thank you


foreign [Music]

foreign of progress potential and possibilities

discussions with Fascinating People designing a better tomorrow for all of us I’m your host Ira Pastor welcome

everybody again to another episode of our show bringing you another really fascinating guest today helping to

create a better tomorrow for so many people out there a real rock star as we

say here in the U.S of both public and Global Health today we have the honor of being joined by Ambassador Dr Yan Arne

wrote again who is Ambassador for Global Health at the Ministry of Foreign Affairs of Norway as well as a visiting

fellow of practice at pilatic school of government Oxford University Dr Roth

again has served in numerous roles over the years including uh as chief executive of the research Council of

Norway he was the founding Chief Executive Officer of the Coalition for epidemic preparedness Innovations also

known as CEPI executive director of infectious control and environmental health at the Norwegian Institute of

Public Health a founding chief executive of the Norwegian Knowledge Center on Health Services a professor of Health

policy at the Department of Health Management Health economics Institute of Health and security at the University of Oslo and Adjunct professor in the

department of global health and population at the Harvard t.h Chan School of Public Health

last couple years drunk again has also had very important roles in chairing the

executive group and the international steering committee for a who solidarity trial comparing a variety of covid-19

medicines in 2021 he was appointed by the G20 to the high-level independent

panel on financing the Global Commons for pandemic preparedness and response he was also involved in the expert Group

chaired by the G7 presidency preparedness partnership as well as

putting part of the access to uh the covid-19 tools accelerator working group Dr root again has both his medical

degree and PhD from University of Oslo masters from Oxford as well as a masters

in public administration from Harvard a lot of very important topics uh to be getting into today uh Dr yanane rotig

and thank you so much for taking the time out of your schedule to come on the show thank you so much for having me

it’s great having you um you know I would love to start off just uh a little

bit about you and sort of the early days of uh your interest in public health because you know I was sort of going

through your extensive uh uh record in the peer review literature you know in

the very early days you were publishing on everything from uh uh the endocrine disruption potential of environmental

pollutants uh the greenhouse effect on on health uh you probably even published

this really interesting uh book review on Paul Farmer’s book back in 2001 in the Journal of Norwegian Medical

Association take us into the early days what got you started off in in public health if you would

now that’s a good question um I I think I should say that I I I

decided to study medicine because I was really intrigued by by the subjects and

and learning as much as possible um and um early on I started actually doing a

sort of a combined research program alongside my medical studies so so in

addition to what you mentioned I also um actually my PhD is on cellular calcium signaling very very far away from public

health um so I saw those papers too they were exactly and and uh but what at the

same time I I think I’ve I’ve been always very interested in the the larger questions the so

um with with two professors at the University of Oslo and another fellow student be we formed a group uh called

the patient Earth in a way trying to look at the big questions not the clinical questions only

um it was a the professor of social medicine and the professor of international Health um and both of them really inspired us

to to think about the big issues so I think one of the early reports we studied in that group and discussed a

lot was the world development report in 1993 the first report from the World Bank focusing on health

so alongside my more sort of basic science research I I did really yeah

look into public health and and um and worked on those issues in different capacities and then when I finalized my

PhD I had the opportunity to because I had still funding and I had the opportunity to to go to Oxford for a

year as a so-called Norway scholar uh and then I really it was a it was a big decision of mine should I continue on

the sort of by basic science research program which I hadn’t offered to do or or do something else and I decided to

to really train into infectious disease epidemiology Global Health um uh at the the what was called at that

time the welcome trust center for the epidemiology of infectious disease with Roy Anderson and Bob May and others and

actually in the basement of the Black Hills book store uh I found

the the infections and inequality book by Paul Farmer which

um really inspired me and also inspired me because it was sort of a combination of a rigorous academic work of course a

synthesis of his PhD on social anthropology from IIT but at the same

time a very um a book speaking very clearly about the structural inequalities that are

driving infectious diseases so I guess this sort of combining the Infectious

Disease epidemiology with the the understanding that infectious diseases

are very much also driven by social factors and and how we interact in societies that led me to Public Health

