S7-Episode 2: Bringing Health to the World

 

 

 

David Nabarro 00:00

We see an awful lot of needless suffering. You see, we’re not doing this work to make ourselves feel better. We’re doing this work because we are totally convinced that it’s not necessary in today’s wealthy world for so many people to have their lives imperiled.  

 

Melissa Fleming 00:32

From the United Nations, I'm Melissa Fleming. My guest this week is Dr. David Nabarro, a man who has dedicated his life to global health. Welcome, David.

 

David Nabarro 00:44

Hello. It's great to be with you, Melissa. Thanks for the chance.

 

Melissa Fleming 00:48

I was looking at your résumé. And I have to say it's overwhelming. You're a medical doctor. You've worked in over 50 countries, very often for UN programmes, and also for the World Health Organization. And now you are, among other things, Special Envoy of the WHO Director-General on COVID-19. Did you ever…? Given all of this background, did you ever expect to live through a pandemic like COVID-19? And what were your thoughts about how you were going to tackle this?

 

David Nabarro 01:24

I had a feeling in my bones that this was going to be really difficult. The reason why we were [inaudible] all of us nervous about it was that the virus had a strange profile. It didn't kill everybody that it infected. It killed older people. It killed people with diabetes. And the illness was an unusual illness. And people when they got badly ill with this coronavirus were finding it super hard to breathe and they had to go on ventilators, and the ventilators were having to pump in air at very high pressure. And that's not a good situation to be in. So right at the beginning, it felt as though this was going to be a difficult disease to deal with. It was also a disease that we did not fully understand because it was due to a new virus. And then the third thing, something rather special about 2020 was that we were at the beginning point of fragmentation of relationships internationally. And it was clear that it was going to be a tough one to deal with. Simply, if you don't have governments on the same side when you're dealing with a crisis, it's really hard to get a strong international response. That's why the United Nations is so important because it's the only instrument that exists for bringing governments together to respond to problems that go beyond national borders.

 

Melissa Fleming 03:00

Sometime early on it was also not very clear what was the best way. I believe you also spoke out against lockdowns.

 

David Nabarro 03:09

Yes. I need to explain that. Within WHO, right from the earliest days, the teams were saying, ‘Don't respond to a disease by putting people into a lockdown.’ What is a lockdown? It's what you do with a prison when you've got a riot. And you want to stop everything. So, you just stop all movement, which does mean that things come under control. But it's really awful for the people in the prison, both the inmates and the people who look after them. And I think that we've always said the really important thing to do is to help contain an infectious disease without needing to create too difficult a situation for the people who are caught up in this infectious disease. Because in the end, if you're requiring everybody to make a huge sacrifice for the sake of the response to the disease, sooner or later, some of them will get frustrated and may even say, ‘We won't cooperate.’ So, what we were trying to do was to get across that you can do a lockdown temporarily, perhaps for a very short period of time, while you then put in place the measures that are needed to deal with the problem. And when any infectious disease, history has always told us that the most important thing to do is to identify those who might have the disease. And if you suspect that they're sick, to ask them to isolate themselves immediately. To ask them to tell you who they've been in contact with, and to isolate those contacts immediately. Because then you're breaking the chains of transmission. You're stopping the disease from building up into a huge great surge. You do the lockdown temporarily while you set all the systems up. But don't keep people in lockdown for a long time. They'll go against you. And then if they go against you, then dealing with the disease becomes really, really difficult.

 

Melissa Fleming 05:16

Did you ever get COVID yourself?

 

David Nabarro 05:19

Yeah, I've had it once. And I'm kicking myself. I really didn't want to get it at all, because for me I've always thought COVID’s a rather unpleasant disease, that I don't like the virus. There are things about the virus we don't know. I don't understand what makes some people get long COVID. And I didn't want to get long COVID. I didn't want to have increased risks to my health after my COVID. So, I was doing my best. But I went to a conference in May 2022 when movement was becoming possible, and there was lots of COVID protection in place. But a lot of us got the disease. I think we were in a train carriage where the virus moved around or something like that. So yeah, I got it. And I didn't like it at all. And I'm still doing what I can not to get it. I'm keeping my immunizations up to date, Melissa. And I would encourage everybody who's eligible for an immunization, don't skip this one. It's worth doing because the virus is still mutating. We don't know what new forms are going to arise. And everybody should be doing whatever they can to protect themselves just in case the unthinkable return of bad COVID happens.

 

Melissa Fleming 06:42

Right. Well, I mean, just going back a little bit. You're somebody who's been dedicated to fighting inequality. So, it must have been hard for you to see rich nations hoarding vaccines when they finally miraculously were released. And then poor countries waiting in the back of the line. How did you react to that?

