Glaudina Loots, Director for Health Innovation at the Department of Science and Technology
Moderator: Tian Johnson
Complied by: Anna Matendawafa – with inputs from Wilfred Gurupira & Maaza Seyoum
Webinar Recordings & Supplementary Materials:
Date: 15 October 2020
WHO Glaudina Loots is the Director for health innovation at the Department of Science and Technology and responsible for implementing the health components of the bioeconomy strategy for South Africa. She concentrates on enabling research and innovation that leads to discovering and evaluating new drug and treatment regimes, developing new vaccines, and new robust diagnostics for identifying diseases or conditions and the development of medical devices. The range of research activities that Loots encourages as part of the portfolio includes interrogation of indigenous knowledge, basic molecular science and genetics, chemistry and biochemistry, biotechnology, nanotechnology, nuclear physics, information communication technology, and manufacturing processes and engineering. Among others, Loots serves on the South African National Health Research Committee, the South African National AIDS Council(SANAC) , and is a ministerial committee on antimicrobial resistance. She is also a board member at the Biobank Institute, a public-private partnership aimed at the local manufacturing of vaccines and biologics
QUESTIONS AND ANSWERS
*This section contains a transcribed account of the Question and Answer Session
When the virus first came to our shores, we had no local manufacturing capacity for ventilators. And yet the health care demand for ventilators surged. But today, as we speak, South African designed and manufactured ventilators are rolling off the production line. Since that country, we know that thousands of non-invasive ventilators, the CPF ones you spoke about, are being delivered to hospitals and medical facilities. And this is all made possible by South African ingenuity and made by South Africa. So what would you say we’ve gone from this no capacity to produce these c pap ventilators to now having them coming off the production line? What would you say is the next innovation, the next big thing that is coming? In the foreseeable future in the next few months as a result of this ingenuity and innovation space? What can we look forward to? What can we anticipate? What can we begin to engage communities to start thinking about in the context of innovation and COVID?
So one thing that COVID has taught us very heavily is we let slip our manufacturing abilities because it was cheaper to import from India and China. And when there was the scare, we didn’t even have enough Paracetemol because India closed its borders. I think it came as a shock to several people when things like Panado, well, you’re not going to have sufficient Panodo, and people start thinking we do have the abilities in South Africa. So why do we not bring it together? And this is why we did the ventilators. This sort of we’ve got a powerful engineering group within the medical device sector and within the CSR and universities. And then that is what we brought in that together. Now the thing is, what do we do post COVID? How do we keep that momentum going and not just drop it off and go back to our dependency environment? But at the same time, we also then started to look at…………diagnostics and to what extent we can begin to manufacturing diagnostic kits in South Africa to not be dependent on imports, whether it’s from the US or anywhere else. So we are looking at the sort of medical device component, we’re looking at the diagnostic element, how to retain the momentum and the funding we’ve put enough. Simultaneously, we also are a different part of going forward, looking at manufacturing several essential drugs’ active pharmaceutical ingredients. So that we build that capacity, we’ve lost that capacity, and we need to start from scratch. So we got a different plan that we are building on their expertise sitting at University, and it’s some industry on actually then begin manufacturing some of the essential drugs. And so that we will not be caught short. We’ve got many capacities in Africa to formulate drugs, but not the actual to manufacture the actives, and the actives take up to 70% of the cost of any drugs. And so it is a business case for that. But we’re not only doing it on our own; we’re doing it within the Southern region and in discussion with the African Union to see to what extent we collectively across Africa can start building this ability to do that. South Africa is the furthest down the line concerning the manufacturing of active pharmaceuticals. Some other African countries are looking at…….secondary formulation and to at least strengthen that component as such. And then lastly, we are looking at the local manufacturing of vaccines. So, with Biovac, they do have. Biovac is partly owned by the government and then a private Consortium. And they are manufacturing one of the primary childhood vaccines….. that they got through the tech transfer process into start manufacturing. But it’s only the fault for finishing the formulation and finishing of that. So we also realized but we need to start looking at how we get the actives required for different vaccines. But this is pure like you need to look at the economics as well, to what extent does it make financial sense? And how can we roll out and make that capacity available across Africa? One of the main problems within vaccines is how they can manufacture the vaccine APIs. But the full finishing is one of the major bottlenecks. So Biovac, as such, is busy gearing up to take more oversized vials than the normal ones that they use so that we can manufacture up to 15 million doses of Covax vaccine within a year if it’s needed. So those these are all happening in the background to build that capacity for Africa to be more self-reliant on what we are doing.
