Emilie Alirol is a biologist who pursued her career in clinical research. Today she is Associate Director at the Medicines for Malaria Venture (MMV). On this episode, Emilie shares with me her experience on leading projects in resource-constrained settings, mainly focusing on infectious diseases. We also talk about the future of public health, plus Emilie gives some advice to those eager to start a career in clinical science.
At the end of the show, I ask all my guests the same set of questions to get a sneak preview into their favourite music or books. Here are the links to Emilie's answers. The song she constantly listens to at the moment is 'Over the Rainbow' by Melody Gardot. The music that particularly resonated with her at a specific time in her life is from Radiohead. Her all-time favourite book that she absolutely recommends is L’usage du Monde by Nicolas Bouvier (English-language version with the title The Way of the World).
If you want to follow Emilie on social media, this is her channel: LinkedIn.
In case you wish to have more information on the organisations mentioned in our conversation, here are some useful links. The World Health Organisation (WHO) where Emilie served as vice-chair for the ethics research committee. The Drugs for Neglected Diseases Initiative (DNDi) that Emilie talked about. The Global Antibiotics Research & Development Partnership (GARDP) where Emilie worked before joining the Medicines for Malaria Venture (MMV). The Foundation for Innovative New Diagnostics (FIND) and the Access to COVID-19 Tools (ACT) Accelerator that Emilie spoke about.
Hi everyone, and welcome to narratives of purpose podcast, a place where we discuss how ordinary people are making extra ordinary social impact. My name is Claire Murigande, and I am your host on this show. On today's episode, my guest is Emilie Alirol. Emilie is Associate Director at the Medicines for Malaria Venture (MMV), based out in Geneva. Today, we will speak about clinical science, anti microbial research, and neglected tropical diseases. As you can see, it's a healthcare related conversation. And I'm very excited to share the discussion with you.
Hi, Emilie, welcome to the podcast. Thank you so much for taking the time to have this conversation with me today. It's great to have you on the show. So first things first, how are you doing today?
I'm doing very well, thank you. The sun is up in the sky. It's a very nice day. So everything is alright.
Great, perfect. Now let me start with a few words of introduction on your background. So you're a biologist you studied at the University of Geneva, you hold a PhD in cell biology. You also have a Master of Science in Epidemiology from the London School of Hygiene and Tropical Medicine. You started your career after your PhD in Clinical Research at the University Hospital of Geneva. And you also worked at Doctors Without Borders, or Médecins Sans Frontières in French. Then you joined the GARDP, which stands for Global Antibiotics R&D Partnership, as project leader, you worked there for a few years, until very recently, just a couple of months, that you have a new position as Associate Director at the Medicines for Malaria Venture (MMV). So we obviously know each other from our studies, because I'm also a biologist. And I recall visiting you for a few days, I think it was in the summer of 2004, in northern Italy, Cordova where you were doing your PhD. And I have to say I was really amazed and impressed by all the activities that you were doing, and the hard work and dedication that you're putting in your studies. I wanted to know what brought you to focus on HIV research, neglected tropical diseases from the very beginning of your career.
So I guess the answer is to be found in my childhood. I somehow had a different childhood. Although you know, today, maybe it's not that unusual for some people, but I was born in France. But very quickly, I left France with my parents and went to live in several countries that are classified as low and middle income countries. So I spent part of my childhood in Peru, in Senegal, and in Nepal. And very early in childhood, I became aware that I was actually born in you know, on the right side of the fence, I was pretty lucky to be born in a European family with a good social economic status. And living in those countries, I quickly realised that a lot of people didn't have the same luck as I had. And this notion that globally there are wide disparities among people among children and other populations was something that accompanied me since then. It's true that when I grew up and started my studies, I became very interested in life science. I was and I'm still fascinated by life and its multitude of forms, and in particular, by pathogens, viruses bacterias. And parasites are very simple forms of life. Yet they can bog down entire societies as we currently experience with COVID-19. So I was fascinated by those very simple forms of life and how they could affect human beings and yield to diseases. It became quite obvious after, you know, during my studies during my PhD, that I wanted to find a job where I could contribute to improving the faith of populations in LMICs (Low and Low Middle Income Countries), just to give back a little bit of what I had the chance to receive. So, you know, for me, working on NTDs, on infectious diseases on HIV enabled me to, at the same time, satisfy that aim that will, I had to make a difference for the most deprived populations, but also it coincided and it fitted well with my interest for for pathogens. So that is where, you know, I started to look for opportunities in HIV, in particular, and also other diseases that primarily affect neglected populations.
