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Global health is full of contradictions. New medical innovations are being developed faster than ever, but many remain unaffordable or inaccessible to the countries that need them most. The International Affordable Diagnostics and Therapeutics Alliance (IA-DATA) wants to change that, aiming to build a global ecosystem where both diagnostics and therapeutics are not just affordable, but equitably developed and distributed. On this episode of #ConsiderThis Melisa Idris speaks with Dr Sanjeev Krishna, Professor of Molecular Parasitology and Medicine at City St George's University of London, and Jean-Michel Piedagnel, Director of the South-South Diagnostic Alliance.
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00:00Hello and good evening. I'm Melissa Idris. Welcome to Consider This. This is the show where we want
00:16you to consider and then reconsider what you know of the news of the day. Now global health is full
00:21of contradictions. New medical innovations are being developed faster than ever but many remain
00:28unaffordable and inaccessible to the countries that need them the most. A newly launched alliance
00:35wants to change that. Its goal is ambitious to build a global ecosystem where both diagnostics
00:42and therapeutics are not just affordable but equitably distributed and developed. So today
00:50on the show joining me to discuss this further is Dr Sanjeev Krishna who is a professor of molecular
00:55peristology and medicine at City St George's University of London. We also have Jean-Michel
01:01P. Daniel who is the director of the South Diagnostics Alliance. Welcome to the show gentlemen. Thank you
01:08so much for joining me. Thank you for having us. An exciting new alliance with a very long name which
01:13I will attempt to say. So International Affordable Diagnostics and Therapeutics Alliance. We shortened
01:19it to iData. Well done. Okay so I'm just going to call it iData from now on. Thank you. I'm curious to
01:26know what it is. Talk to me about the formation of this alliance and why you founded it, co-founded it.
01:35Thank you so much. Well thank you for having us. That's, you know, it's a real privilege to be able to
01:40discuss some of these ideas now. Malaysia is not new in leading in many innovations for South-South
01:50development. So, you know, actually Jean-Michel was part of the process of developing, for example,
01:55a new treatment which was for the first time affordable for Hepatitis C, Ravidezvir. And, you know,
02:03this has become, I think, a kind of beacon for how to do things in the global South. And, you know,
02:12and also within the framework of Madani, the Madani government's goals for equitable health care
02:19and allied to that systemic resilience within the area. So that's the kind of context that we're
02:28working in. And you mentioned at the start, Melissa, I mean, there are such exciting developments
02:34in medical science these days. But look at them, you know, CAR T-cell therapy, which treats leukemias,
02:41lymphomas and so on, half a million dollars a pop. Gene therapy is coming online now. You can actually
02:47cure genetic diseases, two million dollars. So who can afford that in the global South?
02:54So really, we've come together and this is like-minded people. So it's within an alliance
03:00to see, you know, how can we subvert some of these issues and make health care really accessible
03:09and affordable where it's needed so that no one gets left behind. And that's really the heart of
03:14what we're up to. And we're starting off in these two areas. One is on diagnostics and the other is
03:20on new treatments. And we can discuss that. Yes. Okay. So very exciting. But I think, Melissa,
03:25the one thing that Sanji forgot to mention, because it's obvious to us, but it's Malaysia.
03:31It's a Malaysian initiative. So it's an initiative from the global South, as we call it. So countries
03:36that are not seen traditionally as leading innovation, as leading research. And I think that has been
03:42the mistake. It is to underestimate a lot of the emerging countries such as, I mean, Korea
03:49is a good example. Of course, China is a gigantic, India, but also Malaysia, Thailand and other
03:55countries which have a potential to innovate. And so the problem is that innovation doesn't
04:02have any channel to be accessible and commercialized. So I think what we want to do is to create a channel
04:09for all this potential, all this innovation that exists in, you know, what we call the global
04:15South, all these countries, which we are not usually seen as active in innovation.
04:21So I want to ask about what the gaps are, what it's trying to address, what this alliance is
04:28trying to address in that maybe other global health institutions, existing global health institutions
04:34haven't addressed at the moment.
