 day, Sean Casey. Sean is the Pacific Health Costa Coordinator for the World Health Organization. And Sean has been a leader in some of the most challenging global health emergency events in the last decade, I would say. To name a few, I know you were heavily involved in the West Africa Ebola outbreak. In 2014, the Nepal earthquake in 2015, the Typhoon Haiyan in the Philippines, Haiti 2016, the measles outbreak in 2019. And you have what I consider quite the distinction of being named humanitarian hero of the year in 2015. So welcome, and thank you for joining us today. Thanks so much, Nadine. Thanks for having me and greetings from French Polynesia. Yes, that's wonderful. I'm particularly excited that you can set this up from a distance. And you said you were sitting right outside the emergency room. I'm sitting at the Emergency Operations Center here in Tahiti, where the government of French Polynesia has commandeered two buildings next to the Ministry of Health to bring together all of the repurposed staff from across the government who are supporting or coordinating the COVID-19 response. Amazing, amazing. Hey, as we talk about, go through this little 30-minute slot or interview that we have. I thought we would start very general and broad and then get down to what I think is going to be the most interesting things to ask you. But just starting very basic, I think the average person is very familiar with terms like the CDC, the Centers for Disease Control, the WHO, the World Health Organization. But they may not actually be very comfortable of what role the WHO plays in global health crises, pandemics such as COVID-19. Do you want to start there and give a sense? Sure, well, the World Health Organization obviously works globally. We have six regional offices and a global headquarters in Geneva. So I work in the Western Pacific region, which is headquartered in Manila in the Philippines. And I work in a division that's called the Division of Pacific Technical Support, which is based in Fiji and supports the 21 countries and territories of the Pacific, the small island developing states across the Pacific Ocean. The World Health Organization has a few roles in pandemic preparedness and response. We have a historical, traditional role of technical advice and serving as the kind of global organization of reference for technical guidance, situational analysis, risk assessment. So we have responsibility basically with where we've been made responsible by member states. We're a member state agency. So all of the member states of the world have charged us with understanding what's happening in the world of infectious disease, noncommunicable disease, environmental health, and other areas, giving evidence-based advice and providing the best available information that we're able to provide for any given situation. In recent years, we've also become much more operational. So in a number of responses around the world now, you'll see WHO directly supporting field hospitals, deploying supplies, deploying staff. For example, I've been deployed to French Polynesia to provide technical advice and operational coordination support. And we also serve a coordination function. So my title is Health Cluster Coordinator, and that's basically WHO is the cluster-lead agency for health in any emergency. So we're responsible not just for supporting ministries of health, but also for helping to coordinate any partners, any agencies, any NGOs, organizations, emergency medical teams that may deploy to basically ensure that we're addressing all of the needs and also not duplicating efforts. Tell me a little bit more as you narrow in what your role in the Pacific is about, and what specifically, either as the World Health Organization or you as the Pacific Health Cluster Coordinator, what is your focus? So for COVID-19 in particular, we've been working on preparedness and response since really early January. The Pacific, like I said, has 21 countries and territories. Most of which are quite small. And many of the countries that we support have many islands, which are difficult to reach. There are enormous logistical challenges. So I'm in French Polynesia today. There's over 100 islands here. And some of them can be reached by air. Some of them can only be reached really by sea. That's the case for a number of the countries around the Pacific. We have limited flight connections. Some of the countries are very, very small. So we work with Fiji, which has close to a million people, on the larger side. And countries like Tuvalu, which has just over 10,000. So in those very small countries, there are all kinds of human resource constraints, financial resource constraints. And so we have been working since January to help all of the Pacific countries and territories to prepare as best as possible to prevent the importation of COVID-19, to detect it if it arrives as quickly as possible, to isolate and manage those cases, and to reduce morbidity and mortality as much as possible. The good news is that, to date, only a small number of Pacific countries and territories actually have confirmed cases. So in the North Pacific, the Northern Mariana Islands, and Guam, which are US territories. In the South Pacific, we have New Caledonia, Fiji, and French Polynesia that all have cases. The numbers are much lower than most other parts of the world. So Fiji has 17 cases. As of today, French Polynesia, where I am, has 55 over a one month or so period. And most of the other countries don't have cases, which is good news. But at the same time, we still have to continue to prepare. Because for now, flights have been stopped. Travel has stopped. We don't know how long that can be sustained. A number of Pacific Island countries rely very heavily on imported goods and flight connections to the rest of the world just for their basic supply chain. So we'll continue to prepare, reinforcing