On November 8, you can attend an exclusive edition of “The 5th Table on Health Tech” in Antwerp. The topic: “Contributing to Global Health: from most advanced technology to applications in the field.
How can we better address major global health challenges? How can we provide faster help in regions where expensive and complex innovations are less accessible? And what have we learned from the COVID-19 pandemic and other crises?
With the current pandemic, it has become clear once again that global cooperation is of the utmost importance. At the same time, it needs to focus on the specific context in different countries. And this cannot be done without collaboration between all stakeholders, globally and locally, whereby digital transformation, networks, digital infrastructure, and big data play an essential role.
Paul Stoffels, Marc-Alain Widdowson, and Elies Van Belle are familiar with the challenges from their diverse backgrounds. At the event, they will share the lessons they learned and engage in debate. In a series of interviews, we give you a sneak preview.
We start with Paul Stoffels, Vice Chairman of the Executive Committee and Chief Scientific Officer at Johnson & Johnson, retiring at the end of this year. Paul, a recognized global leader in the world of public health, will give a presentation before the panel discussion in which he talks about his approach to the major global health challenges – and what we can do better.
Making a maximum difference for as many people as possible
Paul, you have dedicated your career to curing and even eliminating various diseases, which started early on with the emergence of HIV. How did that happen?
Paul Stoffels: As a physician, I have always tried to make a maximum difference for as many people as possible in the world. That started during my studies in Hasselt and at the Institute of Tropical Medicine Antwerp.
As part of my doctorate and internships, I went to Africa every vacation for four years to assist and gain experience. That was in the late 1980s, in the middle of the HIV pandemic. This catastrophe and the mass mortality it caused encouraged me to move from practicing physician to scientific research to control that virus.
As a physician and a scientist, it is gratifying to see the healthcare landscape transformed as we unlock the best science and technology to deliver innovative medicines to solve the world’s toughest health challenges (Paul Stoffels)
I then got in touch with Dr. Paul Janssen, who researched HIV and started working for him.
After several drugs had failed, we learned that resistance to HIV inhibitors was a fundamental problem. I studied that with Rudi Pauwels of Biocartis. We then founded two biotechnology companies, Tibotec and Virco, and were able to make three drugs that are used by doctors today and make a huge difference. Hundreds of thousands of people have been taking our AIDS inhibitors for fifteen years now.
In addition, those drugs for multidrug-resistant HIV proved to be very appropriate in the early stages of the disease because they not only treated the resistance but could also prevent it. And so, we were able to increase life expectancy in HIV from an average of three months to fifteen years today. The longest-lived patient I am counseling became ill in the 1990s and has survived for 31 years.
Then I started looking at how we can prevent HIV through vaccines. The search for a vaccine and our study of HIV led to the knowledge and resources we have to very quickly develop vaccines against other diseases, with our COVID-19 vaccine being the most recent.
The fact that we managed to create a vaccine against the coronavirus in twelve months – from the genetic code to an emergency use authorization by the FDA – is the result of the capabilities we built up over a period of thirty years.
Between the first outbreak of HIV and today, in 1996, we developed a vaccine against Ebola with which we have already vaccinated hundreds of thousands of people in Africa. We developed the vaccine against Zika in six months. And then, I made a drug with our team to treat tuberculosis, the first new drug in 50 years. The latter was an accidental discovery and is now a drug used worldwide in all resistant TB combinations with which we have now treated four hundred thousand people.
In total, my team and I now have seven drugs on the World Health Organization’s ‘essential drug list,’ with some also in the field of cancer and metabolic diseases.
And all by focusing on using science to maximize the impact on medicine. “Years of life saved, years of quality of life”: this is what we do and also the goal with which I motivate the teams.
From research and innovation to global accessibility: the role of partnerships
Johnson & Johnson is a company in a sector where much money is put into R&D, there are typically several years between innovation and bringing it to market, and the window of commercialization is also limited. How can you combine that with fighting significant health challenges, especially in poorer countries?
Paul Stoffels: At Janssen, we put eight to nine billion dollars into research each year, a huge amount.
We always try to target areas where there is still a very high medical need and see how we can use the right science to find a solution. Our research budget goes to research on cancer, neuroscience, metabolic diseases and infectious diseases.
Of course, this raises the question of how you can build a solid business in the Western world and still achieve the goal of “years of life saved, years of quality of life” on a global scale.
We are not only one of the largest pharmaceutical companies in the world. We also have a public health division that translates our knowledge into what we can achieve by leveraging it in low-income countries, the Gavi countries (Gavi is an international alliance for vaccinations in more than seventy countries).
Wherever we have the technology or medicines that can make a real difference in the rest of the world, we make sure that we can make them available in those countries through partnerships.
In doing so, we also work with WHO, the Gates Foundation and the Welcome Trust to help as many people as possible with generic products in very inexpensive ways.
