Episoder
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Main points
Definition of global health in the context of Africa Primary problems in quantity and quality in human resources confounded by the multiplicity of stakeholdersLack of harmonization of partnership and funding channels and modalities are different for stakeholdersLack of tracking of resources by governmentsWeak point: no direct government oversight of the project: no political will and/or no mechanism to harmonize the projectsInternational programs often lack sustainability. Example: H3Africa Program (Human Heredity and Health in Africa) Competition for the same skilled workers to carry out international programs who are thus diverted from provided healthcare to local populations. It also participates in the brain drain (example: H3Africa)No prioritization of the programs in the interest of home countries (medications, tests, equipment). Example in South Africa: patient genetic difference between California and AfricaAccountability: No separation between politics and judicial systems. As a result, there is no prosecution when waste or corruption occurs in many cases. Example: SASA conferenceSuccesses: H3Africa with sickle cell and genetic diseases / Training of workers skilled in global health / Help in rural areasTo counter the brain drain, two examples: (1) Brain Circulation, (2) Carnegie Foundation (cross appointments) Rural areas. The situation has improved in the last decades but they are still underserved particularly regarding access and distribution. Moreover, facilities are underdeveloped, understaffed, and lack diagnostic tools. Example in Tanzania for the training of healthcare workers but it has plateaued. Priority: mother and children healthcare Collaboration between African countries: despite African Unionâs efforts there is little collaboration. No continent-wide standards for healthcareCurrent Ebola outbreak in Uganda (date: 10/3/2020)Disproportion between funding and priorities: HIV/AIDS, TB, malaria are well funded at the expense of other diseases like neglected tropical diseases and chronic diseasesDeciders for best ROI: African governments but external players like the Bill Gates foundation have their own projects. Political consequences if programs fail: no mechanism holding anybody accountableInfluence of academia on decision-makers. Difficulty in developing policies to advise governments. They have problems on their own: insufficient funding, low salaries, lack of academic freedom, nepotism and lack of competent leaders and staff, lack of equal access to academic institutionsHigh cost of tuition deprives African countries of bright studentsAdvice for people wanting to get involved in global health in Africa:- Despite of challenges, follow your heart
- Work in rural settings. Personal examples (1) in Tanzania, (2) McMaster University, (3) Distributed medical education
Advice to fix what is not working in global health in Africa: (1) Training level: Expand distributed medical education nationally or internationally in Africa, (2) More collaboration between academic institutions promoting global health creating guidelinesGood example of a successful program that can be scaled: In Tanzania a training program initiated by a foundation in the Netherlands and taken by the Fogarty foundation Good example of program successful for sustainability: Nutritional program started by Oxfam against kwashiorkor and marasmusExample of good collaboration between anglophone and francophone countries: Rwanda and Uganda and DRC (Democratic Republic of Congo) regarding EbolaBIO
Dr. Kapalanga is a physician-scientist and educator who received his medical education from Yale University, the state university of New York, queenâs university and the university of Guelph.
He is currently professor of paediatrics at the Schulich school of medicine and dentistry and the South Western Ontario academic health network - knowledge translation group, Canada.
His scholarly and research pursuits are in the epigenetics of neurodevelopmental disorders and exploration of shared endophenotypes in neurobehavioral disorders.
https://www.linkedin.com/in/joachim-kapalanga-62a64551/?originalSubdomain=ca
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Main points
Speaker introduction (international experience and expertise / pharmaceutical industry and corporate background) Presentation goals (road map for reaching maximum efficiency and efficacy in providing healthcare across the globe / providing food for thought to frame issues)Global and healthcare challenges: The African exampleThe Clinton foundation as an example of unreliable fundingOne requirement to face multiple challenges: PrioritizationAnalogy: Medical emergency departmentTriage processCriterion #1 for global health: ROI with several dimensions (medical, financial, societal, political, moral, and personal)First concrete example: Acute vs chronic disease (tetanus vs HIV/AIDS)HIV/AIDS situation descriptionHIV/AIDS age distributionHIV/AIDS treatment yearly cost (for life)Maternal and neonatal tetanus situation description2022 study: Vaccination coverage of mothers in East Africa The financial calculus The question: Why is the choice not made in favor of the tetanus vaccination?ConclusionFear: Resurgence of historical diseases with COVID-19 is in the news (TB, cholera, polio, HIV/AIDS, malaria) Second concrete example: Prevention vs cure (the tetanus example)Conditions for success (avoiding bureaucracy and making the hard choices)SolutionsPriority #1: Good healthThree values (equity / solidarity / liberty)One need: One accepted and respected leadershipOne urgency: A general political consensusTwo sub-priorities: Nutrition and educationOne must: Erasing the African debtThree strategies: A new and serial approach / Thinking locally and acting globally / Consolidating global health Six suggestions: Mergers, coordinating superstructure, drastic limitation of face to face international conferences and congresses, the right to interfere in countries for healthcare reasons (particularly transmissible diseases) and the creation of global health blue helmet brigades, having poverty as the #1 risk factor for many diseases)The past and the futureFood for thoughtVisionConclusionBIO
Dr. Yann Meunier is an international and multifaceted healthcare professional and a pioneer in academia, healthcare provision (in clinical settings and public health programs), research, and business.
