Dr Noubar Afeyan: “After enduring millions of deaths, we can’t go back to live our lives normally.”
GP podcast on Moderna's fight against the Corona pandemic and on revolutionising our health care system
Dr Noubar Afeyan is an entrepreneur, inventor and philanthropist. As co-founder and chairman of Moderna and founder & CEO of Flagship Pioneering, he has been crucial in the development of the coronavirus vaccine and is revolutionising our understanding of healthcare through his ventures. As co-founder of the Aurora Humanitarian Initiative, he awards the Aurora Prize, the Nobel Prize for Humanitarianism, every year.
Elhadj As Sy is a humanitarian aid expert, chair of the board of the Kofi Annan Foundation, former UNICEF Director for Partnerships and Resource Development and former Secretary General of the International Red Cross and Red Crescent Movement.
Recording of the podcast
In the third episode of our new season of The Africa Roundtable – The Podcast, we talk about the technical masterpiece of the COVID-19 vaccines, Moderna’s commitment to make patents available to the public, pharmaceutical production in Africa, Flagship Pioneering’s vision of a new, preventive understanding of health care, challenges of health care in African countries and demands to the new German government.
Read the full transcript of the podcast here:
GPI: Vaccination as prevention and protection against diseases before they break out. Vaccination in Africa as a protective shield for the world. And what about health care in Africa? What does it have to do with Europe? We talk about this today. With our guests, Dr. Noubar Afeyan, co-founder and CEO of Flagship Pioneering, a company that does science, builds, funds and develops life science platforms to transform health and sustainability. The company is better known by the brand name of its vaccine Moderna. He is also co-founder of humanitarian projects, such as the Aurora Prize for Awakening Humanity. And we speak with Elhadj As Sy, chair of the board of the Kofi Annan Foundation. As Sy served as Secretary General of The International Red Cross and Red Crescent Movement. Health – our topic today. Welcome to a new podcast edition of The Africa Roundtable – The Podcast with Danilo Höpfner.
Dr. Noubar Afeyan, first, let’s talk about a simple idea: vaccinate before diseases develop. Do we need a shift in the understanding of healthcare, away from curing towards prevention and preparedness?
Afeyan: I think the notion of vaccination, which we usually think about only in the context of infectious disease. I think it would be better to think more generally about health. And how do we protect our health and how do we preserve health instead of waiting for disease to take hold and then try to combat disease? Sounds like a logical idea, but if you look at the reality of health care today, it’s largely about fixing problems as opposed to delaying or preventing them. And except for infectious disease vaccines, essentially there is no other way of doing that. There’s no way to do that with diabetes. There’s no way to do that with cancer or Alzheimer’s or cardiovascular disease. And yet, I think that the biological understanding, both in terms of identifying who is vulnerable to what eventual disease and the way to intervene exists. What doesn’t exist is either the societal demand for it, the government wanting to fund it and the regulators allowing for such interventions. Because I think people have historically believed that the only time to use any intervention is when somebody is sick. In fact, worse yet, the sicker they are, the more comfortable people are testing drugs and interventions, which seems illogical because the sicker they are, the harder it is to address the disease. So that’s the reality that we find ourselves in here in the 21st century, and I think that it’s time to take a major relook at the pandemic that we’re enduring, certainly exposed just how vulnerable we are. And we were vulnerable not just to the infectious disease, but to these interactions between our underlying health or disease states and such an infection. So, whether you’re obese or whether you have hypertension or diabetes as comorbidities, just expose further what kind of price we pay if we only concern ourselves with treating disease instead of the upstream free treatment what I call of disease before it happens.
GPI: I can imagine that that will be a big change for many people regardless of whether they are in Africa or in Europe. A totally new way to fight diseases. Perhaps associated with skepticism, not to wait until people get sick, but to vaccinate preventively, beforehand. Wouldn’t it take generations to convince people here?