04:36Could I jump to you? Sure, of course.
04:38Because, you know, that's the heart of the matter. So long, we, you know, we've been responding
04:45to other people's priorities. You know, we think we need to solve this problem for you,
04:54or we think, you know, you should look at this maybe. What we're trying to do is to work
05:00in a needs-driven way. So let me give you a concrete example. I had the privilege October last year of
05:07working with Professor To in Sarawak, which is one of the more in-accessed areas in Malaysia.
05:14And we also went with a Chinese company. And we went up country, we went up to Capit, and we talked to
05:21healthcare workers en route. We went up there and we said, look, what do you folks need? And they said,
05:28we need diagnostics, really. We need diagnostics, which we can use here. Dengue, big problem,
05:36also monkey malaria, also one or two other diseases. And we turned to the Chinese technology
05:43innovators who are our partners. And we said, well, what do you think? Can we do something here
05:48which is accessible and affordable? And they said, yes, we can certainly try. And we can even go one
05:55step further. We can try and make a diagnostic test for all four of these in one go. So you see,
06:03the principle, and Jean-Michel has already emphasised this, and it's critical, is it's needs driven
06:11by what we find in the region. And we're not just talking about Sarawak, for example, but ASEAN in
06:18general. When you mentioned those neglected diseases, right, dengue, monkey malaria, Jean-Michel,
06:26you've spent years working on neglected disease. From your vantage point, how do you
06:32define neglect in terms of diagnostics and therapeutics? And I'm just wondering, if I may put it this
06:40way, who is doing the neglecting? You know, I will respond as someone who has been actively engaged
06:47in access to treatment and diagnostic for neglected tropical disease. I think there are more and more
06:54neglected disease because there are more and more diseases where pharmaceutical companies cannot make
07:00huge profit. And that comes back to the problem of the current system, which is a very high profit.
07:08I've got nothing against profit. My parents were shopkeepers, so I come from a very, you know,
07:13commercial background. Yes. But a huge profit, the kind of profit that the pharmaceutical companies make,
07:20a small group of cooperation that is driving the whole research system and the whole marketing system.
07:27So this is what we say, innovation is not the issue. Cost is the issue. I often make an analogy which
07:35seems to resonate with people if we look at the Ukraine-Russian conflict. Follow me on this.
07:41You know, which drone is the big innovation in, if we can call this like that, in the Russian-Ukraine conflict?
07:49What the global north, the west, can produce is very expensive, very smart, very innovative drones, which are also usually expensive.
08:00And we can't dispute that those drones are amazing and probably have a use in the context of war. I'm not a war specialist.
08:08But what does Ukraine and Russia use every day? They use small, cheap drones. And that, the global north cannot produce.
08:18It's China, or now they are producing themselves. And so this gap that we see in the context of the drone is the same gap
08:25in a context, for example, of diagnostics. There are amazing diagnostics which are out there, as we say.
08:32Innovation is not the issue, but they are usually expensive. Because this is what the current model provides for.
08:38This very expensive equipment that will be available in a few hospitals, but not available, you know, in Borneo, in a remote area.
08:47So what we want to do is to use the potential of endemic countries and countries that have those neglected diseases
08:54and develop a pathway so that the product they have can access patients.
09:00Right. Do you think diagnostics has been, or gets less visibility than therapeutics?
09:07I think a lot of us are familiar with the issue of access to medicines, that people in the global south often can't afford
09:15or don't have access to the drugs that they need. But diagnostics are just as important, right?
09:21Because if you don't get an accurate diagnosis, you probably won't get the drugs you need,
09:26you might not get the right treatment, you might come too late. Do you think that there's an imbalance there?
09:33That's such a critical question, Melissa, because it's only on the basis of a diagnostic
09:37that more expensive products are then used. And the use of interventions, drugs, surgery, whatever,
09:48depends on having an accurate diagnosis in the first place. But here's the rub. Why is the driver,
09:58you know, what are the drivers for developing new products like drugs compared to diagnostics?
10:04And of course, if you look, you know, shareholders value, you know, the costs recovered from diagnostics
10:12and the markets are smaller in terms of value compared to drugs. So we have this imbalance.
