Professor Flahault, when you arrived in Geneva to set up a new Institute of Global Health, how did you define the missions you wanted to pursue?

At the time, the very definition of global health was not that clear. To stimulate collective reflection, I brought together a small group of experts in Switzerland, including Marcel Tanner, then the director of the Swiss Tropical Public Health Institute before becoming president of the Swiss Academies of Arts and Sciences, Ilona Kickbusch, who headed the Centre for Global Health at the Graduate Institute of Geneva (IHEID), Fred Paccaud,  my counterpart at UNIL, Gérard Escher, then an advisor to the EPFL president, and Didier Wernli, who was still a PhD student before becoming a professor at the UNIGE Global Studies Institute. Together, we proposed and published a definition of global health based on six pillars that formed the architecture of the strategies we wanted to implement in this new institute for research and teaching.

The first pillar is, of course, the geographical, worldwide, dimension of global health, which focuses on health issues that cross borders, such as infectious disease epidemics, obesity, diabetes, smoking or universal health coverage. The second pillar, quite disruptive in the field of public health, was to propose a transdisciplinary approach, seeking to include expertise that went beyond the academic interdisciplinarity more traditionally offered by the University. To address global health issues, we believed that we could not remain solely among researchers and teachers. We needed to include civil society, including NGOs and activist groups, politicians, international organisations, as well as the private sector, without naivety and with complete transparency. 

This brings us to the third pillar, "system thinking", a systemic approach to problems necessary to address their complexity. This research methodology aims to better integrate all skills to prevent the disciplines from working in parallel, in silos that never meet. The fourth pillar on which global health rests is innovation, including new information technologies, biotechnologies and all pragmatic innovative technical solutions. For example, Rwanda uses drones to deliver vaccines or blood bottles to all corners of the country while maintaining the cold chain, at a reasonable cost and in an environmentally friendly manner. This type of technology can sometimes facilitate field work, as long as it remains accessible.

The fifth pillar is sustainability and respect for the environment. We at the Institute of Global Health proposed this definition before the Paris Agreement on climate change, being already aware that global health initiatives needed to be mindful of the carbon footprint they might generate, taking into account the already heavy footprint of healthcare systems. The Institute of Global Health has therefore created the first One Health unit in a medical faculty in Switzerland, tasked with addressing issues at the interface between human, animal and environmental health.  Finally, the sixth pillar, which is particularly important for a Geneva-based global health institute, is human rights – we could not conceive of global health without addressing issues such as equity, social justice and the rights of women, children and minorities. Twelve years ago, we were still a long way from the Covid pandemic, but we already believed that health officials around the world should ensure that human rights were respected in all health interventions. Public health measures sometimes entail restrictions on fundamental individual freedoms. Even when serving the common good and public health, it was necessary to recognize it and set clear boundaries. Creating a unit on human and international rights within the ISG was a step in this direction.

You also wanted to build the ISG on an existing foundation...

I was fortunate to arrive with a very rich heritage. An Institute of Social and Preventive Medicine had existed for many years and formed the starting point, the fertile ground on which the ISG was able to develop. Leading figures already heavily involved in global health helped shape the ISG as it is today, such as Professor Jean-François Etter, who worked on tobacco and addiction prevention, notably with the Federal Office of Public Health, Professor Bettina Borisch, who coordinated the World Federation of Public Health Associations in Geneva, formerly based in Washington, and Professor Emmanuel Kabengele, who worked on having Noma recognised by the WHO as a neglected tropical disease, which happened in 2023. Furthermore, the Institute's dual local and international roots were ensured from the outset, thanks in particular to the Geneva Cancer Registry, which already played a leading role in its field in both Switzerland and Europe. Professor Marc Ryser recently took over as director. 

Does Geneva still have a special place in global health?

Global health is one of the greatest successes of International Geneva. There are, of course, other international organisations in other fields that are very active in Geneva, but, to my knowledge, none has succeeded as the WHO has done since the post-war period, in attracting so many organisations, NGOs, learned societies and foundations active in the field of health (more than 350. Among them are a few flagship organisations such as the Global Fund, GAVI, and of course the ICRC and the IFRC.  Global health, for International Geneva, combines a universal humanist ideal with a concern for making health more accessible to all. Geneva, which every year in May sees all the governments responsible for health converge on the World Health Assembly, the governing body of the WHO, has a unique place in the world.

Coming back to the ISG, one of its objectives was also education. Has it been a success?

In this very special and attractive context of Geneva for global health, we have attracted a large number of candidates since the launch of our programmes. We offer three master's degrees, in public health, in health organisation management, and in global health, as well as a doctoral programme in global health. Thanks to this constant influx of applications, we are fortunate to have high- quality students, many of whom have so far found jobs in International Geneva. The success of our doctoral programme is also due to the original format we have proposed with the substantial support of the Swiss School of Public Health, the umbrella organisation for our Swiss academic institutes in this field. Our doctoral students can continue to work full-time for NGOs or international organisations, and academically enhance some of the results of their work when it qualifies as productive research and is published in peer-reviewed scientific journals. In addition, within the Global Studies Institute, an inter-faculty structure at our university, we have been able to set up our Master's programme in global health, which brings together professors with a wide range of skills from different faculties. Professor Stéphanie Dagron has been recruited on a part-time basis at the Faculty of Medicine, while she remains at her original Faculty of Law for the other half of her time. The support of the Rector of UNIGE and the Dean of the Faculty of Medicine has made these unusual arrangements possible, thanks to their open-mindedness and their vision, which was always aligned with our projects on these subjects. 

The COVID-19 pandemic suddenly placed global health in the spotlight. As an epidemiologist, you have been one of the public faces of science...

