LSIPR 50 2018: At the head of an experiment in innovation

Marie-Paule Kieny’s accomplishments in the life sciences sector are impressive to say the least.

During her time as assistant director general, health systems and innovation at the World Health Organization (WHO), her most notable achievements included bringing coherence to WHO’s work on health systems to support member states progressing towards Universal Health Coverage and successfully leading the work of WHO on research and development (R&D) against Ebola from 2014 to 2016.

Her other triumphs at WHO include the development and licensing of new vaccines against bacterial meningitis, as well as addressing the global supply of pandemic influenza vaccine through technology transfer and manufacturing, with a focus on developing countries.

She is now a board chair at the Drugs for Neglected Diseases Initiative (DNDi) where her previous experience in understanding challenges—such as technical, managerial, political and financial obstacles—has helped her learn how to successfully adopt innovative technologies and interventions in fighting diseases.

In future Kieny—who received her PhD in microbiology from the University of Montpellier in 1980, and is the recipient of two highly-esteemed French awards—will enforce the key role innovation plays in controlling and eventually eliminating neglected infectious diseases at DNDi.

“Improved diagnostics are of course needed for better detection in resource-constrained settings, and new, safe and effective drugs are urgently needed,” she says.

She highlights that this demand is even more important as current treatment approaches are often not effective enough, especially where resistance grows. Another problem when it comes to current treatment approaches is that often they are not adapted to “dysfunctional health systems” and “poor environments”, says Kieny.

Not silver bullets

Neglected tropical diseases are diseases of poverty, she explains, and sufferers are already at a disadvantage when it comes to treating them. That’s where innovation comes in. “We cannot wait for these countries to become richer to treat patients,” she says.

“New technologies have the potential not only of being more effective and less toxic, but also to alleviate some of the stubborn delivery issues facing developing countries.”

This doesn’t come without a caveat. Technologies, she acknowledges, are “not silver bullets”. “For them to be useful, a lot of work is needed on building the conditions for adoption and scale-up.”

This is just one of the obstacles facing Kieny’s work in driving DNDi forward into the future. Other challenges she has to overcome include, but are not limited to: bad governance and corruption; inefficient health systems (not allowing for the implementation of technical solutions); prominence of other priorities at country level; and lack of a profitable market for industry.

DNDi is hoping to create a global R&D framework designed to deliver innovation and equitable patient access to health technologies as part of its current business plan.

Kieny describes DNDi as an “experiment in innovation”, in terms of what it does in developing urgently needed treatments for neglected populations, and how it does it. The ‘how’ is achieved by testing an alternative not-for-profit R&D model based on patient needs instead of profit maximisation, aimed at ensuring innovation and access.

“DNDi has piloted a number of innovative approaches to R&D—including open-source methods of research, some of which rely on multi-partner approaches that allow simultaneous mining of pharmaceutical compound libraries—and is utilising new regulatory pathways that aim to strengthen capacity in disease endemic countries as well as ensure rapid uptake and implementation of new products.”

Difficult waters

With more than three decades of experience under her belt, what is next for Kieny?

Initially, she says, she must navigate DNDi through difficult waters in the wake of the global financial crisis and the West African Ebola epidemic, and of increasing inward-looking nationalism—all of which bring the risk that DNDi’s partners and funders will focus priorities on other areas and not neglected people and diseases.

“As DNDi, we must be their conscience, reminding them that health is a human right and that it is a moral imperative to pursue the fight against neglected diseases,” says Kieny.

The goal is to control and eliminate these diseases wherever possible. DNDi will pursue technical work, which “amply demonstrates that innovative solutions can be found, developed and delivered”.

“We will also showcase that new drugs can be developed for a fraction of the costs often put forward by the pharmaceutical industry, and that new models for innovation should be openly and transparently discussed among all stakeholders,” she claims.