During his education,
He studied medicine at Paris V University (France), the Federal University of Rio de Janeiro (Brazil) and The George Washington University (USA). He holds specialty degrees in emergency medicine (Paris XII University), and tropical diseases (Paris VI University), a certificate from the ECFMG, a certificate from Harvard University in internal medicine and two certificates from Stanford University in communication.
During his career,
In Academia
He was Assistant Professor in Tropical Diseases and Public Health (Paris VI University), Adjunct Assistant Professor of Medicine (The George Washington University); Lecturer (The George Washington University Center for International Health), Director (Stanford Health Promotion Network), Manager in Health Promotion (Stanford Health Improvement Program), Mentor (Stanford Medscholars Research Fellowship Program), and Instructor (Stanford Health Improvement Program)
He is widely published in the international medical literature and is the author or co-author of nine books on global health and tropical diseases (Oxford University Press and Springer published two).
As Healthcare Provider
Clinically
He was (1) Private General Practitioner in France, Singapore (only European Private General Practitioner in the country), New Caledonia (first and only Private General Practitioner on the island of Lifou), and Nigeria (only European Private General Practitioner in Lagos), (2) Tropical Diseases Consultant (at the Pitie-Salpetriere hospital in Paris, France), (3) Chief Medical Officer for Chevron Oil Co. in Papua New Guinea (PNG), (4) Corporate Physician in Cameroon (for Cellucam), Nigeria (for Spie-Batignolles and Schlumberger), and China (for EDF), (5) he was the team Physician during corporate trips in Gambia and Egypt (for Bosch), and Congo-Brazzaville (for a timber consortium), and (6) he worked as Emergency Medicine Specialist for SAMU 94 (at the Henri Mondor hospital in Creteil, France).
In Public Health
He (1) created a public health program for about 10,000 Kutubu-area villagers in the Southern Highlands province of PNG, (2) wrote a report on public health priorities in Lifou, (3) conducted public health programs and epidemiological surveys in Senegal (for USAID), China, Papua New Guinea, Haiti, and New Caledonia, and (4) created and delivered health promotion and preventive medicine tools at Stanford University for the Stanford University staff and the San Francisco Bay area population and corporations, in particular several located in Silicon Valley.
As Researcher
He led or participated in clinical trials providing new treatments for HIV/AIDS, tropical (malaria, intestinal nematodoses, amebiasis, giardiasis), cardiovascular, hematological and respiratory diseases.
As Business Executive
He was the Director of International Corporate Affairs and Business Development for Stanford Hospital and Clinics in Palo Alto, CA, Research Manager for Hoffmann LaRoche drug Co. (in charge of antibiotics and anti-parasitic drugs) and Export Medical Director for Delagrange drug Co. (in charge of Eastern Europe, Africa, the Middle-East, and Asia) in Paris, France. He was Co-founder and Business Manager of International Business Proactivity Pte Ltd in Singapore. He created his own healthcare consulting company HealthConnect International LLC, in Silicon Valley, CA, and is now its CEO and a Global Health Expert.
Dr. Yann Meunier is an Honorary Member of the Brazilian National Academy of Medicine, Associate Member of the Academy of Medicine, Singapore, and Fellow of the Australasian College of Tropical Medicine. He is listed by the Institute of Medicine, U.S., Division of Health Promotion and Disease Prevention (celebrities, public figures). He is fluent in English, French, and Portuguese, including medical terminology.
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Manglende episoder?
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COVID-19 has underlined the current poor state of global health. In this podcast, I have tried to identify the underlying problems that were evidenced, at least in part, by the root causes of the pandemic. My remarks were largely based on my published book âPandemics: Prescription for Prediction and Preventionâ*, especially its Chapter 18.
To summarize:
We live in an unruly, not easily managed world of ~ 8 billion people that is constantly growing. Notwithstanding the plethora of international, regional, national, and other organizations, there are glaring inequities among nations, principally between developed and poor ones. In particular, within the context of COVID-19, the prime organization among them, the World Health Organization (WHO), has been dilatory, at times issuing contradictory recommendations, and deferring to those powerful nations that fund it most (in this instance, China).
In this context, humanity has again proven to have a short memory of past epidemics/pandemics, not having even clearly identified what are their root causes. It is therefore no wonder that these events will continue to haunt us till the end of times ... unless we are able to devise appropriate strategies for predicting/preventing them such as the one I have proposed. For this purpose, I have identified ten important measures:
Highlight global health security;Create and strengthen necessary mechanisms; Promote multidisciplinary engagement;Strengthen multisectoral coordination;Emphasize the importance of financial preparedness;Improve early warning and detection;Collect and share data in a timely manner;Conduct laboratory testing;Develop joint outbreak response capacities; andTake appropriate science-based actions.I have also identified ten intertwined cardinal factors that are the root causes of pandemics that need to be simultaneously tackled and remedied:
Rapid growth of global human population;Increased globalization;Environmental degradation and destabilization of ecosystems;Creation of new urban or agricultural ecosystems;Economies of scale and monocultures in agriculture and dysfunctional agrifood systems;Loss of land and ocean biodiversity;Water scarcity;Human-induced climate change;Societal inequities; andIrrational mass denialism of hard-won facts of science (vaccinations, antimicrobial overuse).Some of the above factors could be correlated with the United Nations (U.N.) Sustainable Development Goals (SDG).