work and I more and yeah more or less worked on in public health or public

management positions leadership positions after returning from Oxford

and in parallel to that you know you you also um you know spent a lot of time

publishing on as you mentioned sort of the broader themes and taking public health and looking at the big picture in

terms of global health and you know we hear this phrase all the time you know what happens there affects us here uh

you’ve written a lot about you know um sort of the the need to think greater I mean the un uh Millennium development

goals are one thing we have to think you know even bigger than that and the concept that we have all of these

um International actors out there a lot of good intents but a lot of fragmentation in global Health talk a

little bit about that as well because I think that’s another sort of important theme in your history that go alongside

your public health interests yeah and and a couple of entry points on

that uh one was really uh the issues related to access to medicines and

um but also understanding that to have access you first need to develop the medicines you need you need incentives

for Innovation um I had the opportunity to to be the Norway’s lead negotiator uh from quite

early on on intellectual property right uh Innovation and Public Health in the

processes that the World Health Organization that of course really

exemplifies how you need to integrate understanding across the trade sector

the the intellectual property sector the the of course public health and and

medical and clinical sectors uh um at that stage this was back in 2005

six I started um there was not a very systematic collaboration between World Health and

organization the World Trade Organization and the world intellectually property right organization but later on they have

formed a three-part type so also trying to combine their technical capacities

and efforts when necessary um I I feel in many ways access to

medicines and and that was actually the subject I also taught at Harvard

um was understanding the sort of balances you need in government policies to both incentivize Innovation and

ensure access and in particular for diseases where we have seen too little

um investments in in development or new technologies uh and of course that’s what we traditionally used to call

neglected tropical diseases then later the term poverty related diseases because of course it’s it’s really a

question of for the purchasing power and the ability to pay among those populations

um but um also understanding that epidemics are among that sort of family

of Public Health needs because of course

we there is very little incentives to develop new vaccines new medicines for epidemic

diseases that only hit now and then and with a higher uncertainty so that’s another area where governments will need

to work with private sector in a different way than for the normal sort

of innovation needs in in healthcare and then finally that took me also to the

fields of antibiotic development and as you know we have seen

uh an emerging uh sort of trend negative Trend in emergence of of antimicrobial

resistance around in particular antibiotic resistance at the same time we have seen fewer and fewer of the big

multinational pharmaceutical companies being still focusing on innovating new

antibiotics because of the lack of Market potential because of the uncertainties and uh and

also as we know the new new antibiotics will never be the first line drugs that

may be second or even third and fourth line drugs so they will need to be up on the shelves and only used when necessary

and that leaves very small profit margins and incentives so how can

we think differently on those three areas as well so so in a way that’s one

space that sort of have been witnessed for the last 15 years is is really thinking new when it comes to

Partnerships between public and private sector when it’s both related to Innovation and then to Future Downstream

access or for medical technologists in particular Pharmaceuticals and vaccines

excellent excellent yeah let’s I mean that was a perfect segue into I think we should go into each of those tributaries

because I think they’re a very important uh you know part of this the story and and one place you know as you mentioned

uh the neglected tropical diseases uh aka the diseases of poverty you know you

have written uh a lot about a theme uh called open source drug Discovery drug

development um and you know you’ve written about case studies interestingly from from

your neighborhood uh about a year ago we had um uh Dr mads Thompson on from the

Novo Nordisk Foundation talking a little bit about uh sort of their perspective on this in the sense you know here we

are as Novo we’re a diabetes company we’re working cardio metabolic health

but our assays you know they’re pretty good for screening tuberculosis drugs and our toxicologists can you know look

at malaria and so forth um take us a little into sort of what

you mean uh in general by open source drug Discovery and development and if you could just just briefly I also wrote

this paper let’s even hop around here but you’ve written a lot of really interesting things on the subject uh

specifically a case study on malaria um take us a little into the model if you would as you see what open sourcing

in drug Discovery and development means yeah and uh and in a way that our

Research into that um identified that um we can use parts of this over open

source regime uh but not all of it will fit uh for for

um medicines development and uh and I and I think the starting point is really one

um um Speedy sort of knowledge creation and Innovation

um Can Happen very well and should happen very well in an open science sort of framework so open science means