 

David Nabarro 07:07

The hoarding of vaccines early in 2021 by rich nations, almost to the point where they would buy five or six times the amount of vaccine that they could possibly need and shoving it in cold stores. And then making it impossible for people in poor countries, low-income countries to have vaccine. And then putting quite difficult restrictions on movement of people from low-income countries if they hadn't been vaccinated. It was a really unpleasant time, because we all knew, and I think we still know it now. And I think most decision makers in most countries know it in their hearts and in their souls that when you've got a problem like this - a disease that's got the capacity to rapidly spread across the world - that if you've got a problem in one part of the world, it's a problem for the whole world. We've seen more and more examples of individual governments basically saying, ‘Our people come first, and the rest of the world comes much, much later.’

 

Melissa Fleming 08:22

And the rest of the world doesn't forget that.

 

David Nabarro 08:25

Oh, thank you for saying that. The resentment from what happened early in 2021 is pronounced but the colleagues that I'm listening to talking about this - doctors, professors, ministers from countries that were treated in this way - what they're saying to me is, ‘We're used to it.’ So, the mood I'm picking up when I talk to seniors, professional colleagues from low-income countries is one of resignation. ‘We just don't trust the word from northern countries anymore.’ So, I say, ‘Who do you trust?’ And that's when this very important answer comes back. ‘We trust the United Nations. We trust the United Nations Secretary-General.’

I mean, the title of the podcast series is Awake at Night. And you know, the thing that keeps me most awake at night is the rampant inequities in our world. The fact that very wealthy people have access to incredible, wonderful technologies, assets, and opportunities. And their access is increasing because their wealth is increasing. There are not many of them, but they are getting wealthier, according to many analyses. And the poorer people in our world - let's say the half of our world who really would be classed as poor, that's between three and four billion people - they're getting poorer. And so, the awake at night challenge for me is how can we collectively, citizens of the world, make certain that these global mechanisms that exist - to encourage equity, to encourage safety, to support the realization of human rights, to protect people who are really short of food or water - how can we be sure that those mechanisms are going to survive and be strong in the coming months, years and decades? So, my awake at night challenge is maintaining the spirit of equity. It's returning to that situation where, as a world, we look after the countries and the peoples who are less well off. That's where I think we have to be. Just imagine what will happen if we don't get back there. It really will be a growing divide between the haves and the have nots.

 

Melissa Fleming 11:04

Well, that's a good challenge. And I agree with you. We have to focus on all of the solutions and the cooperation that is taking place everywhere and scale that. I just want to… Maybe one last, you know, sticking with COVID-19. Can you take me back to the day when you got your first vaccine and just tell me how that made you feel.

 

David Nabarro 11:31

I was nervous at the beginning about the speed with which the vaccines were coming on board. I thought, ‘Will they be pushed into service so quickly that we might get problems that come up.’ And I mean, I was just like other people, I think. Super pleased when the early results came through that both the conventional vaccines that had been tested, and the new what we call messenger RNA vaccines, seemed to be amazingly effective at stopping severe disease and preventing death in people who were at risk. I knew that these vaccines wouldn't stop transmission. But I just loved the fact that that terrible sense that COVID was leading to severe sickness and death in so many people. And we all saw it. Some of us have lost friends and relatives. That sense could suddenly be sort of softened. And I felt a huge, huge joy when that happened.

I felt rather relieved that I’d managed to find some vaccine. It wasn't easy at the beginning. And that I had been able to get a shot. And I suppose the thing that's really concerned me is that the incredible life-saving power of vaccines has been contested by some quite famous people. And I can't confront them. I don't work like that. But I would like to say to everybody that I've thought about this really hard. I've studied it super carefully. And one thing I can say is that vaccination against COVID-19 has been and continues to be and is likely to be for some time to come an amazing lifesaver. It doesn't mean that it’s completely without risk. All medical procedures have a degree of risk. But the point that I have to keep emphasizing is that the risk due to the disease is so much, so much nastier than the risk associated with vaccination. Yes, I'm glad I got a vaccination early.

 

Melissa Fleming 13:53

You trained as a doctor in your home country of Britain. Why did you choose medicine as a career?

 

 

David Nabarro 14:03

Oh, well, that was partly my father. He was a doctor. And within the household it was often presented that there's no other meaningful career than medicine. And so, it was quite hard for me to anticipate not doing medicine. But actually, he wanted me to stay in the sort of conventional ladder. And I went into international health. I, quite early on in my career, was finding myself in a war zone in the Middle East. I was working with First Nations people in northern Canada, and so on. And so, I started very much because it was in the family. But I got into the international work because I was really interested in, and I wanted to have an opportunity to do it.

