Contain This: The Latest in Global Health Security

Indo-Pacific Health Leaders Series: Dr Takeshi Kasai, WHO Regional Director for the Western Pacific Office

August 24, 2020 Indo-Pacific Centre for Health Security: Department of Foreign Affairs and Trade Season 1 Episode 14
Contain This: The Latest in Global Health Security
Indo-Pacific Health Leaders Series: Dr Takeshi Kasai, WHO Regional Director for the Western Pacific Office
Chapters
Contain This: The Latest in Global Health Security
Indo-Pacific Health Leaders Series: Dr Takeshi Kasai, WHO Regional Director for the Western Pacific Office
Aug 24, 2020 Season 1 Episode 14
Indo-Pacific Centre for Health Security: Department of Foreign Affairs and Trade

This week we launch a special series where Australia’s Ambassador for Regional Health Security, Dr Stephanie Williams, interviews leaders in the Pacific and Southeast Asia about how they have faced being a leader and health challenges during the current COVID-19 crisis.

These frank conversations begin with Dr Takeshi Kasai, the Regional Director for the Western Pacific Office of the World Health Organization. As Regional Director, Dr Kasai is responsible for convening and communicating with partner governments on the health and well-being of 1.9 billion of the world's population from Fiji in the East, to China and Vietnam in the West and Japan to the North. A physician by training, Dr. Kasai has been involved in responding to outbreaks and crises, including avian influenza in Hong Kong and Japan, the 1995 Kobe earthquake and the SARS crisis. He has worked for WHO for more than 15 years and was instrumental in developing and implementing the Asia Pacific strategy for emerging diseases and public health emergencies, which guides member states ongoing improvements to readiness and response.

Show Notes Transcript

This week we launch a special series where Australia’s Ambassador for Regional Health Security, Dr Stephanie Williams, interviews leaders in the Pacific and Southeast Asia about how they have faced being a leader and health challenges during the current COVID-19 crisis.

These frank conversations begin with Dr Takeshi Kasai, the Regional Director for the Western Pacific Office of the World Health Organization. As Regional Director, Dr Kasai is responsible for convening and communicating with partner governments on the health and well-being of 1.9 billion of the world's population from Fiji in the East, to China and Vietnam in the West and Japan to the North. A physician by training, Dr. Kasai has been involved in responding to outbreaks and crises, including avian influenza in Hong Kong and Japan, the 1995 Kobe earthquake and the SARS crisis. He has worked for WHO for more than 15 years and was instrumental in developing and implementing the Asia Pacific strategy for emerging diseases and public health emergencies, which guides member states ongoing improvements to readiness and response.

Please note: We provide transcripts for information purposes only. Anyone accessing our transcripts undertake responsibility for assessing the relevance and accuracy of the content. Before using the material contained in a transcript, the permission of the relevant presenter should be obtained.   

The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government.

Dr Takeshi Kasai  0:10  

First and foremost, everybody knows that we can't really respond to COVID-19 alone, so everybody knows that how important it is for us to be connected, and how important that partnership is.

Dr Stephanie Williams  0:24  

Welcome to Episode 13 of Contain this, brought to you by the Indo-Pacific Centre for Health Security. I'm Stephanie Williams Australia's Ambassador for Regional Health Security. Today, I'm launching a special series of podcasts with Indo-Pacific health leaders. I will bring you frank conversations with leaders in the Pacific and Southeast Asia, about how they are facing current challenges, making decisions amidst uncertainty planning ahead while dealing with a current health crisis, and how they as individuals adapt and adjust their leadership style during this large event, that of COVID-19. 