rapid sharing of of the results and data and um and of course in a culture of the

healthy competition to put it that way among researchers and innovators

um so so I think everyone understands and believe that open science is an

efficient way of knowledge creation and development technology but then uh of

course the other understanding is also that for big Investments uh in

technology development you need incentives for private sector to to make

upfront Investments that will fur Downstream give Revenue so that’s why we

introduced the the patent regime and intellectual property rights and how do you balance those two needs so open

signs for Swift Innovation and and then in a way close science in the sense that

at least those who control the intellectual property have the incentives and

to to invest uh upfront to them secure

Monopoly um sort of pricing uh for at least a limited time period

um what on our original thinking on from one of the experts group I led for the

World Health Organization was that for neglected diseases when there is very little private sector incentives

for Innovation we should try to use open science approaches as much as possible

because a lot of the funding also for what is traditionally done by by companies would need to come from public

sector and then open source in that sense would be useful and important

um and you could sort of also use crowdsourcing techniques uh and uh and

and broadly involvement not I think we saw that actually during the just as a side note during the

covid-19 pandemic not for technology development but in particular for for bioinformatics

work and for trying to understand early on Gene sequence variants and and

evolution of the of the virus there was a lot of efficient sort of collaboration uh and

and crowds insights um through many different

uh biologists and and public health professionals working together online

but back to the the open source I think the that what we saw was that as we have

in the software development open source can work and up to at a certain stage

um when it’s when you really need to to pay for the large Investments

um in uh in clinical trials but also in in uh screening uh targets uh where you need

more sort of infrastructure or Capital Investments there is there is a need for

incentives um so either you you then go for models

for um Partnerships public private or you um

you let’s for instance data exclusivity agreements ensure that there is

willingness to to invest in in clinical trials um

then as you mentioned the Nova Northeast example and and we actually have seen it also

um in in the context of other diseases um many companies have large libraries

um uh with potential targets and um they have been willing for areas

where with little or less commercial value to actually use those libraries

um and in that sense they they partner with non-profits uh or so-called product

development Partnerships to screen uh their in-house libraries for BC’s areas

where they see um little commercial private incentives where they

see that they have insights and and candidates that could potentially work

and currently I’m on the board of guard P the Global Alliance for uh on for

research and development on antibiotics the partnership and

they now have or are collaborating with both companies and other

pdps to really screen candidates for potential antibiotic

activity as a first sort of um test and that that makes it cheaper and

you can in a way have an open source approach until you then need more detailed analysis

yeah I think that that Library uh I’m glad you brought that up and we’ll get into that also in a little bit when we

talk about repurposing but uh you know those themes of yeah these these companies and I come out of one of them

you know we have literally millions of compounds and so you know what we learned they ultimately can do for some of these other conditions let’s let’s

with that let me let’s segue a little bit into so you know you brought up antibiotic uh resistance antimicrobial

resistance this has been an important topic for us and aside from um guard P you were also involved in

this drive a b Consortium we’ve been profiling some of the folks from um The quadrupartite Who uh unfao group

um you know you’ve been involved in you know publishing on on different concepts

of of how you know we can deal better with this I have an interesting paper on uh should we rethink whether antibiotics

should be controlled medicines and things that we can learn from how we control other drugs of abuse uh you’ve

also written about some mechanism called the transferable exclusivity voucher that that didn’t work out very well

um talk a little bit about some of these interesting Innovation spurring models

that you see per antibiotic development and then sort of a second part of that

you know based on your uh cellular molecular work um there’s you know there’s other

classes of stuff out there uh whether we talk about bacteriophage which

um you know has been around before the first antibiotics were discovered and then sort of virulence Factor

interfering drugs that you know don’t kill but interfere with the ability of the bacteria to colonize your general

thoughts on you know whether antibiotics in general you know need sort of some diversity on how we go about even

looking at these mechanisms in 2023 you know maybe first overall on

antimicrobial resistance um I feel that is an area that is really complex uh and and more challenging than

many other areas of of Public Health currently um because we need to balance

and what we in many areas are trying to maximize uh for instance maximizing

access here we cannot maximize access because we really want to make sure that that drugs are only used when necessary