Afeyan: You know, pandemics are a pretty good way to convince people because what we’ve just gone through in the last two years and what we’re continuing to go through is such mass destruction that everybody lightly compares it to a war. But there are few wars that have had this type of casualty in our history. And the notion that such a war would happen and then we would go back to business as usual, whether it’s in the way we treat people or treat disease, I would find that an equally skeptical thing to do. So yes, it’s a big change. But again, I want to clarify the word vaccine that you’re using could be a literal word. You know, a shot in your arm. Or it could be metaphoric, which means some way of intervening to delay or deter the disease. It’s not always going to be in a shot. It may not always involve your immune system, but that it can be done, and it should be done. I think is a natural consequence of such a pandemic. As I’m sure you know, the reported numbers of 5.3 million deaths are, by any measure, a major undercounting of the actual deaths. The estimates of excess deaths in the world are closer to 15 to 20 million today that are unexplainable spikes and deaths during this exact period, which are most likely due to COVID directly or indirectly. So, after enduring either five and a half or 20 million deaths, the notion that we would say, OK, now the snowstorm is over, we come back out, and we live our lives normally. I find that to be a very, very disappointing and in fact can be controversial, disrespectful attitude towards the people who lost their lives and could have been prevented.
GPI: Let me ask the question of how to vaccinate the world, looking at current developments and the role of the Global South? And how Moderna is involved in this big and important task?
Afeyan: Well, now speaking about vaccines for infectious disease and in particular COVID-19, clearly the there’s a whole continuum that goes from the research development that leads to creating a new vaccine to the clinical testing of that vaccine, which is done both in our case in the US and elsewhere. The production of the vaccine in small quantities at first in the large quantities later and then the distribution of the vaccine all the way until it gets into the arms of people and from day one. Our objective has been to make the design and make the most effective vaccine that has the longest possible effect and is as safe as we can make it so that we could reach the maximum number of people now towards that end. There’s a lot more than just manufacturers involved. There’s a large dependency on the governments, both in the producing countries and in the receiving countries and how they can coordinate that activity. And then finally, their scale up because you need to be able to produce large quantities. So how did the Moderna Act in this context? First, we scaled up our production from essentially zero. In other words, you may or may not realize that Moderna had no commercially produced product going into 2020. We end this year with over 800 million doses produced in a year, and next year we expect that will be two to three billion doses. That’s first. That is the investment and the risk of the technical feat of ramping up production to hundreds of millions of doses. Parenthetically, I’ll mention to you that there was no vaccine before the current COVID 19 vaccine that was produced at such scales. The biggest vaccine distribution out there is for seasonal influenza, and that was, you know, by various estimates, half a billion doses plus or minus. So, you’re looking at an unprecedented scale, not just by us, but also by others. That’s first. Second thing we did is we realized that many vaccines were completely a new approach. And while they may not have worked if they did work, they might also have been superior to other approaches. And so last October, October of 2020, before we had data showing our vaccine would be very effective, we unilaterally pledged that we would make our IP available without a consequence to anyone who wanted to use our emergency IP intellectual property patents. And we did so, enabling other people to enter the field, which they did. There are other mRNA vaccines that have been developed and that are being developed, and we took that step to clearly indicate that during the pandemic, we would not enforce our intellectual property. This is six months before anybody asked companies to do this forcibly, not just voluntarily. And we did it because we realized that we could never produce enough supplies to satisfy the world, but we were happy to see others step in and do that. A couple of other points we have continued to ramp up. We’ve made partnerships in Europe and Switzerland with a company called Lonza that has allowed us to add significant production. And that took us about nine months to put in place. But finally, we’ve got one of the leading companies in the world in terms of contract manufacturing that’s up and running and scaling up. We announced a couple of months ago a commitment to establish a plant that could produce many vaccines broadly, not just for COVID 19. That would be based in the continent Africa, and we are in the process of identifying the final location and making