June 14, 2022 • 32 mins
The COVID-19 pandemic has brought a new global awareness of the accessibility of diagnostics: we need to test to protect with equal access for all. In this episode of Global Health Matters, we answer key questions such as “how available are essential diagnostics in low- and middle-income countries (LMICs)?”
Host Garry Aslanyan interviews our special guests who have a deep understanding of diagnostics and their application worldwide. Bill Rodriguez is CEO of FIND, the global alliance for diagnostics, and is also founder of his own diagnostics company, Daktari Diagnostics. Our second guest is Sikhulile Moyo who led the team that helped discover the Omicron variant in Botswana through careful cross-examination of COVID-19 tests.
Join us in this podcast episode to understand the state of diagnostic testing in LMICs and how to achieve equity in access to testing in all countries.
Guests are:
· Bill Rodriguez, CEO, FIND
· Sikhulile Moyo, Research Laboratory Director, Botswana Harvard AIDS Institute Partnership
Related documents, transcripts and other information can be found on our website at
https://tdr.who.int/global-health-matters-podcast/test-to-protect-equal-access-to-diagnostics-for-all
We are keen to engage with you, our listeners, at every step of the way – please feel free to suggest topics and questions to be discussed and share your feedback by dropping us a line at TDRpod@who.int.
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Follow @TDRnews on Twitter, TDR on LinkedIn and @ghm_podcast on Instagram for updates.
Disclaimer: The views, information, or opinions expressed during the Global Health Matters podcast series are solely those of the individuals involved and do not necessarily represent those of TDR or the World Health Organization.
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SPEAKER_03 (00:36):
Hello and welcome back to our regular followers of
the Global Health Matterspodcast.
I'm very pleased that ourlistenership keeps growing.
For those of you who are joiningus for the first time, welcome
to the show.
I'm your host, Gary Aslanan.
In this episode, we will beexploring the importance of
(00:59):
access to diagnostics in globalhealth.
Over the past couple of years,diagnostics have moved from
laboratories into our livingrooms.
Many of us have had experienceof performing our own COVID
tests at home and waitinganxiously to see the result.
Unfortunately, to have access todiagnostics is a privilege.
(01:24):
Millions of people around theworld still lack access to
timely diagnosis for a range ofdiseases.
Diagnostics play a critical rolein three major global health
priorities, such as globalhealth security and
antimicrobial resistance, andachievement of universal health
coverage.
(01:47):
In this episode, I'm joined bytwo guests, each with
significant experience and whoare driven to reducing the
access gaps for diagnostics.
Dr.
Bill Rodriguez is the ChiefExecutive Officer of Find, the
Global Alliance for Diagnostics.
FIND connects health systemstakeholders to enhance access
(02:07):
to diagnostics.
Dr.
Sikulele Moyo is a medicalvirologist and the director of
the Botswana Harvard HIVReference Laboratory.
Dr.
Moyo has also been part of theBotswana Presidential Task Force
for COVID-19.
Bill and Sikulele will behighlighting the current
inequities in diagnostics,reflecting on the lessons
(02:31):
learned from the COVID-19pandemic, and sharing some of
the exciting new innovations inthe field.
Hi, Bill.
Hi, Gary, how are you?
Hi, Sikulele.
Hi, Gary, how are you?
Great, thanks.
Bill, how has your careerjourney evolved to focus on
(02:51):
diagnostics and what were someof the professional and personal
motivators along that way?
SPEAKER_04 (02:59):
Yeah, thanks, Gary.
So I trained in medicine as aclinician, as an infectious
disease specialist.
And so I see the world as aclinician and whether focus on
patient care and how do you helpthe patient in front of you.
And so I think probably threedifferent um aspects really in
my career led me to focus ondiagnostic testing.
The first was my careercoincided with the broad sweep
(03:20):
of the AIDS pandemic.
As a medical student, I had one30-minute lecture on HIV.
Two years later, in my first umrole taking care of patients,
the first five patients I tookcare of died of AIDS, and they
were all my age in the early20s.
So that was one very formativeaspect of my early training in
medicine.
(03:40):
The second was one of my earlymentors was the late Paul
Farmer, who's probably passedaway recently.
And I worked with Paul in Haitiand other other places, and his
influence, the way he demandedequity, and said, we need to
take care of every patient thesame way we take care of any
patient, you know, had a prettyprofound influence.
I mean, and then the third wasat the time in the late 90s,
(04:01):
early 2000s, the rapid pace oftechnology development that I
witnessed and the impact of newtechnologies on high-income
country diseases like cancer andheart disease was just
overwhelming.
And I saw how powerful thosetechnologies could be if we
could apply them to globaldiseases, whether they were
infectious diseases or sicklecell disease, but diseases of
poverty.
(04:22):
And so those three forces, theAIDS pandemic, the influence of
Paul Farmer, and the rapiddevelopment of technologies in
the early part of my careerreally led me to see the
potential for diagnostics todrive equity and um uh clinical
care on a global basis.
SPEAKER_03 (04:38):
Thank you.
Sicilera, what about you?
Uh, what inspired you to becomea virologist?
And what do you find mostsatisfying in your job?
SPEAKER_05 (04:48):
Uh that's a good one.
I started seeing a lot of peopledying from HIV, and it was very
close to me because uh I lostsome family members, uh, two
brothers and my sister then.
And I realized that uh uh thepandemic was on us, and uh, you
remember there was no cue at thetime, and there was very little
(05:09):
hope.
And at that time, I met a man uhwho was a virologist, and and I
got interested because of thepassion to see uh how to help.
And as a virologist, I realizedthat they were looking at uh new
tools of diagnostics for HIV,and that really inspired me that
(05:31):
you can do basic science thattranslates to so much impact in
public health.
So that really started mypassion uh for research and also
for diagnostics.
And I trained under him, and itreally gave me a passion to
pursue a career in virology.
So my passion now is to seetimely diagnostics that that
(05:53):
impact patient outcomes andpublic health response.
That's an intersection of mycareer and anything that I can
do either to promote improvementof access to diagnostics, uh,
research that informs publichealth, that really changes uh
how I look at things.
SPEAKER_03 (06:16):
So both of you have really reflected on how the
inequities in terms of access todiagnostics have impacted
various health issues.
So, Bill, the current pandemicclearly exposes a lot of
fragilities when it comes todiagnostic systems.
So, can you tell our audiencewhat they are, especially in low
(06:36):
and middle-income countries?
