Big Think

Topic: Public misconceptions about science.

 

Charles Knirsch: So, I think that researchers themselves could do a better job of trying to explain to the public what it is we do. First of all, I’d like to say that we need to do more of this and I think that the public, if we take the time to do that, we’ll have different view points of course. We’re in a diverse society but unless we do more of that, we can’t say that the public is misperceiving if we don’t give them the information to evaluate. I think that there are many elements that we can explain and speak less in a scientific jargon and actually work with communication specials, frankly, to get messages out in different languages and at different levels. Why not let fourth graders hear about what we’re doing at the level of fourth grader? University students, medical students, medical professional have different ways of communicating with the different constituents in society.

 

Topic: Public-private healthcare partnerships.

 

Charles Knirsch: There are many organizations now that, because the public votes with their checkbook, and otherwise even their taxes, and the people they elect, we have to go to the public. And particularly around public/private partnerships that we want to build, from the private sector with civil society, and with the public sector, we need to be out and to say what it is, what our core values are, what our mission is, what we can do to be part of the solution, not to take on the whole problem and to build these partnerships with the public sector.

 

Topic: Regaining the public’s confidence in the pharmaceutical industry.

 

Charles Knirsch: I am worried that there is mistrust between the public, the academia and with the public entities, as well, but particularly with the pharmaceutical industry. We have many corrective actions that we’ve taken, we are trying hard to respond and get feedback on what type of factors we need to improve ourselves on.

I would like to see us on a much more positive trajectory where it is clear that what we are doing is delivering what the public wants, the diseases they want us to work on. And the public has a lot of voices as well. So we can’t satisfy all of the needs but certainly we want to be serving medical need in the way the public regains our confidence in what we do.

 

Topic: The pharmaceutical industry.

 

Charles Knirsch: So I think that many of the issues that the public has with pharma [sic; the pharmaceutical sector], we need to listen to, we need to understand those issues, what their issues are. And we need to enter into a dialogue with the public about these things. When that happens, we need to negotiate a path out of that. So I think part of this trust is around transparency around data and publication of data and, frankly, the safety of our medicines. When we explain the safeguards that we do, and the fact that we’re a very highly regulated industry, more so than most industries, and get out with what were doing, that to show that we’ve heard what they have said to us, and then what our plans are, and then to ask them is that what you have in mind about our corrective action?

The thing we can do is just talk about the great science we do, about the lives that have affected by our medicines and our vaccines, about the programs that we build, the disease elimination programs to health management programs around our therapeutics, that it’s not just about the molecules, not just about the vaccine, it is about the disease management programs that we build in to this. Timeless story asking our customers, our constituents, how are we doing? Getting feedback, changing course.

I don’t look at the public as having a misperception of us. I look at our need to have more of a dialogue with the public and to evolve. Science is about evolution anyway, so as scientists, we should evolve with the public.

 

Topic: The future of fighting infectious diseases.

 

Charles Knirsch: Personally I’d like to see progress in infectious diseases.

HIV is still a raging pandemic. Now, it’s not thought about as much, in a developed world, because in many pharma [sic; the pharmaceutical sector] and public partnerships working with the NIH, and other public entities, we now have turned HIV, in the developed world, into a chronic disease. It is very treatable, not with optimal medicines, so we still have room to go, but the largest part of the planet with HIV, until recently, had no access. And now we’re making great strides with the Global Fund [to Fight AIDS, Tuberculosis and Malaria], PEPFAR [the US President's Emergency Plan for AIDS Relief], other programs that originated out of pharma, to get into some of the issues around access so

But there are two, three, four, five after HIV, so tuberculosis, malaria, acute respiratory infections in children, etc., that really deserve as much attention, I think, as HIV. So I wouldn’t want to say one thing, I would say let’s have a grander vision and tackle the top ten, at least the top ten.

 

Topic: Trachoma and malaria.

 

Charles Knirsch: Trachoma is a historical disease. It’s mentioned in a Greek Papyri and it’s actually mentioned in the bible, and it was in the U.S., in Appalachia and on Indian reservations. After the battle of the Nile, when basically Nelson sank the French fleet, the returning navy and soldiers brought trachoma to Europe. So this has been a disease in the developed world. But with improved sanitation, the disease has gone away, and actually made it on the Indian reservations with some mass antibiotics. So, until the poverty agenda in the north-south divide is really solved, trachoma is going to be a disease that requires other modalities, including antibiotic treatment. But, again, I believe that with the current mobilization that the disease is within reach.

Trachoma is caused by a bacteria, it’s usually crowded and poor conditions and with repeated infections of the eyes, scarring occurs over many years that leads to blindness.

