Health Innovation and Research and Development (R&D): briefing by Department of Science and Technology Medical Research Council

Meeting report

Health Innovation: Department of Science and Technology briefing
Mr Mmboneni Muofhe, Deputy Director General: International, Department of Science and Technology, said that the social Impact of health on the economy had been a challenge which the Department of Science and Technology (DST or the Department) aimed to combat. He explained that the tag of "productive and competitive" referred to the productive hours of working and cited an example that if the citizens of the people had a reduced life expectancy, then the country was not being productive enough in utilising those citizens, in whom an enormous amount had been invested by way of education, to plough back value to the economy. Health innovation was essentially focused on keeping people alive and well.

On the health side, the DST mainly focused on new and improved drugs, new vaccines, and on the areas of diagnostics and medical devices, based on the belief that the best way to ensure health was to prevent people from getting sick, as that would have down-sides for the economy. The DST was trying very hard, in the years between 2015 and 2025, to reduce dependency on imported vaccines, drugs and devices, which was why the DST and colleagues from the Medical Research Council (MRC) were to present on the Strategic Health Innovation Partnerships (SHIP). That was one area that had successfully brought together the Departments of Health and DST. He concluded that such partnerships were particularly crucial, to work as a united government, and not in isolation of each other, with a joint responsibility to drive health research and development. 

Ms Glaudina Loots, Director of Health Innovations, DST, highlighted the success of the DST in combining activities of research from DST and Department of Health (DOH). She repeated that the DST role was to focus on the development of new drugs, vaccines, diagnostic and medical devices. The DST’s role in health innovation was highlighted in the high emphasis on research and development (R&D) in the National Development Plan, National Health Act of 2004 and South Africa's  R&D Strategy of 2002.

In 2011, the DOH had hosted a National Health Research Summit with the aim of promoting innovation in the health sector. The changing environment of diseases was a challenge. She noted that Human Immunodeficiency Virus (HIV) was a key challenges , but so was TB, and other "top ten" diseases and causes of death included diabetes and road accidents.  The DST used the burden of diseases index to determine what the priorities were. It was also using the Product Development Cycle (PDC) model, as presented on the PowerPoint presentation (see attached presentation for details). DST would then need to determine how it, together with other agencies, would translate research into actual implemented strategies to combat diseases. This method followed the steps from discovery, through development to dissemination. MRC would elaborate on this issue when its explained the partnerships, SHIP.

Ms Loots continued that the health innovation plan started with building the health innovation system. Here there was a focus on the "quadruple helix collaboration", which referred to identifying the market, and monitoring systems, followed by developing capacities and training - something that again the MRC would focus on in more detail during its presentation.

Building of the health innovation system was done by focusing on technology development, knowledge transfer, decision support, and monitoring and evaluation (see attached presentation for further details). In the Translation architecture, the DST would focus on translational research, which would include clinical trial research, tools of analysis and data, information exchange and bio portals to enable the public to access the information easily.

Ms Loots said that when deciding upon the  implementation priorities, the Department looked at the latest developments internationally, with a focus on new and improved drugs, therapeutics, and drug delivery systems. In order to ensure that the drugs prescribed were both adaptable to context and appropriate, the DST worked with big companies like Johnson and Johnson, ultimately looking also to try to utilise South African resources. The main diseases that the Department was presently researching were HIV, TB, diabetes, cancer and neo-natal issues.

She suggested that Chapter 8 of the National Health Act of 2004 needed to be amended in order to address the issue of genetic manipulation and replacement and stem cell based therapies.

In describing the drug development value chain, Ms Loots noted that the DST had focused on drug development and worked with the Institute of Infectious Disease and Molecular Medicine (IIDMM) from the University of Cape Town (UCT), the Medical Research Council, H3D from University of Stellenbosch and others. The Department used the same strategy of trying to harness available capabilities on vaccines and biological medicines, and also worked with the Biovac Institute based in Cape Town.

In regard to new diagnostics, the DST was looking at easier and more user friendly diagnostics that could yield results in an hour,and therefore could be used in local clinics to speedily assist patients and reduce the waiting period.  In relation to new medical devices the DST was building on the excellent history of CAT scan, which was built at UCT and further developed in Cambridge University. The Department was building the partnerships through SHIP, based at the MRC, which brought international role players and the local R&D institutions together.

Discussion
The Chairperson started the discussion with acknowledging that Members of this Committee were not all medical practitioners, but they were all politicians who wanted, as a body, to see the South African economy improving and R&D producing ground-breaking research. It was clear that the country needed more medical engineers than health practitioners. People should not shy away from the past, and from acknowledging that South African Primary Health Care (PHC) was not good in certain areas, so that its R&D should focus on the previously disadvantaged, to bridge the gap. Far too many pregnant women were dying of birth-related complications, and it was necessary to consider, through health innovation, how to address these issues. In many rural areas, indigenous medicines and alternative medicines were being used, yet the Department was not necessarily letting health practitioners know of the benefits and opportunities, and he wanted to hear how the DST was handling the situation innovatively.