SPEAKER_04 (06:37):
Yeah, I think there's a saying that's come up
again and again in the pastyears that pandemics don't
create any new problems insociety, they just reveal all
the existing ones.
And I think that's beenextremely clear when it comes to
testing and diagnostic systemsin um in low and middle-income
countries.
You know, in the past 20 years,we've invested heavily in HIV
testing.
(06:58):
We have uh centralizedlaboratories that do uh high
volumes of viral load tests andcan turn around tests in 24
hours.
We've invested in tuberculosistesting, malaria testing, and we
have strong systems there.
And selectively in a few otherareas like uh uh human African
phantosombiasis or has a verytargeted program that applies
testing to eliminate thatdisease.
(07:19):
But pandemics, almost bydefinition, are community-based
diseases.
Um SARS-CoV-1 or SARS-CoV-2,they spread person to person in
communities, and that's hasbecome pandemic.
And we've realized now that wefail to invest in
community-based testing systems,platforms that can be used as
primary healthcare centers,community health workers as
(07:41):
testers, um, and that thatfailure to invest in a more
community-based platform insteadof a vertical approach, even for
HIV, which is a broad diseasewith impact at the primary
healthcare level, is it'srevealed that um there's a major
gap in our ability to respond topandemics, and it's just played
out over the past years withCOVID.
(08:02):
We've really been behind intrying to get testing out to
communities throughcommunity-based testing programs
because we failed to invest inthose, and we didn't realize it
until COVID uh you know reallyemerged and made it quite clear.
SPEAKER_03 (08:16):
And Sikivela, in Botswana, where you work, what
are some of the gaps that stillexist in bringing the diagnostic
capacity to communities?
SPEAKER_05 (08:26):
Yeah, that's an important one.
I think the systems have grownuh vertically, and when COVID
came, it exposed that somemodels of centralizing care uh
are detrimental to uh to makingsure that people access health.
Ozona has moved a lot in termsof increasing access to
(08:47):
diagnostics, especially in inurban areas or peri-urban areas.
And some of the gaps are reallyuh increasing access to very
remote areas.
Uh, and that has been very, veryimportant.
Uh making sure that diagnosticsare efficient, the timely
(09:07):
reporting, uh, so that theaccess that is given at least
allows for timely response.
And I think just focusing oninfectious diseases alone is
also a time bomb becauseprobably uh because of the
nature of the funding, focusingon HIV and TB to the detriment
(09:29):
of looking at uh what should wedo for NCDs, for example.
Uh, but in terms of ourresponse, uh, we need to make
sure that we close those gapsbecause the uh the COVID
pandemic has really shown usthat we need to be ahead of the
game uh in terms of diagnostics.
We are used to lab-driventesting uh and properly maybe
(09:50):
nurse-driven testing, but thepandemic quickly showed us that
the health system wasoverwhelmed uh and there was not
enough people to test.
Uh, you had the testingequipment, but not enough people
to do the test.
And that really helped us tosee, okay, we need to be
innovative here.
How can we use the community?
(10:10):
How can we train lay workers?
How can we repurpose lay workersuh to really expand the testing?
And that was an opportunity, forexample, uh to expand the
testing and really increased uhuh testing rates by more than
200 to 300 percent, uh, just byrepurposing different codes to
(10:32):
increase access to testing.
And I think that lesson shouldbe important uh as a lesson for
uh any pandemic that may comein, that we need to reduce
complexity in testing.
SPEAKER_03 (10:43):
So both of you mentioned the um fragilities of
the system that have beenexposed due to pandemic and the
experience we had with COVID.
So, Bill, is there any actionthat has been catalyzed on
global or other levels towardsequity in diagnostics, both in
terms of future pandemicpreparedness, but also for all
(11:06):
the other health inequity issuesthat uh you already uh both
reflected on?
SPEAKER_04 (11:12):
Yeah, you know, one thing that we shouldn't
underemphasize is um howrelevant testing has become in
this pandemic.
You know, we we may not rememberall the way back to two years
ago, but in the early days ofthe pandemic, we were acutely
aware of how important testingwas and and how little access we
all had to it everywhere in theworld.
(11:32):
And of course, that's the dailyexperience of most people for
the test they need in lower andmiddle-come countries, but even
wealthy countries and wealthypeople realize I can't access
the test on anywhere.
And I think that relevance haspersisted for two years.
People are very aware of therole of testing in their own
health across the globe.
Political leaders, Dr.
Kendrick on a daily basis, hasto state on a weekly basis, um,
(11:56):
from President Biden toPresident Ramaphosa, are talking
about testing for the public.
And I think that's reallyessential because now people
understand, hey, this is acritical part of our health
system, and we need to um makesure it's it's available.
So that that then raised theinformation in a new way, I
think, on a global basis.
And so equity in crypto testingbecame a cornerstone of a global
(12:18):
response.
And this awareness we justtalked about is how hard it is
to deliver testing to fragilesystems, um, everyone became
acutely aware of that.
So I think that's and that's animportant piece because now
testing is on the agenda the wayit has been before, and equity
is a core principle.
I think a few things that we'veseen and realized are critical
to delivering equity.
(12:39):
One is WTO leadership.
You know, I think the WHO getscriticized uh sometimes for its
response to emergencies.
And I think the WHO has been umuh just absolutely essential and
and and I think that that thepower of the WHO to deliver that
message, I think, is is criticaland something we need to
recognize and maintain when wemove out of the pandemic.
(13:01):
The other issue that I think hasbeen really clear is
manufacturing you know, mosttests for most of these is the
the factories and the equipmentthat make the test kits and the
regions are in the global north.
And that created problems, andit also made a lot of countries
realize how critically they aredependent on things well outside
(13:22):
of their control politically.
And so the effort that's grownover the past 12 months or a
year and a half is okay.
We need manufacturing fordiagnostic tests in the global
south, in Latin America, in WestAfrica, in South Africa, and
we're building those factories.
That's going to support equity,probably not in time for the
(13:44):
pandemic when it was needed lastyear, but for the future, for
future pandemics, fortuberculosis, for tests that
manufacturers in the globalnorth don't really pay as much
attention to.
And that I think is a criticallegacy of COVID is to identify
this sort of niche issue of hey,where the pests are produced is
really essential for equity,especially in Africa, but across
(14:07):
the global thousand.
I think that's something we'lllook back at and realize as a
critical moment in the pandemic.
SPEAKER_03 (14:13):
I can see Sigileli, you wanted to add something to
this.