surveillance, reinforcing case management. Some Pacific countries have only one or two ICU beds that normally function and very limited hospital space. So we're working on all of these fronts. And we have staff deployed over the last few months to a number of countries providing training on infection prevention and control. We've dispatched personal protective equipment to almost every Pacific country. And we're now working on trying to get testing capability to all of the Pacific countries and territories. Right now only a small number can actually perform tests locally, which for sure will hinder their ability to detect and manage cases quickly. So it's across the whole spectrum. And at the same time that we're focusing on COVID, we're trying not to forget all of the other health needs that don't go away. So the Pacific has a huge challenge with non-communicable disease. Women still have babies to deliver, kids still get sick. The regular drug supply has to still be there. And the supply chains are interrupted. So at the same time, we're trying to keep an eye on the rest of the health system and make sure that ministries of health are able to meet all of the needs of the population to be as healthy as possible. You know, you made me think of so many questions. The first is when we think of, in particular, COVID-19, we think of China when it became just a little seedling of a concern, and then when it became a larger issue. What triggered your team to be deployed in the Pacific specifically for COVID-19? How large is your team? And how does the World Health Organization either decide or layer what it does up against the departments of health or the ministries of health depending on what it's called in the individual country? How do you balance that and how do you craft yourself specifically for that country or for that area? So that's about it for your questions. A few questions. Our team actually, not because we had a crystal ball, but because we had a measles outbreak in the Pacific last year, our team was already in existence before our emergency response team, our incident management team was already functioning and deploying around the Pacific before COVID even was identified. So we actually had an incident management team that we pivoted that included repurposed staff from across a number of departments in our offices, but also additional consultants that were brought on board. So we were already working on measles in Samoa where you and I met on measles preparedness in a number of other countries. So in January, I was deployed to the Federated States of Micronesia. We had staff deployed to the Northern Mariana Islands. And at a certain stage in January, we started kind of switching from the focus, or not switching completely, but including COVID-19 in those discussions. And from, I would say, late January, we really started doing dedicated COVID deployments around the Pacific. And we deployed staff, I think, to almost every country and territory at some stage between late January and late March, providing training, providing planning support, and just advising. So I'm probably gonna forget some of the questions that you asked, but I think we take some of our cues from, we take, you know, we respond to requests. So we have an ongoing discussion, an ongoing dialogue with all of the Pacific ministries of health and with the ministries of health across the region. Actually, there's a meeting right now that's happening every week with the regional director of WHO, all of our Pacific offices and the Pacific ministries of health with the ministers and then the directors of health. So we have an ongoing dialogue about the situation in which the ministries and departments of health can ask questions and express some of their needs. We also have, you know, lots of bilateral discussions. At the same time, in the COVID context, we've done some pushing of advice and materials just because not everybody may be fully conscious of what they need. I mean, I think this is a new virus and I think all of us are still not exactly sure what we need to be able to respond effectively. It's a learning process day by day. It's beyond the usual capacity of most of these innate teams or departments of health to be managing a pandemic, would you say? I don't think there's a country in the world that was completely prepared to deal with this. And I think every country and every health department and ministry of health has had to reallocate resources and repurpose staff and rethink everything that they had thought about before. You know, we've all been working on pandemic preparedness for a very long time. We've been dealing with pandemics for centuries and in the Pacific, there's an acute awareness of the Spanish flu pandemic from 1918 where some countries were very badly affected and other countries weren't affected at all because of border control measures and other measures that they put into place. So pandemics are on our mind in the Pacific and we also know that the Pacific countries are particularly vulnerable. They're protected in a way by their isolation but they're particularly vulnerable. So there was no illusion that any country in the Pacific is ready to deal with the pandemic but we had done pandemic planning and almost every country has a pandemic influenza plan but this pandemic is not pandemic influenza, this is pandemic coronavirus which doesn't have a vaccine as influenza does or influenza vaccines are generally easier to develop. It doesn't have any therapeutics that are readily available and we don't have a prior knowledge of the dynamics of transmission and clinical evolution. So we can use some of that content that was developed and some of those plans that were developed as a baseline and thinking about how you manage the incident, how you reorganize resources, emergency declarations if necessary but some of the very technical content we've