and and we and and of course overuse misuse will will reduce the value but a

future value of anti-antibiotics so um so in in several papers that together

with other good colleagues we have written about needing to balance the Triad of access

um conservation or or stewardship you can call it um and Innovation and that in a way you

need policy solutions that at the same time could could solve all those three sort of

problem areas and building of course on um on a broader

sort of commitment to infection prevention and and sanitary and and water

requirements right uh clean water requirements so

um on on then the and we’ve had a series of articles in Lancet back in 2015 I

believe where we talked about sort of responsible access

which is of course will require access only based on some level of

guidance from Healthcare personnel and that is not easy in in a

developing country setting now as as we know uh you you can buy cheap

antibiotics without any prescription without any guidance from health personnel so so actually

responsible use of antibiotics will require a stronger health system and and

more health personnel not necessarily doctors but at least someone who can help making a diagnosis and help making

sure that they are used efficiently um so so combining the conservation and

the access agenda and then on the Innovation side um as I talked about the the there are a

few incentives commercially so we need new models for incentivizing uh and

maintaining private sector activity in this space some can be done with the so-called push

financing where we can subsidize and support antibiotic development in companies uh

by by providing support to both pre-clinical work as well as early

clinical trials thereby reducing the risks of private companies still

investing in the space and then the other big discussion has been on pool

incentives so how can how can the market um incentivize in a better way and

and there the problem was that if you have a unit based

incentive in the market so the more you sell the more you earn that will drive

against the conservation agenda and and we don’t want companies to be over

incentivized to sell High volumes in particular for new drugs that we want to be used as a third and fourth line as I

said so that means that you we need completely new ways of incentivizing um than the traditional reimbursement

per per cure or per dose and in the drive a b program we we

looked into some of those uh including the so-called Market entry reward that

would be in sort of an advanced Market commitment but actually not paying for

[Music] um for the drugs as such but actually

paying for the registration of new drugs with specific characteristics that has been proven very difficult

politically to sell under and the main reason at least from my point of view is

that it’s a big coordination problem because as we know paying for drugs are

the responsibilities of Health Care Systems um and are very distributed decision

making and and no it’s a it’s a sort of a free rider problem it’s a prisoner’s dilemma you need many to coordinate and

do it together so the U.S of course can do it because

being a substantial large Market in Europe I think we would need to have an agreement at the EU level a common

approach to Market entry reward for instance so then an alternative model that has

been proposed by some is um and that has been used for neglected diseases in the

in the U.S is a transferable exclusivity vouchers

um I my concern is that that is a very

unprecise instrument um it will also transfer costs uh within

the healthcare system without Clarity on on who should who will pick who will be picking up the bill because

um the the model will work with a company with a new antibiotic will get

this transferable sort of voucher they can sell it then on the market to other

companies who have potential sort of Blockbuster drugs in completely other disease areas and they could get one or

two or some additional years of exclusivity which would mean that they will have a higher price for a longer period which would increase healthcare

costs for other areas um let’s say cardiac diseases or cancer

or diabetes so my my thinking is that we should have more

precise instruments and actually rather go for models that they are now testing out in the in in the in Great Britain in

the UK uh in Sweden uh and are also discussing um through the potential legislation of

the pastor act in the U.S with a so-called sort of Netflix model where we

where we don’t pay per per sort of cure

um but actually pay um uh a prescription pricing anyways for

allowing to use an antibiotic um in the health system which would then

be more of a almost a sort of an insurance model as well you can another

way of describing it so uh I believe those models are

probably the best models currently again the challenge is coordination and and

the willingness to agree on this across different systems because we need in some to incent device industry

sufficiently well so let’s let’s move to

um let’s move to CEPI now because you you know your founding CEO

um you know a couple years prior you’re involved in uh Ebola uh vaccine trials

you start publishing you know along with Dr kadal and in 2015 on hey the the need

to speed up uh emergency response for unexpected things and then you know obviously ad set B uh you’re focused on

a lot of the really nasty stuff in terms ebola’s here MERS last anipa a list of other things

