to have this goal, and not accept another scenario: It has to be that. So if we need to put measures in place to speed up vaccination, we need to look for them. And now more than ever, pharmaceutical companies are encouraged to share part of that intellectual property protection, find ways to transfer technology, including protecting them in their profits, of course, but somehow accelerate production, technology transfer and vaccination somehow. Because it’s up to us all to restore mental well-being, and stop this suffering that we’re all experiencing. We must accelerate this however we can, and if there are companies like MAPFRE that offer to vaccinate, if there are vaccines of course, we must accept those resources.
 The interview was conducted days before the publication of the WHO’s report prepared by the international team following its visit to Wuhan between January 14 and February 10, 2021.