On Neglected Tropical Diseases and Antimicrobial Research - A Conversation with Emilie Alirol

Claire Murigande00:00:07

Hi everyone and welcome to Narratives of Purpose Podcast, a place where we discuss how ordinary people are making extraordinary social impact. My name is Claire Morigande and I am your host on this show. On today's episode, my guest is Emily Alehole.Emily is Associate Director at the Medicines for Malaria Venture based out in Geneva. Today we will speak about clinical science, antimicrobial research and neglected tropical diseases.As you can see, it's a healthcare related conversation and I'm very excited to share this discussion with you.

Claire Murigande00:00:50

Hi Amelie. Welcome to the podcast. Thank you. Thank you so much for taking the time to have this conversation with me today. It's great to have you on the show.So first things first, how are you doing today?

Emilie Alirol00:01:03

I'm doing very well, thank you. The sun is up in the sky, it's a very nice day. So everything is all right.

Claire Murigande00:01:12

Great. Perfect. Now, let me start with a few words of introduction on your background. So you are a biologist. You studied at the University of Geneva.You hold a PhD in cell biology. You also have a Master of Science in Epidemiology from the London School of Hygiene and Tropical Medicine.You started your career after a PhD in clinical research at the University Hospital of Geneva. And you also worked at Doctors Without Border or Medecin Sans Frontiere in French.Then you joined the gardp, which stands for Global Antibiotics R and D Partnership, as Project leader.You worked there for a few years until very recently, just a couple of months, that you have a new position as Associate Director at the Medicines for Malaria Venture. So we obviously know each other from our studies because I'm also a biologist and I recall visiting you for a few days.I think it was in the summer of 2004 in the northern Italy, in Padova, where you were doing your PhD.And I have to say I was really amazed and impressed by all the activities that you were doing and the hard work and dedication that you are putting in your studies. I wanted to know what brought you to focus on HIV research, neglected tropical diseases from the very beginning of your career.

Emilie Alirol00:02:48

So I guess the answer is to be found in my childhood. I had somehow a different childhood.Although, you know, today maybe it's not that unusual for some people, but I was born in France, but very quickly I left France with my parents and went to live in several countries that are classified as low and middle income countries. So I spent part of my childhood in Peru, in Senegal and in Nepal.And very early in childhood I became aware that I was actually born on the right side of the fence. I was pretty Lucky to be born in a European family with good socioeconomic status and living in those countries.I quickly realized that a lot of people didn't have the same luck as I had.And this notion that globally there are wide disparities among people, among, you know, children and other populations was something that accompanied me since then. It's true that when I grew up and started my studies, I became very interested in life science.I was, and I'm still is still fascinating, fascinated by life, its multitude of forms, and in particular by pathogens. Viruses, bacterias and parasites are very simple forms of life, yet they can bug down entire societies as we currently experiencing with COVID 19.So I was fascinated by those very simple forms of life and how they could affect human beings and yield to diseases.It became quite obvious after, during my studies, during my PhD that I wanted to find a job where I could contribute to improving the faith of populations in LMICs, just to give back a little bit what I had the chance to receive.So you know, for me, working on NTDs on infectious diseases, on HIV enabled me to at the same time satisfy that aim that will I had to make a difference for the most deprived populations. But also it coincided, it fitted well with my interest for pathogens.So that is where I started to look for opportunities in HIV in particular and also other diseases that primarily affect neglected populations.

Claire Murigande00:06:12

That's really fascinating and really interesting. Can you just precise. You mentioned infectious diseases, HIV and NTDs. What are NTDs exactly?

Emilie Alirol00:06:22

So, so neglected tropical diseases. NTDs are a group of 17 diseases that encompass a variety of pathogens. They are prevailing in tropical and subtropical areas and their burden is huge.According to the latest global of disease Global Burden of disease study, about 1 billion people globally are affected by by them. And so they encompass diseases caused by viruses, by bacterias and by parasites. They are found, you know, mostly in resourceful settings.

Claire Murigande00:07:13

I have to ask you this. I've been intrigued, or I would say a bit wondering about the term neglected. Can you tell me why they're called neglected diseases?

Emilie Alirol00:07:23

Well, historically they were called neglected diseases because they were not the subject of great attention, be it from the research community or from policymakers and people involved in setting priorities for health interventions and that were oftentimes put at the very last position in the priority lists when investment in health was to be considered.

Claire Murigande00:07:54

So one of these diseases is Ebola. And while I was reading through your profile, I saw that you mentioned something about the outbreak that took place in 2014.You wrote that during this Ebola outbreak you advised MSF so doctors without Borders on matters of research ethics and implementing clinical trials, how did you come to develop expertise in ethics?