The goal should be to package scientific advances into very simple solutions that you can easily implement on a global scale (Paul Stoffels)
There has been a fair amount of attention recently for the forty years that have passed since the first cases of AIDS were reported. You talked about how this helped build expertise for developing vaccines faster, including against COVID-19. What’s the role of partnerships in that acquired expertise?
Paul Stoffels: We have learned how to achieve an excellent collaboration between academics, institutes, governments, and industry during pandemics and virus outbreaks.
The COVID vaccine was ultimately a collaboration between us as an industry, the institutes, and the regulators in the different countries. To be able to develop a vaccine at twelve months, both we and those governments worked non-stop. And the same goes for the academics and the institutes that are driving the clinical trials.
If you coordinate well with those different teams you work with, you can work much faster and win. And exactly that has happened. We learned to work together, to respect each other, to be able to capture the complementary sides of industry, governments, and academics, and to define who exactly is doing what.
This has been an incredible project, by the way. For the clinical trial, forty-five thousand people were recruited in two months, with a peak in recruitment of about three thousand people a day. We finished everything on September 15 and December 15 to get forty-five thousand people in three continents and two hundred clinical centers into the labs, give them their vaccines, and then evaluate everything. That’s spectacular. But that didn’t happen overnight, and most of it came from the HIV networks that existed in the world (clinical research networks).
You recently stressed the importance of maintaining and further strengthening these public-private partnerships. To what extent do geopolitical factors play a role in this?
Paul Stoffels: There have been some parallel evolutions in the different phases of the development of these networks. We had HIV and then Ebola, but there were also the events of 9/11.
With the latter events, there was a strong focus on the risks of possible biological terror attacks. People then started looking at the viruses that could be used for that and destroy the world.
I have been on various global committees for over ten years now. There was always a discussion about what the next virus would be to prepare for the next pandemic. In addition to that, there was the question of the viruses that could create outbreaks that could eliminate the world’s population. And because of that combination, for a long time, the US government continued to provide tremendous support for that global network of clinical research built with HIV.
The HVTN network (HIV Vaccine Trials Network) has since changed its name to the Corona network, but that clinical infrastructure actually came from the Hiv clinical testing infrastructure.
I think everyone has now realized that it is an essential infrastructure to maintain and strengthen to identify new variants quickly where global collaboration around that data is vital.
The exchange of data around the variants is still an issue here where people are skirting around the IP (intellectual property), among other things. But it is public health that must prevail. There are now laws and agreements between China, Europe, and America regarding the exchange of data – biological samples and so on – but it is not simple. There needs to be very good global coordination and maintenance of the infrastructure.
Let science play its part
You mention 9/11. The world has changed since then. Do you not fear that specific structures might disappear or become weaker, or will academics and others, such as industry, continue to do this despite changing circumstances regardless of the geopolitical context?
Paul Stoffels: I think academia realizes that it is important to work together, including with industry. We are just the same scientifically minded people. We are within the infrastructure of where we work, but when you let people operate together on a common challenge, you see what can happen, and with COVID, that is what has occurred effectively.
I have been very close to the whole evolution of the different variants. If we want to get rid of Corona, then we MUST work together worldwide because other variants will likely appear. We are now in a situation where we should be able to prevent lock-downs through the combination of scientific research and vaccination to set up the right boosting strategies and vaccinate people on an annual basis.
I think in doing that, it’s the connections between scientists around the world that can make sure that science is the preliminary driver of how the fight against Corona will happen and politics do not take it over. It did partially get taken over by politics, and that’s why things are so bad in some parts of the world.
My message is: Let the scientists drive what needs to be done. We know through research what direction the virus could go. Let us make ten additional vaccines to make sure we are ready for that boosting strategy.
People also often forget the role that industry plays. Take Ebola. Today we hardly talk about it anymore but we have in the meantime vaccinated two hundred thousand people, are conducting a study on pregnant women and are making versions of the vaccine to deal with other variants. No one talks about that but if we and Merck stopped those efforts, there would be no Ebola vaccine tomorrow.
Such pandemic viruses are not business for us. We do this ‘not for profit’ to make it accessible worldwide.
We are moving towards a massive health crisis. Multi-resistant bacteria, pandemic viruses, dementia, heart failure, mental health are all huge problems. Add to that urbanization, refugees, and the economic crisis. It’s essential to prepare for that.
Packaging progress into simple and inexpensive solutions
The event will address the major public health challenges, access to new medicines and health care, and technologies. What major challenges do you see regarding accessibility and, linked to that, the impact of technological innovation?
Paul Stoffels: The first scientific solutions formed with new knowledge are usually not simple and difficult to implement in various countries.
When I started with HIV, we had to give people eighteen pills twice a day. You can’t do that in a city like Kinshasa. And so science has to evolve to straightforward solutions where one pill a day is enough, and that’s how HIV has become treated.
In short, the goal should be to package scientific advances into very simple solutions, like a pill or vaccine, that you can easily implement on a global scale and where it typically takes ten to twenty years after invention to get to that point.