In the same book, I have offered a blueprint for a 6-level strategic pandemic prediction and prevention program that should herald the beginning of the end of pandemics:
Creating of a new âWorld Environment Organizationâ;Shifting the current health paradigm to a âOne-World/One-ecoHealth paradigmâ that will be grounded by a new âInternational Pandemic Treatyâ and other international laws;Involving international, intergovernmental, regional, and national health organizations;Incorporating the âGlobal Human Virome Projectâ;Actively developing models (epidemiological, climate-type) with their enabling technologies and databases: andFolding-in the development of vaccines & therapeutics and the corresponding research.The value and success of the proposed approach will be gauged by four measures:
Reducing causes of new infectious diseases;Preventing outbreaks and epidemics from becoming pandemics;Preparing for potential future pandemics that could not be prevented; andEnsuring that the causing virus does not re-emerge thereafter (e.g., by sustaining itself in domestic animals).Within that blueprint, I truly believe we can reach a stage where pandemics could at long last be predicted and prevented.
*Book (hard cover and paperback): Pandemics: Prescription for Prediction and Prevention: https://www.amazon.com/Pandemics-Prescription-Prediction-Alain-Fymat/dp/0228867215
BIO
Dr. Fymat is a medical-physical scientist and an educator. He is the current President/CEO and Professor at the International Institute of Medicine and Science with a previous appointment as Executive Vice President, Chief Operating Officer and Professor at the Weil Institute of Critical Care Medicine. He was educated at the University of Paris-Sorbonne and the University of California at Los Angeles. He was formerly Professor of Radiology, Radiological Sciences, Radiation Medicine (Oncology), Critical Care Medicine, and Physics at several U.S. and European Universities. Previously, he was Deputy Director (Western Region) of the U.S. Department of Veterans Affairs, Veterans Health Administration (Office of Research Oversight), and Director of the Magnetic Resonance Imaging Center and for a time Acting Chair of Radiology at its Loma Linda, California Medical Center. He has extensively published (~ 425 publications including patents, books & monographs, book chapters, refereed articles). As invited/keynote speaker and member of organizing committees of international congresses and symposia, he has lectured extensively across the USA, Canada, Europe, Africa and Asia. He has been the recipient of numerous research grants from government, academia and private industry, and has consulted extensively with these entities. He is a Board member of several institutions and Health Advisor of the American Heart & Stroke Association (Coachella Valley Division, California). He is Editor-in-Chief, Honorable Editor or Editor of 35 medical-scientific Journals. He published more than 167 articles in different journals.
https://www.linkedin.com/in/dr-alain-l-fymat-bb555012/
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The US Healthcare system has slowly evolved over the past century through a combination of legislative efforts, need assessment by the private sector and pioneering efforts by a few dedicated and resourceful patient care givers. As such, morphing over the decades and at times having been shackled by political compromise, it is not surprising that with its evolution there would be some unintended consequences. At this stage, to help create a future healthcare delivery system which can facilitate the timely, efficient and appropriate access to healthcare for those most in need at a cost that is sustainable, one must proceed carefully lest we continue to apply layer upon layer of more ineffectual âband-aidsâ as has been previously done. Healthcare is complicated and so therefore is its delivery. As HL Mencken once warned, âFor every complex problem there is a solution which is simple direct and wrong.â In this digital world in which we now live, do not surrender to the vicarious technological varlets: fax, voice mail, email, text, electronic health records and artificial intelligence, the very effective and personable interactions with your colleagues and your patients, including a carefully performed physical examination. The latter represents an important transactional moment between doctor and patient, âa laying on of healing handsâ which helps foster the trust needed for relational continuity and effective cure. To those who would have you believe that technology will totally replace this interaction, I would have them remember the old girl scouting adageâŠ. âMake new friends but keep the old, the one is silver, the other goldâ⊠Further, please never forget, âNo one cares how much you know until they know how much you care.â Remember, even an intellectual argument, including detailed statistical analyses can at first appear quite cogent, but upon more careful examination may be found to be fraught with erroneous assumptions and even faulty methodology. Be critical in your review of the literature. As Benjamin Desraeli, 19th century Prime Minister of England twice over quite perspicaciously once stated, âThere are three kinds of lies; lies, damned lies and statistics.â When reviewing the literature, remember to fix your sights on the proper target. Albert Einstein once stated, âNot everything that can be counted counts and not everything worth counting can be counted,â words of wisdom when applied to healthcare.
