Global Health

The panel discussion “Understanding global health market opportunities: reaching for the greater

good can help you go global” was moderated by Lisa Cohen, Director of the Washington Global

Health Alliance.

Panel Members:

• Jennifer Dent, President, BIO Ventures for Global Health (BVGH)

• Guy Palmer, PhD, Director, Paul G. Allen School for Global Animal Health,

Washington State University

• Maurizio Vecchione, Senior Vice President, Global Good and Research, Intellectual

Ventures (IV)

• Jerome Zeldis, MD, PhD, Chief Executive Officer, Celgene Corporation

• Ed Yu, Principal, Health Industries Strategy, PwC

The goal of the panel was to inspire the audience to consider investing in underrepresented

countries and help the most vulnerable and under-served populations in the world. Moderator

Lisa Cohen, of Washington Global Health Alliance, first asked panelists why people should

consider investing in underrepresented countries.

Jennifer Dent, of BIO Ventures for Global Health (BVGH), explained that investors and

companies couldn’t ignore these countries because they have become key markets. They are fast-growing countries expected to grow 3-6% in the next few years. Investing in growing countries is

always a great business opportunity. Dent cited the example of Nigeria, which has half of the

population of the US and has become a very wealthy country. Dent said that the seven fastest-growing economies in the world are in Africa.

Cohen next asked Jerome Zeldis, of Celgene, to explain why his company is already investing in

these countries. Zeldis said that Celgene is not a pharmaceutical company; they develop libraries

of compounds. In 2009 they decided to include in their libraries information on neglected diseases

found in developing countries. They built a library with over 50,000 compounds and sent the

information to a variety of institutions to test the compounds against malaria, Chagas,

tuberculosis, and other diseases carried by bugs. They found that some of the compounds that

were already being used for other diseases were also useful against some of these bug-

transmitted diseases. They observed that these compounds are not disease-unique. Already

existing drugs could be used against new diseases and Celgene would make revenue with them.

Zeldis said that a percentage of the revenue comes back to their global health division to continue

testing new compounds against other diseases. Ed Yu, of PWC, added that, to succeed in global

health issues, you need to have capital and meaningful results. Money is not enough. In fact,

between 2005-2012 the return shrank 12%. Yu explained that it is hard to fund global health; one

of the main reasons is that fundamental science does not interest many people nowadays.

Then Cohen asked what a scientist looks for in a corporate partner. Guy Palmer, a scientist at

WSU, explained that scientists expect a partner will hold respect for the primary mission of the

institution in which they perform their research. “We look for curious partners that have a sense of

social service and innovation to improve things,” said Palmer. Maurizio Vecchione, of Intellectual

Ventures, added that global health is a very interesting market that involves philanthropists.

Currently, most of the capital is coming from private donors, a source of venture capital that is not

looking for a return. IV, for example, looks for a good, efficacious strategy to implement solutions

to global health problems. IV is deploying efforts specifically for the 75 poorest countries in the

world.

Cohen next asked what the challenges of these partnerships are. Dent responded that new

financial models should include philanthropists but also the countries’ ministers of finance, and

together they should engage to fund some of the programs in their countries. She said that to

engage a company you need to make a profitable system where the employees would want their

products to help patients. For that, she said, you need to approach companies with a small plan

to participate in global health, and they will want to get involved.

Cohen asked Yu if he had an example of a company engaging in global health. Yu explained that

some companies need to validate their products through clinical trials and those are hard to

perform in the US. “We have a client doing the clinical trial in India; they can have a rapid result

and validate their technology,” he said.

Cohen then asked Palmer how to choose where to work. Palmer explained that they look for a

population that will be at the same time partners and users. In short, the community needs to be

involved and engaged for the partnership to succeed.

Cohen asked Zeldis how his company first got involved in global health. Zeldis explained that in

2009, he felt that the whole company wanted to be involved in innovation. When he suggested

starting a global health program, he received very positive messages from everyone; they all

found the idea wonderful. Zeldis added that Celgene has advanced because everyone, including

the CEO, supports the global health program. Employees feel good and are enthusiastic about

the work.