and then in the list there is you know what is known as diseasex uh where you need to Define uh serious International

epidemic that could be caused by a pathogen currently unknown to human disease um I don’t know if you could say a few

words about sort of you know your perspective on um disease X strategies you know we’ve

been talking a lot about one Health on the show different perspectives out there on whether you know we should be

trying to catalog you know the next couple hundred thousand unknown things that are out there in nature whether we

should just be looking at the hot spots instead um take us a little into sort of what

you think about when you think about disease X nowadays her organizations like seppi but also

your experience like in the field doing you know Ebola vaccine trials yeah yeah

maybe go back to the Ebola outbreak in West Africa um and what happened then was

um of course we had an unprecedented outbreak that was really reacted on far

too late so I got involved in um in August September I think in 2014

and in hindsight we saw that that the outbreak then had already been going on nine months um and really building up so

it was really unprecedented in scale um and um we were then involved in planning

vaccine trials in the three countries um Norway partnered with the World

Health Organization msf uh Doctors Without Borders borders and the the authorities in Guinea

uh partly because um they were already large trials

planned for Liberia and Sierra Leone and we decided to use a so-called ring vaccination trial

approach which was Innovative it had never been used as a clinical trial methodology

um and the idea was to build on how the world eradicated smallpox uh when in the

last sort of period you identify when new cases aroused you

vaccinated contacts and contacts of contacts around that individual and so more or less as a fire gate strategy and

and therefore induced a very strong and fast immunity because the smallpox

vaccine had that characteristic so what we did was to use that experience but

set it up as a clinical trial instead uh cluster randomizing

groups of contacts and giving them either vaccine immediately or after three weeks delay we demonstrated that

Ebola vaccine was very very effective and I will not spend more time on that

but that really led us to see that okay if we had been prepared we could have

started that trial immediately when the outbreak happened and not

I I think actually it took us six no actually let me see it took us nine

months actually from August 2014 to to Really implementate the implementing the

trial which was at the last phase of the epidemic in Guinea if you had been able

to start immediately I don’t phase one and phase two trials uh we could have saved many many lives and we would have

reduced all the the non-health consequences economic and livelihoods so

that was really the business idea and uh and the business model for CEPI saying that we need to be prepared so seppi

then had had two strategies one was to be prepared for the highest risk or or the pathogens where we

already believed there was the highest risk for new outbreaks then we worked with the World Health Organization in

CEPI and used their priority list of pathogens but then you know this

addition you need to be prepared for the new the new virus the new disease the disease X as you say

and the challenge then is then you cannot be you don’t have a product because but you

you can because of course you don’t know what kind of pathogen this is and and what are the sequence what is the

characteristics what are the antigenic um the the best antigenic parts of the

virus so how could you prepare for that and then there have been different sort of ideas and Concepts some really going out

there and and trying to to sequence very broad number of viruses that are in the

environment another is to try to identify the most likely ones of families and then prepare

products for each of those and then adapt those products um when uh when disease X hits

um and then it’s it’s uh really also just to make sure that we develop very

flexible um platform uh vaccine platforms new

technologies and of course what was then interesting with

um for the covid-19 pandemic was that CEPI had already started investing in mRNA platforms but to a minor level

indeed for a disease X scenario um in many ways the scale of the

pandemic over took the The Innovation on the events uh the

operation of warp speed in the U.S really incentivized uh false development

and and we know the history of uh and how the MRNA technology really has

demonstrated high value but I think it also demonstrates that we indeed now have a vaccine technology

platform that can be adapted to new pathogens but it but we cannot only rely on mRNA technology I think we need other

other technology platforms because we yeah this is biology it’s uncertain and

we need uh more platforms so a combination of the second and in a way the third strategy so trying to develop

products for broad vaccine oh sorry pathogen families virus families as well

as continuing developing uh flexible platforms

and you know that that feeds nicely into you know what what you were touching on before in terms of uh sort of the

library screening you know you um per the per the the theme of repurposing

you were involved in the um the solidarity trial uh per The Who and

looking at repurposing uh some of these uh these anti-viral drugs

um you know not great results but nonetheless you know you got some

experience in sort of this little basket uh focusing on covid-19 and obviously

um you know we don’t have a tremendous armamentary just an antiviral development at all