It is clear that there are still a lot of diseases where we are not that far yet. For example, the treatment of diabetes today is still very complex and needs to be further translated into simplicity.
It has to be top science wrapped up in a simple and inexpensive solution that can get to the patient where there are only five dollars a year per person in healthcare available. And from the discovery of something to that realization is often a long period, and you need to persist.
On the one hand, you have to keep doing new science and making progress, but on the other hand, you have to make that simplification.
The essential role of digital infrastructure
There is also digital technology. The role of data is obvious and digital infrastructure is essential. What are your experiences?
Paul Stoffels: That’s right, and again we have to look at what is relevant in a given context.
In Rwanda, we have vaccinated against Ebola on a large scale. Rwanda has a digital healthcare record with an identity card. Based on that, for that vaccination campaign – that requires two vaccines – we created a tool with iris scanning because you don’t want to touch the patient and a fingerprint can transmit the virus.
This was linked to a central database and to people’s phones to send them messages to call them for their first and second vaccines. Moreover, by linking that to a medical record, we can pick up the side effects of that vaccine over the long term.
So the digital infrastructure that is built up in many of these countries helps us to implement, connect with the patient, and follow up the medical data.
Another example. In South Africa, we did part of our global COVID-19 study. The Beta variant reared its head at one point there, and we were asked to vaccinate all health workers. Again, electronic health records played a crucial role. The national health care record in South Africa was the source of data collection to see the output of the real-world evidence regarding the Beta variant. We could then do sequencing of samples from sick and deceased patients and work on vaccination based on that. In this way, we were able to vaccinate five hundred thousand people in two months and follow them up at the same time, thanks to the digital infrastructure that was in place.
To what extent does that remain a challenge? In interviews for earlier editions of The Fifth Conference, the compatibility of electronic data even within countries still proved difficult with different platforms.
Paul Stoffels: It remains an essential fact. Today, we can email and phone each other globally, send text messages and use WhatsApp because the various protocols are aligned.
If you can optimize the healthcare data infrastructure, provide structure and have protocols that meet specific minimum requirements, that is a huge advantage.
You can see that in Belgium with Covid and the Covid Safe Pass, linked to vaccination data, diagnostic data, and so on. Digital infrastructure has a very beneficial impact if everything is worked out properly. In addition, you have a cost advantage, for example, in avoiding duplicate research. How many times in the past have we gone to a hospital to do the same examination again because they couldn’t find the documents from the previous one?
By the way, I should note that low- and middle-income countries have an advantage in terms of digital health infrastructure because they are not struggling with the “legacy” of an old infrastructure as in many Western countries.
With Paul at the helm, Janssen rejuvenated its pipeline, launching multiple new medicines, making a difference for people all over the world. Under Paul’s leadership, the Janssen R&D teams developed more than 25 new medicines across multiple therapeutic areas. Seven of these medicines have been added to the Essential Medicines List of the World Health Organization, a recognition for the huge impact these medicines are making for patients worldwide. (Joaquin Duato, Vice Chairman of the Executive Committee and the next CEO of Johnson & Johnson as of January 3, 2022, at the occasion of the retirement announcement of Paul Stoffels)
There’s also typically high mobile penetration which also provides benefits for mHealth in many of those countries?
Paul Stoffels: Absolutely. We did a project in South Africa like that to protect babies from HIV through breast milk infection. That was essentially a digital network that mothers could dial into to see what they could do to prevent that and guide them through the pregnancy. Half of the pregnant women in the country now use that platform which the government has since acquired.
That digital component, mobile platforms included, has become essential. But again: it has to be structured and organized to pick up the most important things. Then it can facilitate clinical research, vaccine implementation, and preparedness for new pandemics.
I know Bruno Holthof from Oxford very well, and they work with electronic medical records in a pretty advanced way. I’ve worked a lot with Bruno around the possibilities of simplifying clinical trials and bringing down the cost of generating information.
They use electronic medical records as a patient population for big questions about what produces a better outcome. In no time at all, they managed to find out that dexamethasone was life-saving. It is perhaps the best example of how you can quickly valorize your healthcare system to learn what to do.
They also do follow-ups over the long term. Today, we are able today to detect cancer at an early stage. We are now working on ways to detect twenty to thirty cancers with one blood sample through deep sequencing so that people no longer have to do various tests for each type of cancer. But to prove that this works effectively, you have to use your health record system to follow up the population. This is just another example of what is possible.
The possibilities are there. The scientific will is there. Now we need to persevere and maintain and strengthen the necessary collaborations. Paul Stoffels, thank you for your time, and see you at the event!
Interviews conducted at the occasion of previous 5Th Conference events on healthcare:
- Wouter De Ploey (CEO of hospital network ZNA): transformation in the hospital sector
- Frank Dendas (Philips): new healthcare models have become a necessity
- Valerie Storms: mHealth – from research to real-life applications
- Telemedicine expert Leonard Witkamp on truly transforming the health system
- Smart health investment: health economics and policy with Prof. dr. Dominique Vandijck