Dr A Lotriet (DA) noted that the National Research Fund (NRF) was also involved in SHIP, and asked what the impact, percentage-wise, was of South African investment and whether South Africa was regarded as a major player or a small component of these partnerships.

The Chairperson added that the private and public healthcare seemed to be moving parallel to each other without getting to a meeting point, and stressed that Private/Public Partnerships (PPPs) were needed. He wondered if SHIP was making this a reality.

Mr Kekana (ANC), made the point that the last Presidential State of the Nation Address (SONA) had referred to the establishment of a new initiative, Ketlaphela (a pharmaceutical manufacturing plant at Pelindaba). He asked about its status, and how far it had gone, seeing that DST was given R2 billion. He asked how many people were employed, who were the key people in this project, and what the role was of local private companies. In terms of the Broad Based Black Economic Empowerment (BBBEE) requirements, if the project involved international companies, then at least 30% must be given to local.

Ms L Maseko (ANC) wanted to enquire how South Africa was planning to compete with India and China on pharmaceuticals production. There were manufacturing plants in Northern Cape and Limpopo that were producing medicinal plants, and she asked how the country was capitalising on those. She also referred to media advertisements about the benefit of vukuhlale, where people claimed to have been cured after taking it, and she wanted to know more about the relationships between traditional, indigenous and modern medicines, saying that she believed that SHIP should be cultivating and building on African innovations. She also asked how the DST would encourage, monitor and mentor students joining the DST.

The Chairperson added that prior to the arrival of Jan van Riebeeck in 1652, the inhabitants had used  indigenous medicine, and were not profit-driven, but now people were wanting to make money through healing. He wondered how the DST was improving the capacity of traditional healers, and whether it was tapping into the knowledge of those who may have little education but substantial knowledge.

Ms Maseko asked, in relation to slide 16, what percentage of support DST was offering to vaccine development and how much ownership it had in Ketlaphela.

Mr Muofhe responded that what was said in the National Development Plan (NDP) was something that the scientific and health communities had seen coming for years. The DST was fully aligned on the NDP strategy.

Ms Loots added that the DST approached the MRC to join SHIP, which was a DST initiative. DST and MRC signed a three year contract, where MRC would act as the DST's agency on implementation, and where DST, DOH, and the Department of Trade and Industry (dti) were key departmental partners. DST held three seats on the steering committee of SHIP. Departments that wanted to assume a seat had to be prepared to put in money. The SHIP was holding discussions with local producers such as ASPEN. In the area of Bio Vaccines, approximately 40% of funding would go to vaccine developments.

Ms Loots said that Ketlaphela was registered as a company, although there were not yet any developed physical structures and DST was negotiating  with South African local manufacturers to work with the company, such as ASPEN, CIPLA and Sonke. CIPLA was based in Durban, Sonke in Soweto and Ketlaphela was sitting in Pretoria but did not have its own building. The API component would only be run in five years’ time, but DST would be doing things locally and with key international partners.  DST was looking at high volumes drugs used by DOH, and ensuring that Ketlaphela would house the production of those.

Ms  Loots then noted that, in regard to traditional medicine, the DST was very concerned to build on what it had, and combining traditional and modern medicines was regarded as a key consideration. South African medicine was good, but for any producers like Vukuhlale to claim that it could cure certain diseases, the DST would require scientific testing, verification and proof. The DST was putting in place platforms to support traditional healers.

Mr Muofhe added that the same approach was also taken with alternative products, such as health drinks, where DST had entered into partnerships with the South African Bureau of Standards, to ensure that any dangerous side effects would be addressed. The DST was looking at how plants were domesticated and how the Department could preserve plants that were medicinal. 

Ms Roxana Rustomjee, Director: Clinical and Biomedical Research, MRC, added that in regard to Primary Healthcare, the MRC was developing a whole manual for nurses to be able to use on mobile apps, and there was also consideration of how the DST could provide health workers with cheap tablets, for easy access to information, to help with diagnosis. The use of mobile devices to bring information to nurses was currently being tested in Cofimvaba and if it worked there it would work in most areas in South Africa.

Mr Richard Gordon, Director: SAMI and SATRI platforms, MRC, added that there had been discussions on how innovative ideas could be harnessed to improve health in communities. The MRC had the idea of a "TB in communities" project, where people were simultaneously using indigenous and modern medicines. Not much research had been done yet to explore the effects and how this matter could be addressed in a user friendly way. He reiterated that SHIP is held in high esteem internationally because it was bringing the African context to the global agenda. The MRC was the first point of call for interested parties outside Africa. MRC was driving both research and implementation through SHIP.