um your thoughts on on just repurposing in general uh specifically when we think

about uh antivirals your experience per uh this particular clinical development

and other thoughts around you know where we should be going in sort of the broader repurposing uh per pandemic

preparedness Beyond vaccines I’ll uh having some yeah better antiviral sitting around

yeah and then and one I think you are right we we are I think we are much more advanced when we when it comes to

vaccines when we now think about structuring our Collective Innovation capabilities and and actually being

prepared and the so-called hundred day mission is now a real Mission uh for sepe but

also for partners uh and that we should be able to to develop new vaccines uh

100 day after having identified a new disease X um I think for antivirals we

um there are more challenges and and they are both sort of biological and medical

but also organizational on the on the biology side

um uh of course the specific antibi antibodies molecular antibody approach

could be sort of set up and and worked out in the same way as vaccine

development um and and we definitely saw that there were some very for covid-19 specific

monoclonal antibodies that have been working well and and would be important

for in particular high-risk individuals and those who would have harder to mount

their own um uh immune response when vaccinated uh and we would also need I think new

regulatory Frameworks for actually approving such um uh such uh Therapeutics given that

the virus evolved and and as we have seen now in this this time around we we

had effective um antibodies for the early strains and then they were not effective anymore

when you saw the Omicron uh strain and variants coming in

but then in addition uh more and yeah I should say we also saw that it may be

the most effective uh Therapeutics that is predicted for hospital patients have not been really

antivirals but they’ve been immune modulators so and and of course immune modulators have more generic capacities

and could potentially work for any viral disease but but just need to learn more how we should use them and and those I

think we should have a very clear strategy on how to test immunomodular raid drugs

um uh in in new outbreaks and epidemics but then back to the chemical antivirals

um what I think I’ve learned from the being involved in this sort of directed

trial and also working alongside uh remap cap and Recovery the large

multi-country trials one I think we need such large trials to really get solid

evidence and get that evidence out quickly um but we also need better screening

techniques before entering drugs into clinical trials but I think what we saw

this time around was that there was a lot of hype has been hope for for drugs that could work

in that sense it was good to have large trial that could actually document that

a drug does not work because if it’s used very much um in in out in the daily practice in

clinical work it’s important also to avoid that patients are are been giving non-executive drugs

but but I believe what we should have invested more on early on was

um screening drugs in animal models because we saw a lot of antiviral

activity in cellular cultures and in screening techniques but that was really

not transferred to a clinical impact and I think more solid work on animal models

that could screen and then enter drugs into repurposing trials uh would have been a

better strategy um that could probably have increased the likelihood of uh almost of drug hits I

think in in the larger clinical trials of course the other big problem was that we we started far too many small

clinical trials that never gave any conclusive answers uh given the size of of the trials needed

generally you you mentioned um before um operation warp speed

um and you know we just had on the The two scientists of FDA a couple days ago

talking a little bit about everything that’s going on sort of in the regulatory environment in her shop her

emergency authorization Dynamics and how that’s sort of changed a little bit about the culture of things that FDA the

last couple years um you wrote this very interesting paper uh entitled accelerating clinical trial

implementation in the context of covid-19 pandemic and specifically looking at lessons per Discovery in the

EU solid act um Response Group say a few words about this a little bit about sort of what you

learn per sort of adaptive trials and then you know you were

looking sort of at Europe in general and obviously many countries a lot of diversity

a little bit of the learnings there on how sort of Europe you mentioned sort of the United Europe of research ultimately

for these situations in the future take us a little into sort of your vision here per

innovating clinical design yeah so maybe start first start so if we

could get sort of pre-clinical screening uh of um of drugs

um uh that because that that would need to be the starting point because we we really want to

introduce drugs in clinical trials with the highest likelihood of the potential

of uh of being able to work um then it’s really about what is the

clinical trial strategy um and I think we should be honest to say that the

country that did this the best way um was the UK uh and and that was

through a very National and strategic approach to clinical testing

um I’m not seeing this sort of overall numbers but I think at some stage they in hospital patients they were able to

