Even in the midst of a crisis, Mike Ryan, the Irishman leading the response of the World Health Organisation (WHO) to the coronavirus outbreak, finds room for optimism.
“We’re still hoping this virus can be put back into the box,” he tells me from his office in Geneva. “And even if we can’t, the overall impact might be less severe than we originally thought.”
He calls himself "the old dog for the road", a 25-year veteran of viral firefights with Sars, Ebola, bird flu and many other threats to global health. In an eventful career, he's been held hostage in Iraq, buried bodies to stop contagion in west Africa and faced down guns just about everywhere, even in the operating theatre.
For once this time, he’s not leading the effort in the field, having been promoted to head of emergencies in WHO last year. Now the buck stops at his door and, with the threat of another pandemic looming, the stakes could not be higher.
Ryan says his "biggest fear" is that the virus gets established in a "fragile" country with a weak health system, or in a conflict zone. "That would be a big problem. China, in contrast, has a strong health system. But it's a highly connected country, so that's a problem."
The fatality rate with the new virus has been estimated at about 2 per cent; that’s 20 times that of the common flu but Ryan says researchers are seeing this number fall as they come across milder cases.
The overwhelming majority of cases outside China are mild ones, with only one fatality outside that country so far reported, in the Philippines.
“There’s a lot to be learned yet about this virus. It clearly can kill but we do not know what the real severity is.”
He also sees positives in the way China has reacted to the crisis. “They had an early-warning system that identified the virus. They isolated and sequenced it in record time and they have shared this information around the world to allow diagnostics to be developed.”
The Chinese government deserves credit for putting health and people first, he adds.
Also on the plus side, he says the ability of international health agencies to respond has greatly improved. There is greater international collaboration, improved supply chains, more involvement with private-sector supplies and improved scientific capacity.
We're in an arms race with bugs and we've got to develop the capacity to counter them faster than they harm us
He sees the almost inevitable emergence of the virus as a consequence of “the way we live now”.
“If you look at the amount of movement around the planet, the pressure we place on our ecosystem, all these things are driving our vulnerability to these viruses. You have so many risk factors converging.”
“Against that, we have the ability to develop new therapies. We’re in an arms race with bugs and we’ve got to develop the capacity to counter them faster than they harm us.”
The WHO delayed a week before declaring the outbreak a global emergency, but Ryan said this did not hamper its efforts. “I don’t believe the world lost time but it did give everyone time to come to terms with what needs to be done.”
From Curry, on the Sligo/Mayo border, he developed his taste for travel from devouring his grandmother’s copies of National Geographic. He trained as a trauma surgeon but switched to public health after suffering a life-altering back injury during the first Iraq war in 1990.
That led to training in communicable diseases and a full-time post in the WHO, when he ended up as a troubleshooter in some of the most hostile environments in the world. Working in the field, he was instrumental in the setting up of networks of United Nations bodies and NGOs to better co-ordinate the response during emergencies.
In 2011, he called it a day and returned with his wife and family to Galway. Six years later, however, the WHO came calling again; stung by criticism of its response to the Ebola crisis, it set up a separate emergencies division and wanted Ryan to head it up.
Does he feel frustrated, being deskbound?
“It’s not what I’m used to,” he concedes. “But no, we’ve got brilliant people here and in our global response unit who are well capable of doing the job.”
He still has the “muscle memory,” he adds.” “It’s like being in your second or third All-Ireland; you know what to do.”
So how does this outbreak compared with the previous epidemics he has tackled during his career?
“It’s hard to say yet,” he replies, laughing. “I’ll tell you when it’s over, mate.”