the arrangements for that. That will take another two to three years to establish. But it’s an important measure to ensure vaccine security in the future, even while we work on the present. And then the final thing we’ve done, and I think it’s the most important is that we’ve been working with the U.S. government as well as European governments to help redirect vaccine supplies, which they had secured and paid for a year ago already, which is occupying, if I can say, preoccupying the vaccine supplies in the world. To be able to redirect them to the countries that need them most, particularly in the continent of Africa. And I’m happy to say that that has resulted in 100 million doses being redirected from the US and several other European countries doing the same. And those would only be possible in collaboration with us because as the manufacturer, as the developer, we must ensure the quality, the pharmacovigilance that is making sure that on the ground, it’s safe in its use, et cetera. And so those are the steps we’ve taken, and we continue to take more steps. One last thing I’ll say, and I’m sorry, I’m giving you a long answer, but I think it’s important to be comprehensive is that as we look at the picture today, you know, we have seen reports of over seven billion doses being shipped so far of COVID-19 vaccine of all kinds and that supply is beginning to overtake the demand globally. That wasn’t the case three or six months ago, but it seems to be the case today. The question is, are those doses getting into arms? And we have said since September that for us, the concerning thing is that it’s one thing to make great pronouncements that big amounts of doses are being shipped. It’s another thing to have the coordination, the logistics, the education, the training to be able to get there and the willingness at the level of people to accept these doses. And that I think going into 2022 is our biggest challenge. Omicron, as a variant, is going to increase the threat, but the question is, are we ready to respond to that threat with all the things it takes to get shots into arms?
GPI: Noubar, during your career as an inventor, entrepreneur, and CEO, you have co-founded and helped build over 50 life science and technology startups. What potential do you see for startups in the health sector in Africa to improve the health system sustainably. And how is this interesting for you as an entrepreneur?
Afeyan: Well, look, I think that as the continent develops and adopts technology and as the education system and the health care system advanced to allow some of the cutting-edge frontier research to be done and development to be done, I think there are multiple things that can be done there. One of them is particularly focusing on diseases that are particularly relevant and making sure that progress is made there. It’s not an accident that this omicron variant was first detected through the great research done in in South Africa because they had the capacity to react to it with the best molecular tools. And so, we need to see much more of that throughout the continent. We see pockets of advancements in Rwanda. There are activities in Nigeria, other places that needs to be. That needs to be advanced. And I think a lot of that can be done through a cooperation between governments to try to get some of the educational capacity established. And then I think the conditions would be ripe for biotech to start taking hold again, likely initially focused on diseases that are very pertinent. Also, by the way, clinical trial capacity must be established so that people can participate there in clinical trials because often those clinical trials lead to new drugs that will then be used in places where two trials were also conducted. So, I think it’s going to develop as an important part of the future because I do think that planet’s health and people’s health are the two most important issues on our agenda today. And it’s a distributed problem and it needs distributive solutions, not central solutions.
GPI: Finally, the pandemic has especially affected African countries. Is there a need for more humanitarian aid and support? Especially from business and the Global North?
Afeyan: But there’s no doubt the whole globe has been thrust into a humanitarian crisis. And depending on the wealth and the means of the countries where this is happening, their ability to respond is quite mixed. And so, where there are needs, whether it’s fighting the infection or dealing with the aftermath or in other times, famine or in other times, war, and conflict, definitely it is in the world’s interest to share the responsibility. And often that’s done through a humanitarian intervention. You know, one of our projects, one of the projects I’m very proud of the Aurora Humanitarian Initiative has been engaging for seven years now in a variety of humanitarian assistance programs throughout the continent. But now the conditions on the ground have gotten even worse vis-a-vis this disease. So, we will continue to do that work. Even while absolutely, I think the recovery of from this pandemic, and we don’t even know exactly when we will be out of the woods in terms of the attacks has to start and has to continue and a much larger scale.
