S3-Episode 4: We Need to Save More Lives

Melissa Fleming  00:00

My guest today is Mike Ryan from the World Health Organization. as Executive Director of The Health Emergencies Programme, he's leading the team responding to the international containment and treatment of COVID-19. Mike, you first joined WHO in 1996. And since then you've had to deal with the epidemics of Ebola, Cholera and SARS. How is this situation today different? 

 

Mike Ryan 0:30

It's different in terms of scale and impact. I mean, many of us who've worked in this field and many of us in the humanitarian side of UN have seen great epidemics in the past, and epidemics that have killed many people and sometimes across countries, but they've tended to be regional, or sub regional. It's very, very rare event in the world where we face a global disease that's effectively bringing all systems to their knees, and therefore it's much more difficult to help people when everyone is affected. 

 

Melissa Fleming 1:04  

Did you ever think you'd be in a situation like this, though, that you would see a global pandemic, on your watch? 

 

Mike Ryan 1:11

You know, we've had scares in the past, certainly with Avian influenza, in the 00's and certainly SARS, and 2003. We did have a pandemic in 2009, with a very mild strain of Influenza a real bullet dodged. And in that sense, we had the warning shots, we very definitely had the warning shots. I just don't think collectively, we've invested enough. I don't think we collectively the global or national level, have taken the threat of epidemics and pandemics seriously enough. 

 

Melissa Fleming 1:46

Are you hopeful that this time the world will listen after COVID-19? 

 

Mike Ryan 1:51  

Yes, I mean, will we live in hope. My greater hope is, I mean, I think two things one is that humanity displays the best of what it is, at times like this times of adversity, we've seen a massive outpouring of human solidarity around the world. And we need to be able to use that going forward. To make a better planet. To make a better world. We need to make some big decisions we need to, we need to sit down and talk to ourselves as a human civilization and say, you know, what are our values going forward regarding our planet, the way we live the way we treat each other. 

 

Melissa Fleming 2:28

In order to fight this pandemic? What does WHO need right now?

 

Mike Ryan 2:32

I suppose six months in you sort of try and distil down in your head, from all the hundreds of things that are going on and all the things that you need to do the day to day that everyone is doing. But for me, there's four fundamental things we need to do better in the next six months and improve not that we haven't collectively done already, but we need to do better. One is we need to continue to drive down mortality In other words, we need to when people are sick, we need to save more lives. And we're seeing how we can do that with better care with oxygen with better management of clinical pathways and making sure that everyone on the planet has access to basic medical care if they have COVID. Second thing we need to do is continue to suppress transmission drive transmission down. So driving down mortality, driving down transmission, but neither neither of those two work in reality, unless our communities are empowered, knowledgeable, they know what to do. They feel that they're in control of their destiny, they have the information that they can trust and they're able to act on that information. And if you get those three things, right, again, you have a problem unless you have a really committed government, good governance and solid coordination of what sort of international national and at the state or the province level. And I think when we look at the, you know, the missing ingredients in this pandemic, They haven't necessarily all been scientific. Yes, we don't have a vaccine, we need to build one. We don't have fully effective therapies and we need to find them. But we also haven't had optimal coordination and leadership. We also haven't had enough success in transferring knowledge to people and communities.

 

Melissa Fleming 4:20

We're living in the first global pandemic in the internet era, the information is there, but the people are not necessarily getting it or what they're getting is distorted.

 

Mike Ryan 4:29

The number and availability of channels of communication has just exploded. I mean, I've been involved with so many epidemics and at local level in all epidemics, there are rumours there's misinformation, there's disinformation. There are people for it, people against or people who believe in people who don't believe that's been part of the impact of contagion on human populations forever.  In mediaeval times in the plague. You know, we get people believing it's the wrath of God. We've seen the same with tuberculosis and other diseases. We've seen stigma and misinformation around so many - HIV in the latest memory and then the amount of misinformation and disinformation and misunderstanding and stigma and and frank discrimination that emerged around HIV so we shouldn't be surprised that the information gets distorted, manipulated, misunderstood that that's not new. I think what is new is the means by which the number of channels and the very volume of information that can be pushed through the so many different systems. And the way in which that can be actively manipulated is just mind boggling. The info-demic can be just as damaging as the pandemic itself, because if people aren't getting the right information, if they're not able to trust that information, and then we have a problem. There's no point having solutions to offer people if they don't hear about them, or they don't believe in them.