I begin this series today with Dr Takeshi Kasai, the Regional Director for the Western Pacific Office of the World Health Organization. The Regional Director role's is convening and communicating with partner governments on the health and well being of 1.9 billion of the world's population from Fiji in the east to China and Vietnam in the West and Japan to the north. A physician by training, Dr Kasai has been involved in responding to outbreaks and crises including avian influenza in Hong Kong and Japan, the 1995 Kobe earthquake and the SARS crisis. Dr Kasai has worked for WHO for more than 15 years and was instrumental in developing and implementing the Asia Pacific Strategy for Emerging Diseases and public health emergencies, which guides Member States ongoing improvements to readiness and response.

Dr Kasai, welcome to Contain This. Dr. Kasai, you commenced your term as regional director in January 2019 and you named health security as one of your three priorities, which also included NCDs (Non-Communicable Diseases) and ageing and the health effects of climate change. One year later, the SARS-CoV-2 virus emerges. Can you cast your mind back to early this year to January, and talk us through what were some of your initial priorities as SARS-CoV-2 emerged in the world looking at our region?

Dr Takeshi Kasai  2:32  

Yes, Ambassador Williams. The four topics you just refer was the topic that we thought is important for us to address as a future agenda. But now that is with us. So I strongly feel that we also have to really prepare for the other three agenda. But let me focus on this COVID-19. There are two important task for WHO at the regional level to play. 

One is actually very obvious - to provide the support to the country who need our help, but also to connect the countries. We've been helping countries to develop the response plan or setting up, establishing the surveillance system or the laboratory diagnosis. We're also help in countries to strengthen their healthcare capacity, including the infection prevention and control. But for infectious diseases, this virus will not respect the national boundary so it's so important to continue to connect every country, regardless of development state. Even if one country has a capacity and the neighbouring has not, no countries are saved. 

So we've been trying paying attention to those two elements as a Regional Director. My role is about making a decision, and also trying to help the leaders to make a decision. Infectious diseases, is actually a series of decision making. But under the uncertainty. And ironically, the more earlier we detect less information and more uncertainty. But we have to make a decision. And some of those decisions has a very heavy consequence. And again, to make these difficult decisions, we have the method called risk assessment and risk management. 

I still remember, it was the last meal of 2019. I finished the dinner together with my family. And then, enjoying. You know there's a music show in Japan that many people watch as the last program of the end of the year. And then I received information from my deputy saying that there is information, about the cluster of unknown pneumonia, in Wuhan, China related to seafood market. There is a lot of uncertainty. But what came up to my mind is that is the next SARS. 

Actually after SARS, WHO has established the disease's surveillance system to monitor those kind of rumours, information around the world, which might potentially pose a threat to international community. So actually, I received information from my deputy, but WHO headquarters, and then also the regional office, and also the country office detected, this information. And then once we detected this information, all three level initiated the validation of the information and switch on this risk assessment and management cycle. The WHO's role is actually defined in this International Health Regulations, it's a legal framework. The current one is revised based on this SARS experience.

I received information from my deputy, but the WHO headquarters, and then also the regional office, and also the country office detected this information. And then once we detect this information. All three level initiated the validation of the information and switch on this risk assessment and management cycle. Now that your role is actually defined in this International Health Regulations, it's a legal framework. It's actually the current one is revised based on this SARS experience.

And we were requested to facilitate information sharing, but also mandated countries to share information on that outbreak they're experiencing. And so to make that happen, I repurpose a little bit of programs in China, and strengthen our country office in China, so that we can fulfill that job, and China also was trying to share the information. And they have, for example, they have identified a new virus, they shared. And then also, they shared the gene sequence that allowed countries around the world to set up their diagnostic system and we continue to doing that.

But when it comes to the decision making, again we follow these International Health Regulations, based on the SARS experience, member states requested to have more objective and fair and transparent decision making for the entire world. 

