Dreams and Reality
Sitting Down With: Bernard Pécoul, Executive Director, DNDi, Geneva, Switzerland
Angus Stewart | | Interview
How did your career begin?
Upon completing my training as a doctor, I applied to Médecins Sans Frontières (MSF/Doctors Without Borders). I intended to join for six months, but I stayed for 20 years, eventually becoming its Executive Director in France! With MSF I worked in dangerous situations across unstable regions such as Rwanda, Somalia, and the borders of Honduras and El Salvador. Often, I saw patients who were affected by infectious diseases and without appropriate treatment. The contrast I witnessed at this stage in my life – between my experience in hospital in France and what I faced abroad – stayed with me and influenced everything that followed.
What are the origins of DNDi?
At one critical moment with MSF, we were using an arsenic-based treatment called melarsoprol to treat sleeping sickness. The toxicity killed one out of 20 patients, but we had no other option; it was the only drug available. It was absolutely unacceptable and we wanted to come up with a better solution. We evaluated the existing research and development for neglected populations and documented the lack of investment. Following this, we created the Drugs for Neglected Diseases initiative as a body that would at least try to demonstrate that another way was possible.
And we succeeded! We proved the viability of a model that is smaller, more collaborative, costs less, and can prioritize neglected patients’ needs.
Is DNDi as concerned with neglected regions as with neglected diseases?
For me, “neglected disease” is an important concept, but so is “neglected people.” These are people whose medical needs do not attract investment from the classical model because of a perceived lack of return on investment. Of course, poverty is the central problem. In the last two decades of the 20th century, medical science made great progress – but for whom?
How do you work with the pharma industry?
DNDi began as a dream. In the early 2000s, some said we would never convince a pharmaceutical company to join our project – but, ultimately, the opposite proved true! There is a massive inequity of investment in neglected diseases and regions, and this has given us the credibility to attract the partners we wanted.
To share one example, with a pharma partner, we developed a response to the sleeping sickness crisis by combining two existing drugs developed by companies that are today part of Bayer and Sanofi. Together, we developed a first combination to improve the situation slightly, but the treatment remained very complex. So we continued our research and selected totally new drugs.
The first was fexinidazole, a product developed in the 1980s and abandoned because of lack of profitability. Eventually, we presented a full dossier to regulatory authorities in Europe and Africa. The product now is used as a 10-day oral treatment in Africa. We brought in a pharma company partner, Sanofi, to work together with relevant partners in Africa – particularly in the Democratic Republic of Congo and Kenya – and with several public institutions in different parts of the world to achieve our goal.
We are also completing the development of a new chemical entity called acoziborole, a single-dose oral treatment that can be administered at the point of diagnosis, even in the most remote places. Since humans are the only reservoir of the disease, it will contribute greatly to our efforts to eliminate it. This project is also in partnership with Sanofi, among others.
How do you build relationships?
New technologies and the internet have improved our capacity to work as a “virtual” model but, if you want to build strong partnerships, you need to do it offline. Opening regional offices and networking platforms to be closer to patients and their reality has always been part of our strategy. You cannot perform a clinical study on your screen!
Where would you like the next generation to carry the baton?
We need to stop thinking about innovation as something Europe, North America, and Japan bestows upon the rest of the world. Asian, African, and Latin American groups will increasingly lead – of course, they will still collaborate with partners in the global North, but in a leading role.
In terms of processes, I hope open-source models succeed. At DNDi, we brought eight companies together to share their libraries of molecules for neglected diseases. They’ve pooled resources on the condition that, if something comes from this bank of chemical compounds, it will be made available for development. I hope the next generation of researchers adopt models just like this.
What role should the state play?
In the private sector, we need to work with various companies. But, for the public sector, we need governments that are engaged in their responsibility to deliver public goods. Without commitment from governments, partnerships with academic institutions will not suffice. Whether the partner is a Ministry of Health or a Ministry of Research, it is a political power in the country and its commitment is crucial for our projects to succeed.
If you had never joined MSF, where would you be today?
Before leaving for that originally planned six months, I had expected to continue my career as a medical doctor. In fact, I had even begun to specialize in nephrology. I always tried to maintain contact with nephrology but, year after year, my involvement in public health replaced it. I even stopped for a year to study for a Masters of Public Health in New Orleans; after that came the next stage of my life, finding new ways to implement the lessons I learned in my youth.