At the beginning of May, after almost 10 years at the helm of one of the world’s richest biomedical foundations, British physician Jeremy Farrar traded funding clout for a bigger international stage, moving to Geneva to become chief scientist at the World Health Organization (WHO). Farrar had helped make the U.K.-based Wellcome Trust a major player in global issues such as infectious diseases and the health effects of climate change. He also wasn’t shy about criticizing WHO’s leadership, specifically its slow response to the West African Ebola outbreak in 2014.
Only the second person in the chief scientist post, he succeeds Indian pediatrician Soumya Swaminathan, who was promoted from another WHO position in March 2019 and left the new post late last year. “I think it’s fair to say that the role of chief scientist is still to be fully framed,” Farrar says. But in his eyes it offers an opportunity to provide countries with science to help their political decision-making. “I wanted to do something closer to countries, because ultimately, that’s where health and science is going to be delivered.”
COVID-19 will remain a focus, Farrar said in an interview last week, because the world needs to prepare for the unlikely but possible scenario “that we could go back in a bad direction.” But he also wants to look forward. “Part of what I would like to achieve is bringing a sense of tomorrow into the World Health Organization.” This exchange with Farrar has been edited for brevity and clarity.
Q: Why did you decide to take on this job?
A: The world is facing some really big challenges and I think almost all of them are transnational. Climate change, pandemics, antimicrobial resistance, demographic shifts, inequality: These ultimately require the world to find a way of working together even if they can’t agree on anything. And if you believe that, then you can’t just sit on the sidelines and say: “Multilateralism is great.” I was planning to stay at Welcome till September and then hand over to a successor. Then this opportunity came and here I am. Multilateralism is important and international organizations are ultimately one vehicle through which that’s delivered. If you can make a contribution to [it], your career will have had meaning.
Q: How do you hope to make a contribution? At Wellcome you were running one of the wealthiest, biggest science funders in the world, now you are in a chronically underfunded international organization.
A: It is very different and maybe that was actually the attraction. I think science will be central to [WHO] and it will be central as a mechanism to feed into how governments make decisions. Money is critical, but it’s not enough. If you’re not willing to use the best evidence to inform the best policies, then no matter how much money you’ve got, you’re going to struggle. So having had 10 years of a lot of money and freedom and self-governance and the rest of it, I wanted to do something closer to countries, because ultimately, that’s where health and science is going to be delivered.
Q: You’ve said very often that in February 2020, we really knew everything we needed to know about SARS-CoV-2. So how do you make sure knowledge has impact?
A: There’s no doubt that countries around the world made their own decisions [about COVID-19] based on their own drivers. No individual country got every decision right. I believe that you are better in policymaking if you have access to the available evidence and science and data. The decisions you then make are largely political. But try and do that in the absence of science and you have weaker options. I think there is a much greater appreciation in 2023 than there was in 2020 of the importance of having scientific input in decision-making in a political environment. I haven’t spoken to a government in the last year that didn’t appreciate the critical role that science made to their decision-making ability. I think we’re actually at a point now when that door is more open than probably at any time in my professional career, and I think that’s the opportunity you need to try and to push through.
Q: That surprises me. Science is under attack around the world and it seems like dismissing science has become easier because it is cast as part of the elite. It’s part of the populist playbook to denigrate scientists.
A: I agree with you that we are in that debate. But there has always been a debate about these issues, going back to Galileo, and to Darwin and John Snow. If in February 2020 you had told me we will have a vaccine available before the end of the year, and that within 2 years, probably somewhere over 6.5 billion people will have lined up in supermarkets, football stadiums, etc. to be vaccinated by somebody they’ve never met before and will never meet again, and will have repeatedly done that once, twice, three times … I would have been amazed.
If we don’t engage, if we just say, “Trust us, because we’re scientists in our ivory tower, we don’t need to make the case because we’re always right,” then of course, we’ll lose the argument. So in a way, it comes back to your first question, why come to WHO? It is important to make the case that actually science, social science, biomedical science, whatever science we mean, has a critical role in our culture, the way our societies operate. And ultimately, if we scientists don’t go out to make that case, then there’ll be a vacuum, which might be filled by other people.
Q: When I interviewed Swaminathan, your predecessor, at the end of her tenure, she said her biggest regret was not calling SARS-CoV-2 airborne earlier. Is that an example where WHO failed the world on the science?