OECD (Organization of Economic Cooperation & Development) https://www.oecd.org/health/health-statistics.htm World Index of Healthcare Innovation www.freopp.org/wihi/homeKaiser Family Foundation Schaeffer Center for Health Policy Brookings Institute Center for Medicare & Medicaid Services Commonwealth Fund https://www.commonwealthfund.org/international-health-policy-center/system-statsIMS Institute for Healthcare Information Global Medication Use in 2020 US Census Bureau https://www.census.gov/quickfacts/fact/table/US/PST045221 American Hospital Association https://www.aha.org/statistics/fast-facts-us-hospitalsUS Dept Health & Human Services Office of the Inspector General https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf / https://oig.hhs.gov/oei/reports/OEI-06-18-00400.pdf Association of America Medical Colleges https://www.aamc.org/data-reports/reporting-tools/report/tuition-and-studentfees-reports 3M Clinical and Economic Research https://multimedia.3m.com/mws/media/2117913O/his-pm-cer-socioeconomicstatus-health-care-deliverysystem-performance-report-en-us.pdf American Association of Nurse Practitioners (AANP) https://www.aanp.orgBIO
Dr. Zema has enjoyed a tenure of forty plus years in the healthcare arena on the âinsideâ as physician trainee; private practitioner; member of a hospital medical board; vice president of a physician independent practice association; board member of a physician holding company; pharmaceutical industry and malpractice legal consultant; chief of cardiology at both community hospital and academic medical centers; professor of medicine at two state university colleges of medicine; and physician clinical reviewer for a large national radiology benefits manager. Having operated in all of the above "silos," at one time or another, unlike so many of today's so-called "pundits,"
Dr. Zema has indeed walked the walk and not merely talked the talk and as such is uniquely qualified to debate healthcare delivery providing a glimpse from the inside out.
https://www.linkedin.com/in/michaeljzema-md/
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Plus on dĂ©tecte prĂ©cocement un problĂšme de santĂ© en devenir, plus son traitement sera facile, voire seulement possible. Câest une Ă©vidence.
La mĂ©decine de plus en plus sâattache Ă chercher des « signaux faibles » qui permettent des diagnostics de plus en plus prĂ©coces. Câest le cas par exemple dans lâimagerie en utilisant de savants algorithmes. Mais câest aussi le cas pour des choses aussi simples que de mesurer le taux dâhĂ©moglobine glyquĂ©e Ă la recherche dâun diabĂšte, de TSH Ă la recherche dâun dysfonctionnement de la thyroĂŻde ou de PSA pour la prostate, voire une simple mesure de la tension artĂ©rielle. Bien dâautres examens sont possibles.
Proposer de faire un « bilan de santĂ© » est une fausse promesse car nul ne peut prĂ©tendre dresser lâĂ©tat de la santĂ© dâune personne dans son entiĂšretĂ©. Ce que lâon peut faire est dâexplorer le plus probable pour une personne en fonction de ses antĂ©cĂ©dents personnels et familiaux, et des signes cliniques quâil prĂ©sente. Ăgalement, on va chercher ce qui est le plus frĂ©quent Ă©pidĂ©miologiquement pour sa tranche dâĂąge ou son genre. Ainsi pourra-t-on approcher un « bilan mĂ©dical » ciblĂ© qui a le plus de chances dâĂȘtre pertinent pour une personne donnĂ©e.
Câest pourquoi notre Centre MĂ©dical International propose des « bilans mĂ©dicaux modulaires » attachĂ©s Ă une fonction (sommeil par exemple), ou Ă un organe (cĆur par exemple), plusieurs modules pouvant ĂȘtre assemblĂ©s pour rĂ©aliser ce que dâautres appelleront un « bilan de santĂ© ».
Mais ce nâest pas le tout de dĂ©pister, encore faut-il savoir que faire de ce que lâon a trouvĂ©. AprĂšs un bilan, on ne se prĂ©cipite pas toujours sur un traitement mĂ©dical ou une opĂ©ration. Surtout lorsque lâon a dĂ©tectĂ© des signaux faibles ; il suffit parfois juste de mettre en Ćuvre des mesures de prĂ©vention de lâaggravation. Ou alors au moins de mesures accompagnant des traitements qui peuvent en ĂȘtre plus lĂ©gers.
Car câest bien joli de faire un bilan pour dĂ©tecter un sujet Ă considĂ©rer, mais quâen fait-on ? Lâimportant pour nous, ce sont les suites quâon donne Ă un bilan. Certaines conduiront Ă un spĂ©cialiste pour approfondir une recherche parce quâun rĂ©sultat questionne. On entre dans la sphĂšre mĂ©dicale classique.
Dâautres conclusions ne conduiront quâĂ des recommandations dâhygiĂšne de vie. Elles sont fondamentales. Les dĂ©terminants de la santĂ© sont loin dâĂȘtre entre les mains des seuls mĂ©decins. Ils sont avant tout entre les mains de chacun ou de sa destinĂ©e. Pour le patrimoine gĂ©nĂ©tique ou les traces laissĂ©es de lâenfance, on ne peut que les subir. Pour les facteurs importants conditionnant la santĂ© de tout un chacun comme les facteurs sociaux, Ă©conomiques ou familiaux, tout comme lâenvironnement, on ne peut pas faire grand-chose. Il reste toutefois de nombreux domaines sur lesquels on peut agir pour influencer considĂ©rablement lâavenir de sa santĂ©. Il sâagit pour lâessentiel de lâactivitĂ© physique, de lâalimentation, du sommeil, du stress et des addictions Ă commencer par le tabac.
Notre objet dans le podcast Ă©tait dâen souligner lâimportance et leur place dans la mĂ©decine moderne. En effet celle-ci sâefforcera de plus en plus de ne pas ĂȘtre rĂ©active â Ă savoir attendre la maladie pour agir, mais prospective â Ă savoir anticiper et prĂ©venir les risques pour ne pas avoir Ă en traiter les consĂ©quences plus tard.