Ironically, in August 2019, our NCCR project (the SNSF's flagship call for projects) on the prediction and preparation for epidemic emergencies has been rejected because the federal authorities considered at the time that communicable diseases no longer represented a major public health threat for the country! But the work done for this NCCR was not lost, far from it, as it enabled us to forge links between Swiss institutions that would prove to be very valuable. As a result, the ISG, EPFL and ETHZ were able to quickly offer a platform for global epidemiological forecasts, which received extensive media coverage during the pandemic and were published in the prestigious US journal PNAS. Thus, from the beginning of 2020, the Institute positioned itself to serve the country and beyond our borders in terms of epidemiological expertise and analysis. Our researchers have often stepped up, notably Professor Olivia Keiser, a specialist in mathematical modelling, who agreed to coordinate an ambitious epidemiological surveillance programme for Swiss hospitals. For my part, together with Professor Idris Guessous, Professor Andrew Azman (now hired at ISG) and Professor Silvia Stringhini, who headed the HUG Bus Santé, we conducted one of the first seroprevalence surveys ever published in the world (in The Lancet). As I was co-director of the Swiss School of Public Health, it helped to share our Geneva protocol and enabled other cantons to develop the Corona Immunitas programme within Swiss universities.

Even before I arrived at the ISG, my research had focused on communicable diseases, particularly respiratory diseases. I had already developed some experience – albeit less extensive – with media engagement, particularly on the subject of influenza. During the COVID-19 pandemic, media exposure was extraordinarily intense, but for me it was part of my job. My mentors had taught me that in “public health”, there is the word "public". This academic discipline, perhaps even more so than others, needs to know how to speak to the public, explaining and deciphering the complexity of health crises. The Kiel Institute, a highly renowned German think tank, has shown in one of its working paper that public information campaigns, because they are based on the best scientific evidence available at the time, were the most effective measure against the COVID-19 pandemic during its pre-vaccination phase. Indeed, while school closures, border controls and other health pass measures proved effective in combating the spread of the coronavirus, high-quality public scientific information surpassed them all. 

This period also revealed a mistrust of science...

Indeed, but attacks on science are nothing new. During the pandemic, although health restrictions were often very burdensome for our fellow citizens, they were remarkably well followed. Much of the population understood the risk and trusted their authorities and scientific experts. Those opposed to the pandemic response strategy were certainly a very vocal and sometimes even violent minority, greatly amplified by social media, but in Europe, the vast majority of the population retained a high level of trust in science and their authorities. This is evidenced by the high levels of vaccination coverage achieved in a very short time. We must acknowledge that there may have been a certain arrogance on the part of our academic community at times, and that we were too quick to label people who simply asked legitimate questions about the quality or safety of the vaccines as anti-science or anti-vaccine. Having doubts is part of the scientific process and, with hindsight, we must admit that both sides were sometimes at fault.

Returning to current events, are you concerned about the crisis in multilateralism, particularly with the US withdrawal from the WHO?

The almost total cessation of the US funding for international health and humanitarian organisations and the dissolution of the US Agency for International Development are already having very worrying and sometimes very serious consequences, particularly for people who benefited directly from this aid for accessing healthcare. For the WHO, losing 20% of its budget is obviously not insignificant. However, we must bear in mind that the WHO's overall budget is barely larger than that of the HUG, so if there is the political will to compensate for this withdrawal, it would be fairly easy to do so. The WHO's management is seeking to reduce its expenditure. What seems more worrying, apart from these budgetary issues, is the loss of influence and expertise that the US withdrawal, followed by all Western countries, entails. There is a risk that the values of equity and human rights that have prevailed in international organisations and that the USA has upheld since the post-war period will be diluted. The absence of US expertise and influence in these areas could ultimately lead to an erosion of the values that we declared universal, but which, we now realise, are never definitively acquired. The United States is leaving a void that others may be eager to fill, and not necessarily with the same vision of the world that we have.

Does the Geneva Health Forum play a role in these debates?

The Geneva Health Forum, led by Dr Eric Comte and co-chaired by UNIGE and HUG, is held annually on the sidelines of the World Health Assembly. It has become a place where civil society, particularly field workers, Swiss and international academics, politicians, private sector actors in the field and the international community in Geneva can meet freely in an atmosphere of academic dialogue and neutrality that is sometimes lacking within UN organisations. It has become a place where discussions can take place in a calm but scientifically rigorous manner. Several resolutions subsequently brought before the World Health Assembly originated in the discussion circles of the Geneva Health Forum, such as those on noma and snake bites.

Any final thoughts as you turn an important page in your career?

Although I will continue my research and teaching activities at Paris Cité University and Inserm over the next few years, I have experienced the best moments of my professional life here. In addition to the students and doctoral candidates mentioned earlier, who have enriched the ISG with their generosity and talent, other brilliant personalities have joined the ISG: Stéphanie Dagron for international rights, Nicolas Ray for health geography, Olivia Kaiser for epidemiology and modelling, Karl Blanchet for humanitarian aid, Andrew Azman for cholera, and Marc Ryser for cancer epidemiology. Close collaboration with the Department of Tropical and Humanitarian Medicine headed by François Chappuis at the HUG has also been an invaluable asset and source of support in building the ISG. A partnership with Duke University is now being developed with the arrival of biostatistician Liz Turner. All these skills, supported by highly dynamic and productive teams, are working to promote global health and will continue to ensure the prosperity of the ISG, which I am convinced is greatly needed by International Geneva.

Watch the conference (in French) - 23 September 2025
«Global health: the unfinished utopias of multilateralism»