GPI: In times of Corona experts are regularly reminding people that there is a universal human rights to be able to access adequate health care. But this is not always guaranteed in the poorest countries in Africa. The African continent bears more than 22% of the world’s disease burden but at the same time has only 3% of the world’s doctors and health workers. These is what the figures of the World Health Organisation say. We must therefore talk about health in Africa. We will do that with Elhadj As Sy. He is a Senegalese expert for humanitarian aid, who was Secretary General of the International Red Cross and Red Crescent Movement for many years and is now, among other things, chair of the board of the Kofi Annan Foundation. As Sy, German virologists and medical professionals are never tired of pointing out that the pandemic will only be over when everyone has been vaccinated worldwide. With a view of Africa, we are far away from that. Ethiopia has a vaccination rate of 1.3 %. Other countries such as the Democratic Republic of Kongo at less than 0,5 %. There are still far too little vaccines available despite many promises. The African states are back in the line again. What is it? Is it vaccine selfishness? Is it vaccine apartheid as other say or has the Global North simply not learned anything about this point?
As Sy: That’s totally unacceptable. That is a totally irrational. You will have heard everybody saying the motto: “None of us is safe until we all are”, but this become sentimental only words until it is put into question. I think that is not difficult to convince and to give the reasons why it is important in a pandemic that having a global population vaccinated at a rate is much more appropriate protective than having in one place 80 % the rest 1 %. And the virus will be finding a fertile ground to mutate, to change and then new variants are coming and everything we predicted and what is happening. Well, the irrational behavior now consists of having certain countries having vaccines that could cover 150 % of the population. Of course, you know, we believe nationalism, we call it populism, we call egocentrism, but it is blood sucking. We use them in this time where we need solidarity and solidarity is not charity. It should be the right thing to do at the right time to protect us all. And I think everybody here has a role to play. We are one thing, of course, those who are rich enough that would be grabbing everything on the market. But we are pointing fingers to the African leaders that sort of get their priorities right, strengthen their health systems, invest in their populations, prepare for the hazards and making sure that they are on the multilateral settings, having their voice loud and deep in their pocket. Also, to get what is needed for their own population. We need a common platform where we all come together, but we still have a very long way to go.
GPI: Germany and many other European countries are discussing compulsory vaccinations and third vaccinations for everyone against the background of vaccination quote in the per mil range in many African countries, how do these current European discussions affect you?
As Sy: Well, this is going to be exacerbating the gaps in this type of disparities, which is going to be deepening the inequities that we see when with one dose and then on the second dose, we don’t even have a coverage that could be leading to 10 percent of the whole continent. Now we are talking about the booster and another booster. And every time a variant look like we are now experiencing with that omicron, there may even be a call for another specific type of vaccine or for another booster. And all of this will be exacerbating now the disparity in equities, you know that we see. Well, again, we must come back to reasons to be guided by facts, be guided by science, and then making sure that sharing of vaccine is good for everyone. It is also protecting those ones that are sharing and not only those who are benefiting from it because we are in a pandemic situation.
GPI: Health is a key prerequisite for stability in almost all areas of society. That is exactly what the potential landers of the Global North are demanding from the African States repeatedly: stability. What does this great shortage of vaccines mean for the political stability of African societies for example?
As Sy: Yeah. First, I think the African leaders must shift to take their responsibilities very seriously. A strong leadership that is accountable to their citizens and deliver to the promises that they make to them on the African continent. We need this strong citizenship that ought to be asking for their rights and challenging decision makers. Other priorities be set and separate that. If that doesn’t happen, trust will be eroded, and we’re at a time where trust is eroded between leaders and their citizens. But further, the same trust is being eroded at the international level because promises that have been made were not fulfilled well with established mechanisms such as COVAX right from the beginning. But we’re again at the end of the queue only when they satisfy their needs, and a modern day needs also to hoard and vaccines or put even export restrictions for their own domestic needs. And all of that will be contributing to the fragility and instabilities that we’re seeing everywhere. It is one thing to say: Let’s have stability, let’s work together. But when it comes now to common threats, you know that we are facing that. We all go back, you know, to our own geographic confines. And forget that it is exactly the time that we need the solidarity in this situation. We’ll be all safe or not. It is also the situation will be unprotected or not. In the situation, we will be all threatened by instabilities of all kinds internally, regionally, movements of populations, migration, everything else you know, will be coming to the fore and then further exacerbated. It is high time that we come to them and come together to have a global solution to a global problem.