Cohen then asked Vecchione what he expects the partners to bring to the table. Vecchione

responded that money is not the issue. For him, the problem is not making something cheap, but

rather something useful for the community they are trying to help; something that will be relevant

to the local culture. He said that Bill Gates predicted that in 20 years there won’t be poor countries

anymore. Vecchione thinks that at present, there is an economic opportunity. The partners need

to show that their technology is appropriate for the country they want to help. For example, none

of the top five killing diseases in the world are relevant to the US. “You have to pick your

problems and see how your technology can be used to solve them in the context of the countries

where those problems exist,” he said. For example, technology needs to be autonomous

because, in many of those countries, there are not enough doctors or nurses to use them.

Vecchione added that all the data they use to determine the needs of the developing world come

from the Institute of Health Metrics and Evaluation. This is open-source scientifically validated

data. However, in most of these countries, scientifically validated data is not available. Most data is

provided verbally and scientists and healthcare providers have to rely on that. You also have to

realize the logistical issues. Africa is a huge continent with the infrastructure of the European

Middle Ages. Delivering perishable vaccines in remote areas is still a major challenge.

Then Cohen asked Palmer what investors need to consider regarding cultural issues. Palmer said

that investors need to make sure they understand the priorities of the community where they want

to invest. “Share the metrics with the community; they need to know what is going on. Work

around the daily priorities of people,” recommended Palmer.

Dent then summarized the take-home messages. Scientists and investors need to find new ways

to approach the diseases that are neglected in developing countries, and they also have to think

in terms of solutions to deliver in remote areas. “Be innovative, create bright technologies” she

recommended. She also added that investors need to be flexible and work within the countries’

culture. “Do not try to establish a healthcare system like the one in the US in Nigeria” she stated.

“Use their platforms, their infrastructure”. Kenya, for example, doesn’t have enough physicians,

and parents are more likely to trust their kids’ teachers than some foreigner bringing in vaccines.

“You need to work within that system” she finalized. Vecchione agreed with Dent and added that

the technology needs to be effective and address the challenges within the established culture.

Palmer added that investors need to figure who wants to adopt their technology and why they

would do so. Zeldis mentioned an example that Celgene encountered some years ago. He said

that in Nepal they don’t practice medicine in the same way as the occidental world does, so when

Celgene sent treatments to Nepal, they were ineffective.

Vecchione reminded the audience that some common global diseases are treated as

emergencies in the US. For example, some time ago there was an outburst of insecticide-

resistant Malaria mosquitos in Florida and other states. This brought to light that the techniques

we have in the US and Europe to control those mosquitos do not work anymore in Africa, where

they are becoming resistant. Palmer mentioned that there is a need to find new antibiotics and

understand how they work more effectively and how to fight the transmission resistance. “These

questions have tremendous room for innovation” he said.

Then Cohen opened up the discussion to the public. Someone asked how interesting it would be

to find a way to diagnose autism at age 0. Is this relevant to the developing world? Zeldis

responded that mental diseases are actually very relevant because they are also an important

issue in these countries. The major problem is that they are very expensive to research because

they require lifetime treatment.

Another person from the public said that vascular diseases are the number one mortality cause

worldwide. He wondered whether there is a misalignment in research. For example, there is more

diabetes in India than in the US. Cohen responded that indeed, it is important to work on global-

local technology, to help solve local issues. Vecchione added that the world is flattening and

infectious diseases are expected to be eradicated, or at least be under control, in the next 20

years, and cardiovascular and mental diseases will become more relevant. Zeldis said that the

UN passed a resolution (valid until 2026) to approach some non-infectious diseases that are

becoming increasingly important. Palmer said that although “non-communal” diseases are related

to family and society, they are still as communal as infectious diseases can be and that a drug to

treat an infectious disease might be also effective to treat a non-communal disease. “You have to

stay open-minded,” he suggested.

Finally, Dent added that the system needs to be self-sustaining. The technology or innovation

needs to be as efficacious as it is profitable. Cohen ended the panel discussion by saying that

she hopes that the public sees global health as an investment opportunity, and she encourages

all to share their innovations. The secrets to success rely on working with the community and

addressing people’s needs through the country’s systems and infrastructure and, especially,

through the culture.