SPEAKER_05 (14:16):
I think he raised uh very important points uh around
the need to be able to producekids uh and and supplies within
our region.
And we've seen it as well, isrolling not only to testing
kids, but it's also rolling outto vaccines and also several
(14:37):
testing products that we need uhto increase access as well as
probably innovative ways oftesting.
Uh, some people tried innovativeways like food testing uh or
different algorithms to expandtesting and scale up testing.
Uh, and I think that has becomevery, very important.
(14:57):
Uh well-safe Bill.
SPEAKER_03 (15:00):
So, Siklele in 2021, uh late 2021, uh, you and your
colleagues and scientists thatwork with you uh were the ones
who sounded the alarm around theOmicron variant.
Uh to me, this means thatBotswana had a very good early
warning and detection systemsupported by diagnostic
(15:24):
capacity.
Maybe you could tell ouraudience a little bit more about
that experience and how that uhunfolded.
SPEAKER_05 (15:32):
The discovery of Omicron in Botswana was not an
accident.
I think it was a result of astrategic intent to increase
access to detecting what isgoing on in the population.
Unique diagnosis.
So testing, testing, testing,testing.
So Botswana decided to make surethat there's access to testing
(15:55):
in all its dispatches andincreasing access using COVID
zones where in each of thecatchment areas there's a PCR
lab and also using theinfrastructure from HIV, the
sample referral system, you wereable to refer samples to the
next PCR lab.
(16:15):
And we developed now asurveillance strategy that was
going to be able to be built onthat, that if we get a positive,
we are going to sample it.
And our strategy was made of somany uh pillars.
First of all, we wanted to knowwhat is coming in into the
country, surveillance of ourpoints of entry.
(16:37):
So if there's a new virus comingin, we were there trying to see
that and sample.
We're also interested to seewhat is happening in people who
are being hospitalized who havethe fast disease progression.
Uh so we were there, deathcases, we were also sampling
those.
We were also looking atgenerally in the population.
(16:58):
We couldn't sequence everyone,but what is the representative
way of sampling across theseareas that will give us a
meaningful data to estimate whatis happening in the population.
So this strategy allowed us tobe on a weekly basis
accumulating representativesamples uh that cut across these
(17:20):
uh different objectives.
And that was very, veryimportant.
Um uh we received a lot ofsupport uh from organizations
like uh Find and Pilent Melindaand the Minister of Health in
terms of setting up our systemsuh and also enhancing the
testing.
Uh the 11th of November wereceived these unique samples.
(17:46):
Uh and they were they weretested in one of the labs, and
they noticed that we monitorwhat we call cyto threshold
values.
It's a measure of howconcentrated the virus is.
So this one was veryconcentrated and was like, oh,
we've never seen such aconcentration of viruses.
And they brought it in becausewe were sequencing weekly, uh,
(18:09):
we got those samples into ourpatch.
Uh, when we got them into ourpatch, we noticed that when we
compared them with others, theywere sitting in their own tree.
When you put two a tree ofvirus, a family tree of viruses,
what we call phylogeneticanalysis, we realized that these
four clustered together.
(18:30):
And boom, what is this going on?
Uh, when we looked at theminitially, as a virologist, you
think there's an error.
So we went back to the lab.
So we could have reported thisdata as early as the 18th of
November, but we went back tothe lab.
Uh, and and by the 19th, we weresure that we saw exactly what we
saw.
And on the 22nd of November, wenotified the Minister of Health,
(18:54):
we made the data available, andthat was a Monday.
And by Tuesday, we got a callfrom uh an independent group
that saw our sequences and theysaid, Oh, we've seen something
similar.
So, two independent labsidentifying a lineage.
So, for us, when we reported tothe Minister of Health, we say,
Oh, we've identified an unusuallineage.
(19:17):
I still have that email, I'mframing it for future because it
it changed the world.
Uh, an unusual lineage.
We didn't know that it's avariant, we didn't know it's a
variant of concern.
Uh, so when we notified uhMinister of Health and South
Africa as well, then we realizedthat this is worth reporting to
the World Health Organization.
(19:38):
And then as Bill said, uh, WHOhas played a very critical role.
They formed a technical workinggroup.
And on the 26th of November,they classified this unusual
image, uh, a variant of concern,now called the Omicron.
Uh and and I think for me, I wasfulfilled as a scientist to
(20:01):
report something like that.
Uh, but also uh it was a rollercoaster of emotions because the
the way the world reacted uhwith travel bans.
Uh and I think we have learned alot over the past two years that
I think that reaction wasunfortunate.
Uh, economies were damaged, uh,the even the medicines and the
(20:25):
vaccines that we're expectingwere delayed.
Uh, a lot of businesses wereclosed.
There was a lot of lockdownsunnecessarily.
So the cost implications werehuge.
And uh uh some of us got umcalls about what you have done,
uh, you scientists with your bigmouth, it was a holiday season
(20:47):
coming up.
And uh, why didn't you keepquiet until we come back from
Christmas?
Uh and when you look back, whilewe went through that rough time,
I feel even more strongly thatdata transparency, data should
be shared transparently andshould be used to improve public
(21:08):
health.
SPEAKER_03 (21:10):
Bill, uh, beyond the developments you mentioned
related to COVID-19, what arethe other exciting and
disruptive innovations indiagnostics that are emerging?
And how could they apply toother diseases to TB or other
neglected issues, especially inlow and middle-income countries?
SPEAKER_04 (21:30):
Yeah, Gary, I think I'll highlight two really
exciting developments that areon the near-term or medium-term
horizon.
One is actually sequencing.
Sikolelli told a really powerfulstory about the identification
of Omicron and the consequences,but the commitment to sharing
data and transparency.
And so we we what we've seenunder COVID is um literally
(21:52):
every country in the world nowhas the capacity to do
sequencing of pathogens and turnthat information or information
around, share it publicly, andincorporate into a global
response.
And what that means for diseasesurveillance is potentially
transformative.
Um we will be able to trackvariants of every pathogen, the
(22:15):
major viruses, uh HIV, TB, andto apply that not only for
epidemiologic purposes tomonitor diseases in much
something much closer to realtime than we've ever been able
to do before, but alsopotentially for clinical
applications in TB drugresistance, in antimicrobial.
Microbial resistance moregenerally in HIV management.
So that capacity and the cost ofsequencing has come down
(22:38):
dramatically.
So that's a really powerfultechnology that we rarely had no
access to in LMICs until COVID.