GPI: Dr Noubar Afeyan, the founder and president of Moderna has announced a huge investment to start the production of its corona vaccine in Africa in the coming year. The goal is to produce hundreds of millions of cans on site. Is that enough?
As Sy: It’s not enough, but it is a first step and every step here is very much more welcome. Now we see that there is Africa is not producing any of the vaccine that it is using, and this must change. And this must change fast. Now we are talking about the lack of capacity. We’re talking about the technology that is not available, but the capacity can be built. Technology can be transferred. Provisions are there for voluntary licensing, but to spur participation of different sectors, including government, financial institutions and pharmaceutical companies is all of that is possible. And that first step is welcome, and there are certain countries already initiating action in that regard. South Africa, Morocco, Rwanda, Senegal and to see Moderna moving in that direction alongside others who have all promised already to work in partnership, such as BioNTech. That is a move that is very much welcome.
GPI: What about the readiness to vaccinate in the African countries. Is it now the vast majority who also want to be vaccinated?
As Sy: Well, Africans are used to be vaccinated really for the simple reason that many of the diseases that needed the vaccination were originating from tropical climate and in Africa is in that ecosystem. We’re used to that, frankly. Vaccine hesitancy is a very new phenomenon that has been amplified by social media. It is not led by Africans. It is led by Europeans and Americans using social media. You know, using digital means not to promote ideologies and ideas that sometimes may be attractive to Africans such as you’re being used as guinea pigs. You see, they are making the cans in your continent. But when the vaccine is available, it is being used in the north. We have not yet evidence that it is working, but they are forcing you to buy all this very populistic kind of statements and very dangerous a time criminal confinement echo among some Africans. But this is not the problem here. The problem is accessing the vaccines. The problem is building on the already platform of vaccinating and reaching out to the most vulnerable and hardest to reach like we’ve done in fighting tuberculosis, like we’ve done in fighting many other diseases including the Ebola outbreaks of mild fevers and all those other nasty bugs that we have. And that gives already a certain experience and readiness of the population to engage in it when it is available, and it is done properly through the channels about the domestic ones.
GPI: If we talk about health these days it is primarily about COVID-19 of course. But Africa has also completely different problems with diseases such as Malaria, Ebola, AIDS, and tuberculosis. Many tuberculosis cases are simply left untreated. What do the numbers say? More people are now dying from other diseases because all means are now being used to combat the corona pandemic.
As Sy: There is a double whammy there. You know, what is there are those diseases that are still there and then left untreated, left unfunded. And then at the same time, we have COVID that came and exacerbated in a turn where people are immunocompromised and then there is a fertile ground to develop those infections and then die from it. The other one is the fact that the health systems, that are quite weak, and then we have those number of people that are infected with COVID-19. There is not enough space and capacity in the health system to care for the other diseases. And that is a worldwide problem we’ve seen in Europe and in America that some of the surgeries were delayed and we’ve seen that many other health conditions will get treated and that situation is further even exacerbated on the African continent. What we need to do is, in our own ways, not to get to what we call the cycle of panic and neglect. We panic when we see something big coming and then we neglect what is happening. There is this subsides. We go to what we call business as usual until we get back to the next step is that there is a permanent need to continue to strengthen health system, need to strengthen the primary health care, permanent needs to address the pathologies and to prepare for the big ones. And I think on that basis we can have a response that is a sustainable one. What we would like to see in the continent, is that to run it in parallel, taking care of the health needs of the population anyhow, but also not to neglect them. You know, when we have the big problem that is a global one because everybody else is concerned about it. So again, domestic problems in addition to global ones. And together, building the strong health systems know for a sustainable response.
