English subtitles

← What it takes to crush a pandemic

Get Embed Code
38 Languages

Showing Revision 7 created 12/02/2020 by Erin Gregory.

  1. My son was born in January 2020,
  2. shortly before the lockdown in Paris.
  3. He was never scared
    of people wearing masks,
  4. because that's all he knows.
  5. My three-year-old daughter knows
    how to say "gel hydro-alcoolique."
  6. That's the French word
    for hydroalcoholic gel.
  7. She actually pronounces it
    better than I do.
  8. But no one wants to be wearing a mask

  9. or wash their hands
    with hand sanitizer every 20 seconds.
  10. We're all desperately looking at R and D
    to find us a solution: a vaccine.
  11. It's interesting that in our minds,

  12. we keep thinking of the vaccine discovery
    like it's the Holy Grail.
  13. But there are a couple of shortcuts here
    that I'd like to unpack.
  14. I'm not a doctor, I'm just a consultant.
  15. My clients focus on health care --
  16. biopharma companies, providers,
    global health institutions --
  17. and they've educated me.
  18. We need to find the tools to fight COVID,
  19. and we need to make them
    accessible to all.
  20. First, one single vaccine
    will not get us out of this.

  21. What we need is an arsenal of tools.
  22. We need vaccines, we need therapeutics,
    we need diagnostics
  23. to make sure that we can prevent,
    identify and treat COVID cases
  24. in a variety of populations.
  25. Second, it's not just
    about finding a tool.

  26. What do you think will happen
    when one of those clinical trials
  27. demonstrates that the tool is effective?
  28. Do you think we can all
    run to the pharmacy next door,
  29. we get the product,
    we take off our masks
  30. and we go back to French kissing?
  31. No.
  32. Finding an effective tool
    is just one step in this big fight,
  33. because there is a difference
    between the existence of a product
  34. and access to that product.
  35. And now you're thinking,

  36. "Oh -- she means other countries
    will have to wait."
  37. Well, no, that's not my point.
  38. Not only others may have to wait,
  39. but any of us may have to.
  40. The humbling thing about COVID
  41. is that because of its speed
    and magnitude,
  42. it's exposing all of us
    to the same challenges
  43. and giving us a flavor
    of challenges we're not used to.
  44. Remember when China got into lockdown?
  45. Did you imagine that you
    would be in the same situation
  46. a few weeks after?
  47. I certainly didn't.
  48. Let's go to the theoretical moment
    when we have a vaccine.

  49. In this case, the next access challenge
  50. will be supply.
  51. The current estimate
    of the global community
  52. is that by the end of 2021 --
  53. so that's over a year after
    the discovery of the vaccine --
  54. we would have enough doses
    to cover one to two billion
  55. of the eight billion of us on the planet.
  56. So who will have to wait?
  57. How do you think about access
    when supply is short?
  58. Scenario number one:

  59. we let the market forces play,
  60. and those who can pay the highest price
    or be the fastest to negotiate deals
  61. will get access to the product first.
  62. It's not equitable at all,
  63. but it's a very likely scenario.
  64. Scenario number two:

  65. we could all agree,
    based on public health rationale,
  66. who gets the product first.
  67. Let's say we agree that
    health care workers would get it first,
  68. and then the elderly
  69. and then the general population.
  70. Now let me be a bit more provocative.

  71. Scenario number three:
  72. countries who have demonstrated
    that they can manage the pandemic well
  73. would get access to the product first.
  74. It's a little bit extrapolated,
  75. but it's not complete science fiction.
  76. Years ago, when the supply of high-quality
    second-line tuberculosis drug was scarce,
  77. a special committee was established
  78. to determine which countries
    had health systems that were strong enough
  79. to ensure that the products
    would be distributed properly
  80. and that patients would follow
    their treatment plans properly.
  81. Those select countries got access first.
  82. Or, scenario number four:

  83. we could decide on a random rule,
  84. for instance, that people get
    to be vaccinated on their birthday.
  85. Now let me ask you this:

  86. How does it feel to think of a future
    where the vaccine exists,
  87. but you would still have to wear a mask
    and keep your kids home from school,
  88. and you would not be able
    to go to work the way you want
  89. because you wouldn't
    have access to that product?
  90. Every day that passed
    would feel unacceptable, right?
  91. But guess what?
  92. There are many diseases for which
    we have treatments and even cures,
  93. and yet people keep being infected
    and die every year.
  94. Let's take tuberculosis:

  95. 10 million people infected every year,
  96. 1.5 million people dying,
  97. although we've had a cure for years.
  98. And that's just because
    we haven't completely figured out
  99. some of the key access issues.
  100. Equitable access is the right thing to do,

  101. but beyond this humanitarian argument
  102. that I hope we are more sensitive to
  103. now that we've
    experienced it in our flesh,
  104. there is a health and an economic argument
  105. to equitable access.
  106. The health argument is that
    as long as the virus is active somewhere,
  107. we're all at risk of reimported cases.
  108. The economic argument is that
    because of the interdependencies
  109. in our economies,
  110. no domestic economy can fully restart
    if others are not picking up as well.
  111. Think of the sectors
    that rely on global mobility,
  112. like aerospace or travel and tourism.
  113. Think of the supply chains
    that cut across the globe,
  114. like textiles or automotive.
  115. Think of the share of the economic growth
    that is coming from emerging markets.
  116. The reality is that we need all countries
    to be able to crush the pandemic in sync.
  117. So not only is equitable access
    the right thing to do,
  118. it is also the smart thing to do.
  119. But how do we do that?
  120. Let's make sure we're on the same page
    in terms of what "access" means.