En ce sens, la prĂ©vention ne peut ĂȘtre utile que si elle rencontre le projet de santĂ© dâune personne. Si un fumeur ne veut pas arrĂȘter, un obĂšse ne pas arrĂȘter de mal manger ou un sĂ©dentaire de rester devant sa tĂ©lĂ©vision, une action prĂ©ventive sur lâaddiction, la nourriture ou lâactivitĂ© physique sera inutile. Par contre, discuter avec son mĂ©decin de ses points faibles que lâon veut renforcer, et des moyens que lâon veut se donner pour amĂ©liorer sa santĂ©, câest ce qui permettra de travailler une prĂ©vention en santĂ© vraiment utile pour Ă©viter lâapparition de maladies, ou lâaggravation de pathologies existantes.
BIO
Parcours du Dr. Lichtenberger aprÚs avoir pratiqué la médecine en contexte tropical, essentiellement en Afrique:
1983-1990
Creation de la la sociĂ©tĂ© SMI « Service MĂ©dical International », qui a pour vocation de rĂ©pondre Ă la problĂ©matique mĂ©dicale et financiĂšre des entreprises operant dans les regions insuffisamment mĂ©dicalisĂ©es du globe. Elle Ćuvrera principalement en Afrique mais Ă©galement au Moyen Orient et en Asie du Sud Est.Gestion de projets (secteur privĂ©) : montage et supervision de dispensaires et de petits hĂŽpitaux, gestion du personnel medical et administratifs, systemes dâinformation, approvisionnement en materiel medical et medicaments (Cameroun, Chine, Congo, GuinĂ©e, Nigeria, RDC (ex-ZaĂŻre), Sultanat dâOman).Direction de programmes de lutte contre le paludisme, puis plus tard contre le SIDA (Angola, Cameroun, GuinĂ©e Ăquatoriale, Mali).DĂ©veloppement de projets de maĂźtrise mĂ©dicalisĂ©e des dĂ©penses de santĂ©, en CĂŽte dâIvoire, puis au Gabon. DĂ©veloppement de mutuelles de santĂ© dâentreprises.Ătudes medico-sanitaires dans de nombreux pays (en plus de ceux dĂ©jĂ notes : Arabie Saoudite, IndonĂ©sie, Hong Kong, Kazakhstan, Maroc, Pakistan, Russie, SĂ©nĂ©gal, Sultanat dâOman, Soudan, Tunisie).Depuis 1990
Vice-président de la Société de Médecine des Voyages (deux mandatures). Membre actif depuis la naissance de la société. Toujours en cours.Depuis 1992
CrĂ©ation de SMI Ăquipements, fournisseur de produits de santĂ© aux cĂŽtĂ©s de SMI, fournisseur de services mĂ©dicaux.En 1999
Co-crĂ©ation du CollĂšge International du Voyage, association de rĂ©flexion transversale pluridisciplinaire sur le voyage (colloques «Au seul souci de voyager», cafĂ©s du voyage, voyages littĂ©rairesâŠ).Entre 2001 et 2011
CrĂ©ation de Health cy, Agence de dĂ©veloppement et de gestion de la santĂ©.DĂ©veloppement de SMI Ăquipements et SMI Pharma.Enseigne dans le DIU de mĂ©decine des voyages Paris Sorbonne (toujours actuellement).2011: Vente des sociĂ©tĂ©s au groupe International SOS et retrait de toute activitĂ© dans leurs domains.2012: CrĂ©ation de lâAssociation Voyage et SantĂ© (AVS) et redĂ©marrage du Centre de Vaccinations Internationales Air France, par AVS.2016: DĂ©veloppement et dĂ©mĂ©nagement du Centre au 38, quai de Jemmapes, Paris 10eme.2018 đĄȘ ce jour
Création du Centre Médical International integrant le Centre de Vaccinations Internationales, accueillant quelque 90 000 patients et réalisant plus de 100 000 vaccinations internationales par an.https://www.linkedin.com/in/jean-michel-lichtenberger-0128869/?originalSubdomain=fr
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Main points
Unequivocal support for vaccines (examples of tetanus and yellow fever)
Criteria for good vaccination
The degree of difficulty increases incrementally: (1) Against viruses, bacteria and parasites, and (2) For chronic diseases (examples: TB, HIV/AIDS, malaria)Progress in empirical. Examples: Big for conjugated vaccines but small for adjuvantsStrong and fast immunity induced by a germ translated into very good vaccines (examples: tetanus, diphtheria)Future: Molecular ecology of human-germ interactionProblem of misinformation on the internet (examples: aluminum hydroxide, measles)
International vaccination requirements protect first and foremost a country not the individual
Mass vaccination and COVID-19
Speed of action to produce the vaccine was worrisome for some peopleLive attenuated vaccine would have been âuniversalâ and not variant-specific like with the spike protein but less efficientThe vaccine winner was the fastest and easiest to manufacture (1 week on the computer / Available in 6 months)Nationalism, politics and capacity to conduct clinical trials and of production played a role in the choice of the technologyRNA vaccines have been known for yearsVariants are selected by immunity pressure coming from mass vaccination and immunity gained from infection (asymptomatic or not)
Possibility of the emergence of more virulent strains: Usually, in a pandemic the evolution is toward less pathogenic mutants
Low mortality in Africa may be due to protective immune cross-reaction between the COVID-19 virus and coronaviruses causing seasonal rhinitis (4 different types)
The current vaccines protect much more against death and severe forms of the disease than infection
One should stop talking about antibodies
A âuniversalâ vaccine would take 3 years to develop
There is a need for both vaccines and antiviral drugs
Malaria
5,800 parasitic molecules. Over 30 years, 20 have been studied. Only 5 in detailsUsual approach: hypothesis verified by studies (examples: GPI-anchored and surface proteins). All the studies failed. In the global North they used models with rats. However, for example, malaria mortality is 0% in African tree rats but when a vaccine-candidate is studied in lab mice mortality is 100%. Similarly good results in animals do not translate into the same in humans Other approach based on reality and molecular ecology Vac4All studied 12 molecules that have shown no antigen variationVaccine results with children in Mali and Burkina Faso have been encouraging (good efficiency and good tolerance)Immunogenicity has been increased with adjuvantsTrials have been almost completed in adultsBIO
Dr. Druilhe is a physician, immunologist, parasitologist, inventor and entrepreneur. He started his research career at the Department of Tropical Medicine of the Pitie Salpetriere Hospital, where he initiated many first-of-a-kind malaria research experiments, including the first cultures of the pre-erythrocytic stages of the malaria parasites, characterization and cloning of P. falciparum liver stages antigens, and the investigation of natural immunity to malaria blood stages through passive transfer of African adult immunoglobulin in Thai individuals with malaria.