10:19And so people don't tend to focus on, in fact, they focus even less on diagnostics for neglected diseases
10:28than on perhaps even developing new treatments for neglected diseases. And yet the two go hand in hand.
10:34You need one for the other. If you have a treatment without diagnostic, you probably will miss part
10:42of the treatment pathway. And so because there is no research for treatment, why should there be research
10:47for diagnostic? And that's, you know, this, we need to break that cycle. And so we are starting
10:54with diagnostic because it is an easier approach. It's easier to do than developing new treatments,
11:04especially new chemical entities. We should not underestimate the effort, the cost, the knowledge
11:11that is needed. But we will hit at some point if we develop, we are now starting to work on dengue.
11:19If we have a good diagnostic on dengue, and if we can bring people to the health center quicker,
11:24if there is no treatment, then people will stop using those diagnostics.
11:31So we have an answer also for this question of expensive drugs. You see, COVID, I think we've
11:39been taking drugs and using them in a repurposed way for over 100 years. I mean, look at aspirin.
11:46But it was COVID-19 that showed that when you're working under pressure, and you want to get
11:53impact on people's health, you can take a drug like, for example, the steroid dexamethasone
11:58and repurpose it, you see. So that's the approach that IA data is also developing now for managing
12:09some conditions, which are also becoming highly neglected in ASEAN and the Global South, for
12:15example, cancers. They're not affordable to treat.
12:18Repurposing drugs for cancer care?
12:21Repurposing drugs, for example, for cancer care. So this is part of the program. In fact,
12:26we've literally, this month, we're starting clinical trials here in Malaysia on using a Chinese
12:34discovery originally, an anti-malarial. So it's very affordable.
12:38For what kind of cancer?
12:40Well, we're studying at the moment one precancerous condition, which is cervical precancer caused
12:47by infection with HPV. But we're also working on colorectal cancer, where we've had some very
12:54exciting but very preliminary data.
12:57It's important in Malaysia because of high instances here.
13:00But let's come back. So in other words, you know, Jean-Michel was completely correct. You
13:05can't have just a diagnostic without having a solution that the diagnostic, you know, then
13:11says we need to have. So we're working on those aspects as well.
13:16So it has to come in hand in hand.
13:17What is then iData doing for this? Is it funding new test kits? Is it building new manufacturing
13:28capacity? How do you come in?
13:29It's all of the... So iData is embodying the Madani government goals, you know, and actually
13:40Prime Minister's recent Shangri-La speech on, you know, cooperation, not coercion. So what we're
13:45trying to do is to, you know, embody that cooperation, the collaborative side of needs-driven research
13:53by bringing together government resources. You've got the Ministry of Health, Ministry of
14:00Higher Education. You've got the, you know, IMR, ICR, the Institute of Clinical Research,
14:05Institute of Medical Research, all these wonderful institutes. University of Malaya as a center
14:11of excellence for drug repurposing, bringing all this together with civil society, with product
14:18development partnerships that Jean-Michel is leading, with academia I've mentioned, and with industry.
14:25Because you can't do anything without having people to actually deliver the products. You've got to have
14:30the products in hand. So I think what we want to see happening with IA Data is the consolidation of knowledge through an expertise center.
14:42Knowledge that already exists. There are gaps, but they are not that difficult to fill in. This is why a partnership with a university like City St. George is useful. So you create an expertise center in Malaysia, around U.M. essentially. And then with the South
14:51South-South Diagnostic Alliance, you collaborate with other countries in the Global South who share the same agenda as you are. So for example, on Dengue, we are already working with Thailand, Vietnam, Sri Lanka, and Brazil. So that's what we call the South-South collaboration.
15:12Wonderful. Can you talk to me a little bit about what you both see as the most promising avenues to pursue? So I understand this alliance is brand new. It's still a baby, so an infant in many ways. But there's a vision here.
15:32So what is taking priority in terms of where you see the most promise that can help democratize access and affordability to diagnostics and therapeutics?