Malaria is a mosquito transmitted disease and actually, again, the south all the way up to Washington in this country was endemic from malaria. But today 90% of malaria and malaria deaths are in sub-Saharan Africa. And, again, the parasites have the advantage because of their sheer numbers and replication, and that they’ve become quickly resistant to many of the available drugs.

 

Topic: Eliminating diseases.

 

Charles Knirsch: I believe, with trachoma, that the global elimination of trachoma is within reach by about the year 2020, and that is our goal.

I’m going to the World Health Organization tomorrow evening to be part of that annual meeting. That program is being linked with other neglected tropical disease programs that, again, many people in the field have been working on it. But for about 50 cents a year, with four or five already approved medicines, we can look at eight or nine neglected tropical diseases and imagine, and actually set metrics around the elimination.

That’s different from diseases like malaria where, frankly, resistance is some of the biggest concern. And we really do need a full pipeline, from early discovery to full development, to address the continuing evolution of resistance of the parasites have the advantage. There will always be in need for new therapeutics until we eliminate malaria, but I don’t see elimination as a real viable strategy from where we are right now.

 

Question: What are super-resistant bugs?

 

Charles Knirsch: Very often these are bacteria, viruses or parasites that were formerly, completely susceptible to a therapeutic. Many people don’t so, one such bacteria is MRSA and people hear about it in the news, which is Methicillin-resistant Staphylococcus aureus.

When [Alexander] Fleming first discovered penicillin, penicillin would treat staph aureus. That didn’t last very long. Other agents have been synthesized including different penicillins, completely new classes of agents. And I would say now that staph aureus is pretty well served, so what I would expect would be there’ll be a lack of further discovery in development for staph aureus, and maybe in a period of time, 5 years, 10 years or 15 years, we’ll be back to the problem of not having agents for staph aureus.

Right now we have gram-negative organisms so these are bacteria, they are found in water supplies especially in hospitals because of the antibiotic pressure there, where, again, if you were to get infected with one of these organisms, there may not be a therapeutic that will help fight against these organisms. These are the super-resistant bugs that you asked about

 

Topic: Super-resistant bugs in New York City and South Africa.

 

Charles Knirsch: In New York City, just to make the case locally, in the late 80s early 90s there was relaxed control of tuberculosis and so that patients would be admitted with tuberculosis at the hospital for isolation and therapy after two weeks they’d feel better, but they needed six more months of therapy, would be sent out. They would often get disorganized, as they were often in their cities, or actually had mental illness, and this would happen three or four times until they developed multi-drug resistant tuberculosis, and in layman’s jargon a super-resistant bug, and this was frightening.

This situation is now prying out in places like South Africa where they have something called XDR Tuberculosis. I had many patients. And these epidemics will have outbursts in clinics and hospitals; I knew healthcare providers that were infected and got sick. Sometimes both the patients and the healthcare providers were HIV positive. That seems to promote actually the aggressiveness of the bacteria progressing in these patients; so it was quite a frightening situation.

 

Question: How has globalization impacted healthcare?

 

Charles Knirsch: One of the good things about international travel now is that people are more aware of cultures and environments, because they are traveling on business to emerging markets and, frankly, even some of the less develop countries.

So I think, in general, what globalization has brought us--more awareness of some of the inequities, not just with poverty but diseases. And I hope with some of the economic trouble in the developed world that we don’t lose sight of the fact that in the developing world they are suffering much worst than we are. So that we have an obligation in the developed world to not loose focus on international development issues.

 

Topic: Infectious diseases.

 

Charles Knirsch: In the 1970’s when [Richard] Nixon announced the war on cancer, budgets were decreased for infectious diseases. This has been well published and talked about. It involved the scientific and the live press, and look what happened: HIV, multi-drug resistant tuberculosis, West Nile virus. I think we’ve responded now. What we can’t do is relax our surveillance for emerging diseases, our laboratory capabilities to study these organisms, and then to scale up to have useful either therapeutic or vaccines.

 

Topic: Responding to the next pandemic.

 

Charles Knirsch: When SARS [severe acute respiratory syndrome] hit,and people probably have forgotten SARS, it was terrifying what happened. And it was like an influenza type of illness, and the company I worked for actually synthesized 65 compounds in less than a year, in a very much Manhattan Project-like environment too. Then the disease went away, inexplicably. I think that capability to quickly respond--

Also I’m a firm believer in science evolving and new technologies becoming available, so wouldn’t it be nice and actually we are working on this technology to have a vaccine response that take weeks, and not in nearly a year in some cases. And so there are approaches and we are working in that field as well.

So it’s about having existing capabilities and not relax the guard both on surveillance of new diseases and also develop ability to respond.

 

Conducted on: July 15, 2009

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