For over 20 years (1987-2011), he led the Laboratoire de Parasitologie Bio-Medicale at the Institut Pasteur in Paris, France, where he pursued his scientific strategy of analysis of immunity to malaria in humans and where he and his team made major discoveries, identified novel mechanisms, not foreseen in animal models, and important molecules believed to be responsible for malaria immunity in humans.
His work covers the wide breadth of vaccine research and development, including involvement in the organization and conduct of 8 vaccine clinical trials. He has authored around 330 Scientific Publications and holds more than 23 patents on inventions.
His main scientific interests have been and remain the analysis of host-parasite immune interactions in human beings, and the pre-eminence of clinical investigations over those performed in animal models.
In December 2010, using a combination of private funds and public grants, he created Vac4All with the aim of capitalizing on >25 years of experience in malaria research, and speeding-up malaria vaccine development.
Dr. Druilhe directs and oversees all company strategic, scientific and technical direction.
https://www.vac4all.org/home/about-us/
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Main points
Importance of chronic diseases in global health: (1) definition of chronic diseases, (2) their burden (morbidity and mortality are rising: 75% rule, premature deaths, in LMICs, preventable, economic impact, risk factors (example: poverty).Definition of chronic diseases.Challenges: (1) The fact they are asymptomatic for some time, (2) They are less âsexyâ, (3) Misalignment of funds (compared to acute diseases), (4) Low and Medium Income Countries with less resources and not as well-equipped. Example of diabetes.Priorities: Investment mobilized toward (1) Training and education, and (2) Research in risk mitigation and prevention (behavior change).Personal example: (1) Historical background of medical mobile clinics (MMCs), (2) Missions (5,000 people per day, real impact?), microscopic and telescopic views, (3) Four platforms for ABCs: (a) Treatment, (b), Prevention by early screening and mitigation of risk factors, (c) Education of workers, students, public, and (d) Research. Launched in 2016. Telemedicine.Phenomenal results of MMCs: Efficiency, low cost, and prevention of the downstream consequences of chronic diseases. Impact of missions: Triage, preparation starts a year ahead of time, ROI?Obstacles to scaling: Cost (a kit costs $500), one gadget per community (vision: 1 per person by showing data of cost-effectiveness.Description of a mobile clinic (website: https://www.abcsforglobalhealth.org/). Only outreach program in the Philippines equipped with an Electronic Medical Record device (4 years of data). Problem of internet access and power supply in rural areas. In 4 communities. Upswing during COVID. Partnership with local healthcare structures: A big challenge. With universities and colleges: Going very well. Limited funding is a challenge. Night and day when compared to what was available before. Results at the individual level are fantastic. Public health level results: Available and they show tremendous results. Also decreases poverty and it can be scaled in the country and globally.Maintenance: Not the costliest aspect. 60 to 70% of the cost is due to salariesGlobal health trends for chronic diseases: WHO / Millennium Development Plan Targets for 10 years are not achieved. No practicality in the matter. The missing link is the connection with the people.Waste is more prominent in developing countries.Mobile technology should be embraced and emphasized. Advice for students: Have heart to serve.BIO
Dr. Julieta Gabiola is a Clinical Professor of Medicine at Stanford University. She is an Educatorâs for CARE faculty, teaching the Practice of Medicine at Stanford Medical School, while mentoring medical students longitudinally. She is involved in mentoring medical students with their MedScholar projects with focus on global health outreach programs. Her specialty is Internal Medicine with interest in chronic diseases like Hypertension and Diabetes. She is a Stanford CIGH faculty fellow.
She practices Internal Medicine at Stanford Express Care, involved heavily in her foundation, ABCâs for Global Health with a mission to improve chronic disease management and outcomes in Filipinos in the Philippines and in the US. She collaborates with hospitals and universities in the Philippines to mitigate disparities in health care and improve health care access. She has partnered with institutions in the Philippines in research and health education. She provides opportunities for global health immersion in the Philippines to students from high school to medical school. She co-authored an interdisciplinary textbook in clinical assessment, published by Pearson. This book is poised to provide clinical assessment tools to various disciplines like medical students, nurse practitioners, physician assistants, and other paramedical practitioners. She was also one of the authors for DISRUPT, a book by Filipina leaders with the idea that in order to effect change, we must be willing to disrupt the status quo.
