Health Innovation investments & initiatives: Department of Science and Innovation

Meeting report

Department of Science and Innovation investments and initiatives in health innovation
Mr Mmboneni Moufhe, DSI Deputy Director-General: Technology Innovation, spoke about health innovation within the bio-economy; quadruple burden of disease in South Africa; health innovation opportunities; drivers of health innovation; convergence of technologies in health innovation; the DSI Decadal Plan in health innovation; diagnostic test for breast cancer; capacity development; global health innovation accelerator; Covid-19 research coordination and vaccine manufacturing.

In terms of health innovation opportunities, DSI noted the following points:
- Largest market in the world for HIV drugs,
- A well-developed generics industry,
- Flora and unique micro-organisms offer a largely untapped source of new therapeutics and production platforms,
- A genetically diverse population can be leveraged to provide new insights to factors determining health and disease, as well as prevention and therapeutic strategies
- Local biodiversity and indigenous knowledge systems could be combined to accelerate product development,
- World-class clinical sciences researchers and a regulatory framework provide opportunities for globally competitive clinical development,
- World-class researchers in basic sciences, drug and diagnostics discovery, and therapeutic delivery systems,
- Significant historical and new investments in vaccine production,
- Strategic international partnerships with countries and organisations, which could be leveraged to provide resource to drive research and innovation, infrastructure development and human capital development .

Mr Moufhe noted the DSI key achievements in the field (see document).

Discussion
Dr W Boshoff (FF Plus) was pleased with the presentation and said so much money is spent on social grants while this kind of work is ongoing because it could propel South Africa to a much better reality. He asked what the relationship was between this work by DSI and the scientific work done with animals on viruses. Is there some kind of synergy?

Ms J Mananiso (ANC) was also pleased with the presentation. We do not need to leave anyone behind when we discuss these issues. She was more interested in public participation on this and asked what DSI was doing in bringing everybody to understand the kind of work it is doing and how people can contribute in this space. Secondly, three sectors were identified – were the implementation plans and timeframes published and shared with the public? Has information progressed at the scale originally envisaged? What is the status of implementation in terms of its short, medium and long term targets? What are some key successes to date and how much has the DSI invested in these three sectors to date? How much has the Department of Health invested into health innovation to date? How much funding has been secured to date? Lastly, on page 28, how are monitoring and evaluation structures coordinating this strategy? Has a review been done on this strategy?

Ms C King (DA) said that in 2009 the South African pharmaceutical industry was estimated to be around R22 billion. How far is it from achieving manufacturing 25% instead of using imports? If you look at the 2013 report it states 80 to 90% of products were imported and it would like to reduce imports and have local manufacturing. On the manufacturing of local products, we have an Innovation cluster which was instrumental to ensure that – how effective will the cluster be in ensuring that we are a pharmaceutical friendly South Africa? Thirdly, how does the Innovation cluster differ from the state pharmaceutical company?

How much has been spent on research and development in the health innovation sector? We are not even reaching 1% of spending on R&D through DSI but then one wonders if the health sector itself spends more or around 1% on R&D.

Mr T Letsie (ANC) noted the new Covid-19 variant found in South Africa and many EU countries have shut the door on travellers from South Africa. This is not the first time this happened. We found a variant before and that also meant other countries closing the doors on us, which has a far bigger economic impact on South Africa. Is it possible that our medical researchers are so effective that we become the first country to identify these variants, which impacts negatively on us? Or do other countries also pick up these variants but choose not to make them public? Have we satisfied ourselves that we are 100% accurate about this new variant?

It was indicated a while back that South Africa would have a fourth wave by 2 December and it would last 75 days. Now we have learnt that there is a new variant and it looks as if this is pre-planned to ordinary people out there. People may think that we suspended Covid-19 because of local government elections. When these things come, they add propaganda. When exactly was the new variant discovered? Was it known before and kept under wraps or was it truly discovered conveniently after the elections?