  121. It would actually mean
    that the product exists;
  122. that it's working sufficiently well;
  123. that it's been approved
    by the local authorities;
  124. that it is affordable;
  125. but also that there is evidence
    that it works in all the populations
  126. that need it,
  127. and that can include pregnant women
    or immunodepressed people, or children;
  128. that it can be distributed
    in a variety of settings,
  129. like hospitals or rural clinics,
    or hot climate or cold climate;
  130. and that we can produce it
    at the right scale.
  131. It's a very long checklist, I know,
  132. and in a non-crisis situation,
  133. we would likely address these issues
    one after the other in a sequential way,
  134. which takes a lot of time.
  135. So what do we do?
  136. Access is far from being a new challenge,

  137. and in the case of COVID,
  138. I have to say, we're seeing
    extraordinary collaboration
  139. of international organizations,
    civil society, industry and others
  140. to accelerate access:
  141. working things in parallel,
  142. speeding up regulatory processes,
  143. engineering supply mechanisms,
  144. securing procurement,
    mobilizing resources, etc.
  145. Yet we are likely to face a situation
    where, for instance,
  146. the vaccine would need to be
    constantly stored at, let's say,
  147. minus 80 Celsius degrees;
  148. or where the treatment
    would need to be administered
  149. by a highly specialized
    health care worker;
  150. or where the diagnostic
    would need to be analyzed
  151. by a sophisticated lab.
  152. So what more can we do?
  153. Pushing further the logic
    that the global health community

  154. has advocated for for years,
  155. there is one additional thing
    I can think of that might help.
  156. There is a concept
    in product development and manufacturing
  157. that's called "design to cost."
  158. The basic idea is that
    the cost management conversation
  159. happens at the same time
    as the product being designed,
  160. as opposed to the product
    being designed first
  161. and then reworked to bring the cost down.
  162. It's a simple method that helps ensure
  163. that when cost has been identified
    as a priority criteria for a product,
  164. it's made a target from day one.
  165. Now, in the context of health and access,

  166. I think there is untapped potential
  167. in R and D to access,
  168. the same way that
    manufacturers design to cost.
  169. This would mean that,
    instead of developing a product
  170. and then working to adapt it
    to ensure equitable access later,
  171. all of the items
    on the checklist I mentioned
  172. would be built into the R and D process
    from the beginning,
  173. and this would actually benefit us all.
  174. Let's take an example.

  175. If we develop a product
    with equitable access in mind,
  176. we might be able to optimize
    for scale-up faster.
  177. In my experience, drug developers
    often focus on finding a dose that works,
  178. and only after do they optimize
    the dosage or make adjustments.
  179. Now imagine that we're talking
    of a candidate product
  180. for which the active ingredient
    is a scarce resource.
  181. What if instead we focused
    on developing a treatment
  182. that uses the lowest possible amount
    of that active ingredient?
  183. It could help us produce more doses.
  184. Let's take another example.

  185. If we develop a product
    with equitable access in mind,
  186. we might be able to optimize
    for mass distribution faster.
  187. In high-income countries,
  188. we have strong health systems capacity.
  189. We can always distribute
    products the way we want.
  190. So we often take for granted
    that products can be stored
  191. in temperature-controlled environments
  192. or requires a highly skilled
    health care worker for administration.
  193. Of course,
  194. temperature-controlled environments
    and highly skilled health care workers
  195. are not available everywhere.
  196. If we were to approach R and D
  197. with the constraints
    of weaker health systems in mind,
  198. we might get creative
  199. and develop sooner, for instance,
    temperature-agnostic products
  200. or products that can be taken
    as easily as a vitamin
  201. or long-lasting formulations
    instead of repeat doses.
  202. If we were able to produce and develop
    such simplified tools,
  203. it would have the added benefit
  204. of putting less strains
    on hospitals and health systems
  205. for both high- and low-income countries.
  206. Given the speed of the virus

  207. and the magnitude
    of the consequences we're facing,
  208. I think we have to continue
    challenging ourselves
  209. to find the fastest way
    to make products to fight COVID
  210. and future pandemics accessible to all.
  211. In my perspective,

  212. unless the virus disappears,
  213. there are two ways this story ends.
  214. Either the scales tip one way --
  215. only some of us get access to the product
  216. and COVID remains a threat to all of us --
  217. or we balance the scales,
  218. we all get access to the right weapons,
  219. and we all move on together.
  220. Innovative R and D can't beat COVID alone,
  221. but innovative management
    of R and D might help.
  222. Thank you.