Most recently, she was instrumental in launching the first medical mobile clinic in Pampanga, Philippines with a vision to promote community outreach programs, continuity of care, education, prevention and research in health care. Focus is on improving health outcomes in chronic non- communicable diseases and decreasing health disparity. Specific target populations are: disenfranchised population with chronic cardiovascular diseases with limited access to care and the indigenous population (AETAS tribes).http://www.abcsforglobalhealth.org
She is now involved with the planning and execution of Stanford Digital MedIC in the Philippines where academic institutions and non- profit organizations partner with Stanford to enhance digital medical education.http://www.digitalmedic.com
https://med.stanford.edu/profiles/julieta-gabiola
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Main points
Difference between healthcare and healthAre we providing healthcare making a difference in peopleâs health?Healthcare research importance: What are the things that make a difference? Example: tuberculosisImportance of big data in global health research: large number of people needed to draw conclusions about the impact of measures without double blind trials. Example: Foreign aid Interface global health - public health - big data. Examples: global politics and global warmingInfluence of politics in healthcare research. Examples: Mexico City policy (abortion) and PEPFARHow do researchers maintain independence? Example: NIHSources of funding at Stanford University. NIH, Stanford community (philanthropy) Mismatch between funding and public health priorities in developing countries. Examples: TB, HIV, malariaMain challenges for global health research. Difference between traditional research and global public good (examples: emerging diseases detection, guidelines). The latter is underfunded. Example: TBStrategic solutions with two examples: (1) A successful one and (2) a failure. For (1) Foreign aid with HIV/AIDS and GAVI, and (2) Clean water (book co-author: âDisease Control Prioritiesâ)Government ownership and international intervention brigades for emergency situations (examples: Ebola, famines, wars)Research mechanisms: from top to bottom versus the inverse. The notion of respect and boots on the ground. Sharing research results: The usefulness of face to face international congresses given the cost and carbon footprint.BIO
Dr. Bendavidâs academic appointments include:
Associate professor, medicine - primary care and population healthSenior fellow, stanford woods institute for the environmentSenior fellow (by courtesy), freeman spogli institute for international studiesMember, bio-xFaculty affiliate, institute for human-centered artificial intelligence (hai)Member, maternal & child health research institute (mchri)His work broadly investigates the drivers of population health improvements in developing countries. He studies how economic, political, and natural environments affect population health. He uses a mix of experimental, econometric, qualitative, modeling, and demographic tools to produce insights and strategies for improving health. A sample of current projects address the following questions:âą What role does US foreign aid play in reducing mortality and improving equity in developing countries?âą What forms of engagement in health improvements - social marketing, public health interventions, or community empowerment, for example - work, and which do not?âą What effect do malaria control programs have on child mortality?âą What combination of prevention strategies are most cost-effective for Africaâs HIV epidemic?âą What is the evidence that foreign aid for health is good diplomacy?âą Which populations are most vulnerable to the effects of climate conditions on the availability of food?
His research focus is: Infectious disease.
https://healthpolicy.fsi.stanford.edu/people/eran_bendavid
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Main points
Importance of technology in global health: The single most important driver of health improvement around the world is technologyTechnology definition: Anything that defines how input is transformed in output (devices, drugs, know how, management, etc.)Example: the bacteriological revolution in the 19th CenturyPositive and negative aspects: Choices made on social preferences regarding redistribution Differentiation of technology with intrinsic property vs distributive property (expensive vs inexpensive ones). Economic growth increases inequity but it does not mean economic growth is bad. Wealth distribution is the issueInexpensive technology has the potential to reduce health inequality from the get-go. Examples: (1) Rehydration therapy, (2) Penicillin, and (3) Antiretroviral drugs in places like sub-Saharan AfricaDifferentiation between progressive and regressive technologies. How are they produced and what are the incentives to produce and distribute them? Example: For the pharmaceutical industry, market forces are a regressive factor. Positive factors include the public sector, philanthropies but success benefits are not as direct and rewards as immediate as the for the market. Epidemiology of developed and developing countries is converging on chronic diseases. It will put the focus more and more on distributionImpact evaluation: Experimental methodology, and others like models done by international bodiesHow is technology prioritized? 2 ways: (a) Centralized (using cost-effectiveness guidelines). Example: endemic malaria and (b) Decentralized (people choosing their preferences)Access to potable water. Reasons for not being done: (a) Multiple actors having different incentives, and (b) Water disinfecting pills give it a bad taste Some progressive technologies address issues that donât exist for high income households. Example: CookersValue of better health (primary and secondary)Importance of politics. Misalignment of incentives (in government and other organizations)For the poorest: No other incentive than moral. Relying on philanthropy Trends for technology and health equity: Hopeful but the need is still great, but caution must prevail for chronic diseases Strategies to bridge the gap between developed and developing countries: Economic commitment, choice of technology (for example, technology related to nutrition). Real area of focus: Technologies that donât require behavior changeBIO
As a health and development economist based at the Stanford School of Medicine, Dr. Miller's overarching focus is research and teaching aimed at developing more effective health improvement strategies for developing countries.