Could you talk to us a bit more about what your regional work and partnerships look like? How are we as leaders as some of us as one of the only countries in Africa leading this work? How are we bringing the rest of the continent and us with this innovation and increased capacity and identifying opportunities to think out of the box to get answers to COVID?
So we work very closely with the African The Centers for Disease Control and Prevention (CDC) based in Kenya, especially around the vaccine, and to see to what extent, based on our experience, we can both the clinical trial abilities of our fellow African countries. So I’m part of the sort of CDC Africa union, COVAX clinical trial steering committee, to see how we can make sure that one or two countries do not dominate the whole clinical trial. Still, it is more equally spread across Africa and, at the same time, build that capacity so that we, fellow African countries, can also start doing that thing. Let’s go down to what equipment is needed in research facilities and community engagement because, concerning community engagement on a vaccine, South Africans are the leader. It’s been acknowledged that we are the leaders on that, and we honor to import that, how to do that community engagement. We were requested by CEPI (Coalition for Epidemic Preparedness Innovations) assist them in taking the modules that were developed as part of the HIV component and then do the training then of how to do that in community engagement, how to bring your community board, and that into your clinical trials. So it’s very much we’re looking at, on a moment on the vaccines’ health within a system with building the capacity.With regard to the manufacturing by Biovac on the vaccine side, Biovac is basically to a large extent leading the whole process on that, combined with Senegal and Egypt. So we are looking at what can be done in a short time, and then on, as part of the drug manufacturing component, we also have several discussions and add a new label on to see which country can do what with regard? And how can we learn from one another concerning how to start scaling up and what is needed and what is not needed? And what kind of negotiations Do you need to enter into? We’ve explored things around procurement and to what extent it makes sense and any ties back to having your collective voice around the prices of access to drugs and vaccines. And to start having those discussions about what is needed and what is a fee, and how we even take those discussions further. It’s a very delicate situation when you have to go to your originators and then start discussing with them, find what can be done and what cannot be done. So it’s very much within South Africa important, yes, but within the African context that we are doing those discussions as such. So we work very close to the African Union here. It’s also because President Ramaphosa is in the moment the chair. It made it so much easier than to have to start engaging in those discussions. One of the worrying things is when you start looking at COVAX; there are eight African countries that do not qualify to become part of that advanced manufacturing commitment. Where those eight countries need to find the money themselves, and it’s not only, there are several countries in South America, as well excluded from the benefits of it and you have to buy your space into the COVAX facility the same as what the UK or Germany or what will buy the space in. So you don’t have the money, but you have to compete at that level. And it’s becoming quite a problem for several countries as such, and how do you take this further?
The Department of Science and Innovation has redirected some research funds to COVID-19 related proposed interventions. Could you speak to what could be regarded as detrimental effects to the research where that funding came from? So you’ve moved funding who lost out because of this shift?
We were cautious. We looked at all the projects and the lockdown, which we had to hold on to for a period. None of the projects are actually some of them are postponed, and some of it went slower with some of them. So that excess money that was not immediately used, we then pull that into making that available for COVID. So we were cautious not to affect any projects as such that is being funded adversely. We also made additional funding available for a large project that was still in the design phase. And because of COVID, that would not have happened this year. We took that money in a relatively substantial amount of money. We then redirected that to COVID, so there’s nothing that’s being negatively affected because COVID just shifted the timelines. So we were very careful about that. As such, we made sure that people do not lose their jobs. I sort of checked on that sufficient funds available still, to ensure that people can carry on with their jobs, they might not be able to conduct the research or go into the laboratories for a period. But just to make sure that we don’t lose the expertise as such.
Could you unpack for us some of the indigenous knowledge systems work that the Department is currently undertaking? And I guess you it will be a two-part answer one generally and then specifically to COVID.