 

Melissa Fleming 6:00

Well, I've heard you also in that context, say how concerned you are about vaccine hesitancy, people, you know, record numbers of people unwilling to get vaccinated

 

Mike Ryan 6:13  

We’ve only ever eradicated one disease with a vaccine that was smallpox. But if we look at things like Measles, we have a perfectly effective vaccine that's very, very safe. And yet we haven't been able to eliminate Measles as a public health threat around the world. So the existence of a vaccine in itself gives us hope. It gives us the opportunity to stop this disease, but it doesn't guarantee victory. Sometimes we blame people who don't want to be vaccinated and that becomes an us and them and a binary thing. People who don't want to be vaccinated, have, have in their minds they have genuine reasons why or they believe they do and some of those reasons are based on bad information. Some of those reasons are based on on how they assess the information they're given. So I do think we, we need to enter into a really important and careful dialogue with with communities. Because it is very, very difficult to impose a vaccination or any health intervention on people who don't want to have it. So we have time, it's going to take at least another six months to have any vaccine available around the world. And that gives us an opportunity to engage in a proper discussion with communities around this vaccine, how it will be used, how it will be tested, so we can reduce the hesitancy for the vaccine and increase the demand for that vaccine.

 

Melissa Fleming 7:38

I mean, is there anything that makes you feel hopeful? Will we ever overcome COVID-19?

 

Mike Ryan 7:45

Absolutely, we will. I am a very hopeful person, I think our Head of Operations, calls me a pathological optimist. So I maintain an optimistic spirit. I think what gives me most hope is people. You know, people with ingenuity, determination, people who just refuse to give up. People who care about other people, people who see beyond themselves, whatever the human race faces. We always seem to find our way out through human ingenuity, intuition, and that sense of community and that sense of responsibility to each other. And I just hope as we emerge from this, that we don't forget, that it's that solidarity and collective response that we're doing is really getting rid of this virus. It's what we've done together. It's the humanitarian collaboration. It's the scientific collaboration, it's the community groups. It's those people who've fed the frontline workers. It's those kids who are visiting older people in their homes to keep them from losing social contact every single person right now is a responder to COVID-19. Each and every one of us is making our contribution to stopping this disease because this threatens all of us, threatens all of humanity. It threatens our way of life. And from this, if we could just amplify, and continue and sustain that sense of commitment to a better planet and a better society, I think we'll come out a lot better from from this pandemic than we went in. But, you know, unfortunately, we will have lost a lot of precious human beings along the way.

 

Melissa Fleming 9:31

That's for sure. You didn't start working out in the field of infectious diseases at the beginning of your career, you trained or were training as a trauma surgeon, but that changed after you and your wife who was also a doctor went to Iraq in 1990. And this was just a few days before the outbreak of the first Gulf War. Why Iraq? And then tell me what happened to you there.

 

Mike Ryan 9:55

Yeah, long time ago now, but I was actually en route. Supposed to be en route to Australia. To finish my residency, I actually got appointed to finish my residency at the Royal Prince Alfred Hospital in Sydney. And I had a three month gap in in that time, and I was offered, whether I would like to go to a twinning hospital in Iraq that was being supported by the College of Surgeons in Ireland, and was really just to go and support a neurosurgeon who was coming in to do a series of operations on kids and others in in Iraq. And I said, Well, that sounds interesting and exciting. So I signed up and went off to Iraq with the plan to be flying off to Australia a few months later, but it wasn't to be because obviously, Kuwait was invaded by Iraq, and we all became hostages in Baghdad, and obviously, there were very few foreign doctors in Iraq and Iraqis weren't able to leave Iraq. Obviously after the The blockades and the sanctions so we ended up essentially continuing to run the hospital in Baghdad and for I think four or five months and it was a challenging experience,

 

Melissa Fleming 11:14

But you were not able to leave you were a human shield 

 

Mike Ryan 11:17

Very definitely not able to leave. But we wouldn't at the time people were being taken to various sensitive locations. The human shield factor was that we didn't need to be - our hospital was literally stuck between the telecommunications centre, a major military training camp, the General Post Office, and I think the walls of the presidential palace with a big red cross on top. So we were probably in the most sensitive square mile of of land in the whole of Iraq. So they didn't move us anywhere. But increasingly, you know, during that time, the well the hospital had originally started with being a treatment Centre for all Iraqis, it very rapidly became very much a privileged treatment Centre for more the elites in Iraq. So it was a really mind bending experience to be to be a hostage and yet seeing people and faces who you recognize from TV and having to treat and resuscitate and engage with people from that side. But I have to say to be honest, I love the Iraqi people and an amazing country, amazing, amazing people. But uh, you know, after a number of months, we were all very exhausted and the authorities decided that we needed to have a rest. In fact, we thought we were been taken away to be executed or something because we were put in vehicles and taken to supposedly been taken for a rest at a lake camp but we had a very bad accident on the way and I fractured my spine in multiple places and

 

Melissa Fleming 12:54

You're sitting in that car, you had no idea where they were taking you and you were fearing the worst.