Emilie Alirol00:08:25

Well, as I started my career in NTDs and HIV, I. As I mentioned before, my main drive was really to address unmet needs and address in particular, needs of neglected populations.That entailed working in settings where there were very few health infrastructures, very limited resources.And that came with a number of challenges, in particular, when it came to ensuring research ethics was respected, that scientific rigor was respected. So, very early, after I had joined the Geneva University Hospital, I volunteered to become a member of an ethics committee.First, I joined the Ethics Committee of Internal Medicine at Geneva University Hospital. And then a couple of years later, I joined the WHO Ethics Research Committee.And that committee oversees all the research that is supported or funded by WHO globally. And that is where I learned a lot about the key principles that have to be respected when conducting research in vulnerable populations.So I stayed with the WHO ERC for about six years, including three as a vice chair. And this is where I gained insight into research ethics.And that is what probably positioned me quite well at MSF to advise on how to do research in Western Africa during the 2014 Ebola epidemic.

Claire Murigande00:10:19

Wow, that's quite an impressive track record. I mean, being vice chair of the World Health Organization Ethics Research Committee, that's. That's really impressive.And you did earn your place as being an advisor to MSF during the Ebola outbreak. Now, let me just touch upon another point that I'd like to have your opinion on. I.I also have a bit of background on ethics and running trials, but my experience is more about running trials, I would say, in the Western countries, or rather more in Europe.So from your experience, what is the fundamental difference, or the fundamental differences, I would say, between running a trial in West Africa for Ebola and let's say, running a trial on osteoporosis in Switzerland. I know it's quite an extreme example, but just to. To have your take on that, there.

Emilie Alirol00:11:16

Are a number of differences. The two that come to mind are the following. The first is the vulnerability of the population.So oftentimes, people affected by neglected tropical diseases or by diseases such as Ebola are much more vulnerable due to their economic situation.But also they might not have the same education levels as populations in rich countries, and that creates the need to protect them even more from research misconduct in particular.So their ability to consent to studies, to understand the complexity of what is being investigated, and their ability to make a truly informed decision to be part of A trial is something that needs to be really evaluated carefully.The other aspect that is fundamentally different is that clinical trials conducted in Western countries often, I mean, happen within a health system that is pretty strong with, you know, good quality of care, access to health insurance and the like. So patients that are, that participate in clinical trials also have an alternative that is is a good alternative.If they don't want to be in the studies, well, they will still receive care, they will still have access to medicines and the like. In resource poor settings, it's much more difficult.And so there is also a risk when you conduct trials in such situations that you actually create undue incentives for participation. So those are two aspects that are fundamentally different, but there are many others.

Claire Murigande00:13:20

Yes, absolutely. Very insightful indeed. Now, moving a bit further into your career, I previously mentioned that you were part of the GARDP or gardp.What is the purpose of this organization?

Emilie Alirol00:13:37

So GARDP is a joint initiative between WHO and dndi, the Drugs for Neglected Disease Initiative. It was created in 2016 and was incubated for a couple of years by DNDI.The initial idea behind GARTP is to create an organization that focuses on developing new treatments for infections where antimicrobial resistance has become a serious concern. And GARPI adopts a model that is similar to other product development partnerships such as DNDi and MMV.This model is based on very strong partnership with pharmaceutical companies, but also public actors, so NGOs, academic organizations and other international organizations.The idea is to leverage public funding to be able to develop treatments for indications that are traditionally not commercially interesting for private actors.And so GARDP has partnered with several pharmaceutical companies, mainly small biotech companies, to be able to develop new antibiotics where the need is arising due to drug resistance.

Claire Murigande00:15:13

And what was your role exactly? As project leader?

Emilie Alirol00:15:17

I was leading the Sexually Transmitted Infections programs, which is a program focusing on drug resistant gonorrhea. We had one new chemical entity that was the primary focus of the of the program, which we developed in partnership with Entasis Therapeutics.It was a very, and it is still a very promising drug candidate.But the SDI program also looked at other antibiotics that could be either repurposed or further developed with the idea that STIs in the community are treated syndromically. They are treated oftentimes without knowing what pathogen is causing them.So it was a very, very interesting and very much needed program because gonorrhea is really nowadays causing a lot of concerns in terms of drug resistance. And the current treatment is, is going to become, you know, useless in, in a few years time.

Claire Murigande00:16:32

So you just mentioned drug resistance becoming increasingly a major concern. And it's true. This is something that, at least for now, in terms of awareness, it's not really front and center.I mean, not everybody is really aware of that. But as you said, it's going to be really increasingly an issue globally. So this is really real what's, what's happening there?