And we got a separate unit. One of my colleagues, Dr. Tshabalala, is specifically looking at indigenous knowledge innovation and starts looking at what medicinal plants are based on previous use. The knowledge from the traditional areas can be then repurposed for certain things. So they put several plant-based remedies that they are now putting through the process of actually doing clinical trials to show that it does have effect and COVID as such. So they also have several projects, looking at diabetes, getting a TB treatment based on your traditional remedies that have been around for quite a long time. But this is now to scientifically the invalidate. And so that people can claim that yes, Southern landia, or boohoo or whatever, honeybush but these things do have a medicinal effect, and it will not cause harm. So then that is what they are concentrating on. Dr. Tshabalala and some of his current contacts are closely collaborating with the World Health Organization and one of his colleagues. Dr. Matshidiso, from Free State University, is actually on this specific WHO traditional medicine committee. So they are very much involved also internationally, ensuring that people do listen to conventional remedies to traditional people’s knowledge. And we look from that. Fox, for example, the whole issue around the claims that were made with automation. And they are looking at yes, does it have a fit or no. Because we also have to do, for example, atomism, one of the essential things, it is still the main component for the malaria treatment in Africa. And if you suddenly start using it for something else, but you’re not sure if it’s going to use for that something else, you might create resistance. Then, that treatment for malaria and no treatment for malaria will then become obsolete. You need to find something else introduced for that. So you have to sort of make sure that your treatment tests address that specific disease and before you can start making those kinds. So he’s very much involved with that component and harnesses the knowledge to ensure that there’s also the benefit-sharing. One of these things goes further: the benefits go back to the community or the traditional leader. So that is the fundamental role that he is playing as such. I assist from the side. We look more at the scientific component, and there is not necessarily traditional knowledge involved, but we still do this sort of looking at specific plants. We use this, but we work closely together on how you can do these things.
So Glaudina COVID has come, and our world has changed. We’ve got the tsunami of research. We’ve got vaccine candidates on the go. We’ve got people looking at treatments, we’ve got movements, looking at PPE and access and equity and all of these things. So within this entire landscape and perhaps honing into vaccines. What keeps you Glaudina Loots, the most hope .what excites you? What trial, what innovation? What intervention has stopped you in your tracks, and you thought, Hmm, there is something here. in all of the noise, what stands out to you?
There’s no, I’m more from a skeptical perspective and say, give me the proof that it’s working. And to weigh through all the hype, it’s crucial not to clatch on to something and start running with it. From experience being down so many times that you think something will work, and then it stops the moment when it gets into phase two clinical trials, that it doesn’t do. The exciting fact is that we are starting to look closer at the genetic diversity in Africa. We cannot just copy from America or Europe; we have to make sure those things are applicable. There are so many of these drugs that in an African genetic component, they do not seem that we either have receptors that you, the disease does not attach to it. And this is what we need to understand what makes us unique, and why can’t we sort of apply a specific drug and expect the same outcomes? We need to make sure those applicable things are compatible with our genetic set up before subscribing to it. So the knowledge that we’ve started to create for other drugs, we now applying to COVID, to understand what genetic setup of different populations and you can’t just say this one is African, you know, you need to start looking at what is this bull? I this definitely good for us? Will it not cause harm and other aspects? Or will it have any effect? So there are many polls that we know that you might as well keep people smart, we have the better result. But the doctors prescribe it. So to me, COVID has sort of fast track that component; we start to look at the genetic setup and acknowledging that Africans are unique. Do not just say it works in the West; it will work in Africa, no. I think, and we need to acknowledge that.
Where would you place our performance as a country regarding how much we contribute to health RND, which global and regional declarations or targets are we meeting?
I don’t think they have such targets. Based on our experience, we are acknowledged as leaders in HIV research, and based on that; we are now involved with the COVID component and such. Still, we constantly are what I call punching above our weight on the scientific contribution South Africans are making. But it is essential that we keep that momentum and not let that slip and make sure that we teach the youngsters, they need to be at the same scientific quality as we advance. When you start looking at the sort of publications and things like that, it is this; if you compare it with the fellow lower-middle-income countries, South Africa is definitely off the top. Our universities are of a higher standard than many neighbors and so on. It is acknowledged, but how do we maintain that and not let it slip? That is one of the significant things to say .