We call it an emergency committee. The experts around the world already selected before the event and then from that pool, the experts of the subject matters are called in and assess the situation based on the report submitted from the member states affected with the diseases. And, as you know, that the first meeting was organised on 22nd and 23rd, and they mentioned the committee was divided. But then in the second meeting on the 13th of January, unanimously they concluded to recommend Director General, that the current situation warrants the public health emergency of international concern, and immediately after that, we really help member states to prioritize and expedite the preparation for preparedness. We should not be regret, we should not regret in the preparation. But again, when actually we make a decision, we have to be very cautious because there is a consequence, and therefore we are continuously doing the risk assessment and then the continuous decisions up to today.

Dr Stephanie Williams  8:10  

Thanks Dr Kasai. This theme of uncertainty but the absolute necessity to make decisions every day comes through in a number of discussions. And I'm interested in when you looked at the region and as you're in your role as RD [Regional Director] and this daily process of risk assessment and decision making. Who you bring around you to go through that process in the Manila office, for example, tell me how you broach that uncertainty with different people when you look at the Western Pacific region?

Dr Takeshi Kasai  8:50  

The WHO consists of headquarters in Geneva. And then there's six regional offices, and then beneath Regional Office, we have a country office in our region, we have 15 country offices. And we have staff working on this response in each of these three levels. So first and foremost, we connect this three levels. And now the country office. They've been investing, or we've been investing for them to connect with their counterparts in the Ministry of Health. And so, another connection and then the investment is not to make a connection just between the country office and then our member state but helping the central government to be connected to their provincial level and then to their frontline level. 

So firstly, first and foremost, it's important is that we fully utilize this network to access the information on the ground. But then we also have to connect the expert and the partners because they are the one also have a lot of information and experience, diverse experience. So trying to connect those different groups depends on the different topic. And then they're making decisions. 

I'm very impressed with the Communications group. I've never seen these communication groups, they set up the network and then the monitoring the people's perception and then fine tune their message. And they're also using this network to fight so called misinformation. We have never experienced this level of rumour going around in during the response. So, this is the one example in connecting people.

Dr Stephanie Williams  10:58  

And you also have a hugely diverse set of member states in the Western Pacific regional office, within the region. Can you tell us how you brought, you talked about connecting countries, how you did that in the early stages of the pandemic and how you continue to bring people together in terms of the leaders of those countries or health leaders?

Dr Takeshi Kasai  11:20  

First and foremost, everybody knows that we can't really respond to COVID-19 alone, so everybody knows that how important it is for us to be connected and how important that partnership is. WHO is providing and trying to make them happen by sharing information, and try to come up with the one framework where everybody can find the space to contribute in this work so that we can avoid the duplications and also increase the effectiveness by coordinating ourselves. 

But, to tell you the truth, saying it is easy, but it's not that easy. This time, I was so impressed by the partnership in the Pacific, there'd already a mechanism to respond to measles, and then they transform this mechanism to respond to the COVID-19. And I have to really acknowledge, Australia is really leading, are the major partners on this, Australia, New Zealand, South Pacific community and others. Everybody's coming together to try to help the Pacific, which impressed me a lot. 

But we do also have another type of partnership. Beyond the health sector, for example, like health financing. Before this COVID-19 occurred, we spent one year, as Ambassador mentioned, that we discussed what is important topics for the future. And then we identify four agendas, and to pursued these four agendas. We noted that we need a partnership beyond the health sector. So we have started those kind of partnerships and during COVID-19 have been really helped with this prior effort. So we have a regular conference with the health financing groups such as World Bank, IMF or ADB to monitor the impact of the virus, but also the response, and also discussing what kind of you know the impact we have in health financing.

Dr Stephanie Williams  13:33  

Dr Kasai you mentioned your first thought back in December last year was throwing your mind back to SARS. And in part of the learning lessons is not only as we go during the COVID pandemic but reflecting on previous infectious disease events, of which I know you have had the experience of responding to many over your career in the front of your mind. Did you have any lessons from SARS that you applied immediately to the COVID response? Say in January or February was there anything that you thought back in 2002 looking at the head of WHOWPRO at the time, if I was RD and this happened, this is what I would do. What were the things that stood out for you from SARS that were relevant to COVID-19?

