World Health Organization Chief Scientist Dr Soumya Swaminathan, a respected voice in WHO’s senior leadership is expected to resign within the next month – in the first major leadership shuffle by Director General Dr Tedros Adhanom Ghebreyesus since the COVID-19 pandemic began, Health Policy Watch has learned.  

Conversely, Dr Mike Ryan, executive director of WHO’s Health Emergencies Programme, who had earlier been expected to leave the organization, appears set to remain, several WHO insiders with knowledge of the pending reshuffle confirmed.

Sources said that Swaminathan, who at age 63 is still two years short of WHO’s mandatory age of retirement, had wanted to remain for one more year in the office which she has built from scratch.  

However, Tedros is reportedly keen to make changes in his leadership, senior staff perform at the director general’s will – and there have also been hints  that Swaminathan’s style was too independent for the director-general. 

Another source close to the chief scientist, however, said that she was leaving voluntarily after five years in senior WHO leadership to reunite with her her husband and elderly parents – who have remained in her hometown of Chennai, India while she served in Geneva.

The upcoming reshuffle is also likely to include the departure of WHO Deputy Director Dr Zsuzsanna Jakab, sources told Health Policy Watch.  

Jakab, a Hungarian health professional born in 1951, is already well over the WHO mandatory retirement age of 65 – which can be exceptionally extended only by three years. She previously served as the Regional Director for WHO’s European office.

 Ryan, who appears set to remain for the moment, is highly regarded in emergency circles. However, he is also someone who has remained consistently deferential to Tedros’ own political authority and direction throughout more than two withering years of WHO’s COVID pandemic response.  

Ryan was appointed as executive director of health emergencies in 2019 following Tedros decision to sideline the noted Australian epidemiologist Dr Peter Salama.  Salama had held the post since 2016 – when he was appointed on the tail end of the West African Ebola epidemic that caught WHO off guard and prompted a major reorganization of the agency’s emergencies team. 

But in Tedros’ first big internal reorganization, the director general nimbly moved Salama from Health Emergencies into a newly-created position as the Executive Director of “Universal Health Coverage”. 

Salama accepted the new role with grace.  But internally the shuffle was seen as a figurehead role and a kind of demotion by Tedros, who reportedly habored a grudge against Salama, one former WHO official told Health Policy Watch.  That dated back Salama’s reported criticism of Ethiopia’s mishandling of a series of cholera outbreaks in the period when Tedros was the country’s health minister from 2005-2012. A mismanagement scandal that rocked the WHO Emergencies team, led by Salama in 2018-19, had nonetheless created the political opportunity for Tedros to act. 

In January 2020, shortly after Salama took on his new role on UHC, he died of a heart attack.  

Tedros’ Centralised leadership style  

The question is now who will replace the outgoing Jakab and Swaminathan – both known as strong, experienced leaders – along with other, lesser-known names who may also be swept aside in the pending shuffle.  

Tedros’ tenure at WHO has been marked by a centralized leadership style, as a Lancet editorial observed in late August. And that has left less space for senior staff to express themselves independently, than they typically did under past director-generals – a concern for a science-based organization. 

“Power has been increasingly centralised around the Director-General’s office under Tedros’ leadership. This strategy might be advantageous in a crisis that demands a commander-in-control. But a lack of depth in wider leadership leaves shortcomings in the organisation, stated The Lancet, in an August editorial marking the start of Tedros Adhanom Ghebreyesus’ second term in office.

“It’s a very sort of lonely, authoritarian way of power – that’s clear,” one diplomatic source, who has known and admired Tedros since his days as Minister of Health in Ethiopia (2005-2012), told Health Policy Watch.

Expresses herself publicly on sensitive topics – including COVID treatments   

Swaminathan has been one of the few senior WHO staff to express herself publicly and independently on oft-controversial issues. During the COVID crisis she appeared very frequently not only at WHO global media briefings, but on international and Indian TV.  