had to really develop as we go along. So since January, WHO has been releasing technical guidance and updating it constantly which is a massive undertaking to develop and it's also a massive undertaking to digest. And so when I mentioned before that the Pacific countries have limited human resources it's particularly important that we as WHO in the Pacific can help to process some of that content and translate it for the local context and also filter what's really needed at what time and what can maybe be used later or what can be used differently. You know, you maybe think of something in the context of Hawaii, because people in Hawaii view themselves culturally and very much part of the Pacific basin and at first when you were discussing this I thought, yes, this is in the context of Hawaii but is that true? Does your team view Hawaii as part of the United States and are the strategy or the relationship that the World Health Organization has with us is from the lens of the United States under the CDC or are we part of that strategy for the Pacific region as a whole? So the United States is a member state of WHO in the Western Pacific region because we have three US flag territories in the region. So our Pacific office doesn't directly cover Hawaii from a technical support perspective but we do support American Samoa, Guam and the Northern Mariana Islands, the Commonwealth of the Northern Mariana Islands. Having said that, you know, we met through a collaboration with Hawaii and supported the Pacific and I think it's an area where we'd like to see more development. I think that Hawaii is inextricably linked to the rest of the Pacific through flights, through culture, through language and through history and there's incredible resources that are available there which we saw deployed for the Samoa measles response in November and December of last year. At the same time, I think our focus on technical support is really across the breadth of the Pacific but there are always some countries that might require more support than others and Hawaii has an incredible level of resources particularly compared to most of the rest of the Pacific. So we're always happy to engage with Hawaii but it's not a territory that's, you know, a state that's in our typical remit as the Western Pacific region. No, I know exactly what you're referring to. We've had discussions on this as a result that Hawaii Health Corps was created and a lot of thoughts of what we could do both locally as well as with our island neighbors and I don't mean our island neighbors within the state but in the larger Pacific basin and some of those conversations have come to a halt as we're all trying to deal with our regional COVID-19 but I know these conversations will continue because the excitement that was generated just in the healthcare community was palpable to say the least. You know, there's an incredible level of Pacific solidarity. I mean, like I said, there's 21 countries and territories and they're all different and they have their own languages and their own culture but there's an incredible level of solidarity in the Pacific and we saw in the measles response last year, smaller countries, countries that did not have formed emergency medical teams, Kiribati, the Solomon Islands, Fiji, with varying levels of resources, financial and human, still sent support to Samoa which is one of the larger Pacific countries to help them with their measles outbreak and we've seen that same kind of action in past emergencies and I'm sure we'll see it in the future. I couldn't agree with you more. And you can see that in healthcare, you can see that in the Polynesian Voyaging Society in their history and of itself. I couldn't agree with you more. You know, Sean, talk a little bit about some of the challenges that who has been struggling with in, let's just use COVID-19 because that's where we are now. It is such an incredible example whether it's been, whether it's general structure is, was ready to handle this. Is it been a learning process? Are you stretching yourself in ways that you've not had before? Either in professional resources, having the language or the defined type of teams that were necessary to do this. It's a very open question and to just understand what does it feel like going through this process live? Right. Well, I think, like I said before, I don't think anybody was completely prepared for COVID-19 but I think for WHO, we learn in every response. So we have a systematic after action review process that we apply and we take very seriously. So we learned a massive amount through the Ebola response in West Africa where I spent a year and a half. We learned a huge amount through the Ebola response in the Democratic Republic of the Congo, which is ongoing and through past pandemic experiences, through the SARS response, the H1N1 response. And so nobody's perfect, no organization is perfect. We have our strengths and our weaknesses but I think the systems that we have developed through those responses were well adapted to COVID. So the principles, the underlying principles are there and that's why it was in the Pacific so great that we already had an incident management team established. There was basically no blip whatsoever. We immediately pivoted that team to work on and aside from having some people who were tired from several months of pretty intense work on measles pivoting to the next response. I think the model is really a good one and it allows us to act relatively quickly to process information pretty quickly, to deploy support quite quickly. A lot of the challenges that we're facing at the moment are logistical challenges that are really outside of our control. So even if we have staff who are ready to deploy, even if we have PPE that can in theory be shipped, we don't have a way to move a lot of these supplies. So we're having to get creative and that's why this