His agenda addresses three major interrelated themes: First, what are the major causes of population health improvement around the world and over time? His projects addressing this question are retrospective observational studies that focus both on historical health improvement and the determinants of population health in developing countries today. Second, what are the behavioral underpinnings of the major determinants of population health improvement? Policy relevance and generalizability require knowing not only which factors have contributed most to population health gains, but also why. Third, how can programs and policies use these behavioral insights to improve population health more effectively? The ultimate test of policy relevance is the ability to help formulate new strategies using these insights that are effective.
Academic Appointments
Professor, Health PolicySenior Fellow, Freeman Spogli Institute for International StudiesSenior Fellow, Stanford Institute for Economic Policy Research (SIEPR)Professor (By courtesy), EconomicsMember, Maternal & Child Health Research Institute (MCHRI)Affiliate, Stanford Woods Institute for the EnvironmentAdministrative Appointments
Director, Stanford King Center on Global Development (2019 - 2019)Director, Stanford Center on Global Poverty and Development (2017 - 2019)Director, Stanford Center for International Development (2014 - 2017)Executive Committee, Stanford Population Center (2011 - Present)Faculty Advisory Board Member, Stanford Journal of Public Health (2011 - Present)https://ngmiller.people.stanford.edu/
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Main points
70 to 80% of the world population donât have access to medications. It is not only a problem of cost but it also involves logistics and politics.HIV/AIDS changed the situation with the South African trial. The result was a tri-therapy cost 20 to 30 times lower.The economic model changed for drug companies. I showed what could be done for some diseases including other partners. My first challenge was malaria.Working with an agreement with DNDI (Drugs for Neglected Diseases Initiative) in 2004 with 3 conditions (1) Common development, (2) Cost less than 1euro in the adult and 5o cents in children for a 3-day treatment, and (3) No intellectual property and no patent. Financing came from the Global Fund to fight AIDS, TB, and malaria. Manufacturing took place in Morocco from where the medications were exported. Half a billion treatments were sold. A very large impact on malaria resulted on the global scene. This program was coupled with others on education from UNICEF, and mosquito nets. example. It opened the door to this kind of partnership.Drug alone is not enough. Infrastructure, logistics and human resources also play a role. Compliance is also an obstacle. Local bridges are indispensable. We worked with NGOs.TB and HIV/AIDS are major examples for compliance and observance. It was replicated with African trypanosomiasis (sleeping sickness). It led to the discovery of fexinidazole, the first oral treatment for the disease. It was given for free. 2-prong partnership: (1) DNDI for the clinical trials and registration, and (2) Sanofi for the pharmaceutical aspect (dosage, number of pills, for example). A 10-day oral treatment was the final result. Disease elimination is in sight.Strategic priority is recommended by WHO taken by local or not by local authorities. One example: The president of Chad had never heard of sleeping sickness! Predominant role of awareness.After African nationsâ independence Sleeping sickness exploded. Mobile units of disease detection in the villages and treatment (created by Eugene Jamot) were discontinued. Political obstacles: (1) The place given to international collaboration, (2) Health budgets with priorities matching epidemiological data, and (3) The brain drain.The situation is improving due to new communication means.Chronic diseases are a major challenge: Diabetes, cardio-vascular diseases, psychiatric diseases. Examples: Chronic psychoses and epilepsy. Education is the #1 priority for the latter. My program at Sanofi in this regard was stopped. Development assistance. Multilaterally: Global Fund to fight AIDS, TB, and malaria isa big success for malaria and HIV/AIDS less with TB. So is GAVI for vaccines. Bilaterally: Depends on the country. Ivory coast and France are a success story, for example. France with Myanmar, Mali, and Burkina Faso are failure stories. In some places Russians are taking over but they do not bring healthcare assistance. Chinese only build infrastructure (hospital, roads, etc.). In Asia and South America compare favorably to Africa. Compliance: A new drug in the Borole family will soon be available for the treatment of sleeping sickness and it requires a single oral intake. NGO challenges: Duplication, lack of control, no evaluation, one-shot interventions, and more. Solutions: (1) Make all forms of assistance dependent upon healthcare assistance, and (2) Establish priorities followed by commensurate budget allocations. This is tied to challenges linked to migrations. One example: TB. Governance and intervention in countries in case of health crisis: The Ebola example.BIO
Dr. Robert Sebbag was Vice President, Access to Medicines at Sanofi-Aventis drug Co. In his role, he participated in the companyâs access to medicines strategy development for the southern hemisphere.
Prior to joining Sanofi-Aventis, he worked in Brussels for the European Pharmaceutical Industry Association (EFPIA) on creating a communications platform for the pharmaceutical companies operating in Europe.
In his prior role, he was Senior Vice President of Communications for the vaccine company, Aventis Pasteur (which became Sanofi Pasteur)
In addition to his activities within the pharmaceutical industry, he is also teaching public health courses within the Paris hospital system, focusing on tropical diseases.
He is also active within the French Red Cross and has been involved in numerous health missions in the global South.
Dr. Sebbag is a doctor in medicine with a specialty in tropical diseases and training in psychiatry.
https://www.wipo.int/meetings/en/2009/ip_gc_ge/bios/sebbag.html