So that's one really disruptiveinnovation that has come about.
The second is um uh at atechnical level in in what's
referred to as multiplexmolecular point-of-cure
platforms.
What does that mean?
So the first generation of thesewere instruments like the expert
(23:02):
platform for tuberculosis thatreally were made a difference in
making uh tuberculosis diagnosisuh simpler, faster, less
expensive.
Instead of taking days or weeksto culture um T B, we can now
use a molecular test to identifythe the DNA in an hour and and
(23:22):
and know that this is TB.
And that changes patient caredramatically.
But those systems are expensive.
You can just say, is this TB?
And if the test is negative,well then what do you do?
So COVID has has led to theaccelerated development of
multiple platforms.
We're tracking over a hundredcompanies, 45 in late
development, five that arealready on the market that can
(23:45):
do multiplex molecular testing.
So that disruptive innovationthat's very likely going to
transform primary healthcareacross the world, and especially
in uh low and middle-incomecountries that really have not
had access to this kind ofpowerful technology because it
was too expensive, toocomplicated.
And we'll see those systemsenter the market in 2023, 24,
(24:06):
25, and likely be transformativeas we enter the end of this
decade.
SPEAKER_03 (24:11):
And what about you, Sikilele?
How does that play out inBotswana in terms of innovative
diagnostic approaches andfuture?
SPEAKER_05 (24:20):
It has really opened up uh avenues for multi-pathogen
diagnosis.
And a lot of these platformsthat were uh enhanced through
COVID are now uh open platformsthat will be able to cover uh
other pathogens.
And I think this is very, veryimportant that now we can will
(24:40):
be able to do things cheaper.
And I think other than justthat, we've also seen an
innovative way of some digitalsolutions that could help us to
accelerate uh uh availability ofdata.
And if we can enhance these uhuh mobile uh apps uh to make
sure data is available at acentral level to enhance
(25:03):
decision uh making very faster,I think that is very, very, very
important.
I think that will drive uhquality of care.
We can put these tools uh nearpatient care.
I think that will really, reallyhelp.
SPEAKER_03 (25:16):
Final question to both of you, Bill and Siculeri.
What promise does improvingaccess to diagnostics hold for
achievement of public healthsystems in countries such as
Botswana and obviously in otheruh settings in low and
middle-income countries?
SPEAKER_04 (25:34):
Yeah, Gary, it's a great question.
I would say um we're reallywe're really at the cusp of a
transformation in testing um aspart of basic healthcare
services on par with treatmentsand vaccines.
And so I think we're we'rereally entering a new era where
disease surveillance andclinical management are going to
be much more data-based, basedon available tests that are
(25:58):
widely used on a regular basis.
Whereas in the past, a lot ofwhat we've done has not been
data-based.
It's been based on best guessand empiric approaches and mass
drug administration, things thatwere effective for their time.
But now this is much a much moretargeted approach that's going
to make healthcare moreefficient, more economic, and
(26:20):
lead to better outcomes.
And I don't want to overpromisewhat testing can do, but we've
seen that potential now begin totransform um public health
surveillance and clinical casemanagement in what was otherwise
a pretty horrible two-yearperiod of this pandemic.
That's the one legacy that Ithink um um we'll look back on
and say, well, at least therewas one positive impact from
(26:42):
this virus and this pandemic ona global basis.
SPEAKER_05 (26:45):
I'll also say that uh this has provided a unique
opportunity uh that isaccelerating research efforts
globally and locally as well,and has highlighted other things
like uh engaging communities andleadership in the response.
Uh, we see uh novel platformscoming up.
(27:08):
It means that disease diagnosisis going to be faster.
Uh, and in the in the era ofoverlapping epidemics, we see an
opportunity to extend uhcross-disciplinary research and
diagnostic into integratedservice delivery for HIV, for
TB, for malaria.
We see that there'sopportunities uh for
(27:29):
integration.
And also it brings otheropportunities in digital data
systems uh because now you haveyou're generating a lot of data
in a very short space of time.
So you need to manage that data.
Uh so solutions for making surethat this data moves very fast.
Uh, you're real near real-timereporting to public health and
(27:51):
alerts and emergencies and dataanalytics, making sure this data
can provide uh uh reasonable uhclinical decisions, but also
public health decisions isbecoming uh a very good
opportunity.
And also we see that thediagnostic industry for
manufacturing diagnostics isreally, really looking up to say
(28:14):
how can we develop thesetechnologies here?
And there are tests developed,for example, in in Dhaka, in
Senegal, uh they develop theirown uh COVID rapid tests.
So I think the future is holdingon to if I mean someone said we
should not waste a crisis.
So we should utilize theopportunities that uh COVID has
(28:38):
brought us uh to advance uhpublic health.
SPEAKER_03 (28:41):
Thank you both for this exciting discussion and for
joining our podcast.
SPEAKER_05 (28:48):
Thanks, Gary.
It was a pleasure.
SPEAKER_03 (28:49):
Thank you, thank you, Gary Bill and Sikulele hold
a deep passion for their work,and this was reflected in what
they shared with me.
I was struck by Bill's quotesaying that pandemics don't
create new problems in asociety, they just reveal the
existing ones.
As we have heard not only inthis episode, but also from so
(29:13):
many of our guests I've spokenin the last year, this indeed is
true.
The COVID-19 pandemic has cast aspotlight on many failures in
global health.
However, the efforts fromcountries like Botswana and the
experience of virologists likeSikulele gives me really great
hope.
This shows that it's indeedpossible for countries to
(29:35):
effectively respond during anemergency, not only safeguarding
the health of their own people,but also to share their
knowledge with the whole globalhealth community.
I want to commend Sikulele andhis team yet again for their
skilled work in discovering theOmicron variant in Botswana.
(29:56):
I feel there is a lot to beoptimistic about with so many
new diagnostic innovationsbiming on the horizon.
Hopefully, they will reduce thegap and assist in achieving
greater diagnostic equity forall.
SPEAKER_00 (30:36):
Gary clearly set the stage for Dr.
Zagnas and Catherine to speaktheir truth, which is necessary
if we are to hope that the fieldof global health will transition
from the historic powerimbalances, inherent racism, and
patronizing programming, towardwhat beloved Dr.
Paul Farmer taught us, which hasmuch more to do with being
(30:59):
allies to one another.
SPEAKER_03 (31:02):
I totally agree with you, Margaret.
We must never lose sight that weare all allies in this quest for
health globally.