That's really fascinating and really interesting. Can you just precisely mention infectious diseases, HIV and NTDs? What are NTDs exactly?
so Neglected Tropical Diseases, NTDs are a group of 17 diseases that encompass a variety of pathogens. They are prevailing in tropical and subtropical areas, and their burden is huge. According to the latest global disease, Global Burden of Disease Study, about 1 billion people globally are affected by them. And so they encompass diseases caused by viruses by bacterias. And by parasites, they're found mostly in resource poor settings,
I have to ask you if this has been intriguing, or I'll say wondering about the term neglected. Can you tell me why they're called neglected diseases?
Well, historically, they were called neglected diseases, because they were not the subject of great attention, be it from the research community, or from policymakers and people involved in setting priorities for health interventions. And they were often put at the very last position in the priority lists when investment in health was to be considered.
So one of these diseases is Ebola. And while I was reading through your profile, I saw that you mentioned something about the outbreak that took place in 2014. You wrote that during this Ebola outbreak, you advised MSF, so Doctors Without Borders, on matters of research ethics and implementing clinical trials? How did you come to develop expertise in ethics?
Well, as I started my career in NTDs, and HIV, I, as I mentioned before, my main drive was really to address unmet needs and address in particular needs of neglected populations. That entailed working in settings where very few health infrastructures had very limited resources, and that came with a number of challenges. In particular, when it came to ensuring that your research ethics was respected. That scientific rigour was respected. So very early, after I had joined the Geneva University Hospital, I volunteered to become a member of an ethics committee. First, I joined the Ethics Committee of Internal Medicine at Geneva University Hospital. And then a couple of years later, I joined the WHO ethics Research Committee, and that committee oversees all the research that is supported or funded by WHO globally and that is where I learned a lot about the key principles that have to be respected when conducting research in vulnerable populations. So I stayed with the WHO for about six years, including three as the vice chair and this is where I gained, you know, insight into research ethics. And that is what probably positioned me quite a well at MSF to advise on how to do research in Western Africa during the 2014 Ebola epidemic,
Wow, that's quite an impressive track record. I mean, being vice chair of the World Health Organisation Ethics Research Committee, that's really impressive. And you did earn your place as being an advisor to MSF during the Ebola outbreak. Now, let me just touch upon another point that I'd like to have your opinion on. I also have a bit of background on ethics and running trials. But my experience is more about running trials, I would see in the Western countries or rather more in Europe. So for my experience, what is the fundamental difference, or the fundamental differences, I would say, between running a trial in West Africa for Ebola, and let's say running a trial in Switzerland, I know it's quite an extreme example, but just to have your take on that
There are a number of differences, the two that come to mind are the following. The first is the vulnerability of the population. So oftentimes, people affected by neglected tropical diseases or by diseases such as Ebola are much more vulnerable due to their economic situation, but also, they might not have the same education levels as populations in rich countries. And that creates the need to protect them even more from research misconduct in particular. So their ability to consent to studies to understand the complexity of what is being investigated. And their ability to make a truly informed decision to be part of a trial is something that needs to be really evaluated carefully. The other aspect that is fundamentally different is that clinical trials conducted in Western countries often happen within a health system that is pretty strong, with good quality of care, access to health insurance, and the like. So patients that participate in clinical trials also have an alternative that is a good alternative. If they don't want to be in the studies, well, they will still receive care, they will still have access to medicines and the like. In resource poor settings, it's much more difficult. And so there is also a risk when you conduct trials in such situations, that you actually create undue incentives for participation. So those are two aspects that are fundamentally different. But there are many others.
Yes, absolutely. Very insightful indeed. Now, moving a bit further into your career. I previously mentioned that you were part of the GARDP, what is the purpose of this organisation?
So, GARDP is a joint initiative between who and DNDi the Drugs for Neglected Disease Initiative. It was created in 2016 and was incubated for a couple of years by DNDi. The initial idea behind GARDP is to create an organisation that focuses on developing new treatments for infections where antimicrobial resistance has become a serious concern. And GARDP adopts a model that is similar to other product development partnerships such as DNDi and MMV. This model is based on very strong partnerships with pharmaceutical companies, but also public actors, so NGOs, academic organisations and other international organisations. The idea is to leverage public funding to be able to develop treatments for indications that are traditionally not commercially interesting for private actors. And so GARDP has partnered with several pharmaceutical companies, mainly small biotech companies, to be able to develop new antibiotics where the need is arising due to drug resistance
and what was your role exactly as project leader,
I was leading the sexually transmitted infections programmes, which is a programme focusing on drug resistant Gonorrhoea. We had one new chemical entity that was the primary focus of the programme, which we developed in partnership with entasis therapeutics. It was a very and it is still a very promising drug candidate. But the STI programme also looked at other antibiotics that could be either repurposed or further developed with the idea that STIs in the community are treated syndromically, they are treated, often time without knowing what pathogen is causing them. So it was a very interesting and very much needed programme because Gonorrhoea is really nowadays causing a lot of concerns in terms of drug resistance. And the current treatments are gonna become useless in a few years time.