And then that's what I think led to me focusing on issues like communication, issues like engaging with the community, forming partnerships, trying to reach across to people in other sectors besides medicine. Because so quickly I understood that the medic can cure people who are sick, but the determinants of their sickness come from outside medicine. They're to do with food, with water, with whether or not they're able to live in dignity. And also, to do with what their incomes are like, and their employment, and their position in society.

And because of that recognition that illness and health had its antecedents outside my area of influence, I then I think quite quickly gravitated into having this more international perspective. And gravitated into understanding that at the heart of everything we do is being able to communicate. We're often having to work with people who are very angry. People are very distressed because they've lost staff, angry because they've been attacked. Or just simply people who are just scared, scared, scared because of what's going on. And that's it. You just have to be able to listen to them and touch them with your words, or with your eyes, with your body shape, and all that stuff. Or how you turn up and behave. And yeah, I think it applies to more than communications. I only thought of that just now, but it just seems to make sense.

 

Melissa Fleming 16:41

Speaking of scared, you've also worked for WHO in dangerous places. And in 2003, after you were appointed Representative of WHO Director-General for Health Action in Crises you went to Iraq. And you were in the Canal Hotel, which was the United Nations headquarters in Baghdad, on the very day it was bombed where 22 of our colleagues were killed, and others were injured. What do you remember about that moment when the bomb went off?

 

David Nabarro 17:24

I was in Iraq at the request of a number of different groups who were trying to come together to start refashioning health services in the country. I'd been early in the morning to pay a very brief call, say hello to Sérgio Vieira de Mello, who was the leader of the UN team in Iraq at the time, an astounding Brazilian man. And we said, we'll meet at half past four that afternoon in August 2003. And so, I had been in the ministry of health and then I came back to where the UN headquarters was in the Canal Hotel. And I remember that somebody in the group wanted to, I think, have a cigar or something. I can't remember the precise reason. And we moved rooms. And we were just getting up to go and see Sérgio upstairs. And there was suddenly this enormous, incredible explosion. We fell over and the roof caved in, and so on. If we'd been in the room where we were going to be beforehand, we would not be alive. If I had not got up when I got up to go upstairs to see Sérgio, a piece of glass that came flying through would have sliced into my back and who knows what it would have done. So, I was lucky.

And then a bomb went off just around half past four. And it smelt very strange. I think there must have been some combustible liquid put in the drums that made up the bomb, which was on a flatbed truck. It wasn't very far away from where I was actually sitting, it was outside a wall. Because it was aimed actually at Sérgio’s office, which was upstairs. And so, my ears were ringing. I noticed that my phone fell out of my pocket. And this bizarre thing of lights had gone out. I could hear cries. I could hear the bells ringing. And still, I could see that there was a cell phone network available. So, I remember very quickly ringing back to Geneva. I wanted to say just two words, ‘I'm alive.’ But then the cell phone network got cut off. And then we managed to get out the door. We could see that the stairs up to where Sérgio was had completely caved in. We found people in the corridor really badly damaged. I remember thinking this must be the worst atrocity that has ever happened to the UN. And I think it probably was at that time.

And then we set up. I mean, there were three medics there and we set up a sort of triage point just outside the building. And we were getting or had more than 100 people who were injured. We started to organize that and then we started finding people who were dead. And we organized that. And then the helicopters after about half an hour arrived. We didn't have a sort of easy way of summoning help. And then we realized that Sérgio was stuck. And the rest is history. There's a film about it.

All I would just say is I was really impressed by the bravery of the staff, who did everything possible to keep going. I was impressed by the willingness of people to want to go back, even though they'd been involved in all this. And security had to tell us, ‘No, no. Calm down.’ I was so upset by the loss of Sérgio. And I kept asking myself, ‘Could I have done anything to help?’ I don't think I could. But you feel bad about that. I lost other friends and that made me upset. I'm not going to say their names. It still makes me cry to think of them. So, all I would say to friends and colleagues is it's really awful when these things happen. There's just no way of lightening the unpleasantness of it. For the people involved who lose their loved ones, the people who end up injured. We know one person who had a very bad leg injury. I think he's not with us anymore. But what a brave person. And so, it's part of the occupational risk of working in the UN that these sorts of things happen. But it doesn't make it any easier for me every time I hear of an atrocity like this, particularly when it involves UN people. It gives me a real uncomfortable sense in my heart.