Be sure to join the GlobalHealth Matters podcast again
next month for yet anotherinspiring episode.
Thank you for listening,subscribing, and sharing the
(31:23):
podcast with others who may beinterested.
SPEAKER_01 (31:27):
Global Health Matters is produced by TDR, an
infectious diseases researchprogram based at the World
Health Organization.
Gary Aslanian, Lindy VanNiekerk, and Maki Kitamura are
the content producers, andObadiah George is the technical
producer.
This podcast was also madepossible with the support of
(31:50):
Chris Koes, Elizabeth Adesti,Isa Suder Dayao, Norin Ogalaer,
and Chembe Collaborative.
The goal of Global HealthMatters is to produce a forum
for sharing perspectives on keyissues affecting global health
research.
Send us your comments andsuggestions by email or voice
(32:11):
message to idrpod at who.int andbe sure to download and
subscribe wherever you get yourpodcasts.
Thank you for listening.
Hello and welcome back to our regular followers of
the Global Health Matterspodcast.
I'm very pleased that ourlistenership keeps growing.
For those of you who are joiningus for the first time, welcome
to the show.
I'm your host, Gary Aslanan.
In this episode, we will beexploring the importance of
(00:59):
access to diagnostics in globalhealth.
Over the past couple of years,diagnostics have moved from
laboratories into our livingrooms.
Many of us have had experienceof performing our own COVID
tests at home and waitinganxiously to see the result.
Unfortunately, to have access todiagnostics is a privilege.
(01:24):
Millions of people around theworld still lack access to
timely diagnosis for a range ofdiseases.
Diagnostics play a critical rolein three major global health
priorities, such as globalhealth security and
antimicrobial resistance, andachievement of universal health
coverage.
(01:47):
In this episode, I'm joined bytwo guests, each with
significant experience and whoare driven to reducing the
access gaps for diagnostics.
Dr.
Bill Rodriguez is the ChiefExecutive Officer of Find, the
Global Alliance for Diagnostics.
FIND connects health systemstakeholders to enhance access
(02:07):
to diagnostics.
Dr.
Sikulele Moyo is a medicalvirologist and the director of
the Botswana Harvard HIVReference Laboratory.
Dr.
Moyo has also been part of theBotswana Presidential Task Force
for COVID-19.
Bill and Sikulele will behighlighting the current
inequities in diagnostics,reflecting on the lessons
(02:31):
learned from the COVID-19pandemic, and sharing some of
the exciting new innovations inthe field.
Hi, Bill.
Hi, Gary, how are you?
Hi, Sikulele.
Hi, Gary, how are you?
Great, thanks.
Bill, how has your careerjourney evolved to focus on
(02:51):
diagnostics and what were someof the professional and personal
motivators along that way?
SPEAKER_04 (02:59):
Yeah, thanks, Gary.
So I trained in medicine as aclinician, as an infectious
disease specialist.
And so I see the world as aclinician and whether focus on
patient care and how do you helpthe patient in front of you.
And so I think probably threedifferent um aspects really in
my career led me to focus ondiagnostic testing.
The first was my careercoincided with the broad sweep
(03:20):
of the AIDS pandemic.
As a medical student, I had one30-minute lecture on HIV.
Two years later, in my first umrole taking care of patients,
the first five patients I tookcare of died of AIDS, and they
were all my age in the early20s.
So that was one very formativeaspect of my early training in
medicine.
(03:40):
The second was one of my earlymentors was the late Paul
Farmer, who's probably passedaway recently.
And I worked with Paul in Haitiand other other places, and his
influence, the way he demandedequity, and said, we need to
take care of every patient thesame way we take care of any
patient, you know, had a prettyprofound influence.
I mean, and then the third wasat the time in the late 90s,
(04:01):
early 2000s, the rapid pace oftechnology development that I
witnessed and the impact of newtechnologies on high-income
country diseases like cancer andheart disease was just
overwhelming.
And I saw how powerful thosetechnologies could be if we
could apply them to globaldiseases, whether they were
infectious diseases or sicklecell disease, but diseases of
poverty.
(04:22):
And so those three forces, theAIDS pandemic, the influence of
Paul Farmer, and the rapiddevelopment of technologies in
the early part of my careerreally led me to see the
potential for diagnostics todrive equity and um uh clinical
care on a global basis.
SPEAKER_03 (04:38):
Thank you.
Sicilera, what about you?
Uh, what inspired you to becomea virologist?
And what do you find mostsatisfying in your job?
SPEAKER_05 (04:48):
Uh that's a good one.
I started seeing a lot of peopledying from HIV, and it was very
close to me because uh I lostsome family members, uh, two
brothers and my sister then.
And I realized that uh uh thepandemic was on us, and uh, you
remember there was no cue at thetime, and there was very little
(05:09):
hope.
And at that time, I met a man uhwho was a virologist, and and I
got interested because of thepassion to see uh how to help.
And as a virologist, I realizedthat they were looking at uh new
tools of diagnostics for HIV,and that really inspired me that
(05:31):
you can do basic science thattranslates to so much impact in
public health.
So that really started mypassion uh for research and also
for diagnostics.
And I trained under him, and itreally gave me a passion to
pursue a career in virology.
So my passion now is to seetimely diagnostics that that
(05:53):
impact patient outcomes andpublic health response.
That's an intersection of mycareer and anything that I can
do either to promote improvementof access to diagnostics, uh,
research that informs publichealth, that really changes uh
how I look at things.
SPEAKER_03 (06:16):
So both of you have really reflected on how the
inequities in terms of access todiagnostics have impacted
various health issues.
So, Bill, the current pandemicclearly exposes a lot of
fragilities when it comes todiagnostic systems.
So, can you tell our audiencewhat they are, especially in low
(06:36):
and middle-income countries?
SPEAKER_04 (06:37):
Yeah, I think there's a saying that's come up
again and again in the pastyears that pandemics don't
create any new problems insociety, they just reveal all
the existing ones.
And I think that's beenextremely clear when it comes to
testing and diagnostic systemsin um in low and middle-income
countries.
You know, in the past 20 years,we've invested heavily in HIV
testing.
(06:58):
We have uh centralizedlaboratories that do uh high
volumes of viral load tests andcan turn around tests in 24
hours.
We've invested in tuberculosistesting, malaria testing, and we
have strong systems there.
And selectively in a few otherareas like uh uh human African
phantosombiasis or has a verytargeted program that applies
testing to eliminate thatdisease.
(07:19):
But pandemics, almost bydefinition, are community-based
diseases.