Glaudina, so in terms of the department. The question in the chatbox, what are some of the standards used for community engagement? And by the Department and where can we find examples of these? Where have you seen examples of community engagement that have particularly excited you in terms of your work?
Let’s see, because we are not aligned Department. As I say, we do not provide services. Our community engagement is through our researches, it is through the work that the researchers are doing with the Medical Research Council and the Human Sciences Research Council, and so they are doing that. The only guidelines that we have been around the indigenous knowledge component on how to engage and make sure that people are treated fairly. And that is the one area where the Department is taking the lead on that. The rest is through looking at what is best practice concerning research. And make sure that is the ethics component is rolled out as such. I’m also a member of the National Bioethics Council. And we had not too long ago, a whole discussion around corruption and how it affects the healthcare workers and the communities. And so we have those discussions, and we are open about it. And because we do not, because we sort of look at a broader perspective and not bogged down by the day to day service delivery, we can have a sort of more looking to what is, how do we engage in those discussions and taking it forward? We are planning to have another one specifically around the ethics around access, and what’s fair?
Could you speak a bit to and I guess this ties into another question in the chat? And it could just be some of the Department’s work around gender and racial transformation within the Department and what your views are in leading that road to a place where we see the fabled South African institution that is genuinely transformative.
Yeah, so when I started at the Department, I was part of the Woman in Science Group and brought together. At that stage, we started then just acknowledging the role that women are playing within the scientific environment and the engineering environment and begin to make people aware that when you design research projects, you have to include the voice of woman into those research questions, that to an extent this becomes standard. Now, as part of the research projects that we are funding. You need to say how you address issues around gender; how do you address issues around transformation? So when we fund research projects, we also say that if it is established, research it to what extent does that research project actually include young black researchers, enabling them then to be able to build their side capacities and learn and to add. We’ve got precise instructions to make sure that we build the capabilities across the board. And if you start looking at how the CSR transformation is happening, you will start seeing it coming through. You also start seeing it at some of the other research councils that we are responsible for to see to what extent we are acknowledging that the expertise is not sitting in one group. We need to recognize many very fantastic people and make sure that they like to go forward. So it is very much built into we have to report on it quarterly. And what are we doing to transform the sciences and transform to the number of X amount of black scientists? But the science questions should be relevant to the society in South Africa. And what are those questions that are pickable? Would it benefit the community in South Africa? So it’s the whole being sensitive to where we are? and have those discussions.
What has been the role of the Department of Agriculture, Forestry, and fisheries? If you can speak to this at all, in approving the investigational vaccine input for trials, as seen in Oxford COVID-19? Could you talk a bit more about how that came about?
Yeah. Well, that’s a million-dollar question, that one. When a company wants to bring a vaccine into South Africa, they need for clinical trials; they need to have two permissions. The one is from the South African Health Product Regulatory Authority(SAHPRA) for the clinical trial to happen in South Africa. And the second one is then actually to get a GMO certificate that their vaccine is safe. And that they feel it will not cause harm from a genetically modified component as such. So for any vaccine trial to happen, they need to have both certificates. So it’s from safety for human health, but also from genetic modification, it will not harm nature or that it is not something that can spread beyond what is the intended purpose. So the Department of Agriculture has been specifically looking at the GMO component of that. Department of Science and Innovation is the committee’s co-chair to ensure that these issues are being addressed. So I don’t know which component they want. If anybody tries to do a vaccine and does not go through both processes, you will not be allowed to do any vaccine trials.
Do you have any specific calls for the participants?
I think I would, and if it’s possible, I would appreciate it if people can drop on social media or your system that you’ve gotten. To please tell us what the burning questions on the research side are? What I think that we should look into to see if we can find answers for that. What are the things that we need to start answering? And I would appreciate it if we can have those burning issues. If you can assist me in getting those burning issues together, we can start looking at it and see to what extent we are doing some of it, and then we need to be more open about it. Or it’s questions that we haven’t even thought about. So it is on your biomedical components, but it’s also on your community components, and what are the issues that we feel that we’re not attending to, and that could cause harm? If we don’t do that, we appreciate it if that can be seen through?