Dr Ebere Okereke is a Consultant in Global Public Health and Communicable Disease Control and Lead for Public Health England’s Official Development Assistance – funded International Health Regulation Strengthening Project. She is a graduate of the LSHTM Global Health Executive Leadership Programme, which she attended in 2017/2018. She describes herself as an optimist and speaks to us about her role in the COVID-19 response and how she sees public health as the ‘translator’ between hard science and political decision making.
How has the COVID-19 outbreak affected your work?
The project I lead is about capacity building for compliance with international health regulations, working across a range of countries we deploy technical experts to deliver training and support the development of national public health institutions. The first impact I saw was the inability to travel and also the partial closing of UK missions which host our staff. The more significant impact I have felt for my work is the fact that we work, as I mentioned, with national public health agencies and they are now entirely focused on the COVID-19 response. That has been good and challenging. We have seen some of the capacity development we have supported take immediate effect. It is also an opportunity to move forward with a lot of things that we have been pushing for and that can now be rapidly implemented.
The fact that the outbreak is on a global scale has had an additional impact in the sense that the staff we deploy internationally now have the UK response to COVID-19 as a priority. Many are fully engaged in working on the domestic side of the response, but still have international work – it can feel like doing two jobs at once.
How has the national and international response to the outbreak affected your work?
The pandemic has created a new challenge in that higher income countries are competing for supplies with low income countries. The global manufacturing base, for example for PPE, is very small. The price for a basic surgical mask has increased from a few pence to a couple of dollars. This demand has created and widened inequalities that already existed.
I am an optimist, so I do see the good things that are coming out of this new situation. As the western world is very much focused on itself it has opened up a window of opportunity for African and Asian authorities to build their own innovations and solutions, some of which are proving successful. Often all we read and hear from low resource settings is gloom and doom, but for example, the way the Africa Centre for Disease Control has taken on an important coordinating role for the African response to COVID-19 is impressive.
I think that even out of this terrible situation a new world order is stepping up and new questions are being asked. I see this, for example, in terms of manufacturing and how this could be much more decentralised.
I do worry what will happen once a vaccine is developed and how we can ensure that countries with less financial clout will have the same access as higher income countries.
How has LSHTM’s training helped you during this outbreak?
Through the Global Health Executive Leadership Programme I was able to build up a network of colleagues from across the globe, working in different fields. Being able to exchange opinions and challenge each other has been fantastic – it really encourages you to take a different approach to a problem. I will be friends, partners and allies with my cohort for as long as I work in this field.
As a graduate of the LSHTM programme, even two years later I can give my mentor David Heymann a call and he will take time to talk to me, you can’t really ask for more. I think this programme really takes you away from the theory and puts it into practice and is probably the best professional development training I have been able to do.
On top of that, the programme presented a fantastic opportunity to speak to global health leaders in their jobs and get an honest reflection of what it takes to do this job. I was able to meet the current chief medical officer and go to Geneva and meet the leaders of WHO, GAVI and others. You are interacting with people who at global level lead very complex initiatives and can give insight into what works and what doesn’t. Part of leadership is also to reflect, challenge and question yourself. That learning has been very formative, also in terms of today’s work: how we work with the challenge and tension between science, public health and the politics of what we are dealing with. In public health you are a broker between pure science and the politician who has to speak to and bring the nation along. The public health professional is there trying to translate the science and take the population context into account. That’s a difficult job in peace times, now imagine that during a global pandemic – it’s extremely challenging.
Do you think public health/epidemiology and related fields will be seen as more important in future due to this outbreak?
I think there has been a change – concepts that were previously unknown, such as ‘R’ have become part of everyday language. In public health we often have to make recommendations with incomplete knowledge and I think that is often not understood. People assume they understand more of what is going on and are then disappointed or impatient with recommendations when these aren’t what they think they should be because the issue is in fact a lot more complicated.
In the long term, I find that population memory is short. Things will most likely go back to the way they were before. We had SARS in 2003 and some changes were made, in the UK a significant change was made to public health structure but was then changed again subsequently. Will it change the world? I believe it is politics that changes the world – not public health.
Do you feel a sense of pride being able to support the response with your work and expertise?
I am a doctor who left clinical medicine and moved into public health. I have never regretted my decision to move into public health and my pride in what I do predates and will outlive COVID-19. In my view, as public health practitioners we need to be satisfied that we are doing the right thing no matter how much the public know about what we are doing. When we are successful the public don’t know we are there – if our prevention work is successful, nobody even notices what we have done. I do ask myself, if, as public health experts there was something we should have done to stop this happening and to have remained invisible. COVID-19 is a once in a lifetime experience, hopefully. In public health we should go back to gaining professional satisfaction from working in the invisible sphere again.
How has the outbreak affected you on a personal level?
My daughter is a theatre actor, so she hasn’t worked since the beginning of March. This is just an example, but there is a whole community of people out there who have been significantly impacted by the decisions that I, as part of public health system, have had to recommend be made to control the pandemic. The discussion of lockdown vs no lockdown isn’t just a theoretical thing for me. I am fortunate to be able to work from home and do my job, but the impact on my family is personal too.
I am also a black woman, who is working in a pandemic that appears to be disproportionately affecting people of colour. I have a personal interest in the findings of the PHE-lead team tasked with gaining a better understanding of this situation.
I can’t look at it entirely detached as a thing I do for my job. I am still, like every other citizen, affected directly and indirectly.
Interviewer: Noreen Seyerl