Adobo in the Gates Foundation
WHILE working for the Gates Foundation, Dr. Melvin Sanicas bumped into Bill Gates several times. One day at the elevator, he said, “Hi Bill, have you had lunch? Asian food at the cafe is good today. But it’s always just Indian or Chinese or Japanese.” Mr. Gates smiled in reply and said that indeed there should be other Asian food available. The following day, there was adobo in the cafe of the Gates Foundation.
Dr. Melvin was a Global Health Fellow and program officer at the Bill & Melinda Gates Foundation where he launched the Collaboration for TB Vaccine Discovery (CTVD) and managed a portfolio of over US$ 20M of research and capability building projects in Europe, US, and Africa. He is a vaccinologist and public health physician physician who has lived, worked, and studied in the Philippines, Singapore, Malaysia, Italy, Germany, Switzerland, South Africa, US, and the UK.
I met him at the Emerging Leaders program of the Harvard Kennedy School, where we were both enrolled. Over lunch, we’ve discussed how CTVD, an international network of scientists and experts dedicated to fostering innovation, cooperation, and collaboration in the up-stream TB vaccine discovery space, is actually a response to one of the biggest challenge of our generation — that is, how to make the “best brains” in one field work together instead of competing against each other.
Dr. Melvin, who writes for the World Economic Forum, Project Syndicate, HuffPost and other newspapers worldwide, tells me that better diagnosis, treatments, and advancements in tuberculosis have saved approximately 43 million lives. But that the infectious disease remains a major global health problem, recording 10.4 millions cases still in 2015, despite the fact that the disease was discovered in the 19th century.
He admits that achieving the goal of reducing the death toll to 0 would be difficult as it would require treating inactive infections and raising the living standards of at-risk populations. In fact, he is worried that there has been little interest in TB because it primarily affects poor people in poor countries and since the prospects of recuperating R&D costs are low.
“Of the “big three” diseases – HIV/AIDS, TB, and malaria – TB and malaria largely affect the developing world. On the other hand, HIV is more common in developed countries and is perceived as a more urgent danger. Each year buildings and landmarks across the world turn their external lights red to show support for World AIDS Day but this does not happen for TB or malaria,” Melvin noted.
“But at least well-known personalities like George Clooney, Conan O’Brien, David Arquette, Elizabeth Banks, and Forest Whitaker have advocated for increased efforts against malaria. That doesn’t happen for TB. In a lot of places, it’s still stigmatized,” he added.
While TB’s annual death toll has been halved since the 1990’s, the annual decline in cases over the past decade has been a mere 1.65%. In fact, TB recorded the highest number of deaths from a single infectious agent, higher than both HIV/ AIDS or malaria.
“Strains of the disease are developing resistance against the treatment which originated in 1921 due to due misuse and mismanagement of antibiotics. Extensively drug-resistant tuberculosis is now 20 times costlier to treat in more than 105 countries worldwide,” he said.
He proposes a four-pronged solution which involves (1) geographic-based data collection, (2) breaking the chain of TB transmission, (3) controlling the seedbeds of the diseases using a more effective TB vaccine, and (4) addressing poverty and social exclusion.
“A biomedical approach with an emphasis on the importance of good nutrition, decent housing, and human welfare will be necessary if the disease is to be brought to heel,” he noted.
Dr. Melvin believes that eradication efforts should be specific to local conditions and that analytical infrastructure must be put in place to measure the effect of any intervention. He emphasizes the need to roll out preventive therapies in at-risk populations and developing better diagnostic tests and vaccines.
When TB is targeted at the dormancy of Mycobacterium tuberculosis, the bacteria causing the disease, such would stop the bacteria’s spread and reduce the disease’s global burden.
Dr. Melvin earned his bachelor’s degree (cum laude) and MD from the University of the Philippines, Executive Master’s degree in Vaccinology and Pharmaceutical Clinical Development (cum laude) from the Università degli Studi di Siena in Italy, and Master’s degree in Infectious Diseases from the London School of Hygiene and Tropical Medicine. He finished postgraduate degrees in health economics, patient safety and clinical risk management in Aberdeen and Leeds and executive education from Stanford University and Harvard Kennedy School.