 

Mike Ryan 12:58

I mean, to be honest with you, we had trust - with our Iraqi Ministry of Health colleagues, many of whom became great friends and still are to this day you know, it's complex to say it's a people are never all good or all bad and those colleagues had reassured us that we were going for a weekend break so but there's always that doubt in the back of your mind but no we ended up with a really bad car accident and

 

Melissa Fleming 13:22

What happened

 

Mike Ryan 13:24

I had the I suppose the the humbling experience of being a number of days later being wheeled back into my own hospital to our own ward in one way is a very terrible experience but also an eye opening experience to be on the other end to be the patient you know and have to

 

Melissa Fleming 13:45

to so they performed surgery on your back No,

 

Mike Ryan 13:47

No, interesting was no surgery on my back because I had a choice. At that point, things were getting very tense and there was a choice to have do surgery on my back which would have left me with an unstable situation or, to stay in a spinal bed and allow the fractures to heal naturally and then have a special arrangement that I could be wrapped up in plaster if things really went to hell and moved safely. So I went for option number two, and we arranged through the diplomatic pouch of my own government to have special lightweight sort of fibreglass plaster sort of flown in which basically sat beside my bed and the SOP was if the if the bombs start dropping, wrap yourself with as much of this as you can and, and move. So I spent a few weeks sitting, you know, laying in my bed looking at this lightweight plaster cast beside me wondering how the hell I was going to get wrapped up in this in time to be able to get away from whatever was happening. So it was it was, but eventually we were we were released.

 

Melissa Fleming 14:54

That must have been quite distressing and how did you eventually get home?

 

Mike Ryan 15:00

Well, we were obviously eventually released on medical grounds. In fact, a man who's now the president of Ireland, Michael D. Higgins was then at the time, I think he was a senator or an MP, and he was one of the people who actually negotiated for us to be released early. And we were, I think, released a month before all the other doctors and nurses and, and flown home but without that was obviously the, the end of my surgical career. I didn't, I didn't continue and sorry, I did try. I did try after a number of months to go back and do clinical medicine and surgery, but it was just, it was too difficult. And the fractures just took a very, very long time to heal them. And

 

Melissa Fleming 15:44

It was painful.

 

Mike Ryan 15:45

Yes. And, you know, if you're doing surgery, you're standing for hours and hours and leaning over and it just was impossible to tolerate and, you know, sliding doors what they say. You know, sometimes in life. Things happen and you rail against them and you feel resentful and, you know, life's great plans, and sometimes you just have to accept and move on. And

 

Melissa Fleming 16:09

If that car accident hadn't happened, you wouldn't be sitting here talking to me now that you somehow made a switch.

 

Mike Ryan 16:16

Yes. we all had those sliding door moments, you know, when you pass through one door or the other. And the it's just that's just the way it's just the way it is. 

 

Melissa Fleming 16:26  

Okay, I mean, your next door was to move into the field of infectious diseases. What made you switch from surgery to this field?

 

Mike Ryan 16:34

Well, I had worked in Africa before and I'd worked I'd travelled and worked in Africa as a medical student. And it was very clear to me that you, you were either a surgeon or a good infectious disease doctor because that seemed to be the two things a doctor could make a difference with, in many developing country environments. So I went into infectious diseases and then ended up coming to WHO In 96, to join David Heymann, who was setting up a new emerging disease programme in WHO.

 

Melissa Fleming 17:07  

Was there any influence in your family that led you to want to explore the world to serve in developing countries?

 

Mike Ryan 17:16

My dad was a merchant seaman for most of his life. So all kids grew up on various stories - I grew up on stories of Mandalay and Sydney Harbour Bridge and photographs and postcards and all of that. So So I grew up with this amazing imagery in my head of being travelling around the world. My my uncle had been in the Irish army and was a peacekeeper in Congo in the 60s and was taken hostage himself at the time. So everyone thought he was dead for quite a while. So there was I suppose, a little bit of a travel bug in the in the family. So it certainly is in my in my DNA for sure.

 

Melissa Fleming 18:02

When you were held hostage in Iraq, did your family know what was happening with you?