So you just mentioned drug resistance, becoming increasingly a major concern. And it's true, this is something that, at least for now, in terms of awareness is not really front and centre. I mean, not everybody is really aware of that. But as you said, it's going to be really an increasingly an issue globally. So this is really real. What's happening there?
Yeah, it is real, and I mean, AMR affects all countries globally. But definitely the impact on the poor population is greatest. And there's been a lot of research around, you know, how AMR actually contributes also to poverty in those diseases in the countries that are affected. It is true that we don't, we don't talk much about AMR, although it has come up in the global health agenda over the last few years. It is indeed a very, very difficult problem to tackle because we still have antibiotics that work. Thank God. But the main issue is that the market for antibiotics is completely broken. It's dominated by generics. So antibiotics are often very cheap. Antibiotics are used for a number of indications. So volumes of sales are very, very high. And so for any new drug entering the market, it is very, very difficult to compete with those existing products. And the reality is that as AMR is progressing steeply and constantly, there's a need to find new treatments, if we want to anticipate the situation where the current tools won't work. And as you know, developing new drugs takes a lot of time.
And now that we are all facing this pandemic with COVID-19, Do you think that the fact that the focus right now is on this specific virus, that this will either increase awareness about all these infectious diseases as you mentioned before, you know, parasites, bacteria, viruses, and so on, to a much broader extent? Or on the opposite, this might actually push back these other diseases which are still present in terms of awareness?
It is definitely true that what is happening with COVID has a lot of similarities with what could happen if AMR, you know, progressed. And we see that already, in some instances, there are infections that can no longer be treated. If you think about neonatal sepsis for instance in some countries, a very large proportion of the infections have become resistant to the first line antibiotics. So the reality is very similar, this untreatable disease notion is clearly something that we're experiencing with COVID. But it's certainly true for some bacterial infections that there's a point to be made and there's a parallel to be made. However, the ability of public and private investors and funders to invest in AMR is really a question mark today, there's an enormous amount of funding that is now focusing on COVID. And addressing the pandemic, you probably learned about the ACT accelerator. And I believe, WHO estimated that $38 billion will be necessary to fund the ACT accelerator, all that money may be diverted from other health problems, including AMR. I also think that countries will have to address the economic crisis that will follow the COVID pandemic. And the amount of funds that will be available for AMR research in the future will also depend on the country's ability to first tackle the economic consequences of the pandemic.
Alright, let me just pause here and rewind a little bit. You mentioned two terms, I just want to make sure that our listeners fully understand what those were. So you spoke about neonatal sepsis. Can you just explain exactly what that is? What condition is that? And then you talked about ACT, please expand a bit on that
neonatal sepsis is a condition that affects neonates in the very first days and weeks of life. It can be caused by a variety of pathogens, a variety of bacterias and some of those bacterias such as Acinetobacter Baumannii have become resistant to most antibiotics used so far. And there are studies in India and other LMICs that show that the current first line antibiotics that are recommended by WHO are no longer working and that the the bacterias are resistant to those antibiotics. It is believed that neonatal sepsis now is one of the prime contributors to neonatal mortality, and that in order to be able to achieve significant improvement in neonatal mortality, neonatal sepsis has to be tackled, and new treatments have to be found. Now, the ACT accelerator is a global initiative that aims at developing tools to address COVID pandemic. There are three components: one is on vaccines and other one is on diagnostics, and the last is on treatments. A number of countries have recently announced that they would contribute to the ACT accelerator and fund part of the research and development activities that need to take place to find these new tools. However, I just read yesterday that we are very far from the commitment that is expected. I mean 38 billion is certainly a very, very high figure.
Yes, absolutely. 38 billion is quite a high figure indeed. I agree. You just addressed vaccines there. And I'd like to jump on the opportunity that you're currently working at medicines for malaria venture and ask you this. I was reading about a project last year's clinical trial, which is run right now in three African countries, namely Ghana, Kenya and Malawi. And it's a pilot project on a malaria vaccine. And it's a trial run in children up to age two years old. So do you know about this project, and can you tell me how it's been going on so far?
