The fireman of global health: The WHO’s emergencies chief is put to the test

GENEVA — Walk into Mike Ryan’s office here on the orderly campus of the World Health Organization and you are in a train station.

Staff members rush in to see the agency’s ruddy, fast-talking emergencies chief to seek guidance on the various disease outbreaks they are trying to end. People crowd into the office where a pair of assistants are stationed, waiting their turn. When Ryan’s door is closed, it’s not long before a hand is rapping on the other side.

Ryan and his staff are firemen, the paramedics of global health. Their work is all front-burner stuff. Half an hour spent on this is 30 minutes not spent on that. There is the Ebola crisis — and a massive measles outbreak — in the Democratic Republic of the Congo, the Rohingya refugee situation in Bangladesh, too many crises to count in Yemen and Syria.

“It exhausts me at times,” said Ryan, who at 55 remains affable and quick to laugh despite the circumstances. Still, Ryan said, he is unwilling to change the tempo or restrict the access, knowing that the higher up one gets in an organization, the more reluctant colleagues are to be the conveyors of unwelcome information. “I don’t want them to hide the bad news,” he insisted.

The WHO employs all kinds of experts. Its scientists set standards for the appropriate use of antibiotics or vaccines, among many other medical modalities. Its public policy officials try to improve access to essential medicines and health products. But its emergency response operation is in charge of addressing infectious disease outbreaks — and if it messes up, people in crises suffer, to say nothing of the reputation of the WHO itself.

Ryan, who took over the agency’s health emergencies program in March, will ultimately be held to account.

With a quarter-century of outbreak response work under his belt, the crisis management veteran is still getting used to the office life — far from the places where he honed his skills combatting disease outbreaks. Nonetheless, those years of chasing down surveillance data and digging graves in Ebola outbreaks, bouncing in four-wheel drives down crater-pocked paths that barely qualify as roads, and sleeping wherever sleep could be found have given him a real advantage in his new job. As Ryan puts it: “It’s very hard to bullshit me.”

Despite his seemingly boundless energy and an outlook a colleague calls “pathological optimism,” Ryan is being put to the test in one of the WHO’s toughest and highest-profile roles.

He has taken on the job at a time when disease outbreaks and natural disasters appear to be happening at a more rapid pace. Many countries around the globe are becoming more affluent and better able to look after the health of their people — but some are spiraling in the opposite direction, creating enormous challenges.

Climate-mediated natural disasters. Conflict-riven failed states. Massive displacement of people. And, as always in this type of work, expanding human populations, encroaching on the natural habitat from which new disease threats emerge.

“We’re not ready,” Ryan said. “If we can’t stop Ebola” — referring to the ongoing outbreak in northeastern DRC, on the cusp of beginning its 16th month — “what hope do we have of stopping … Disease X?”

People with and for whom he has worked over the years see Ryan as a natural choice to run this critical part of the agency.

“I think he’s a very good man in that spot. He really loves this type of work and he does it well,” said Johan Giesecke, former chief scientist at the European Center for Disease Control.

Robert Swanepoel, a legendary expert on Ebola and other viral hemorrhagic fevers, with whom Ryan spent some rather hairy moments in Afghanistan, describes a colleague who knows how to get things done.

“Mike was really highly respected and pushy — and this is what he needed to be,” said Swanepoel.

It wasn’t supposed to turn out this way for Ryan. He trained to be an orthopedic and trauma surgeon, after all. But to listen to the stories about his family and his upbringing and what came later is to realize that, in other ways, he was destined for this job.

Wanderlust is coded in his DNA. His father, who died when Ryan was 11, was a merchant sailor who spent 25 years at sea.

As a child growing up in western Ireland, Ryan would hightail it every month to his paternal grandparents’ house in the town of Tubbercurry — 4 1/2 miles by road, 3 along the railroad tracks from the tiny hamlet of Curry, where he lived. There he’d devour the newly arrived copy of National Geographic in his grandmother’s parlor. The room, Ryan recalled, was filled with flags and swords and statues, mementos his father had collected in his travels.

“This room was like a kind of a TARDIS,” he said, referring to the time machine that teleports the title character in the cult classic British TV series “Doctor Who.” “The idea was you go into this room and all of a sudden you weren’t in this little village in the middle of the west of Ireland, you are in Honolulu. And you were in Sydney and pictures of the Opera House or whatever it was at the time.”

Later that quest for adventure saw him, as a freshly minted doctor of 23 years old, head to Scotland for additional training in orthopedics. He later successfully applied for a surgical residency in Australia.

But the fates had other plans for Michael Joseph Ryan.

In 1990, his departure for Australia delayed by paperwork issues and his mind burdened by looming student loans, Ryan followed his then-girlfriend (now wife) to Iraq for what was supposed to be a stopgap contract helping train Iraqi doctors in specialist procedures.

He arrived in Baghdad at the end of July. Three days later, on Aug. 2, Iraq invaded Kuwait. The U.S. bombing campaign began, and foreign nationals, including Ryan, found themselves captives: held as human shields.

Members of the ruling class, no longer able to travel outside the country for medical care, turned to the hospital where Ryan was working for treatment. He resuscitated “brothers of ministers and sons of the head of the army,” he recalled. At one point, he was trying to save a man while his brother, a military officer, was pointing a gun at Ryan. (“It does an awful lot for your performance,” he noted dryly.)

Another time Ryan got himself into hot water for refusing to remove a kidney for transplant from a person who clearly wasn’t a willing donor. “I’m not — many people would agree — not necessarily a natural diplomat,” he said. “But I’m learning.”