Medical Research Council presentation
Prof Glenda Gray, Chairperson, Medical Research Council, noted that health and wealth are intertwined because a healthy nation is a wealthy nation. The Department of Health had managed to increase life expectancy by five , from 57 to 62 years of age, by rolling out Anti Retrovirals (ARVs) for free. Investing in health was a strategic move

She gave an overview of the MRC, saying that it had achieved clean audits and operated on lean support principles to ensure that the money went directly to the appropriate hands. She took the Committee through the slides on its vision and the mission of MRC, and emphasised that MRC aimed to build a healthy nation through research and innovation. Its job was about knowing what was causing death in South Africa. She highlighted that, like the DST, the MRC drew its priorities from the NDP, but also from the Millennium Development Goals, and was looking into the causes of maternal deaths, and the "Triple H" of HIV, Hypertension and Haemorrhage. The new priority is maternal mortality and child mortality. The infant mortality rate had not changed since 1992, with infants dying within their first 28 days, due to errors in delivery of the child. MRC was also focusing on a new priority, of diagnostics. It was not just TB that needed to be diagnosed fast; diabetes, non-communicable diseases and infectious diseases should also be diagnosed as soon as possible and MRC was committed to doing this.  The MRC was also working on Ebola, although there was no way to diagnose Ebola in one day, and MRC could only manage to do 18 tests in one day, due to the time-consuming test process. However, MRC was in the process of finding innovative ways of dealing with diseases of this magnitude.

Mr Richard Gordon, Director: SAMI and SATRI platforms, MRC, summarised that this had been a brief snapshot of the MRC and the MDG goals of 2015. He reminded Members of the new Strategic Health Innovation Partnership (SHIP) with DST, which was launched in April 2013 with R200 million from DST (70%) and DOH to fund health technologies, whilst MRC came up with vaccine funding. This had built a strong bond. The partnership was based on the global Product Development Partnerships (PDP) that were already running at a global level within the African context. The SHIP seeks, to manage and fund multi-disciplinary and multi-institutional initiatives with innovatory projects from prototype to proof of concept.

Mr Gordon said that the question was asked why it was using the PDP model, which was new in Africa, and which put South Africa at the forefront of innovations. He noted that the PDPs essentially helped to overcome barriers in developing countries. Furthermore, such partnerships built trust and the opportunity to leverage each partner’s strengths towards a common goal.

He presented a slide illustrating the SHIP funding covering the years 2013 to 2015, noting a 300% increase in funding overall. The estimates were that TB funding will increase by 22% from R37 million, and NCD by 11% from R18 million, and MCH by 2.7% from R4.5 million from 2015-2017.  The MRC will contribute R20.1 million to the SHIP initiative.

Some of the achievements included the partnership with the Gates Foundation funding and Path Partnership. There had been the launch of "Grand Challenges" with South Africa, Brazil and Canada whose Ministers were present at the launch. South Africa was focusing on the last trimester of pregnancy and first 28 days of infants' lives in its research. Overall, there were more than 50 major research projects and more than 50% of salaries were covered by grants, and he emphasised again that there was a major focus on innovation. There was a strong governing structure, with MRC, DST, dti, the Technology Innovation Agency and South African National Aids Council (SANAC). MRC was also running a major HIV vaccine project, with eight academics dedicated to that.

Ms Zoleka Ngcete, SA Malaria Initiative, MRC, focused on drug discovery projects, saying that she had been involved in the Malaria Drug Discovery Project, the largest such project in Africa, involving also other major partners such as universities of Cape Town, Wits, Pretoria, and research institutions such as Council for Scientific and Industrial Research (CSIR) and National Institute for Communicable Diseases (NICD). The aim was to try to connect academics, rather than working in silos, which was shown to produce more results. Recently a clinical candidate was presented at a press conference, a huge achievement seeing that more than a thousand candidates were considered to get the correct candidate.

She noted that the MRC had started projects in 2006, and was involved with University of Cape Town, on medicine chemistry, and projects in Switzerland and Australia up to 2011.  Currently MRC had more South African partnerships, including one with the Technology Innovation Agency, on molecule progress, which was the first phase of clinical trials. The compound was presented on the slides. Much work was being done in South Africa.

Ms Ngcete then moved on to describe the work on TB, where the MRC also was running a multidisciplinary drug discovery project, one of the biggest worldwide. MRC was playing a global leadership role in determining the research agenda. The Bill and Melinda Gates Foundation (BMGF) had funded this fully. One of the global partnerships in which the MRC was participating was the integration into the TB Drug Accelerator, which was also ground-breaking, and included seven pharmaceutical companies and six research institutions.