Emilie Alirol00:16:58

Yeah, it is real. And I mean, AMR affects all countries globally, but definitely the impact on poor population is greatest.And there's been a lot of research around, you know, how AMR actually contributes also to, to poverty in the, in those diseases in the countries that are aff. It is true that we don't talk much about amr, although it has come up in the global health agenda over the last few years.It is indeed a very, very difficult problem to tackle because we do, we still have, you know, antibiotics that work, thanks God. The main issue is that the market for antibiotics is completely broken. It's dominated by generics. So antibiotics are oftentimes very cheap.Antibiotics are used for a number of indications. So volumes of sales are very, very high.And so for any new drug entering the market, it is very, very difficult to compete with those existing products.And the reality is that as AMR is progressing steeply and constantly, there's a need to find new treatments if we want to anticipate the situation where the current tools won't work. And as you know, developing new drugs takes a lot of time.

Claire Murigande00:18:43

And now that we are all facing this pandemic with COVID 19, do you think that the fact that the focus right now is on this specific virus, that this will either increase awareness about all these infectious diseases, as you mentioned before, you know, parasites, bacteria, viruses and so on, to a much broader extent, or on the opposite, this might actually push back these other diseases which are still present in terms of awareness.

Emilie Alirol00:19:22

It is definitely true that what is happening with COVID has a lot of similarities with what could happen if AMR progressed. And we see that already in some instances there are infections that can, can no longer be treated.If you think about neonatal sepsis, for instance, in some countries, a very large proportion of the infections have become resistant to the first line antibiotics. So the reality is very similar.This untreatable disease notion is clearly something that we're experiencing with COVID but is certainly true for some bacterial infections. So there's a point to be made, there's a parallel to be made.However, the ability of public and private Investors and funders to invest in AMR is really a question mark today. There's an enormous amount of funding that is now focusing on Covid and addressing the pandemic.You probably Learned about the ACT Accelerator and I believe who estimated that $38 billion will be necessary to fund the ACT Accelerator. All that money may be, you know, diverge from other health problems, including amr.I also think that countries will have to address the economic crisis that will follow the COVID pandemic.And the amount of funds that will be available for AMR research in the future will also depend on countries ability to first tackle the economic consequences of the pandemic.

Claire Murigande00:21:30

All right, let me just pause here and rewind a little bit. You mentioned two terms. I just want to make sure that our listeners fully understand what those were. So you spoke about neonatal sepsis.Can you just explain exactly what that is, what condition that is? And then you talked about this act. Please expand a bit on that.

Emilie Alirol00:21:51

Neonatal sepsis is a condition that affects neonates in their very first days and weeks of life. It can be caused by a variety of pathogens, variety of bacterias.And some of those bacteria, such as Acetynobacter baumanni, have become resistant to most antibiotics used so far.And there are studies in India and other LMI that show that the current first line antibiotics that are recommended by WHO are no longer working and that the bacterias are resistant to those antibiotics.It is believed that neonatal sepsis now is one of the prime contributors to neonatal mortality and that in order to be able to achieve significant improvement in neonatal mortality, neonatal sepsis has to be tackled and new treatments have to be to be found. Now the ACT accelerator is a global initiative that aims at developing tools to address COVID pandemic. There are three components.One is on vaccine, another one is on diagnostics and the last is on treatment. Treatment.A number of countries have recently announced that they would contribute to the ACT Accelerator and fund part of the research and development activities that need to take place to find these new tools. However, I just read yesterday that we are very far from the commitment that is that is expected.I mean, 38 billion is certainly a very, very high figure.

Claire Murigande00:23:57

Yes, absolutely. 38 billion is quite a high figure indeed.I agree you just addressed vaccines there and I'd like to jump on the opportunity that you're currently working at Medicines for Malaria Venture and ask you this. I was reading about a project last year, a clinical trial which is run right now in three African countries, namely Ghana, Kenya and Malawi.And it's a pilot project on a malaria vaccine and it's a trial run in children up to age 2 years old. So do you know about this project and can you tell me how it's been going on so far?

Emilie Alirol00:24:40

It's not my primary area of expertise, but from what I know, the existing vaccines focus on Plasmodium falciparum and not the other species that can also cause malaria. Those vaccines have been tested extensively in Africa, in particular among children, and they have received marketing authorization.However, the protection that they achieve is not very, very, very high. So control of malaria and elimination of malaria cannot rely exclusively on those tools.And definitely other approaches have to be followed, including, you know, use of bed nets and prevention of infections through bed nets and spraying, but also treatment of dormant forms of malaria and in particular those caused by Plasmodium vivax.

Claire Murigande00:25:47

So you're sharing a lot of valuable insights here and I'm really learning a lot. Thank you so much for that, Emily.Now, looking forward in terms of public health and the future of public health, how do you see this area evolving from your perspective, from your expertise, which is more research based?