Um SARS-CoV-1 or SARS-CoV-2,they spread person to person in
communities, and that's hasbecome pandemic.
And we've realized now that wefail to invest in
community-based testing systems,platforms that can be used as
primary healthcare centers,community health workers as
(07:41):
testers, um, and that thatfailure to invest in a more
community-based platform insteadof a vertical approach, even for
HIV, which is a broad diseasewith impact at the primary
healthcare level, is it'srevealed that um there's a major
gap in our ability to respond topandemics, and it's just played
out over the past years withCOVID.
(08:02):
We've really been behind intrying to get testing out to
communities throughcommunity-based testing programs
because we failed to invest inthose, and we didn't realize it
until COVID uh you know reallyemerged and made it quite clear.
SPEAKER_03 (08:16):
And Sikivela, in Botswana, where you work, what
are some of the gaps that stillexist in bringing the diagnostic
capacity to communities?
SPEAKER_05 (08:26):
Yeah, that's an important one.
I think the systems have grownuh vertically, and when COVID
came, it exposed that somemodels of centralizing care uh
are detrimental to uh to makingsure that people access health.
Ozona has moved a lot in termsof increasing access to
(08:47):
diagnostics, especially in inurban areas or peri-urban areas.
And some of the gaps are reallyuh increasing access to very
remote areas.
Uh, and that has been very, veryimportant.
Uh making sure that diagnosticsare efficient, the timely
(09:07):
reporting, uh, so that theaccess that is given at least
allows for timely response.
And I think just focusing oninfectious diseases alone is
also a time bomb becauseprobably uh because of the
nature of the funding, focusingon HIV and TB to the detriment
(09:29):
of looking at uh what should wedo for NCDs, for example.
Uh, but in terms of ourresponse, uh, we need to make
sure that we close those gapsbecause the uh the COVID
pandemic has really shown usthat we need to be ahead of the
game uh in terms of diagnostics.
We are used to lab-driventesting uh and properly maybe
(09:50):
nurse-driven testing, but thepandemic quickly showed us that
the health system wasoverwhelmed uh and there was not
enough people to test.
Uh, you had the testingequipment, but not enough people
to do the test.
And that really helped us tosee, okay, we need to be
innovative here.
How can we use the community?
(10:10):
How can we train lay workers?
How can we repurpose lay workersuh to really expand the testing?
And that was an opportunity, forexample, uh to expand the
testing and really increased uhuh testing rates by more than
200 to 300 percent, uh, just byrepurposing different codes to
(10:32):
increase access to testing.
And I think that lesson shouldbe important uh as a lesson for
uh any pandemic that may comein, that we need to reduce
complexity in testing.
SPEAKER_03 (10:43):
So both of you mentioned the um fragilities of
the system that have beenexposed due to pandemic and the
experience we had with COVID.
So, Bill, is there any actionthat has been catalyzed on
global or other levels towardsequity in diagnostics, both in
terms of future pandemicpreparedness, but also for all
(11:06):
the other health inequity issuesthat uh you already uh both
reflected on?
SPEAKER_04 (11:12):
Yeah, you know, one thing that we shouldn't
underemphasize is um howrelevant testing has become in
this pandemic.
You know, we we may not rememberall the way back to two years
ago, but in the early days ofthe pandemic, we were acutely
aware of how important testingwas and and how little access we
all had to it everywhere in theworld.
(11:32):
And of course, that's the dailyexperience of most people for
the test they need in lower andmiddle-come countries, but even
wealthy countries and wealthypeople realize I can't access
the test on anywhere.
And I think that relevance haspersisted for two years.
People are very aware of therole of testing in their own
health across the globe.
Political leaders, Dr.
Kendrick on a daily basis, hasto state on a weekly basis, um,
(11:56):
from President Biden toPresident Ramaphosa, are talking
about testing for the public.
And I think that's reallyessential because now people
understand, hey, this is acritical part of our health
system, and we need to um makesure it's it's available.
So that that then raised theinformation in a new way, I
think, on a global basis.
And so equity in crypto testingbecame a cornerstone of a global
(12:18):
response.
And this awareness we justtalked about is how hard it is
to deliver testing to fragilesystems, um, everyone became
acutely aware of that.
So I think that's and that's animportant piece because now
testing is on the agenda the wayit has been before, and equity
is a core principle.
I think a few things that we'veseen and realized are critical
to delivering equity.
(12:39):
One is WTO leadership.
You know, I think the WHO getscriticized uh sometimes for its
response to emergencies.
And I think the WHO has been umuh just absolutely essential and
and and I think that that thepower of the WHO to deliver that
message, I think, is is criticaland something we need to
recognize and maintain when wemove out of the pandemic.
(13:01):
The other issue that I think hasbeen really clear is
manufacturing you know, mosttests for most of these is the
the factories and the equipmentthat make the test kits and the
regions are in the global north.
And that created problems, andit also made a lot of countries
realize how critically they aredependent on things well outside
(13:22):
of their control politically.
And so the effort that's grownover the past 12 months or a
year and a half is okay.
We need manufacturing fordiagnostic tests in the global
south, in Latin America, in WestAfrica, in South Africa, and
we're building those factories.
That's going to support equity,probably not in time for the
(13:44):
pandemic when it was needed lastyear, but for the future, for
future pandemics, fortuberculosis, for tests that
manufacturers in the globalnorth don't really pay as much
attention to.
And that I think is a criticallegacy of COVID is to identify
this sort of niche issue of hey,where the pests are produced is
really essential for equity,especially in Africa, but across
(14:07):
the global thousand.
I think that's something we'lllook back at and realize as a
critical moment in the pandemic.
SPEAKER_03 (14:13):
I can see Sigileli, you wanted to add something to
this.
SPEAKER_05 (14:16):
I think he raised uh very important points uh around
the need to be able to producekids uh and and supplies within
our region.
And we've seen it as well, isrolling not only to testing
kids, but it's also rolling outto vaccines and also several
(14:37):
testing products that we need uhto increase access as well as
probably innovative ways oftesting.
Uh, some people tried innovativeways like food testing uh or
different algorithms to expandtesting and scale up testing.
Uh, and I think that has becomevery, very important.
(14:57):
Uh well-safe Bill.
SPEAKER_03 (15:00):
So, Siklele in 2021, uh late 2021, uh, you and your
colleagues and scientists thatwork with you uh were the ones
who sounded the alarm around theOmicron variant.