 

Mike Ryan 18:09

Yes, there was some communication but very little. I often think that was certainly when I was injured. It was terrible news for my mom in particular. just devastating because there's nothing worse I couldn't imagine now. It's only now when I have my own kids who are, you know, almost approaching same age I was when I went, I just could not imagine the terror and horror I would feel if one of my own kids was, was in that situation. When you're in the situation yourself. It's almost reasonably straightforward to manage it. You know what's happening, you know, the risks and yes, sometimes you're fearful. It's when you're fearing for another person is the most awful fear in the world. So it's only now I'm beginning to truly understand the depths of fear and concern that my own family felt at the time - incredible it takes many years to really understand the impact of these things on other people you know,

 

Melissa Fleming 19:07

I can imagine your mother might not have wanted you to go back out and venture into the world after that

 

Mike Ryan 19:13

Every time I travel now she's you know, she's become very good with texts and very good on FaceTime and everything else at 80 years old and I always get the star of the sea, a star that represents the star of the sea the star of the wanderer, you know, it's tough on you know, it's tough on parents and the UN system is full of so many people who give their lives to this work we do and, and go and spend so much time away from their families. And very often when they do get in trouble, their families suffer even more than they do. So. I think it's an unrecognised sacrifice that UN workers all over the world make. So I'm no different to any of the rest. But sometimes I think it's our families that make the bigger sacrifices than us, in fact, I'm sure of it.

 

Melissa Fleming 20:04

Well, absolutely and and I'm sure you you faced situations where the threat was not necessarily wars or hostage taking but horrific, deadly diseases like Ebola. So you know, you served in West Africa, you served in Pakistan, you served in Uganda. Was there a situation that really frightened you in in that time?

 

Mike Ryan 20:30

Well, I mean certainly this last Ebola outbreak in North Kivu, Ituri was very frightening, just because of the scale of the the attacks on on all the workers, particularly our own. And that sense of helplessness when it's your staff, and again, my sense of trepidation and fear and is much more driven by what other people experience I think it's been one of the toughest outbreaks but

 

Melissa Fleming 20:56

More because of the the attacks on health workers? 

 

Mike Ryan 20:59

Yeah, I mean, it's it's, you know, I mean, yes, I mean people say oh my god Ebola everything else but you know we're trained it's the same thing but asking a fireman if they're afraid of fires, of course they are but they're trained to deal with them. So fear is a good thing. Fear is a positive instinct fear makes you do the right things. But you can't be paralysed it. The people you know that I am amazed by are the the de-miners and the mine action groups. I mean, what they do is just unbelievable. But they'll also say to you, that they are trained to do the work they do. We're all trained to do our work and we reduce our risks and we accept whatever is left. But certainly my first Ebola outbreaks were pretty hair raising and you you learn quick, and I've seen colleagues, you know, die of Ebola in the field and, you know, I’ve seen colleagues exposed and knowing that they're walking dead, you know, knowing that they've been exposed. And that's the horror actually the horror for me, has been seeing death and then seeing someone deteriorate before your eyes over a period of days, you know. That inevitability before we had treatments before we had vaccines. So that that was probably some of the in Uganda, certainly we had a number of those situations, we've lost colleagues. That's tough. And I think that's one of the saddest things about the likes of Ebola is to see doctors and nurses in countries dying because they don't have proper PPE or the same in this COVID response. That's the real tragedy. If you get the right equipment and the right training 99% of what we do is very safe. It's when you don't have the right equipment when you don't have the right training. And people are forced to work in situations that are unsafe or without the necessary training to do that work, then that's a real problem.

 

Melissa Fleming 22:46

It must be, it must make you also angry because it's so easy to solve. 

 

Mike Ryan 22:51

Yes, someone's life does actually depend on it you know, that's you can't reduce this down to numbers and pennies and pence. People's lives literally depend on having equipment and training.

 

Melissa Fleming 23:06

Are you ever afraid of failing?

 

Mike Ryan 23:09

All the time. I've got the greatest case of imposter syndrome in the world. You know, I think, I wouldn't say a fear of failure. But I think you've always got to be aware of your frailties. You've always got to be wary of ego, of being over certain. One needs to be confident without being arrogant. So how can you display confidence and a sense of purpose to people without that coming across as arrogance and not listening to what the data or what people are actually telling you? So I'm afraid all the time in that sense. So no, I don't fear personal failure, for sure. I don't. But I often wonder if I've really done enough, and then I have this strange feeling of they're going to find me out eventually, you know,

 

Melissa Fleming 23:58

I probably have assume that you don't get much sleep, what keeps you awake at night?

