Hans Kluge (55) took over as the World Health Organization's (WHO) Regional Director for Europe when the coronavirus began to hit Europe in February 2020. After several years of pandemic chaos, Kluge still has a lot of work ahead of him: shortages of medical personnel, humanitarian catastrophes caused by war, declining vaccination rates, antimicrobial resistance, and preventing future pandemics. Kluge spoke to El Pais last week during his visit to Spain to participate in a primary health care forum led by the Spanish Ministry of Health, which reached an agreement with the government on the care of Gazan children with serious health problems.
Q. Spain will initially take in 29 Gaza children with cancer and other serious health problems. What else can European countries and the WHO do to improve the health of Palestinians?
A. The most urgent thing is to evacuate the children who would not survive otherwise. We have asked Israel to allow these children to leave, because Spain and my country Belgium, as well as France and Ireland, are ready to accept them. Beyond that, what is most important is a permanent ceasefire that can bring about humanitarian assistance and the release of the hostages.
Q. At this point, this is more of a symptomatic solution.
A. Yes, it is not a definitive solution, but imagine it is your daughter who needs help. Palestine has applied to the EU's Civil Protection Mechanism for 9,000 patients. We are also in dialogue with Israel to ease restrictions. This must be done, because 70% of those who died in Palestine were women and children, and that alone is a reason to stop the war immediately. We must start working on reconstruction plans to provide medical assistance as soon as possible.
Q. What have we learned from the COVID-19 pandemic?
A. There are many lessons, but perhaps the biggest is that countries have to learn to work on what is called a dual track. This means that we are living in a permanent crisis. These crises will continue to exist. Gaza, Ukraine, the next pandemic may be just around the corner. This means that our systems have to respond on a dual track to deal with the unexpected. But at the same time, it is very important to ensure the basic essential health services on a day-to-day basis, which we were not able to do during the pandemic. There are 1.2 million children in the region who have not been vaccinated against polio. Measles is up 40 times compared to last year. This is totally unacceptable. And during the lockdown, we need to improve mental health, especially for young people. We have to learn lessons here. One in six people in the region has mental health problems. And the best way to deal with them is primary health care.
Q. Has the WHO criticized itself for its management of the pandemic?
A. It is true that the WHO has saved millions of lives, but we still need to learn how to better manage fake news. For example, Dr. Anthony Fauci estimates that approximately 700,000 deaths in the United States are a direct result of fake news that discourages people from getting vaccinated.
Q. Are we better prepared for a new pandemic?
A. Last Saturday, in the final moments of the World Health Assembly, just before midnight, there was very good news: the 194 member states proved that they could reach agreement on contentious issues, such as amending the International Health Regulations. The pandemic treaty was not ratified, but [there was no agreement between the countries and the initiative failed]These regulations include improved surveillance, timely information sharing, and access to medical countermeasures.
Kluge has been WHO's regional director for Europe for four years and plans to run for the new role.
Q. Bird flu is growing out of control and some experts believe it could cause the next big pandemic. What measures is WHO taking to prevent this?
A. We are very concerned. We have launched a pan-European disease control network. The ECDC in Stockholm covers 27 countries, but now the network covers 53 countries. This is a big step forward since COVID-19. We now have a network that integrates all countries, and one of the first measures that is directly related to your question is the strengthening and sharing of surveillance data, including wastewater surveillance.
Q. You mentioned the issue of declining vaccination coverage across the continent. What can be done to address this issue?
A. We need to work in two directions. The most important is a catch-up campaign to help the countries that have fallen behind catch up. And countries where education on vaccines and healthy lifestyles is already part of the primary school curriculum, such as Portugal and Spain. When I became the Regional Director, I realized that, although I am a physician myself, we were a bit too medicalized. We didn't have anthropologists or sociologists. When I worked as a doctor for Doctors Without Borders in Liberia during the Ebola epidemic, I saw mothers attacking health workers because they were forbidden to touch their dead children. For them, it is culturally important to do something before their child “goes to heaven”. So we are using anthropologists and sociologists to understand the causes of vaccine refusal. There are very few real anti-vaccination people. It's mainly people who don't have the right information or can't afford to travel to get vaccinated. As for the real anti-vaccination people, there is honestly very little we can do.
Q. Another problem is the increase in sexually transmitted diseases.
A. It is very important to work with trusted community messengers, such as Real Madrid footballers and tennis players. My daughters, for example, wore masks because their basketball and volleyball idols were wearing them, not because their father, who is the Director-General of the WHO for Europe, told them to. In addition, it is essential to raise awareness within the health system itself, since in some countries health workers consider these to be diseases of the past. We are also concerned about the backlash around LGBTQ+ issues, sexual health and safe abortion, both within the EU and abroad.
Q. In that sense, are you concerned about the rise of the far right?
A. I am concerned about the backlash against universality – that health is a human right for all, regardless of ethnicity, sexual orientation or economic means. This is especially worrying when we look at the situation in the region. However, when I participated in a meeting with health ministers from BRICS+ countries at the World Health Assembly, it was emphasized that each country has different traditions and cultures. At the Assembly, I did not see any country that doubted that men and women have equal rights, but we cannot force each country to use the same vocabulary and terminology. We must be aware of the different situations and find ways and means to achieve the goal that health services are a human right for all.
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