It's not my primary area of expertise, but from what I know, the existing vaccines focus on Plasmodium Falciparum and not the other species that can also cause malaria. Those vaccines have been tested extensively in Africa, in particular among children, and they have received marketing authorization. However, the protection that they achieve is not very high. So control of malaria and elimination of malaria cannot rely exclusively on those tools. And definitely other approaches have to be followed, including, you know, use of bed nets and prevention of infections through bed nets and spraying, but also treatment of dormant forms of malaria, and particularly those caused by Plasmodium Vivax.
So, you're sharing a lot of valuable insights here, and I'm really learning a lot. Thank you so much for that Emilie, now looking forward in terms of public health and the future of public health, how do you see this area evolving from, from your perspective, from your expertise, which is more research based?
I believe, you know, those tools that are developed by the private sectors do not entirely address the medical needs of our societies. The R&D efforts, driven by pharmaceutical companies, have largely focused on diseases that could bring some return on investment. But we see today, and that is not only the reality in LMICs, but it has become the reality also in rich countries with AMR and COVID. There's a need for other actors to step in. And to develop these new tools. Definitely, in my opinion, treatments, diagnostics, and vaccines should be considered common goods. And there's an urgent need to reset the whole system, and how we, as societies, develop the innovations that are required for everyone to have access to proper care. So organisations such as MMV, such as GARDP, DNDi, and FIND have really demonstrated that it is possible to develop new medicines, new diagnostics, that address those medical needs. And I do believe that the future is really in those types of entities that address needs that may have not been addressed by private companies.
So do you see more and more collaboration taking place between pharmaceutical companies and basically the private sector and these entities that you just mentioned?
I hope that funding is going to increase for those entities because you know that developing new treatments and new diagnostics is extremely costly. Clinical trials are not cheap. And so the investments that are required to develop those new tools are significant. And without proper funding by philanthropic organisations or by public money is really required
I fully agree with you that funding is really key in moving forward, it will continue to be key as well. Still looking forward to it. Now. What would be your advice to young people who say, you know, I'm really eager to pursue a career in life science more specifically in clinical research? from your standpoint, what would you advise them,
I believe that people who have an interest in clinical research or in public health, very early on should pursue that interest, it's very rewarding. From my perspective, and I can only talk about myself, what is absolutely key is to be able to stick to my values. And that is what I enjoy in my work is that I've always put patients and unmet medical needs at the centre of my professional choices. As an individual, it matters a lot for me to do something everyday in my life that can actually contribute to a greater benefit. And my advice to young people is really to never lose sight of their values and what is their driver? Because this is where you achieve the best. This is where you develop what is the most important in my opinion?
Well, I have to say those are really wise words and great pieces of advice. Thank you. We are unfortunately reaching the end of our conversation. But before we part, I would like to ask you a few short questions that are a bit more personal, not necessarily related to what you're doing right now. And you can choose basically, between either books or music. So let's get started. First question, what are you listening to non stop these days? Or what is the book that you are reading right now?
listening to Melody Gardot, Somewhere Over the Rainbow. That's a very old song that was written in the 30s. And Melody Gardot's interpretation is really really nice. So yeah.
All right. Second question. Do you have a song or an artist or a band that particularly resonated with you at a specific time in your life?
When I was doing my PhD, and when I was studying in Padova, in northern Italy, I listened a lot to Radiohead. That's one of my favourite bands. And if I look back to these years studying at university I really already associated with Radiohead.
Third and final question, what is your all time favourite album or book that you absolutely recommend?
My all time favourite book is L’usage du Monde by Nicolas Bouvier (English-language version with the title The Way of the World). It's a wonderful book, it's actually that book that gave me the flavour for travels and, and for meeting people in different places with different cultures, and different ways of looking at the world.
I have to say it is a great book, I read it twice. So it's also one of my favourites. I will make sure that all this information is available on the podcast page so that listeners can go back and check the book and the music that you just told us about. Emilie, thank you so very much for taking the time to discuss with me today. It has been a great pleasure catching up with you after such a long time. final final question before I let you go, what can I wish you for the future?
Well, I guess to be able to always be present for others, and for myself. You know I'm getting older and turning the 40 year old crisis milestone. Pay attention to the moment that you are presently living, pay attention to the people around you and not be you know, travelling to either your past or your future. So yeah.
Well then I wish it to be more present in the future. Thank you, Emilie.
Thank you so much, Claire.
That was episode two, a conversation with Emilie Alirol. Emilie is truly a great person, open and generous and an inspiring professional attached to her core values. Thank you so much for tuning in today and listening to the episode. I really appreciate you taking the time. You will find all relevant information on this episode, on the podcast page here is reference narratives-of-purpose.podcast page.io. Until the next episode, take care of yourselves. Stay well and stay inspired