Uh to me, this means thatBotswana had a very good early
warning and detection systemsupported by diagnostic
(15:24):
capacity.
Maybe you could tell ouraudience a little bit more about
that experience and how that uhunfolded.
SPEAKER_05 (15:32):
The discovery of Omicron in Botswana was not an
accident.
I think it was a result of astrategic intent to increase
access to detecting what isgoing on in the population.
Unique diagnosis.
So testing, testing, testing,testing.
So Botswana decided to make surethat there's access to testing
(15:55):
in all its dispatches andincreasing access using COVID
zones where in each of thecatchment areas there's a PCR
lab and also using theinfrastructure from HIV, the
sample referral system, you wereable to refer samples to the
next PCR lab.
(16:15):
And we developed now asurveillance strategy that was
going to be able to be built onthat, that if we get a positive,
we are going to sample it.
And our strategy was made of somany uh pillars.
First of all, we wanted to knowwhat is coming in into the
country, surveillance of ourpoints of entry.
(16:37):
So if there's a new virus comingin, we were there trying to see
that and sample.
We're also interested to seewhat is happening in people who
are being hospitalized who havethe fast disease progression.
Uh so we were there, deathcases, we were also sampling
those.
We were also looking atgenerally in the population.
(16:58):
We couldn't sequence everyone,but what is the representative
way of sampling across theseareas that will give us a
meaningful data to estimate whatis happening in the population.
So this strategy allowed us tobe on a weekly basis
accumulating representativesamples uh that cut across these
(17:20):
uh different objectives.
And that was very, veryimportant.
Um uh we received a lot ofsupport uh from organizations
like uh Find and Pilent Melindaand the Minister of Health in
terms of setting up our systemsuh and also enhancing the
testing.
Uh the 11th of November wereceived these unique samples.
(17:46):
Uh and they were they weretested in one of the labs, and
they noticed that we monitorwhat we call cyto threshold
values.
It's a measure of howconcentrated the virus is.
So this one was veryconcentrated and was like, oh,
we've never seen such aconcentration of viruses.
And they brought it in becausewe were sequencing weekly, uh,
(18:09):
we got those samples into ourpatch.
Uh, when we got them into ourpatch, we noticed that when we
compared them with others, theywere sitting in their own tree.
When you put two a tree ofvirus, a family tree of viruses,
what we call phylogeneticanalysis, we realized that these
four clustered together.
(18:30):
And boom, what is this going on?
Uh, when we looked at theminitially, as a virologist, you
think there's an error.
So we went back to the lab.
So we could have reported thisdata as early as the 18th of
November, but we went back tothe lab.
Uh, and and by the 19th, we weresure that we saw exactly what we
saw.
And on the 22nd of November, wenotified the Minister of Health,
(18:54):
we made the data available, andthat was a Monday.
And by Tuesday, we got a callfrom uh an independent group
that saw our sequences and theysaid, Oh, we've seen something
similar.
So, two independent labsidentifying a lineage.
So, for us, when we reported tothe Minister of Health, we say,
Oh, we've identified an unusuallineage.
(19:17):
I still have that email, I'mframing it for future because it
it changed the world.
Uh, an unusual lineage.
We didn't know that it's avariant, we didn't know it's a
variant of concern.
Uh, so when we notified uhMinister of Health and South
Africa as well, then we realizedthat this is worth reporting to
the World Health Organization.
(19:38):
And then as Bill said, uh, WHOhas played a very critical role.
They formed a technical workinggroup.
And on the 26th of November,they classified this unusual
image, uh, a variant of concern,now called the Omicron.
Uh and and I think for me, I wasfulfilled as a scientist to
(20:01):
report something like that.
Uh, but also uh it was a rollercoaster of emotions because the
the way the world reacted uhwith travel bans.
Uh and I think we have learned alot over the past two years that
I think that reaction wasunfortunate.
Uh, economies were damaged, uh,the even the medicines and the
(20:25):
vaccines that we're expectingwere delayed.
Uh, a lot of businesses wereclosed.
There was a lot of lockdownsunnecessarily.
So the cost implications werehuge.
And uh uh some of us got umcalls about what you have done,
uh, you scientists with your bigmouth, it was a holiday season
(20:47):
coming up.
And uh, why didn't you keepquiet until we come back from
Christmas?
Uh and when you look back, whilewe went through that rough time,
I feel even more strongly thatdata transparency, data should
be shared transparently andshould be used to improve public
(21:08):
health.
SPEAKER_03 (21:10):
Bill, uh, beyond the developments you mentioned
related to COVID-19, what arethe other exciting and
disruptive innovations indiagnostics that are emerging?
And how could they apply toother diseases to TB or other
neglected issues, especially inlow and middle-income countries?
SPEAKER_04 (21:30):
Yeah, Gary, I think I'll highlight two really
exciting developments that areon the near-term or medium-term
horizon.
One is actually sequencing.
Sikolelli told a really powerfulstory about the identification
of Omicron and the consequences,but the commitment to sharing
data and transparency.
And so we we what we've seenunder COVID is um literally
(21:52):
every country in the world nowhas the capacity to do
sequencing of pathogens and turnthat information or information
around, share it publicly, andincorporate into a global
response.
And what that means for diseasesurveillance is potentially
transformative.
Um we will be able to trackvariants of every pathogen, the
(22:15):
major viruses, uh HIV, TB, andto apply that not only for
epidemiologic purposes tomonitor diseases in much
something much closer to realtime than we've ever been able
to do before, but alsopotentially for clinical
applications in TB drugresistance, in antimicrobial.
Microbial resistance moregenerally in HIV management.
So that capacity and the cost ofsequencing has come down
(22:38):
dramatically.
So that's a really powerfultechnology that we rarely had no
access to in LMICs until COVID.
So that's one really disruptiveinnovation that has come about.
The second is um uh at atechnical level in in what's
referred to as multiplexmolecular point-of-cure
platforms.
What does that mean?
So the first generation of thesewere instruments like the expert
(23:02):
platform for tuberculosis thatreally were made a difference in
making uh tuberculosis diagnosisuh simpler, faster, less
expensive.
Instead of taking days or weeksto culture um T B, we can now
use a molecular test to identifythe the DNA in an hour and and
(23:22):
and know that this is TB.
And that changes patient caredramatically.
But those systems are expensive.
You can just say, is this TB?
And if the test is negative,well then what do you do?
So COVID has has led to theaccelerated development of
multiple platforms.
