Maria Van Kerkhove knows how to operate under stress.
As an epidemiologist and key leader at the World Health Organization during the pandemic, she was at the forefront of trying to combat the ever-changing pandemic. She served as the face of WHO in over 250 media briefings, explaining to the world what scientists were learning about the latest variant and how much sickness and death it might cause.
"I think I'm only now realizing how difficult it was five years on, and the responsibility and the pressure," she says.
But to her, that high-stakes chapter of her career was in some ways more manageable than the past four months.
President Trump's withdrawal from WHO means the global body has lost its biggest funder. And, she says, the cancellation of virtually all U.S. foreign aid and collaboration with U.S. health agencies has halted life-saving work. She says that she and her colleagues are now scrambling to figure out how to continue responding to health crises and preparing for the next pandemic.
Already, the loss of U.S. dues has prompted WHO to cut staff and prepare for the scaling back of programs that tackle everything from maternal mortality to malaria control.
"It's very difficult for me to understand, as a person, why this is happening," she says. "It's a very different type of stress."
Kerkhove, who is now interim director of the department of epidemic and pandemic threat management at WHO, was in Washington, D.C., last week to deliver the commencement address to the Georgetown School of Health. NPR spoke with her on Friday, May 16 about the first four months of the Trump administration and their impact on WHO's work, the importance of the pandemic agreement officially adopted by WHO member states on Tuesday and how the next generation of global health workers should "kick the tires" of the world's health care systems.
This interview has been edited for clarity and length.
What are you planning to tell the graduates at Georgetown who are entering the field of health — particularly global health, at a time of incredible uncertainty?
My message is that they may be thinking that they've chosen the wrong field, but they absolutely have not, that the path they are on is the right one. There's no perfect trajectory to what you think your job is going to be. I'm trying to just be honest and open that there is no perfect path to a career, but that we need to be in this field. And now is not the time to retreat. Now is actually the time to dig in and to think of something different. And we need young people's voices. We need that innovation. We need them to kick the tires and say, hey, you're not doing so great. We have a different way.
What do you mean when you say "kick the tires"?
I think it's about everything we do. Young people questioning how we tackle health, how we work in communities, how we could use innovative ways to communicate, to develop different types of technologies, etc.
Zooming out a bit, I wonder how you're thinking about the Trump administration's intent to withdraw from WHO and canceling foreign aid grants?
It's not just that the funding had stopped, which is really important, but all technical exchange stopped too [between U.S. experts and others]. So all government officials from the U.S. government were instructed not to speak to us. That abrupt stop of technical exchange has been really detrimental.
How so?
I'll give you two examples. One is for influenza, where we work with the U.S. CDC, because they're a WHO collaborating center. And we've been working with them as part of the Global Influenza Surveillance and Response System, which has been in operation for 70-plus years to assess and analyze viruses that are circulating. Now, that system is strong because we have labs in 150 countries who are constantly communicating. But leading up to a vaccine composition meeting [to discuss the next iteration of the flu shot] in February, the U.S. stopped speaking to us. They did ultimately join the meeting.
So then they did talk to you?
They had permission to join the meeting remotely, but they're not part of the discussions. They're not at the table. And that has implications.
The second example is there have been outbreaks of Marburg and Ebola, and there are many U.S. government employees in-country that stopped speaking to us in-country. In some situations they weren't allowed to be in the same room with us or talk with us [because of the Trump administration's initial external communication freeze]. And that exchange of information in supporting a government, it's not about WHO or CDC. It's about supporting the response, to have the best people on the ground within the responsibility of that government to support them in stopping that outbreak. That didn't happen.
And what does that mean?
That loss of voice is significant. We live in a world where pathogens don't care about borders or your political affiliation. They will transmit. And when something emerges in one part of the world, it could be in another in 24 to 48 hours. It's really critical that WHO includes everyone at that table. So when America withdraws, that puts everyday Americans at risk.
What has this period been like for you as someone who was very publicly engaged in the COVID-response?
It's very, very different. During COVID, we knew how to put our heads together. We knew how to address questions. We may not have had the answers exactly when we wanted them, but we knew collectively what we needed to do. Everyone was working together to fight this invisible new virus.
So for me, there was a solidarity, a recognition that this is really, really difficult. I'm only now realizing how difficult it was five years on. And people came together in the first Trump administration. That technical exchange did not stop. So even though there was an intent to withdraw, that technical exchange continued.
What's happening now is very, very different. I find it hard to understand why this is happening. We anticipated some fiscal shrinking. What we didn't anticipate, what I didn't anticipate was the abrupt nature in which it [was] stopped. And it's very difficult for me to understand as a person why this is happening, because people are dying as a result of this. Personally I find it very difficult. It's a very different type of stress for me. So it's been very challenging.
Do you see any kind of silver lining to this crisis? That a better global health system might come out of it?
I think we will get through this and be more efficient. But the problem I have with that type of question and that type of thinking, even saying it out loud, are the people that are impacted right now, they're not going to make it through. We do need innovative voices. We need a new approach to this. But that's not going to help the people who are suffering right now. And I think that's what is so uncomfortable and unnecessary. And I'm really struggling and many are really struggling with what's happening globally.
Let's talk a bit about the pandemic accord that WHO member states have spent the past few years drafting. Why is it so important?
It's incredibly important right now, especially where many countries are retreating inward.
This is really showing that we live in an interconnected world and it's in the collective interests of all countries to work together for pandemic preparedness. Pathogens don't respect borders. They don't care about your political affiliation, the color of your skin, how much money you have in the bank. They look for any opportunity they can. We need to ensure that we are in the best possible situation in terms of our capacities, in terms of our readiness for when this does happen again. Because unfortunately, it will happen again.
The legacy of COVID cannot only be death and devastation. It has to be what was built.
So what is being built? What's in the accord?
There's quite a lot of detail in the accord itself. There's detail in there about what it means to prevent pandemics, looking at either the spillover of pathogens between animals, transmission between animals and humans — Thinking beyond the last pandemic of a coronavirus and thinking forward of what could that next pathogen actually be? Also looking at bio risk management in laboratories.
It also looks at what it actually means to develop medical countermeasures like diagnostics, therapeutics and vaccines, and to ensure equity and fairness of the distribution of those products, based on risk and need.
It's more of a promise. It's more than a handshake. It's actually concretely writing down what needs to be done.
If the world had this accord before the COVID-19 pandemic, would it have played out differently?
I think there were many elements that could have unfolded differently. We could have been in a situation where we would have negotiated access, early access to these vaccines, these diagnostics and these therapeutics when they were available. And instead of the high-income countries having access to these and vaccinating as many people as they could — of course that's up to governments to protect their people — what we would have liked to have seen was vaccinating at-risk people in every country rather than vaccinating everyone in a handful of countries. And that's what happened during COVID.
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