GPI: Interestingly there is a right of health in the Universal Declaration of Human Rights of 1948. There is a talk of access to adequate health care. How can the citizens, also in the poorer regions of the world, make use of this human rights?
As Sy: That is exactly what I meant by active citizenship. And, you know, holding leaders accountable to deliver on their promises, as is a political issue, is a rights issue and still active citizenship and accountable leadership should meet to deliver on that. And particularly if it comes to the health issues of our time, there are three pillars that are inevitable. We need the science to guide us, to tell us what to do and decision making should be based on that and not on other considerations like we’ve unfortunately seen more and more. We need leadership and good political leaders. Political leadership can either be part of the problem or part of the solution, the one we want in the one that is not inhibiting action. But it is one that is facilitating and contributing to solving the problems of the people. And then we need active citizenship, the claim for their rights and then hold leaders accountable to deliver on the promises they made. It is now the activism that we see in climate, the activism that we see in human rights. The same activism should go into the health sector so that the gaps and disparities be reduced and every citizen, no matter where they live, no matter what their socio-economic condition is. Have the same rights to health like everybody, and leaders should be held accountable to deliver on that promise.
GPI: In Germany we have a new federal government. What are your specific demands on the new government in this regard?
As Sy: First, over the last two years, Germany should really be commended for having health as an integral part of their diplomacy. Germany has been leading in health diplomacy in many ways, becoming a very active player, investing in multilateral organizations like WTO, like no other country having also sort of leadership in the G7, not to put it very high on the political agenda and in the bilateral programs, working also with countries who to support their health systems and upset of the development program. We hope with the new government that will be continuing and then further strengthened that the voice will not be lost either, be it in the show or in the United Nations, at large or in the G7. And we would really like to see that leadership continue and not be discouraged by these new challenges we face that can push us to go back into our national boundaries. And no matter how big the challenge is to remember one famous sentence from one famous lady that will be missing in Germany was that we are suffering this
GPI: At the end, I will now go back to the beginning of our conversation. We are familiar with sentences like “Corona can only be overcome if vaccinations are distributed fast worldwide. Even in densely populated Africa.” But when do you think it will happen? Will Africa decide the global outcome of the pandemic?
As Sy: Well, no. Africa will not decide the global outcome of the pandemic for many reasons. One is that Africa is has a very young population, and this pandemic has proven over these last months and in the last year that there is a kind of a demographic shift that prevented this epidemic from worsening the situation in Africa. If we did not have that, you know that the situation would be way more catastrophic. But in many countries, we have 70 to 75 % of the population, which is younger than 35 years, and I think that is one. The other one is that there is a population of exposed and experience in epidemics, and there are certain good things that happened in terms of early action and very courageous measures in very, very, very difficult situations that were taken. Well, all of that has so far, despite the low coverage of vaccination, helped the continent not to fall in the catastrophic situation or fear it is that of. Probably not. But we must build on that. You know, making sure that with the combination of investing and getting into the medical countermeasures, negotiating local production of vaccine and other also medical tools and all of that combined, you know, will help. I think the continent will continue to sustain this kind of a situation we have. But it’s being seen globally everywhere, and we have a low vaccination coverage and then we have weak health systems and immunocompromised people. It will provide a fertile ground for mutation of the virus and the emergence of new variants. And what does new variants come? If not, does not necessarily mean that they will be impacting Africans more than anybody else, but in the contrary, they may emerge from that, but then impacting the world one editor. So, we all have an interest to turn into re-election. What do you all say? None of us is safe until we all.
GPI: Elhadj As Sy from the Kofi Annan Foundation. Thank you very much!
Judith Ramadan, Project Management