 

Melissa Fleming 22:20

I imagine, though, given how committed you are and how you've just described your commitment through your career, that even having been in such a dangerous situation where you just you saw so much death and injury around you - friends and colleagues you respected and you yourself were almost a victim. Did you ever think of reconsidering? Or did your family ask you to reconsider working in conflict zones?

 

David Nabarro 22:56

Actually, yes. Families I think generally don't like it when somebody has a bit of a narrow escape and get really nervous if there's any sense that the work is being somehow given an unacceptable priority. I've not personally solved that side of things in my life. And I suspect there are many inside the UN who will be feeling the same. That it's often really difficult to combine your passion for your work, and your respect to your family, and to what that represents. And I can't really say much more, because it's been one of the challenges of my adult life. It's really tough. And I think every one of us who works in this has experienced it. And we go on experiencing it. And I think it's one of the unresolvable mega challenges of modern life.

 

Melissa Fleming 24:12

Yeah, I mean, I wonder if it's also because you've seen people who are in situations that are so dramatic, that it might make it seem that what you're risking is nothing like what they're going through. For example, just a year after the Canal Hotel bombing in 2004, you were head of WHO’s crisis unit, and you were responsible for dealing with the aftermath of the tsunami which hit Southeast Asia. So, what did you see during that tsunami that has affected you most?

 

David Nabarro 24:54

The tsunami was as a result of an underwater earthquake, sort of between Indonesia and India. But the main damage was done in Indonesia. And I was sent to just be in northern Sumatra and to try to understand what was going on. When a big earthquake or a tsunami happens, very quickly the whole infrastructure gets damaged and particularly water supplies and sanitation get affected. And there is a really big risk of disease outbreaks. And some of those disease outbreaks can be very nasty. Lots of watery diarrhoea can happen. Even cholera can happen. So, the first priority for all of us on the health side is to make certain that everybody, that civilians and others, its children, as well as women, as well as men, is able to get acute care for any illnesses, shelter, food, water, and the other essentials for life. And that is done in a place of safety, where you're not going to get aftershocks or anything like that. And also, a place where they're not going to be subject to any kind of threat or violence.

And so much of what I did was to be involved in moving around from place to place, trying to make certain that we had found everybody who was in danger, trying to make certain that everybody had access to supplies. And always in the immediate aftermath of a disastrous event that's really hard to do. You get kind of traffic jams, landing strips, but then there's shortage of warehouse space. And then the wrong stuff comes. People send sometimes old clothes and so on, when what you really need is food or tents. And this was a tough one to organize. And the most difficult part really was organizing the air strips and the local airport in Banda Aceh. But also organizing the logistics for distribution.

 

 

Melissa Fleming 27:21

Yeah, absolutely. It is that huge coordination role that is really behind the scenes, but it is so crucial, which enables the humanitarians and the others to deliver for the people. But David, in 2007, your own family was hit by tragedy when your son Tom suffered a snowboarding accident. What happened to him?

 

David Nabarro 27:49

It was April 2007. My son Tom, who was 21 at the time, was travelling to Bulgaria to be with his girlfriend, Ellen, who was doing a period of her studies in Bulgaria. And Tom had just arrived. And he loves snowboarding. And the next morning after he just arrived, he said to Ellen, ‘I'm going to go up onto the mountain just outside Sofia, where there was still snow. And I'm going to practice my turns and my jumps and even my somersaults.’ And he was there. The snow wasn't that good. The Bulgarian snowboard team was around the place on the halfpipe doing stuff and he joined them in. And he tells me that he was doing a series of somersaults and he got into the run to do one, and his snowboard hit a patch of ice and started speeding up. And he realized he was going into the somersault too fast. He tried to pull out and instead he completed the somersault almost, but then landed on his head and his neck broke. And in fact, he didn't really remember much. He just remembers waking up and seeing people looking after him. And wondering whether he was dead and finding that they were pressing on his chest. They got him down the mountain. He was still alive.
 
I was called. I was in New York at the time. His mum was in Geneva. Sorry, in Oxford. And the early signs were not good. There are tests that you can do on people when they've had these very, very bad injuries to find out whether their spinal cord is intact or not. And the early signs, just the physical sign as we call it, suggested that his spinal cord had been badly damaged. I got straight on a plane and went out. Joined Ellen. Joined the other people who were there, who had started to gather. He was in the military medical hospital in Sofia. His neck was plated to try to stabilize his spine. But it was clear that he had got a bad, bad damage to his spinal cord. After a bit over a week, he was brought back and was taken in by Stoke Mandeville Hospital, who were brilliant. And it was a year of rehab. He had to have numerous operations. He got infections and stuff in his neck. He got super thin. His heart didn't beat properly, and he had to have a pacemaker put in. But gradually, he got up, got better.