week or next week, French Polynesia is going to be sending a plane to China and they're sending the plane to Paris and we're coming up here with creative solutions and I think everybody in the world is doing that including WHO at the moment. But I think the fundamental systems have developed over time and will continue to develop, they'll continue to improve. But yeah, I think the systems that we've evolved over time are all being used and they're being used the way that they were intended to. No, by all means, that's an excellent answer and this was not in any way to place any, other than an intellectual conversation of what do you think and what do we live as we fly the plane that we're building in the future? I don't think any of us could have expected that global air travel would have come to a grinding halt. So I think that's something that raises lots of questions about staff deployments and production of materials and stockpiles and things like that. I think what's really encouraging in this response is seeing the level of investment and financial investment and human investment and political investment in finding out as much as we can, sharing information as quickly as possible and acting upon it. So there's never been a level of investment in effort in vaccine research, therapeutics research, diagnostics research in such a collaborative way. We see papers coming out every day, just required information sharing, which is completely overwhelming, but also really useful. And I think it's enabled us to learn at a click that we would not have seen before in previous pandemics. And in such a collaborative way, the speed in which we are using international papers, research, opinion pieces, and trying to incorporate them on the clinical level into our procedures, protocols, and guidelines. I've never experienced anything like this before. Absolutely. You know, I've got two really quick questions for you. One along the lines, and let me be very oversimplistic. You know, when you think of COVID-19, there, we don't have the typical tools in which we often address other illnesses. We often use the flu or the measles as an example of having a preventative tool or arm, which would be the vaccine. We have medications to deal with someone getting it, such as the Tami Flu or antiviral medication and other ways in which we can do point of care testing to be able to quickly tell what is going on in our immediate population and in a reporting system. Tell me a little bit about what you think, and I'm gleaning not necessarily the official World Health Organization opinion. I am asking you. We will not have a vaccine likely for at least another year, two year and a half for very safe and logistic reasons. We are not likely to have an antiviral ready. You've heard everyone from politicians to singular papers discussing whether certain drug combinations or drugs that are used in other purposes might be of some help. So there's a lot of focus on having point of care testing. And what I mean is testing that can be, we can get results in a very short period of time anywhere from 10 to 15 minutes and that it's cheap enough and easy enough to be in any office clinic or emergency room. Any thoughts about that in the role that the World Health Organization might play with the various countries and giving any guidelines? And I know that there's no official response yet. Right, so I mean, I think fundamentally we're going to need some combination of diagnostic capacity, clinical capacity, therapeutics or otherwise. We're going to need to continue to apply non-pharmaceutical measures. And I don't think anybody has figured out what the right dose of non-pharmaceutical measures is. And when I say non-pharmaceutical measures, I mean social distancing, physical distancing, lockdown, travel restrictions and things like that, which are obviously showing an impact, but we don't know yet when they can be led up and not, and all of those pieces fit together. So the diagnostics are going to be absolutely useful, but they'll still have to be paired with some kind of social distancing measures, some kind of non-pharmaceutical measures. We'll absolutely, hopefully, we are very, very hopeful that we'll have a vaccine at some stage, but until then, testing and social distancing, there's some kind of non-pharmaceutical measures are going to be the prescribed approach. So yeah, I mean, for WHO, we're investing a lot in all of these areas and trying to figure out what the best solutions are and also recognizing the different countries and have different contexts and different needs. So large scale testing is definitely needed in populations that have large scale transmission and where we really don't know who's infected and who's not and there's likely to be more social interaction. In some countries like here in French Polynesia, we're not testing everybody because we know that half of the cases that we've identified so far are imported. So here, we wanna have very focused testing and reasonable application of social distancing measures maybe with an eye at some point for too long to not having local transmission. So some countries that still don't have cases, most of them are in the Pacific and that's where the non-pharmaceutical interventions are absolutely key. There's other countries that have very large scale transmission and their diagnostics, whether it's point of care or some kind of rapid diagnostics are gonna be really critical for them to be able to reopen, but diagnostics are not on their own solution. A vaccine at some stage might be a very, very helpful solution, but it's gonna take time. So in the meantime, it's gonna be diagnostics, it's gonna be continued focus on finding therapeutics that work. WHO is supporting a trial now that has 90 countries signed up or interested in 900 patients enrolled looking at four different drugs or combinations of drugs. We're gonna