 

Mike Ryan 24:06

The pigeon on my, on my, my windowsill, to be perfectly honest - two pigeons who moved in recently but seriously, I think what keeps me awake is facing, you know, the possibility. That two things - one is that we will this will go on for a lot longer than we want or expect and having to sustain that effort across a marathon time. People are fed up of lockdowns and they're fed up of restrictions. And there's a lot of people and a lot of agencies getting very, very tired. And I just hope that we can sustain the effort and it worries me because I see my own staff tiring, you know, I see myself tiring and we're going to have to sustain this for a lot longer. And if there if we don't get an effective vaccine quickly. And even if we get that vaccine if we can't deliver that efficiently and equitably, then we're facing into a very long battle with this virus. I fear that we we just may not have the stamina to sustain that effort, we'll find that stamina we always do, but that worries me more than anything right now.

 

Melissa Fleming 25:21

So when you wake up in the morning, you know, what is it that you that just keeps you going?

 

Mike Ryan 25:26

I don't know. Strange thing. I think what we have a job to do and we serve. We're privileged to serve in that sense. I have a wonderful job. I have fantastic staff and hugely committed people around the world. We have a job to do. So we got to get out of bed and we got to get to it. We got to get up, pick ourselves up, dust ourselves off and get back to it because we serve people and we've seen this affects every community in every single corner of this planet. It will be arrogant of us to not leap out of bed. Get back and start again. Push that rock back up the hill, whatever it is, we will do whatever it takes to do that job. And I think there are so many other workers around the world doing just that. So we have no excuse not to. 

 

Melissa Fleming 26:16

Yeah, well, I hope you also, do some things that help you relax and is there anything that you do for fun?

 

Mike Ryan 26:27

Yes, I love I love music, I listen to a lot of music and that's where I just can disappear. 

 

Melissa Fleming 26:34

What kind of music? 

 

Mike Ryan 26:35

Everything. I mean, I'm an absolute hound for anything from from rock music to classical to jazz to Irish traditional music, the whole thing. I find music, just very uplifting and it doesn't matter where you are around the world you can put in your headphones and close your eyes and you're transported with for the job at the moment to be honest It's a seven day week job and sometimes it's 18/20 hours in the day. I haven't seen my kids since I think the 25th of February.

 

Melissa Fleming 27:09

I bet they're anxious to see you and worried about you too.

 

Mike Ryan 27:13

They're great. They're they’re troopers their fantastic, I think I need them more than they need me to be honest with you. They're wonderful, but it's amazing how much you miss you miss your kids. You know, it's just it's very that's the toughest part of this response for me. By far, you know.

 

Melissa Fleming 27:33

Last and final question, is there is there anyone who inspired you?

 

Mike Ryan 27:39

Um, yeah, more or less I suppose. My dad for the travel part of it but probably my mom most of all, she she. She was made a widow very young in life. And to be quite honest, I have no idea where myself and my brothers would be right now, if it wasn't for her tenaciousness in the Ireland Ireland of the 1970s she fought very hard to protect us and bring us up in a difficult situation. So I suppose in that sense, she's an inspiration. She's a great lady and and still zooms around backstreets the back roads of Ireland in her sporty car and, whatever else so she's very active lady But no, it's and I think it's very tough for for people, older people I really feel for many older people who, you know, really been isolated during this pandemic. And people who are older know that they're, you know, they have limited time and they, they value so much the connections with other human beings, particularly their family, their kids, their grandkids, whoever. So I think they've suffered hugely in this pandemic, beyond the physical suffering and the fear of the disease, just social isolation, and that's why I think the people who were really working to support our elders with, with that social contact and visiting and phone calling and facetiming and everything else. They're heroes to me because I think our society has, as, over time, we've we've lost that respect for the wisdom of our elders. And I think it's something we can usefully regain. I think we've seen that come a lot during this pandemic, and how we value the wisdom of those gone, gone before us, you know,

 

Melissa Fleming 29:34

Mike, thank you so much for taking the time out of your incredibly busy schedule to talk to me and to talk to the listeners of Awake At Night. Thank you so much, and all the best to you and your incredibly important work.

 

Mike Ryan 29:52

Thank you. I really enjoyed this. This was this was like a nice break in my day Melissa, so thank you.

 

Melissa Fleming 29:58

Thank you for listening to Awake At Night, we'll be back soon with more incredible and inspiring stories from people working to do some good in this world at a time of this devastating pandemic. To find out more about the series and the extraordinary people featured, do visit us as un.org/awake-at-night. On Twitter, we're @UN I'm @melissafleming and Mike is @drmikeryan. Subscribe to Awake At Night wherever you get your podcast and please take the time to review us. Thanks to my colleagues at the UN and to my producers Bethany Bell and the team at Chalk and Blade Laura Sheeter, Fatuma Khaireh and Alex Portfelix. The original music for this podcast was written and performed by Nadine Shah and produced by Ben Hillier.