She distinguished herself, in particular, by her willingness to speak out about the emerging evidence around new COVID treatments – in cases where WHO went against the trends of politically popular but scientifically unfounded therapies – including remdesivir, Ivermectin and hydroxychloroquine. 

On remdesivir, in particular, WHO recommended against using the drug in November 2020, bucking a US Food and Drug Administration approval of the drug developed by the pharmaceutical company Gilead.

At the time, Swaminathan bluntly told journalists in a WHO global briefing that the FDA had ignored evidence submitted by WHO from in a multi-country “Solidarity Trial” to the effect that the drug failed to reduce mortality or yield other measurable benefits.  The fact that she dared to reveal such information on the powerful FDA so frankly was an unusual move for a WHO official.  

Independent voice in Indian science circles

Swaminathan’s statements also have bucked politically popular positions in India. Her statements on the lack of evidence for Ivermectin as a COVID treatment, earned her the wrath of the Indian Bar Association – which went so far as to file legal complaints against some of her comments in 2021.  

The IBA, Indian insiders told Health Policy Watch, tends to parrot positions of the government of Prime Minister Narendra Modi,   

Swaminathan’s comments on ivermectim, however, lined up squarely with the fact-based guidance of not only WHO but also India’s own Ministry of Health and Family Welfare – which in spring 2021 dropped ivermectin from its own list of recommended COVID treatments. Swaminathan welcomed that move saying that the revised national guidelines were  “simple, rational, and clear guidance for physicians. 

Evidence based guidelines from @mohfw DGHS – simple, rational and clear guidance for physicians. Should be translated and disseminated in all Indian languages.
Can be updated as and when new evidence becomes available @drharshvardhan @WHOSEARO https://t.co/xNX0Ngj35y

— Soumya Swaminathan (@doctorsoumya) June 6, 2021

When Tedros first was elected as WHO Director General, in 2017, he appointed Swaminathan as his deputy director general.  However, in a 2019 reshuffle, he then moved her from the DDG’s post into the newly-formed chief scientists’ office.  It was something some WHO insiders also interpreted as a kind of political sidelining by Tedros – although Swaminathan was eminently well-suited for her new role that placed her in charge of WHO’s evidence base.  

WHO observers will now be watching closely to see if Tedros appoints a new chief scientist with the stature to speak out as Swaminathan did.  A noted India pediatrician and researcher in tuberculosis, she previously served as the director of the Indian National Institute for Research in Tuberculosis in Chennai and from 2015-2017, as director general of the Indian Council of Medical Research.  

From 2009-2011 Swaminathan also was coordinator at TDR, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, based in Geneva. 

Anticipation mounting 

Anticipation of the pending senior WHO staff reshuffle, was mounting this week as Tedros formally announced several new director’s level appointments in WHO, as well as 11 new country representatives, in an internal WHO staff message distributed on Friday.  

The new appointments include Gaya Gamhewage, a Sri Lankan physician as  Director, Prevention and Response to Sexual Exploitation, Abuse and Harassment. 

Gamhewage has already been acting in that critical position, where she is leading much of the WHO programmatic response to the sexual exploitation and harassment scandal that erupted in the Democratic Republic of Congo in September 2020. The allegations raised in DRC are the focus of a still-ongoing internal investigation.

Tedros also announced the appointment of Dr Alian Labrique, a Belgium researcher as director in the relatively new WHO entity of Digital Health Intelligence.  Labrique is a former Professor and Associate Chair for Research at Johns Hopkins University. 

At the same time, Tedros announced a new WHO country representative to the Democratic Republic of Congo, Dr Boureima Hama Sambo, as well as new heads of office in Mauritius,  Barbados, Panama, Qatar, Romania, Albania, Belarus, Solomon Islands, DPR Korea (north Korea) and Myanmar. 

Along with the resignations of Swaminathan and the retirement of Jakab, Tedros is expected to announce the retirement or removal several other senior staff, who currently hold positions as Assistant Director General, in charge of WHO’s major disease and thematic clusters.

Image Credits: WHO, Fletcher/HPW .