The Future of Healthcare in Africa: Opportunities for Ecosystem Driven Innovation with AI

Originally posted on LinkedIn:

The purpose of this post is to: i) highlight the need, and thus the opportunity to invest in advancing healthcare outcomes in Africa; ii) showcase how global organizations, including non-profits and pharma have invested in the region and are continuing to do so; iii) how artificial intelligence (AI) is and can increasingly add value; iv) what Cyclica is going to do to contribute. 

But first, some context: In March 2018, I was invited by Johnson & Johnson Innovation and JLabs, the innovation arm of the global healthcare and pharmaceutical company to speak on a panel at the the Next Einstein Forum (NEF), a wonderfully well organized event in Kigali, Rwanda.



The topic of the panel was Leveraging Artificial Intelligence (AI) to Improve Health Outcomes with a direct link to Africa. This is an important and personal topic as, while I am born in Canada and identify as Canadian, my parents and multiple of my grandparents were born and raised in Tanzania and Kenya before they immigrated to Canada in the mid 1970s. I feel a deep connection to East Africa and the Africa continent, and fell in love with the continent during my first trip at the age of 10. My first role out of undergrad was to volunteer full time at the Aga Khan Development Network’s (AKDN) disaster response and humanitarian aid agency, FOCUS. Sine then, I’ve believed that it’s my obligation to contribute my time, knowledge, and other resources in a meaningful way to the advancement of that part of the world. Attending the NEF was an opportunity to listen to the Presidents of those countries (many of whom spoke at the event), leaders of industry, entrepreneurs, and students from across Africa who are working hard to build healthcare-focused companies to solve some of the most complex problems that the continent is facing. It was one of the most profoundly impactful conferences that I have attended to date. Prior to that event, I published a blog post on my views of the healthcare industry in Africa and the current and future role of new technologies, with a focus on the role of AI. Recently, the topic of creating capacity and improving infrastructure in an effort to enhance health outcomes in Africa has become more salient. As such, I decided to adapt my original blog post with a bit more colour.

The World Health Organization (WHO) stated in their 2014 African Regional Health report, that "HIV/AIDS continues to devastate the WHO Africa Region, which has 11% of the world's population but 60% of the people with HIV/AIDS". The report also states that “more than 90% of the estimated 300–500 million malaria cases that occur worldwide every year are in Africa, mainly in children under five years of age, but most countries are moving towards better treatment policies." According to S. J. Rweyemamu and D. Mtango in a 2014 paper, "An African child dies due to malaria every 30 seconds, making a mortality of 3,000 children each day." 

According to Joe Jimenez, former CEO of Novartis AG, writing in the January 2015 issue published by the World Economic Forum (WEF): "in sub-Saharan Africa, infectious diseases such as malaria and HIV/AIDS causes 69% of deaths", and "Africa bears one-quarter of the global disease burden, yet has only 2% of the world’s doctors." Polio has also been a historically devastating disease. In 1988, 350,000 people a year, mostly children under 5, were paralyzed by polio across 125 countries. Tuberculosis (TB) is also a devastating disease, and according to the WHO is the ninth leading cause of death worldwide, ranking above HIV/AIDS. In 2016, 2.5 million people fell ill with TB in Africa, and approximately 417,000 people died from the disease in Africa alone (1.7 million globally).



Fast forward to the present day, advancements in state of the art medicines and healthcare practices have resulted in a reduction in numbers. According to Avert, Global Information and Education on HIV and AIDS, "between 2010 and 2018, new HIV infections declined among children (0-14 years) from 1.1 million to 84,000. New infections among adults declined from 930,000 to 710,000 over the same period, although there is significant variation between countries." And according to this WHO report "In 2017, 380 000 people died from AIDS-related illnesses in the Eastern and Southern Africa Region, corresponding to 42% decrease since 2010." There's also been a 41% decrease in malaria cases and 66% decrease in malaria-related death rate between 2000-2015 (Africa). Much of this is thanks to education and public health policy that has been implemented, including encouraging children and women that are pregnant to sleep under malaria bed nets." TB and HIV are directly linked, and the WHO states that TB is a leading killer of HIV-positive people: in 2016, 40% of HIV deaths were due to TB, and that "about 82% of TB deaths among HIV-negative people occurred in the WHO African Region and the WHO South-East Asia Region in 2016." The WHO has reported that "TB incidence is falling at about 2% per year", but suggest that "this needs to accelerate to a 4–5% annual decline to reach the 2020 milestones of the End TB Strategy."