Emilie Alirol00:26:09

I believe those tools that are developed by the private sectors do not entirely address the medical needs of our societies. The R and D efforts driven by pharmaceutical companies as largely focused on diseases that could bring some return on investment.But we see today, and that is not only the reality in LMICs, but it has become the reality also in rich countries with AMR and Covid, there's a need for other actors to step in and to develop these new tools. Definitely, in my opinion, treatments, diagnostics and vaccines should be considered common goods.And there's an urgent need to reset the whole system and how, you know, we as societies develop the innovations that are required for everyone to have access to, to care, to proper care.So the organizations such as mmv, such as gardp, DNDI and find, have really demonstrated that it is possible to develop new medicines, new diagnostics that address those medical needs. And I do believe that the future is really in those type of entities that address needs that may have not been addressed by private companies.

Claire Murigande00:27:53

So do you see more and more collaboration taking place between the pharmaceutical companies, basically the private sector, and these entities that you just mentioned?

Emilie Alirol00:28:03

I hope that funding is going to increase for those entities because you know that developing new treatments and new diagnostics is extremely costly. Clinical trials are not cheap. And so the investments that are required to develop those new tools are significant.And without proper funding by philanthropic Organizations or by public money is really required.

Claire Murigande00:28:39

I fully agree with you. Funding is really key. And moving forward, it will continue to be key as well.Still, looking forward now, what would be your advice to young people who say, you know, I'm really eager to pursue a career in life science and more specifically in clinical research. From your standpoint point, what would you advise them?

Emilie Alirol00:29:02

I believe that people who have an interest in clinical research or in public health very early on should pursue that interest. It's very rewarding from my perspective, and I can only talk about myself. What is absolutely key is to be able to stick to my values.And that is what actually I enjoy in my work, is that I've always put patients and unmet medical need at the center of my professional choices. As an individual, it matters a lot for me to do something every day in my life that can actually contribute to a greater benefit.And my advice to young people is really to never lose sight of their values and what is their driver, because this is where you achieve the best, this is where you develop what is the most important, in my opinion.

Claire Murigande00:30:16

Well, I have to say those are really wise words and great pieces of advice. Thank you.We are unfortunately reaching to the end of our conversation, but before we part, I would like to ask you a few short questions a bit more personal, not necessarily related to what you are doing right now. And you can choose basically between either book or music. So let's get started. First question, what are you listening to Non Stop these days?Or what is the book that you.

Emilie Alirol00:30:53

Are reading right now listening to? Melody Gardo, Somewhere over the Rainbow. That's a very old song that was written in the 30s.And Melody Gadot's interpretation is really, is really nice. So, yeah.

Claire Murigande00:31:14

All right. Second question. Do you have a song, an artist or a band that particularly resonated with you at a specific time in your life?

Emilie Alirol00:31:24

When I was doing my PhD, when I was studying in Padova in Northern Italy, I listened a lot to Radiohead. That's one of my favorite bands.And if I, if I look back to this year's, you know, studying at university, we really are really associated with the Radiohead.

Claire Murigande00:31:49

Third and final question. What is your all time favorite album or book you absolutely recommend?

Emilie Alirol00:31:57

My all time favorite book is from Nicolas Bouvier. It's Lusage du Monde. It's a wonderful book.It's actually that book that gave me the flavor for travels and for meeting people in different places with different cultures and different ways of looking at the world.

Claire Murigande00:32:29

I have to say, it is a great book. I read it twice, so it's also one of my favorites.I will make sure that all this information is available on the podcast page so that listeners can go back and check the book and the music that you just told us about. Emily, thank you so very much for taking the time to discuss with me today. It has been a great pleasure catching up with you after such a long time.Final, Final question before I let you go. What can I wish you for the future?

Emilie Alirol00:33:02

Well, I guess to be able to always be present for others and for myself. You know, I'm getting older and turning the 40 years old crisis milestone. Pay attention to the moment that you are presently living.Pay attention to the people around you and not be, you know, dragged into either your past or your future.

Claire Murigande00:33:41

So yeah, well then I wish you to be more present in the future. Thank you Emily.

Emilie Alirol00:33:49

Thank you so much. Claire.

Claire Murigande00:33:58

That was Episode two, A Conversation with Emily Adiron. Emily is truly a great person, open and generous, an inspiring professional attached to her core values.Thank you so much for tuning in today and listening to the episode. I really appreciate you taking the time. You'll find all relevant information on this episode on the podcast page.Here is a reference narratives of purpose podcastpage IO until the next episode, take care of yourselves. Stay well and stay inspired.