One weekend Ryan and his girlfriend, Máire Connolly, were being driven along with other foreign doctors to a lake near the border of Kurdistan — some rest for a group that had been under extreme stress. En route, their vehicle was run off the road by a military convoy, pitching it over an escarpment. Ryan was thrown; lying in the sand he immediately knew he was badly hurt. Later he would learn that several vertebrae had been completely crushed.

People who came to help wanted to drag Ryan clear of the vehicle, which looked like it was about to ignite. But one wrong move could have landed him in a wheelchair for life. “I could feel my toes but I knew my back was fractured,” he said. “As they trying to save my life, I’m trying to save my legs.”

He was forced to spend weeks immobilized as his spine healed, forgoing surgery to insert pins in his spine because if bombs had started to rain on the Baghdad hospital, he could not have been evacuated.

Eventually the Iraqis let three injured doctors — Ryan, Connolly, and one other — return to Ireland. After about six months of rehabilitation, Ryan tried again to take up the surgical fellowship in Australia, but that door, he quickly came to understand, had closed. The rigors of surgery were too much for his back, which years later is still a source of constant pain.

“Everything in life is like sliding doors,” he said. “I mean, my life has been one of those lives where nothing I’ve planned has come true and nothing I’ve intended has happened.”

As he recovered and cast about for a new path, Ryan began reading about public health. His interest in the field led him to a master’s degree in public health from University College Dublin and, later, a stint at what is now Public Health England, with specialist training in communicable diseases.

Then another one of those sliding doors opened. Ryan was accepted into a training program for European epidemiologists. He was assigned to work in Sweden with Giesecke, who at the time was the state epidemiologist there.

Before heading to Stockholm, he had a chance meeting in Geneva with David Heymann, an American infectious diseases expert at the WHO. Heymann was setting up a new emerging diseases program.

The meeting went well — so well, in fact, that Heymann, without informing Ryan, asked the epidemiology program to transfer Ryan’s posting to the WHO. “I got traded!” Ryan said with a laugh.

“I liked him. And I knew he would get things done,” said Heymann, who now teaches at the London School of Hygiene and Tropical Medicine. Asked what made Ryan good at this new line of work, Heymann put it down to personality and work ethic. “He’s oriented towards work and not towards himself,” Heymann said. “His goal is to do things. And he does them.”

Ryan eventually ended up with a full-time job at WHO.

He recalled that when he started at the agency, many of the public health giants who had been involved in the successful campaign to eradicate smallpox — people like the late D.A. Henderson — could be seen from time to time roaming the hallways of the WHO’s Geneva headquarters.

He tried to learn as much as he could from them. “To be sitting in a room with those individuals … for an epidemiologist it was like an audience with rock stars, you know?” said Ryan, who punctuates many sentences that way.

In the years that followed, he worked on countless infectious disease outbreaks — Ebola, Marburg, cholera, Shigella, SARS, bird flu. He was in the field 44 weeks his first year.

Some people might hunger for a more stable life, but not Ryan. He’s boots on the ground, as people in this line of work say. “I see myself as, yes, a field person,” he said.

He’s also someone who will jump in and do what needs to be done. He became one of the WHO’s leading responders when crises struck and helped to found the Global Outbreak Alert and Response Network, which was designed to improve planning and organizational structures to address outbreaks.

The network was set up after Ryan and others concluded that the same players — CDC and UNICEF and Doctors Without Borders and other nongovernmental organizations — would turn up each time an infectious disease outbreak or natural disaster occurred. Applying some planning to it — to make it, in Ryan’s words, “less cowboy, you know?” — only made sense.

“It was based on the principle that the capacity is out there. If we put all the major institutions and put all their skills and capacities and their expertise together we have something quite special,” he said.

Likewise, during the 2003 SARS outbreak, Ryan led the effort to set up networks of experts to advise the WHO and affected countries on clinical, epidemiological, and virology issues as scientists around the world raced to figure out what was causing the new disease and how to stop its spread.

Over time, though, the WHO began to change.

After the 2009 H1N1 flu pandemic, the agency started to lean into its normative — standard-setting — role, and lean away from its disease response activity. Ryan, who thought that was a mistake, was pushing for the offices that handled epidemics and emergencies to be merged and for more resources to be put into these areas. He lost that battle and left the WHO in 2011.

He and Connolly moved their three children back to western Ireland, to Galway. Ryan worked for the Global Polio Eradication Program, in Pakistan, Afghanistan, and the Middle East. Connolly became a professor at National University of Ireland Galway.

In 2017, though, WHO Director-General Tedros Adhanom Ghebreyesus came calling and lured Ryan back to the agency.

The WHO had been roundly criticized for its handling of the Ebola crisis in West Africa — for not recognizing until far too late that Ebola transmitting in crowded African cities would be unlike previous outbreaks. Among the many reforms that were set in motion was the establishment of a separate emergencies program, with guaranteed funding. That work began under Tedros’ predecessor, Dr. Margaret Chan.

On his return to WHO, Ryan was made No. 2 in the office, under Peter Salama. And when Salama was moved into a different role in a management shuffle earlier this year, Ryan took over.

Though he spends more time in Geneva, Ryan still makes sure he heads out to the field from time to time; he was in DRC a few weeks back, checking on the Ebola response.

“Getting to the field regularly keeps you honest and it keeps you focused on why you’re doing what you’re doing,” he explained. “I like that feeling of being out with the teams, you know?”