To help eradicate polio, the World Health Assembly launched the Global Polio Eradication Initiative (GPEI) in 1988. In their 2015 letter, Bill and Melinda Gates suggested that “we can get polio out of Africa this year and out of every country in the world in the next several years," According to a 2015 WHO report, the incidence of Polio was down 99.9% from 1988 level, and in 2017 there were 22 cases in 2 countries. According to this CNBC report, the reduction was largely a result of mass immunization to orally vaccinate 2.5 billion children in 122 countries, bolstered by the 1988 launch of the GPEI. And while substantial progress has been made in reducing the incidence of polio to near eradication level, recent systematic challenges have prevented complete eradication and there has been some backward traction. For example, according to an interview by Melinda Gates in Jan 2017, there were 22 cases in 2 countries in 2017, which increased to 29 cases in 2018. According to a presentation by Bill Gates at the Rotary Joint District Conference in May 2019, there are now about 40 cases a year primarily in 3 countries: Nigeria, Pakistan, and Afghanistan. While this sounds encouraging (40 is a few orders of magnitude lower than 350,000), according to the WHO, as long as a single child remains infected, children in all countries are at risk of contracting polio. Failure to eradicate polio from these last remaining strongholds could result in as many as 200 000 new cases every year, within 10 years, all over the world.



With commitment from organizations like WHO, the UN, the National Institutes of Health (NIH), and non-profit organizations like Rotary International, the Gates Foundation, and the AKDN, these complex diseases continue to be addressed. The UN has the vision to end the tuberculosis, HIV/AIDS and malaria epidemics by 2030. The Gates Foundation has poured more than $10Bn in organizations like GPEI, Gavi, the Vaccine Alliance; the Global Fund to fight AIDS, tuberculosis, and malaria; and the Global Financing Facility, which aids mothers and children. Rotary International has raised over $1.8Bn to eradicate polio. And in May 2017, Medicine for Malaria Ventures (MMV) teamed up with the AKDN to tackle Malaria in Mali. According to the press release "together with Aga Khan Foundation Canada (AKFC), and with financial support from Global Affairs Canada, MMV will conduct qualitative research in the Mopti region of Mali to understand gaps in the management of malaria for women and children under five." But non-profit organizations need support from governments, large corporations, and innovative companies. 

It is important to note that while big pharma tends to receive a lot of flak from mainstream media for price gouging, without them, many of diseases in Africa and in developing countries would be spreading uncontrollably. In their 2015 letter, Bill and Melinda Gates talked about reducing or eradicating many diseases, and they state that “the drugs that can stop these scourges are now being donated in huge numbers by pharmaceutical companies, and they're being used more strategically thanks to advances in digital maps that show where diseases are most prevalent”. I dug into this further. I spoke with a former colleague at Cyclica, Natasha Puri, who is now pursuing her MD and has previously worked in the area of public health. She shared with me some some stats that were pleasantly surprising: that Johnson and Johnson have for several years donated up to 200 million tablets of mebendazole a year for intestinal worms, that GlaxoSmithKline has donated billions of tablets a year for 5 years of albendazole for lymphatic filariasis (LF), and have committed to do so until the disease is eliminated, and that EISAI committed to provide 2 billion tablets of DEC for LF, which is used with albendazole outside of Africa. There are many more examples like this from companies like Merck, Novartis and Pfizer - you can learn more in this Guardian article.

While public health policy and education have been critical to controlling and reducing the rate at which many of these diseases spread, technology has also played an important role. There’s the whole wave of personalized medicines , genomic profiling, preventative medicine, and the availability of information accessible to our smart phones about oneself. That’s largely driven by AI algorithms. Smartphone use is expanding in Africa as prices and affordability has improved - according to Quartz, smartphone penetration more than double from 2014 to 2016. From a health care perspective, this is important, and patients already are being impacted. In the same 2015 article mentioned above, Mr. Jimenez also talked about the impact that digital technologies can have in saving lives, particularly the impact of leveraging mobile phones in areas where healthcare infrastructure is currently under developed. According to a Newsweek article, "in Uganda, tens of thousands of government health workers use MTRAC—an SMS-based technology connecting hospitals to the national drug chain—to report on local medicine stocks using their mobile phones. LifeBank uses digital supply chain technology to deliver blood when and where it is needed in Lagos, Nigeria’s biggest city with a population of over 20 million." Looking forward, we have the opportunity to drive better health outcomes through hands of patients in Africa by empowering pushing information and data to the end user while concurrently investing in infrastructure.