have to keep doing more of that. We have to go full speed on all of these efforts. There's not gonna be one vaccine. Thank you. Exactly. Do you know, as you're describing all of these things, it occurs to me that one of the big questions that is going to be on every politician's mind as well as government is how do we go from the social distancing many people have to stay in place where we are now to returning back to whatever degree of normal or new normal. And it seems to me by the way you were describing the World Health Organization's role in other pandemics or that this would be a very new role to be involved in turning the faucet back on and giving guidelines along those rules or such. Comment about that because it's very political space right now but I think you and I can also agree it's also very clinic science space. You're in the box. Sure. Well, there's the health side of it which is for us as health authorities we can say the ideal solution is that for now everybody stays at home or washes their hands or wears a mask or whatever the specific advice is that comes from the health authorities but we have to take into consideration the fact that schools are closed that parents can't work because their kids aren't at school that in the US today they just announced that I think in four weeks 22 million people have lost their jobs the economic impact is going to be absolutely massive so we have to strike that balance but we can't strike it alone as health professionals because there are other dynamics at play and what will really influence the direction that COVID-19 takes us is human decisions many many different human decisions that are going to be made some of what's your health decisions and some of what's your social and economic and political so I think the really important thing as we go forward is having that dialogue and continuing the dialogue and continuing the debate and there's no right answer but we want to protect as many lives as possible whether that means reopening or keeping things closed for a while or gradual reopening there's no formula yet so countries that are inching out at the moment are doing it in a kind of a trial fashion to try to find the channel that will work best for them and then all of the rest of us are going to have to keep watching and learning almost everything that's been done in the Pacific to keep population safe has been referencing what happened in China and what happened in Singapore and what happened in Korea and what happened in Italy and that's influence decisions and I think we're going to have to keep doing that so as health authorities we need to keep looking at what everybody else is doing and learning from it use the best available evidence and science but also take into consideration that we can't keep everybody locked down forever so we're going to need to find additional solutions and those solutions are likely to include diagnostics like you said at some stage maybe therapeutics lots of non-pharmaceutical interventions of different kinds continuing to reinforce good hygiene practices and physical distancing measures maybe that are not social distancing but physical distancing measures so we can still interact as a society and hopefully someday vaccines it's going to be a combination of those from a response perspective but also from a planning perspective oh man that is perfect and it's exactly what I think we want to know and want to hear that the World Health Organization is up to I know we're in trying times as the US has put a halt to some of the funding that goes to the World Health Organization but it might be too presumptuous in saying it's very likely that the World Health Organization is going to continue to do what it does regardless of what is going on politically we're laser focused we're laser focused on our mission before coming on with you I was on a call with the entire staff of the Western Pacific region there were 375 people in the call and the the central message from our regional director from across the staff as we have a mission and I think now is the moment for focus and solidarity we've we continue to receive very positive feedback from member states and partners of course like I said no response is perfect and we're all learning it's a novel disease but we're focused right now on trying to prevent as many infections as possible trying to make sure that as few people as possible get infected and get ill and die from COVID-19 and from everything else so WHO's mission remains the same it's not just COVID-19 it's about advancing the health and well-being of society and we're going to keep on trying to do that and of course the decisions on funding may have an impact on us and we'll work through that and hopefully those resources can be made up in other ways through additional contributions or through working more efficiently which we all wanted to do but we're not going to let up on the work that we're doing it's absolutely continuing I can tell you I am in awe of what the WHO does of the mission believe in it I tell you our small interaction if I could speak for Hawaii was nothing but positive on our brother country brother sister country or Polynesian country and thank you thank you for everything you do thank you for being our guest today and taking time out from Papa Ete thanks so much I hear you're going to be off soon to your next assignment is what you were saying also well no I don't know I came here one month ago today for five days and there are no flights out at the moment so there's a flight to Paris every 10 days Fiji is kind of in the other direction that's where I'm normally based so we'll see where I end up and when but I've managed to buy some shirts in the supermarket and I'm still finding baguettes and french cheese here so I'll survive in the meantime and we'll keep focusing on the work okay that's okay it was so great thank you so much