recruit more than 10 or maybe up to 15 of all admitted covid-19 patients in in

British hospitals they were created into the recovery trial and of course

when we don’t know what works um I think it’s really important to systematize what we can learn from

from uh treating patients uh and and the most the ethically best way of managing

those patients and and giving them the the best treatment we can offer is actually to offer them entry into robust

clinical trials that can generate results um that will they will then be able to

be tested with new treatments uh and and then the the next generation of patients

will be able to to get the treatments that that are documented do work

and the challenge then is how do you orchestrate them or and and do that across countries because we need scale

uh that’s why we we called for a more coordinated approach in Europe across

countries that emerging coordination mechanism is

is being is there now uh we we have a trial coordination board for

um Health emergencies and epidemics in Europe now um we have a prioritization mechanism I

think the challenge though is still to link linked those mechanisms and

collaborations to funding and making sure that we can enter into multi-country trials as

quickly as possible when a new outbreak or epidemic it’s um as we know there were a lot of sort

of ad hoc testing without doing any clinical research really early on uh

when when the the big number of patients came into European hospitals in February March April 2020

um but the problem as I said there were most patients not entered into clinical trials and and some

patients entered into very small hospital-based trials that didn’t generate the necessary results so uh

really big multinational trials is the way to go and I think we need collaboration within Europe but also of

course across the Atlantic and also making sure that patients in low and

middle income countries can benefit from being part of clinical trials

standing so we’ve been talking a lot about

um biology uh let’s hop over to Silicon for for a moment because uh another sort

of uh component of your portfolio um which you started publishing on you

know a couple decades ago is digital Health um during time at the Norwegian

Knowledge Center you know you you talked about uh the the Norwegian electronic health library at the time and sort of

wiring uh the country for health information uh you’ve written about sort of the importance of of Health

technology assessments and evaluating these Technologies and now fast forward here we are sitting

in 2023 and there’s all sorts of other permutations of this stuff out there from chat GP whatever we’re on now to

the world of Twitter to whatever classifies or accounts as digital Health uh in a 2023 World

um talk just a little bit about sort of the digital side here what excites you what concerns you

um any other important uh tools per sort of the digital Health realm that you

wanna you’re interested in per Republic and Global health yeah no thank you um and in a way I think the alternative

to to sort of the big pragmatic trials that I just talked about is really to

use the patient administrative data in a much more robust way and use population

help data um and I think we have seen

a lot of important results [Music] not at least from the United States

where you you have now to a larger extent than previously been able to aggregate

electronic patient record data and and demonstrate yeah efficacy of paxilvid

for instance and and now more recently also the mcox vaccine based on

observational they’ve done and not trials I am though a bit concerned about biases in

observational data so we need to better understand those biases and better yeah

really look into them and one way of of sort of making sure that we have less bias is to really have full population

data sets and as you may know the Nordic countries have uh so-called personal identifiers

for every inhabitants but that means that we we can follow

individual patients um in and out of hospitals based on our

registry data and we can have long-term follow-up data on on both side effects as well of

course long-term clinical effects beneficial effects on both yeah any technology

um I think we’re so ex um so how those data sets could be used in this pandemic

um uh the the side effects related to the uh AstraZeneca vaccine uh were

strongly documented through um combining the the full population

data sets um on on those vaccinated in Denmark and

Norway um and we could quite robustly demonstrate the the increase still as

still very low risk but still an increased risk for the for the for the

for the disease as it’s called with the Hemorrhoid Bridge Hemorrhage uh in the

in in the brain um the um and I I guess

fully ex exploiting sort of digital Health Data um could it be another approach than

clinical trials to really make sure that we have a learning health system and that can

um can really help clinicians making informed decisions together with their patients another

example I know in Sweden they they have for some years now used observational

data for um for

improving uh adherence to to new by to to the different regimens

for new biologics in Real Madrid arthritis really based on

um data from their quality Registries including all patients in Sweden on on

on those medications with the with those diseases

um so so really trying to benefit much more of the data we are generating in healthcare and then I think as you

started to think about this is of course the use of AI and and

um sort of non-hypothesis driven uh results generation I think we we haven’t

really understood that yet I think there are many of course concerns related to Black Box uh sort of approaches of AI at

the same time I think it can be really powerful generating new insights but my

belief is that if if it should be seen as generalized the knowledge we would need to then test those hypotheses that