Over the past few months, I’ve written and spoken about the application of AI in healthcare, and in particular the future of AI in drug discovery for the pharmaceutical industry - an area that I live every day leading Cyclica. When applied appropriately to specific problems and questions, AI has far reaching implications across the entire healthcare value chain, including: diagnosing diseases earlier, managing patient care, discovering and developing better medicines for individual patients or populations, prescribing those medicines more effectively, monitoring patient adherence to prescription, detecting safety signals in clinical trials or in the market, etc. AI will undeniably play a large role in the near future in addressing these issues, by providing solutions to specific research questions that otherwise would be onerous or lengthy to do solely by traditional approaches.

Within the pharma industry more specifically, and outside of drug discovery, AI can help design better clinical trials and stratify different patient cohorts in a more organized fashion. As noted by the World Economic Forum (WEF) "3 Things that Will Change Medicine in 2018", AI and machine learning "are revolutionizing the way we can interrogate data, leading to a faster clinical trials process. They enable us to understand data sets more deeply, so that we can better identify new insights from our decades of clinical trial experience." A great example of this is a partnership between Quantum Black, a technology acquired by McKinsey & Company in 2015, and Novartis called Nerve Live. The partnership combines data on clinical trial operations from multiple internal systems, using AI, machine learning and advanced analytics to "mine vast quantities of internal data on trial site performance to predict enrolment rates, data quality and cost across multiple trial sites". Quantum Black says the work has already shaved 15% off trial times and 11% off annual costs for the big pharma. 

Downstream, AI will be a major influence in the application of personalized medicine and pharmacogenomics, and eventually to support how physicians and practitioners prescribe medications. At Cyclica, we believe that we need to think differently about the discovery of medicines and move away from the classical approach of finding a molecule that interacts with a protein target. Multi-target drugs offer a number of advantages as I wrote in a recent Forbes article. Diseases that involve multiple pathogenic factors such as infectious disease, neurodegenerative diseases, cardiovascular disease and cancer are not adequately addressed with single-target medicines. For these diseases, standard treatment often involves multi-drug therapy. Multi-targeted drugs on the other hand can be tailored to target relevant disease pathways to minimize drug resistance which is useful in infectious disease for anti-bacterial and anti-malarial drugs. That’s why we are so passionate about polypharmacology - with our approach, and with the right partners, we can address diseases that were previously thought too challenging or unaddressable.

It is also important for us to understand how molecules will move through the body, how they will interact with a person's genes to better understand patient response, etc. So we’ve evolved our thinking away from the classical model and instead are focused on designing drugs for patients, not just for protein targets. We are striving for "personalized drug discovery" which will enable us to tackle disease endemics to certain populations, like Africa, South America, India, etc. This is bold aspiration, and we have a lot of work ahead of us. But as we have said time and again, innovation in this highly non-trivial world of biomedical science requires patience and collaboration. No one technology or approach will solve all problems, but if we are able to come together and form an ecosystem of technologies that drive impact across the healthcare value chain, then we can realize demonstrable and significant value. By accessing the SOSCIP Cloud Analytics Platform for the past few years, supported by the Ontario Centres of Excellence and IBM, we have taken our first strides in this space by integrating genetic variant data directly into our drug discovery platform to guide the first steps into what we call "structural pharmacogenomics". This effort has been led over the past 18 months by Dr. David Kuter, PhD, a Team Lead at Cyclica. David received his PhD from the University of Cape Town (South Africa) in 2016, and has completed post docs at Stellenbosch University (South Africa) and McGill University (Canada). His research has predominantly focused on understanding the mechanism of action of antimalarial drugs using complementary experimental and computational approaches which has been disseminated in 13 peer-reviewed publications. (The red arrow in the image below is pointing at David)



With a robust drug discovery platform, a world class team of scientists, including subject matter experts in malaria and like Dave, we are ready to contribute to the application of new innovation to these massive global health challenges. Join us on this journey. 

Naheed Kurji, Chief Executive Officer

Naheed Kurji, Chief Executive Officer

Naheed Kurji is the Co-Founder, President and CEO of Cyclica. Naheed is passionate about building AI-augmented technologies that enable researchers to make more strategic and informed decisions in Healthcare and the life sciences. He spends the majority of his time obsessing over Cyclica’s culture, defining its strategy to best effect change in the pharma industry to achieve the company’s vision, and exploring opportunities for continued innovation.

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