Ms Roxana Rustomjee, Director: Clinical and Biomedical Research, MRC, continued the presentation. She gave an example of infection rates, saying that statistically, in a room of around 30 people, one could expect eight to be infected with TB. The main aim in successfully challenging TB was to diagnose and treat under the host and the bug, to develop a new drug or vaccine. MRC had a project in each of these focus areas, to combat the disease.  Bioinformatics addressed the R&D on drugs and bugs understanding. The MRC had a number of bioinformatics research platforms, as detailed in her presentation (see attached document for full details). The search for new drugs was always important; but MRC also aimed to decrease the infection of health workers with TB as they were the most vulnerable.  One of the new (and underfunded) projects was researching and exploring unconventional T Cell immunity (Aurum).
 

Ms Rustomjee added that MRC had realised that when it aimed to eliminate TB, this would achieve substantial benefits, as had happened in some regions in China. However, it had to work with what it presently had; hence the call for TB implementation science.

Ms Rustomjee described the progress in fighting HIV, and noted that there were seven projects, looking at the HIV vaccine. UCT and Wits were focusing on immunogenic design while National Institute for Communicable Diseases (NICD) focused on broadly neutralising antibodies, on which more work was also being done by CSIR and Harvard also. She reaffirmed that MRC had an HIV prevention agenda, a silver-based microbicide led by CSIR, and on diagnostics MRC was working with UWC on HIV Resistance Platforms, whilst UCT and CAPRISA were working on vaginal inflammation diagnostics for HIV risk.

Ms Lungelwa Kula, Technology Transfer Officer, MRC, addressed the Members on non-communicable diseases which were a particular challenge where it was important to diagnose as soon as possible. MRC was working on early diabetes diagnostics through blood and urine based samples, and funding clinical validation. She noted that, per day, 800 women died through preventable errors during delivery of babies.  SHIP was currently funding a project to decrease the overpopulation in public clinics, by having alternative, mobile, well fitted clinics. She gave an example that over 250  000 patients in the Western Cape alone were being incorrectly triaged. In regard to maternal and child health, existing projects included triage devices developed by Cape Peninsula Technikon, and a school medical record app developed by Nelson Mandela University. She also informed Members that new projects in partnership with PATH (GHIA) were under way, such as oral oxytocin for post-partum haemorrhage in Eastern Cape, and the Milk Banking Project in KwaZulu-Natal.

Mr Richard Gordon further highlighted some of the achievements of the app. This had included a presentation by well renowned Ted Talks. Last year alone the MRC had funded 152 scientists, with a bias towards doctoral and post doctoral candidates. Last year, for a few months, there had been so much public focus on ebola that the ever-prevalent HIV, cancer and TB tended to fade into the background. It was, however, true that the MRC was working on an app to help diagnose people with Ebola correctly and speedily, as opposed to the last year's experience when some people with flu were incorrectly diagnosed as having ebola. 

Discussion
The Chairperson reassured Members that they should not be confused by terminology; DST was competing with the world to produce ground-breaking research and technological devices, which did carry unfamiliar names. He applauded the DST for its visible transformation, but noted he was particularly concerned with the slow pace with which TB in the mining sector was being addressed.

Mr Kekana (was concerned by the apparently skewed allocation of funding, showing a strong focus on the better-known universities such as UCT and Wits, and asked what partnerships and funding MRC had with previously disadvantaged universities to also bring them to the fore.  He also asked what measures the MRC, DST and SHIP had put in place to foster Public-Partnerships Partnerships (PPP) with more focus on the local private sector.

Ms Ngcete answered that the MRC was negotiating with Newton Fund on addressing issues relating to hyper-tension related matters. 

Mr Muofhe noted that the challenge of racial transformation in research institutions and departments in fact started back in school and it was out of the reach as DST, SHIP and the MRC, but was a role of the Department of Basic Education, to ensure that more students were encouraged to opt for Maths and Sciences subjects. He noted the question on funding, but said that most of the formerly disadvantaged universities were under-capacitated, hence more partnerships were developed with those who had capacity, although the DST was working will all to try to raise their capacity to work on bigger projects.

Prof Glenda Gray reaffirmed that she was passionate about promoting women in science. She assessed where  MRC was spending its funding, and confronted some universities with the demand that they demonstrate their commitment to transformation, failing which they would receive less funding. She committed herself. over the next five years. to be assessed and judged on her transformation performance. 

Mr Richard Gordon told Members that he would be presenting statistics on transformation in the following week. 

The meeting was adjourned.