15:45Well, Jean-Michel is spearheading on the diagnostics side. And, you know, we've mentioned Dengue. Wherever you look, Dengue and related viruses are becoming a huge problem, whether it's in Brazil, in Sri Lanka,
16:00or in so many countries in ASEAN. But look at the UK. Just last week, mosquitoes carrying the West Nile virus were discovered for the first time in the UK.
16:13Wow. So these are not problems that are going to be...
16:16It's climate change, isn't it?
16:17All these issues are happening more and more and more. So diagnostics, and especially for diseases which people look away from or don't bother to help, you know, that's one area.
16:29But I think... And it's a longer term challenge because whenever you're working on delivering new ways to treat, it takes, you know, it takes a longer process because you've got to do the right level of science.
16:41So scientific excellence delivered through new treatments, new diagnostics, but overarching all this is, of course, bringing the best ideas through international alliances,
16:53working with leading industries so that their technologies, you know, can be applied with one shared goal, which is, you know, access, affordability.
17:04So I think for the South-South Diagnostic Alliance, which is the more global collaboration arm of AI data, we're looking at collaboration on a scientific level, but also collaboration on an industrial level.
17:18So collaboration on a scientific level. The usual scheme of development innovation is, you know, the global north, Western countries, Europe, US are at the center of it.
17:32And so you go from a South-based country to the global north and from the global north to another South-based country.
17:39Yes, yes.
17:40So we want to get research centers, research organization, public, especially public research organization in the global south to work together.
17:53Are you cutting out the global north?
17:55No.
17:56Is that the idea or is that even feasible?
17:59No, no, no, no. See?
18:01Yes, I can see the reaction.
18:02Not at all.
18:03The global north, and I can say that because I'm French.
18:07So the global north, in the research environment, acts too much as a gatekeeper.
18:13Gatekeeper, okay.
18:14You see?
18:15Yes.
18:16So you have to be vetted by, even on dengue, which is a disease that doesn't exist in the global north, you always have to be vetted by an older French guy, for example.
18:26Just two, like me.
18:28So we want to, we say why?
18:31The question is why?
18:32Why is, you know, I have some great colleagues in the global north,
18:36I have some great colleagues on dengue, Professor Panisadeh in Thailand, Professor Nelika in Sri Lanka,
18:43Dr. Amy, who is the head of IMR here.
18:47All these people have a competence.
18:49Why do they need an older French man or an older English guy to vet what they are saying?
18:55In fact, they have more knowledge here.
18:58So the idea is that let the knowledge between those groups flow.
19:02So that's the first thing, scientific collaboration.
19:05And then when you look at the industrial potential, the innovation potential, you certainly realize there's a lot of small companies that come with really brilliant ideas, but they cannot get through that system because that system is biased.
19:20It's got a very, very high entry cost.
19:23If you want to get into the global health system, the global health system is very expensive.
19:30And then you've got standards, you've got regulations.
19:33But those standards, those regulations apply mostly to the US or to Europe.
19:41And the question is why do you need to use standards from a foreign country when you want to deliver a product in Malaysia or in Thailand or in Sri Lanka?
19:53Those countries, actually, Malaysia has a very, very good regulatory authority.
19:57I've worked with them.
19:58They are very competent.
19:59They know what they are doing.
20:01They are certified left, right and center according to global standards.
20:05They can review a product and they can tell us whether that product is safe.
20:10And that is much cheaper.
20:14So, Jean-Michel, you know, Jean-Michel has put it so well, Malaysia is now, the government, I think, the approach is not just reforming healthcare thinking, but it's actually redefining it in a different way.
20:29So, you know, Malaysia can become the fulcrum for bringing together these innovations.
20:35And you've got, you know, Professor Ivy Chung at University of Malaya.
20:40She's a focus of an accelerator to bring together industrial technologies that are ready to be applied and the disease expertise, which is so essential if you're going to deliver the technologies for those diseases.
20:57You see, so you've got that confluence now and you've got you've got BRICS, you've got ASEAN.
21:03It's actually quite an exciting time.
21:06I'm sensing it.