Dr Takeshi Kasai  14:22  

Let me answer in this way. Today is very different to the 2003 SARS period. The capacity of countries is very much different. They're significantly improved. I already mentioned about the International Health Regulations revision but in our region we also tried to develop the strategy called the Asia Pacific Strategy for Emerging Diseases to help countries to continue to improve their capacity. Actually, I lost my colleague during SARS. And then I also know that many of our colleagues in the countries had a very similar kind of incident and we all committed to continue to improve our capacity. And so there have been a lot of investment, and we organize annually the meeting to see the past one year progress, and then to come up with the options for us to continue to implement in the coming one year. 

We just finished recently these special kind of meeting, and they confirm that our past investment is really fully utilized in responding to this COVID-19, which made me quite, you know, happy, I would say, because all our investment is the one that member states is fully utilizing. But in the same time people really recognize this COVID-19, the scale, magnitude is not like what we've been preparing. So, our investment, the system we develop needs to be much more scalable. One example is that the volume, and then the speed of the movement of the goods and people are very different to when we had SARS and today. And that's the reason why we seeing so much spread around the world. But we also recognize that if we are going to do the intervention to that point, the impact of that is also significant. 

We also noted, that it is a bit nostalgic, but in 2003 people are getting information from newspaper or the TV. But now, no way. People are really getting the information from all sorts of information from internet and social media. Not just getting, they can also share those information that made as a huge challenge fighting with this misinformation. The rumours spread much faster than the virus. And that made it very difficult to communicate the decision we make, and the uncertainty, ironically this setting made as earlier detection means less information and then we have to make a decision within the uncertainty. I think that's the challenge that everybody around the world, the leaders are facing, how to communicate this kind of decision.

Dr Stephanie Williams  17:42  

I agree with you in the, the improvement in country capacities for health security over the last 18 years or since as has been notable especially in the Western Pacific region. And some of those experiences were borne out for example in Vietnam etc were investment in health security and previous experience has indeed put many countries in a much better position today than they would have been. There's a certain extent of the nature of this pandemic means is, no one can ever be perfectly prepared, just as good as they possibly can be at the time.

Dr Takeshi Kasai  18:18  

Ambassador Williams, I have to also mention this. When we started this Asia Pacific Strategy for Emerging Diseases, it was again Australia, and we was surprised also Canada, and the ADB and Japan. These are the partners who really took SARS 2003 experience, seriously. And then they supported WHO to work with the member states to continue to invest. Usually the partners, their priorities change, every two years, three years. But I have to acknowledge that Australia is the country continuously paying attention about health security. And I think I have to really mention this to your listener.

Dr Stephanie Williams  19:14  

It's definitely a long term priority of Australia in the region. I think you took a very early leadership stance from WHOWPRO in securing access for the Pacific to the first round of GeneXpert COVID-19 cartridges, recognizing that there are unique vulnerabilities in the Pacific and that diagnostic technology was essential. Casting your mind forward, if and when we get a vaccine, what are you thinking about the region, access and distribution, at this stage, in terms of the role of RD [Regional Director]?

Dr Takeshi Kasai  19:52  

Ambassador Williams, this is a very important question. I had a teleconference or the video conference with health ministers in the Pacific. Everybody mentions about the importance of securing the vaccine for their people, which I totally agree. I think we're tested about how we recognize about the vulnerable setting or the vulnerable people, and then work together to protect those people. We see vaccine as a global goods or global public goods. Unless every countries are protected, no countries are safe. 

And therefore, WHO, together with the partners, established a mechanism called Access to COVID-19 Accelerator. And then one of the four pillars is about vaccines, we call it COVAX and I understand that Australia is also participating, I think, on behalf of all the member states. This mechanism is not just to expedite the development of the vaccine. But it's also to think how to distribute it in equal and fair manner. And then now, not just a pledge, not just a commitment, we have to translate this into action. And then from the GeneXpert experience, I learned, the people often just fall into very dry statistics, a formula on what is the country's income level. And then they even use the populations. No way. If you go to the Pacific, even their income level in the UN statistics is like a middle or even higher upper middle. If you think about the population size, the living cost, and then infrastructure, it is not as other countries with the same level of the statistics. 