We're tracking over a hundredcompanies, 45 in late
development, five that arealready on the market that can
(23:45):
do multiplex molecular testing.
So that disruptive innovationthat's very likely going to
transform primary healthcareacross the world, and especially
in uh low and middle-incomecountries that really have not
had access to this kind ofpowerful technology because it
was too expensive, toocomplicated.
And we'll see those systemsenter the market in 2023, 24,
(24:06):
25, and likely be transformativeas we enter the end of this
decade.
SPEAKER_03 (24:11):
And what about you, Sikilele?
How does that play out inBotswana in terms of innovative
diagnostic approaches andfuture?
SPEAKER_05 (24:20):
It has really opened up uh avenues for multi-pathogen
diagnosis.
And a lot of these platformsthat were uh enhanced through
COVID are now uh open platformsthat will be able to cover uh
other pathogens.
And I think this is very, veryimportant that now we can will
(24:40):
be able to do things cheaper.
And I think other than justthat, we've also seen an
innovative way of some digitalsolutions that could help us to
accelerate uh uh availability ofdata.
And if we can enhance these uhuh mobile uh apps uh to make
sure data is available at acentral level to enhance
(25:03):
decision uh making very faster,I think that is very, very, very
important.
I think that will drive uhquality of care.
We can put these tools uh nearpatient care.
I think that will really, reallyhelp.
SPEAKER_03 (25:16):
Final question to both of you, Bill and Siculeri.
What promise does improvingaccess to diagnostics hold for
achievement of public healthsystems in countries such as
Botswana and obviously in otheruh settings in low and
middle-income countries?
SPEAKER_04 (25:34):
Yeah, Gary, it's a great question.
I would say um we're reallywe're really at the cusp of a
transformation in testing um aspart of basic healthcare
services on par with treatmentsand vaccines.
And so I think we're we'rereally entering a new era where
disease surveillance andclinical management are going to
be much more data-based, basedon available tests that are
(25:58):
widely used on a regular basis.
Whereas in the past, a lot ofwhat we've done has not been
data-based.
It's been based on best guessand empiric approaches and mass
drug administration, things thatwere effective for their time.
But now this is much a much moretargeted approach that's going
to make healthcare moreefficient, more economic, and
(26:20):
lead to better outcomes.
And I don't want to overpromisewhat testing can do, but we've
seen that potential now begin totransform um public health
surveillance and clinical casemanagement in what was otherwise
a pretty horrible two-yearperiod of this pandemic.
That's the one legacy that Ithink um um we'll look back on
and say, well, at least therewas one positive impact from
(26:42):
this virus and this pandemic ona global basis.
SPEAKER_05 (26:45):
I'll also say that uh this has provided a unique
opportunity uh that isaccelerating research efforts
globally and locally as well,and has highlighted other things
like uh engaging communities andleadership in the response.
Uh, we see uh novel platformscoming up.
(27:08):
It means that disease diagnosisis going to be faster.
Uh, and in the in the era ofoverlapping epidemics, we see an
opportunity to extend uhcross-disciplinary research and
diagnostic into integratedservice delivery for HIV, for
TB, for malaria.
We see that there'sopportunities uh for
(27:29):
integration.
And also it brings otheropportunities in digital data
systems uh because now you haveyou're generating a lot of data
in a very short space of time.
So you need to manage that data.
Uh so solutions for making surethat this data moves very fast.
Uh, you're real near real-timereporting to public health and
(27:51):
alerts and emergencies and dataanalytics, making sure this data
can provide uh uh reasonable uhclinical decisions, but also
public health decisions isbecoming uh a very good
opportunity.
And also we see that thediagnostic industry for
manufacturing diagnostics isreally, really looking up to say
(28:14):
how can we develop thesetechnologies here?
And there are tests developed,for example, in in Dhaka, in
Senegal, uh they develop theirown uh COVID rapid tests.
So I think the future is holdingon to if I mean someone said we
should not waste a crisis.
So we should utilize theopportunities that uh COVID has
(28:38):
brought us uh to advance uhpublic health.
SPEAKER_03 (28:41):
Thank you both for this exciting discussion and for
joining our podcast.
SPEAKER_05 (28:48):
Thanks, Gary.
It was a pleasure.
SPEAKER_03 (28:49):
Thank you, thank you, Gary Bill and Sikulele hold
a deep passion for their work,and this was reflected in what
they shared with me.
I was struck by Bill's quotesaying that pandemics don't
create new problems in asociety, they just reveal the
existing ones.
As we have heard not only inthis episode, but also from so
(29:13):
many of our guests I've spokenin the last year, this indeed is
true.
The COVID-19 pandemic has cast aspotlight on many failures in
global health.
However, the efforts fromcountries like Botswana and the
experience of virologists likeSikulele gives me really great
hope.
This shows that it's indeedpossible for countries to
(29:35):
effectively respond during anemergency, not only safeguarding
the health of their own people,but also to share their
knowledge with the whole globalhealth community.
I want to commend Sikulele andhis team yet again for their
skilled work in discovering theOmicron variant in Botswana.
(29:56):
I feel there is a lot to beoptimistic about with so many
new diagnostic innovationsbiming on the horizon.
Hopefully, they will reduce thegap and assist in achieving
greater diagnostic equity forall.
SPEAKER_00 (30:36):
Gary clearly set the stage for Dr.
Zagnas and Catherine to speaktheir truth, which is necessary
if we are to hope that the fieldof global health will transition
from the historic powerimbalances, inherent racism, and
patronizing programming, towardwhat beloved Dr.
Paul Farmer taught us, which hasmuch more to do with being
(30:59):
allies to one another.
SPEAKER_03 (31:02):
I totally agree with you, Margaret.
We must never lose sight that weare all allies in this quest for
health globally.
Be sure to join the GlobalHealth Matters podcast again
next month for yet anotherinspiring episode.
Thank you for listening,subscribing, and sharing the
(31:23):
podcast with others who may beinterested.
SPEAKER_01 (31:27):
Global Health Matters is produced by TDR, an
infectious diseases researchprogram based at the World
Health Organization.
Gary Aslanian, Lindy VanNiekerk, and Maki Kitamura are
the content producers, andObadiah George is the technical
producer.
This podcast was also madepossible with the support of
(31:50):
Chris Koes, Elizabeth Adesti,Isa Suder Dayao, Norin Ogalaer,
and Chembe Collaborative.
The goal of Global HealthMatters is to produce a forum
for sharing perspectives on keyissues affecting global health
research.
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