21:07But just to maybe manage some of the hype, because we have seen other global health initiatives come and go.
21:15Some have succeeded.
21:16Some have stalled.
21:17Yes.
21:18What do you think would be common traps that new alliances fall into and what IA data should avoid or to make sure that you sustain this momentum and get to see this vision that we have?
21:31Well, it's not going to be easy.
21:34And one of the reasons it's not going to be easy is people are used to work in a certain manner.
21:39And we are challenging that status quo.
21:43So, for example, you can still have Malaysians or Thai.
21:48It doesn't matter.
21:49It doesn't matter.
21:50The country doesn't matter.
21:51Working in the Ministry of Health, when you come with a Malaysian or Thai innovation, they said, oh, has it been used in the US?
21:59Oh, that's the mindset.
22:00So, I think this kind of mentality, which is directly inherited from, I think, colonial times, we need to shift.
22:12We need people to realize that today, Malaysia is a net contributor to innovation.
22:17And we need to support that.
22:19And why do I say that?
22:20Because I think this is one of the ways we can really improve access, which is something I've been fighting for for the last 30 years.
22:27It's not going to come from us in the global north because we are used to building very expensive tools, drugs, machines.
22:37So, they always end up registered in the country and available in the pharmacy or in the hospital at a high cost.
22:44I grew up in the global south, actually.
22:47I grew up in Tanzania.
22:49So, I really understand from a very early age when both my parents were doctors.
22:56So, I saw the problems there.
22:58And I can see also that just to answer your question, what are the risks, what are the downsides, what are the hazards?
23:06How do we keep the momentum going?
23:08We are always going to come across, this is a shape-shifter, okay, but we're always going to come across vested interests.
23:17Whether it's vested interests at a global scale or whether it's vested interests locally, wherever you're trying to achieve an impact.
23:25And I think our job in IEDATA is to be as open as we can be, as cooperative as we can be to try and address these vested interests.
23:36But I think not subject to coercion.
23:39So, this is what PM was saying, right? Cooperation, not coercion.
23:44And I think this is one way to look at the whole subject.
23:49Absolutely.
23:50I think previously the kind of cooperation that has been offered from the global north is, how do you call it? Co...
23:59What's the word? Cooperation.
24:01Cooperation.
24:02Yes.
24:03Like, we have a great idea for a partnership.
24:05Right.
24:06We tell you what to do and you do it.
24:07Yes.
24:08And we need to change that because knowledge, you know, when you speak about disease like dengue, the knowledge is here.
24:15In Malaysia, in Thailand, in Sri Lanka, in Brazil, in Indonesia, not in Europe, not in the US.
24:23Some knowledge is in Europe and in the US.
24:27And that knowledge is very useful because we cannot deny that there is really immense potential also of knowledge and innovation in the global north.
24:37But that knowledge has to support the initiatives that are led from endemic countries, not the other way around.
24:44And knowledge by itself doesn't have the same strength, doesn't have the same force as experience with knowledge.
24:51And experience is not there.
24:53So our Chinese colleagues, technologists who are innovating these tests, they don't have much dengue.
25:00So they're very happy to share the experience that is already here in Malaysia as an excellent center to develop the best product for the problem.
25:12So you have to have that cooperation between experience, knowledge, and then, of course, the drivers and the ability to implement, you know, the ideas to do the right tests.
25:24Well, that's what iData is for.
25:26Exactly.
25:27And on that note, I want to thank you so much for being here and telling us about this new alliance.
25:32And hopefully, in a few years' time, we'll come back and do this interview again and you can tell me all about the successes you've had in making Diagnostics and Therapeutics.
25:41Maybe not a few years.
25:42Hopefully not a few years.
25:43Hopefully not a few years.
25:44Oh, hopefully by the end of the year.
25:45By the end of this year.
25:46We're optimistic.
25:47Thank you so much, gentlemen.
25:51That's all the time we have for you on this episode of Consider This.
25:53I'm Melissa Idris, signing off for the evening.
25:55Thank you so much for watching.
25:56Good night.
25:57Good night.
25:58Good night.
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