Ellen stuck by him. Eventually, after a few years married him. They've got two boys. Tom is really self-sufficient. I just spoke to him on the way in here today. He's got a really amazing job with the Intel Corporation. And he's good at this stuff. He got a first-class degree in Computer Engineering. He's doing well, Melissa. And he's taught me that people might look disabled, but they have all sorts of abilities. Never underwrite somebody because they are sitting in a wheelchair or because they twitch or because they limp or because they look different from us. My Tom may be disabled, may be tetraplegic, but he's shown me what you can do if you are patient, if you are focused, if you train your memory, if you treat people well. And he has fun. He goes to raves or festivals with rave tents. And he’ll sit in the middle of the tent, right in the middle of the place where everybody's dancing like mad in the pit. And he just loves it. And it's part of his life. He tries to get around. He tries never to be stopped by things. He takes ramps with him. He will use winches. So, the power and capacity of disabled people I think is one of the often-big missing links of society, a huge area where humanity can benefit.

 

Melissa Fleming 32:33

You sound very proud of him too.

 

David Nabarro 32:36

Ouf! I hope he hears this. I'm super proud of this boy. And I'm super proud of the friendships he has in the village. He now lives in Oxfordshire, Standlake. Gosh yeah, I'm proud of him. I'm proud of what he's achieving. And he's teaching me stuff every minute of every hour of every day. His boys. He is their dad. They understand him. They understand that he's got some limitations, but they also understand how to get the best out of him. And I watched the way in which he uses the tone of his voice. He uses the way he moves his chair around them. He uses the expressions on his face to communicate stuff that people like me might have had use different means for. And it's very powerful to see. Yeah, I'm proud.

 

Melissa Fleming 33:32

I wonder if it made you more focused on helping people who have special needs, who are vulnerable.

 

David Nabarro 33:42

It has, but not perhaps as much as I want. Melissa, the thing that is most frustrating for me - and I think for many of us who are working in this area - is that we can't do everything we want to do. We see an awful lot of needless suffering. We see so many opportunities to reduce that needless suffering. We see such inequity. We're experiencing six or seven famine-like situations in the world right now, which shouldn't be happening. And I think that that must be the biggest challenge for all of us. The thing that most upsets us in our in our hearts. You see, we're not doing this work to make ourselves feel better. That sort of conventional notion of what a do-gooder is. We're doing this work because we are totally convinced that it's not necessary in today's wealthy world for so many people to be experiencing discomfort, for so many people to be experiencing hardship, for so many people to have their lives and their livelihoods imperiled.

 

 

Melissa Fleming 35:06

David, thank you so much for sharing your story, your thoughts, your vision, and your reflections with us on Awake at Night.

 

David Nabarro 35:16

Thank you, Melissa. Thank you

 

Melissa Fleming 35:20

Thank you for listening to Awake at Night. We'll be back soon with more incredible and inspiring stories from people working against huge challenges to make this world a better and safer place.

To find out more about the series and the extraordinary people featured, do visit un.org/awake-at-night. On Twitter, we’re @UN and I'm @melissafleming. Do subscribe wherever you get your podcasts and please do take the time to review us. It helps more people find the show.

Thanks to my editor Bethany Bell, to Jen Thomas, Adam Paylor, to my colleagues at the UN: Roberta Politi, Julia Hagl, Geneva Damayanti, Tulin Battikhi, and Bissera Kostova and the team at the UN studio. The original music for this podcast was written and performed by Nadine Shah and produced by Ben Hillier. Additional music was by Pascal Wyse.

 

Melissa Fleming 37:27

Thank you for listening to Awake at Night. We'll be back soon with more incredible and inspiring stories from people working against huge challenges to make this world a better and safer place.

To find out more about the series and the extraordinary people featured, do visit un.org/awake-at-night. On Twitter, we’re @UN and I'm @melissafleming. Do subscribe wherever you get your podcasts and please take the time to review us. It helps more people find the show.

Thanks to my editor Bethany Bell, to Jen Thomas, Adam Paylor, to my colleagues at the UN: Roberta Politi, Julia Hagel, Geneva Damayanti, Tulin Battikhi and Bissera Kostova. And the team at the UN studio. The original music for this podcast was written and performed by Nadine Shah and produced by Ben Hillier. Additional music was by Pascal Wyse.