AI sort of identify as likely uh in more robust research designs

excellent outstanding

um I I noticed that you know you’ve been quite um active or maybe virtually uh in

recent months in in in in public facing initiatives you’ve done a couple uh recent conferences uh one at Oxford on

co-shaping global Health uh uh involved in uh a panel for the center for Global

development on on health aid and financing Health Services what what else is happening uh as far as your concerned

for 2023 conferences that you’re going to be presenting at other initiatives that you may want to highlight places

that we can further listen to you potentially meet you um anything else hot for 2023 please

no thank you um so so that two sort of larger efforts I’m really interested in

currently uh that will come up in in both sort of academic conferences but

also more broader conferences uh in in this year one is really how we can learn

uh from the access to covid-19 tours accelerator on how to ensure a book

development of an access to measures in the future um uh how should we structure that how

should we collaborate um and I organized a meeting um to get a bit my South African

counterpart Olive chisana in Johannesburg a month ago and and there will be follow-up discussions on this uh

in the context of both G7 and G20 as well as the World Health assembly that will come up in in mid or late May then

the other work I’m really interested in on is is trying to sort of use the The

Learning Experience I think the pandemic should be for all of us on how we can ensure

um more resilient Health Systems and and better Primary Health Care capacities

because in the end it doesn’t help us to have Technologies if we cannot make sure that they are

delivered and used in healthcare settings all around the world

um and there we have started a process that we call the

future of the global Health initiatives and that’s really to to see how it can get become more effective when it comes

to health financing globally and how can we think uh better on combining

the domestic Health financing the planning and and of course purpose is that governments

intend to use the resources for with the additional resources generated to

development aid for health um we we hope there would be uh

important opportunities to discuss this moving forward uh again World Health assembly there will be side events and

meetings on this uh on the margin of the health assembly and then I believe the the in the un uh

higher level week in September there will be three important meetings by Where Heads of

states will participate on health one is on pandemic preparedness and response so

very much related to of course the learning from the pandemic and to access to countermeasures as well and then one

on universal health coverage which will definitely take up the responsibilities of countries to deliver on a sustainable

development goal three but at the same time the need for better coordination of supporting the the low-income countries

and then finally a high level meeting on TB the tuberculosis which in a way

reminds us that um still the the disease with the

the highest mortality infectious disease with the highest mortality currently we now see we saw

um that we were really not aiming not able to to treat the patients needed

during the pandemic we see now hope fortunately that we now are at the

better stage again being able to treat more patients but still as I said it’s

the Infectious Disease with the highest mortality when it comes to number of deaths each year and also demonstrating

the need for new innovation we need we need new vaccines for TB and and we need better treatment regimes

yeah tuberculosis is always one of those that it startles me to think that our vaccine is is older than penicillin so I

you know yeah yeah you bring this full circle it’s very sobering but uh yeah I

mean the fact that you come back to Global Health Science diplomacy

um and again the fact that we are all connected and need to every we all need to work together to make this uh

resilient for all of us it’s just an important message and uh again I I it’s

been an amazing journey you’ve been on uh and everything you’ve been doing and just I’m rooting you on uh continue to

follow you and and on all these initiatives and wishing you the best for them again for everybody who’s going to

be listening to this particular episode of our show uh across uh the various

podcast networks or again watching on our YouTube channel uh you’ve been listening to the Ambassador Dr Yan our

neighborhood again Ambassador for Global Health Ministry of Foreign Affairs of Norway visiting professor of practice

politics School of government at Oxford University I want to thank you again for taking the

time out of your schedule come talk to us and educate us on this broad range of topics obviously thank you for doing

what you do and as we like to say here on our show thanks for helping to create a better tomorrow for so many people out

there via what you do it’s really an amazing story and again I wish you the best as you continue to execute on it

thanks so much for having me on the show era

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