Ms N Marchesi (DA) asked how the new variant was discovered. Was it discovered from a patient that was being treated or through other means? Secondly, on the mRNA technology for the vaccine, there are a lot of sceptics and it was not only ordinary people but people from the science fraternity as well. What is DSI doing to ensure that information is made available for people to have a clear understanding of how this technology works and how it is different compared to other vaccines? This scepticism was not only in South Africa but also in First World countries. Government is not able to communicate properly the message of encouraging people to vaccinate. What are we doing about the missing information to ensure that people have access to the right information that will encourage them to get vaccinated?

In 2018, South Africa was spending R45 billion in importing pharmaceutical products and 52% was on generic drugs. How much does South Africa spend on importing drugs now? Africa has asked that the intellectual property on the vaccine should be shared with the continent so that countries can manufacture their own vaccines. Even if the drug cannot be manufactured in the country, surely there is a scope to participate in the manufacturing of the vaccine. Is there any intention to do that? Is the amount South Africa is spending on Covid-19 research adequate?

We speak of postgraduate students, there must also be scope for people who are not necessarily specialised to take part in developing manufacturing capacity. This is a gap that could perhaps be filled by the private sector. What are we doing to ensure that international companies who are role players in the pharmaceutical industry are attracted to invest in South Africa? South Africa could look into the Irish model where it imported specialised people to come to the country and pass on those specialised skills and knowledge. Ireland was now in the top three in medical manufacturing but it was once where South Africa currently is.

The Chairperson asked about the IKS centres and the data that is coming in – are the numbers coming slow or faster. Are people utilising those centres? Is there substantive innovation coming from these centres?

Ms King noted the strategic plan states that South Africa will build its health innovation system using the quadruple model. Can DSI elaborate on this model?

Responses
Mr Moufhe replied that DSI presented in the context of health innovation investment. As this is related to bio-economy in general, it would require a detailed presentation on what has been done in agriculture and other sectors.

There was public consultation on the implementation of the Strategy and this was approved in 2013. It was a product of engagement with the public and all stakeholders. It was launched as a fully consulted document.

Monitoring takes a number of levels. The first is that on an annual basis a report is compiled on impact. For example, on vaccine manufacturing, we were going to start with backward integration – starting by doing packaging and distribution. From this, we would move to ‘fill and finish’ and then into manufacturing of active pharmaceutical ingredients. Through the partnerships and ownership of shareholding in Biotech, it was announced last year that through the partnership with Pfizer South Africa would then lead to local ‘fill and finish’ of the vaccine.

On the drugs side, for the past five or so years, one of the locally developed drugs for malaria has been on clinical trials and it is doing very well and there are successes that can be sampled. There are companies that are funded by DSI whose products have now been accredited by the health authorities for commercialisation. One of the companies is owned by a young black graduate. We are beginning to see successes. At some point in terms of monitoring and evaluation, a full scale evaluation will be done, which would help to begin to prepare the next strategy.

On drug imports, DSI may not have the actual figures but this is where Department of Trade and Industry can advise on imports.

The quadruple model is when you do your R&D, you need to look out for eco-system support. You are looking at four pillars. The one pillar is government – all government departments involved. The other pillars would be academia, industry and the society (non-commercial sector).

As for variants, this is not something that can be hidden. It was not hidden to allow for the elections to happen. By law, we are required to report these to the World Health Organisation as well as to government. We have a very active surveillance programme in South Africa, not only for Covid-19 but other viruses as well. Looking at the evolution of various variants since Covid-19 commenced, variants were identified in the United Kingdom. We were instrumental in the identification of the Delta variant that originated in India, which became the dominant variant globally.

There is no shadow of a doubt that we have some of the best scientists and systems and the work around identifying this variant came from the best labs. This speaks to the quality of the work being done. Once a variant has been announced, other labs globally would also probe it. What we do not know is the meaning of the variant on whether or not we are in trouble. The only way is to assess the people that have been vaccinated and how they respond to the new variant and if the vaccines are able to neutralise the variant.