A: To be honest, I would say I didn’t understand how complex it was. I’m not the strongest physicist in the world. Understanding humidity, environment, droplet sizes, aerosols, temperature, individual components of it, it is an incredibly complex field. And this is one debate which I think has been dominated not by overly simplistic, but by strongly held positions. There is a [WHO] consultation, which has been going on for a while now, trying to bring these communities together and see if it’s possible in quite a polarized scientific debate to get some alignment on basic principles.
Q: But isn’t this one of the examples where we really knew what we needed to know in early 2020?
A: I think the depth of understanding of the transmission came later. I think the science is more complex, certainly than I appreciated before and I think the implications of the consultation are profound, depending on where it lands. There’s COVID, there’s tuberculosis, there’s influenza, there is measles. You’re covering a lot of different pathogens here. Far too many health care workers around the world have died as a result of COVID and continue to die from other infections, including tuberculosis.
This is not the same, but when I started my medical career, none of us wore gloves. We wouldn’t have worn gloves taking blood. No dentist wore gloves. That’s unthinkable now. But even if we can get a scientific consensus [on how to define airborne transmission of pathogens], which is a challenge, we need to think: What are the implications for health care facilities, not just in Berlin or in Geneva, but in every country.
Q: How much of a threat is COVID-19 now?
A: The most likely scenario is the one that the world is sort of now in: that with a combination of vaccination and natural immunity from infection, new variants are to a large degree constrained. My concern has always been that there are other scenarios. There is a small possibility that we could go back in a bad direction and I think it’s really important that the scientific community and public health community don’t ignore that small percentage chance, because it would be unthinkable in 2026, 2027, 2028 for us to go back to March 2020. I think that is unlikely, but we should be prepared. We are not where we need to be. We don’t have transmission-blocking vaccines. Frankly, we don’t have good enough therapies yet. We don’t have enough antiviral drugs, not just for COVID, but more broadly than that.
And the impact of what is called Long Covid is going to be huge. When you’ve had 6.5, 7 billion people in the world infected, you only have to increase the risk of diabetes, dementia, cardiovascular disease by a tiny percentage, and you’ve got a huge long-term problem. We’ve got to understand Long Covid and find ways of preventing it, but also treatments.
Q: You are only the second person in this position. What exactly is the job of WHO’s chief scientist?
A: It’s fair to say that the role of chief scientist is still to be fully framed. Part of the role of the science team is to work horizontally across different topics. And I think governments, U.N. agencies, WHO need to anticipate what is coming, and then debate this in nations, in the public, in the media: data, artificial intelligence, genomics, and the ability to manipulate genomes in agriculture, human and animals, climate change, and so on. What is coming down the track? What do we need to prepare for now, to ensure that inequality and health disparities are not exaggerated by those new technologies? Part of what I would like to achieve is bring a sense of tomorrow into [WHO] and into the member states.
Q: What are some examples of what is coming?
A: Broad genomic approaches are going to come to fruition. And we need to make sure that people are not left behind, that we don’t build in inequality into that so that your genes define how you’re going to go through the rest of your life. Six months ago I had never heard of chatGPT, now we’ve all heard of it. But actually, that was being developed 5, 10, 15 years ago, and people in the know knew about it. I would like to lift the lid on those things.
There are huge questions in neuroscience: What is it to be human? If we can start to manipulate the brain in the next 25 years, what are the implications of that for who manipulates, who gets manipulated, who controls that? I think that has importance for our individual health, but also for public health, and way beyond health itself, including education, in the military, and in all sorts of other walks of life.
You could probably add another 10 things to that which have a more than 50% or 60% chance of coming to fruition in the next 10 or 20 years. And I’m not sure how many of those we’re really thinking about now, not just in scientific institutions, but in the public, in the media, in the political and diplomatic world. My worry is that we’re increasingly diverging there and therefore we’re reacting to changes like chatGPT rather than anticipating it and thinking, “How can we best develop it?”
Q: What about your own future? What would make you feel you made a difference at the end of this job?
A: My contract covers 2 years for now and I haven’t thought beyond that. I think an individual rarely changes things dramatically. [But] if you can be part of a leadership team, help the organization through [WHO Director-General] Tedros [Adhanom Ghebreyesus] to move forward in this peri-pandemic era, to learn the true lessons of the last 3 years … I would look back in 2 years’ time and say that the team here pushed it forward a little bit. We’re all tired at the moment. We’re all fed up with COVID. We’ve all been affected personally, professionally, but we need to lift our eyes because I think the future is bright. But it won’t just happen by chance, we have to push our future. And if I can contribute to that, that’s great.