And we have to really continue to communicate this to the global community that reality on the ground. I'm very happy to share that I've been also having a teleconference with the ministers outside the Pacific. I also mentioned about this issue to them. And then the plea for them to also whatever opportunity to share, and then they advocate for us to pay those attention. And I noticed that they're actually doing it in their meeting setting. So I think we have to continue to advocate, about the vulnerability and special context. And at the end, we are all tested about our empathy or our solidarity, true solidarity in distributing these global public goods.

Dr Stephanie Williams  21:34  

Dr Kasai, I want to finish with a personal question, which is, this is a big event it's going to go for a long time. I'm sure the demands on your personal time are endless but everyone has finite resources. How do you keep going, what are the things that you do to look after yourself as a leader so that you can continue to be out there in the Western Pacific Region leading the COVID response?

Dr Takeshi Kasai  23:36  

First and foremost, we are in the sector serving people. WHO is the organisation set up to serve the people. And now the entire world is facing the challenge. And I think we shouldn't be, we shouldn't regret later, what we see today. And what I think is important is to feel or think about the people who you're serving. And that's the key for us to continue to motivate ourselves and then work every day with no regret. 

But it's actually, you mentioned about me, but it's actually not me, it's about the team. It's everybody working in this COVID-19, and then trying to really connect our staff and then to remind ourselves this issue: those people who we were serving. But of course, also I need to listen to their challenge, and also release their pressure. 

I'm very happy to hear this COVID-19, the virus itself, will not disappear quickly so we need to have a long term perspective, how you're going to respond to this very special situation. Many of our staff, start to see again, you mentioned about this for the future paper, the discussion we had one year [ago] they see, actually, a lot of those discussions are in front of us. So why not, not just see today as a challenge, but opportunity to grab those what we were interested in discussing with the people or member states to bring our visions into the future, where we wanted. 

For example, when we talk about we call it "new normal". The bottom line of this new normal is that everybody pays attention to their health and then take actions, not just to protect yourself, but to protect your family, your colleagues, and then the vulnerable. In infectious diseases, it's very obvious, but then this can also expand to other diseases, such as your own, let's say hypertension. The more you pay attention to your hypertension and stay on healthier side, you continue to be active participants in the community or the labour market. And you can save the medical expense. And actually you can also use your money that you're supposed to save for those kind of risk for other activities. So I think that there's also opportunity in front of us. And if we do this well, I think we can bring our region into the right future. 

But again, the reality is that everybody's tired, everybody's working so hard. So I have to continue to find a way to encourage, and I think it's so important also staff to have an on and off, and have a means to release the pressure. I'm not quite sure if I'm answering your questions but yes it's a challenge. I have to acknowledge.

Dr Stephanie Williams  27:06  

Thank you for taking the time to share your reflections of leadership in COVID with us today Dr Kasai and for the reminder actually that in a mission to serve people, as you have stated, the clarity of purpose, as well as looking after one's own health can sustain you in these challenging times so thank you very much. 

Dr Takeshi Kasai  27:26  

Thank you very much, Ambassador Williams or in the Japanese way Ambassador Stephanie. Thank you very much.

Dr Stephanie Williams  27:34  

That was Dr Takeshi Kasai, Regional Director for the Western Pacific Office of the World Health Organization. I'm Stephanie Williams Australia's Ambassador for Regional Health Security. Join me tomorrow for the next interview in our Indo-Pacific Health Leaders series with Dr Brendan Murphy, the Secretary of Australia's Department of Health and previously Australia's Chief Medical Officer.