We received the first report on the new variant on Wednesday 17 November. Once the variant was picked much work went into investigating the variant further. It is important for us to know that in this kind of environment, it is impossible for us hide these things. He was concerned about many countries not being vigorous in their surveillance. South Africa has surveillance measures through its sewage system for viral material. More than 14 days ago we already saw the signs through the sewage system that there was an increase in infections in Gauteng, specifically in Tshwane.

As for how the variants are discovered, it is either through the sewage system or when people go for testing. For the test sample to register positive or negative, its DNA must be sequenced. When the sequencing is done, we are able to check if there are specific changes in the DNA of the virus. The detection of variants is ongoing work.

As for vaccines, there are a number of vaccine technologies in place; for some of them one can use the deactivated virus or make use of mRNA technology. It is difficult to explain in layman terms how the technology works.

There is no evidence to suggest that people have died from vaccines. The vaccines are there to minimise the risk when they are hospitalised. This is generally how vaccines work. What we are seeing globally from the data so far, is that people who have been vaccinated are not being hospitalised and are not dying at the rate at which the unvaccinated do. We are not aware of people who are dying because of the vaccine.

Capacity development for vaccine manufacturing is a specialised area. Even with the IP provided, it remains a complex scenario and it usually makes things easier when the technology or human capital is also transferred with the IP. You may have the IP but if there is no ‘know how’ or human capability then it becomes very complex and may take forever or never to happen.

On the IKS centres, if the Committee agrees DSI can come back and present what has been achieved through the Indigenous Knowledge Act in terms of health innovation. The DSI has now started moving to clinical trials for some of the indigenous knowledge based remedies that we were working on since last year.

Ms Glaudina Loots, DSI Director: Health Innovation, replied that DSI will provide information in detail to the Committee on funding for health research. The Department of Health provides the funding for the Medical Research Council and the support for growing the basic sciences. When you look at the innovation component, the only funding available is that provided by DSI. This was limited to approximately R72 million per year. This is not sufficient but DSI was utilising this funding as effectively as possible and as result so much great work has been achieved through this funding.

We are planning a forum for all research funders in the country as well as international donors to coordinate who is funding what projects to begin the process of building the research needs in the country.

What we have managed to achieve is amazing but one of the major issues is where the money is spent on health innovation. It must be utilised on technologies that are accessible to even the people that are in the remote areas.

Ms Marchesi said that in manufacturing vaccines, there are active ingredients and inactive ingredients; what can we do to ensure that we are part of the manufacturing without necessarily having very highly skilled human capital? This could be one way of transitioning young people into this field.

She asked what is DSI doing to ensure there is available and accurate information to cut out the fake news on vaccines.

Ms Loots replied on building the workforce needed for the pharmaceutical companies, DSI works with TVET colleges and the Chemical and Industrial SETA to make training opportunities available and not only depend on PhDs.

As for fake news, unfortunately social media is so effective in this. We have engaged through the Medical Research Council with a group called the African Alliance. They started being active around the HIV environment and now they are also active about Covid-19. We utilise them to create new messages for us, engage in different activities and disprove the fake news.

At this point we are not certain about this virus. We do not know when exactly immunity kicks in and for how long because there has not been enough time to observe the data to evaluate immunity. This information does not exist yet.

Budgetary Review and Recommendation Reports
The Committee considered and adopted the Budgetary Review and Recommendations Reports of DSI and Department of Higher Education and Training.

Committee minutes
For the Committee minutes of 17 November 2021, Mr Letsie noted an amendment that should be made to the minutes – it was agreed that the Services SETA would send written responses to the Committee.

Ms Mananiso noted an amendment on the proposed undertaking a skills audit of senior management and staff complement of Services SETA.

Members were all in agreement. The minutes were adopted with these changes.

Minutes for the 19 November 2021 were adopted without changes.

The meeting was adjourned.