D is for Decolonize: Sitting Down With Luis Pizarro

What does leadership mean to you?
 

There are several definitions of “leader.” The world of sport works as an analogy. Some people would say you can become the leader of a team by being its best scorer, such as Michael Jordan of the Chicago Bulls. Another school of thought says that the coach, who decides the team’s strategy and shape of play, is the leader. When I was young, I played a lot of basketball. In fact, I competed in the Chilean championships. Over time, I realized that I preferred coaching to scoring, and this came to inform my work in health. 

How did you enter healthcare?
 

I spent the first 20 years of my life in my home country of Chile before moving to Europe to begin my medical studies. While in France, I was taught by people from Médecins Sans Frontières (MSF, or Doctors Without Borders), and very soon I realized that this was the field that I wanted to work in.

After my medical studies, I completed a Master’s degree in Foreign Affairs; I wanted to try and understand how our world works. Just after that, I was sent on my first field mission – to Niamey, the capital of Niger – to support the country’s national HIV program. I then joined an NGO called Solthis as an Executive Director. Most of my work there was on HIV and infectious diseases.

Next, I moved into what I call “health systems strengthening” – trying to address the roots of access to healthcare in very resource-poor settings. For the last two years, I have been working in a special program called Unitaid, where we focus on innovation. And, of course, I’m now very happy and excited to be joining DNDi.

You are also the founder of the think tank, Global Health 2030…
 

That’s right. During my years in France, I noted the country had excellent diplomats and doctors, but they didn’t have health diplomacy. At the same time, it is safe to say that the global health strategy of the French government was not proportional to its generosity. In what we can call the “global health sector,” France was contributing a great deal financially to DNDi and similar organizations, but without a strategic framework.

So that’s why I joined a group of people, including Nobel prize winner Françoise Barré-Sinoussi and Global Fund former Director Michel Kazatchkine, who worked alongside medical doctors, political scientists, anthropologists, journalists, and so on to consider the problem.

Think tanks have two arms. One arm works to produce knowledge and ideals that could infiltrate or influence decision making bodies – in this case, the French government – while the other arm can engage with relevant stakeholders to help feed back into and expand the think tank’s strategies. Harmony between these two arms is essential, and hopefully you can see this in both the notes and papers on Global Health 2030’s website, and also in the now much more structured global health policy of the French state.

What are your views on the movement to decolonize global health?
 

I would say it’s one of the big questions most people in global health are working to address today. I have an academic side that likes to define concepts. So if we are to talk about “decolonizing,” we first need to determine exactly what “colonization” means in the context of global health. Within the European empires of the past, the authorities sought to implement a colonial approach to public health.

On one hand, these efforts saw some successes – in the rollout of vaccines and establishment of health systems, for example. On the other hand, they also set up radical – we can even say “dictatorial” – approaches to public health that made no effort to correlate with local cultures and local approaches. This colonial approach was the genesis of today’s “global health,” so the first thing we should do today is recognize – and accept – that European-style public health systems and approaches are not one-size-fits-all. Other countries will have – or will need – other kinds of systems that better suit their cultures.

We also need to think about the ideas and forces behind “colonizing” and “decolonizing.” Some of my colleagues frame this in terms of addressing “white supremacy,” and they would argue that we need to recognize that the way we behave and build our organizations today is deeply informed by a Western, white approach that offers insufficient space to alternative ideas, practices, and perspectives. At DNDi, we have been working on this, and, in my capacity as leader, I will try to continue that work in our technical approach to R&D and access. I want to see how we can start at the roots – from talking to our colleagues who are running DNDi programs around the world, and ensuring that we are not bringing our solutions in a top-down, neocolonial approach.

What was your experience with Solthis?
 

Solthis was launched in 2003 to deal with the lack of major HIV programs in West and Central Africa. European doctors working on HIV had received requests for help from their African colleagues with regard to successful antiretroviral therapies that patients in West and Central Africa had no access to. At that time, the Gates Foundation, the World Bank, and the Global Fund had all stepped in to help pay for a solution to HIV in Africa, but the African countries in need lacked the expertise necessary to convert this money into the procurement of HIV drugs, training of staff, and setup of laboratories. Solthis went to Niger, Mali, Guinea, and other countries in Western and Central Africa to support their ministries of health with the implementation of their own HIV programs.

This endeavor is something I remain very proud of. We did not want to come in and set up a Solthis-style health program and take credit for it. Instead we took a “hidden” approach. Solthis dedicated its first ten years to this project and saw a great deal of success.

The next step was to adapt the approach to help the most neglected populations. When these populations are in very scattered and simplistic rural settings, you need to be able to set up the local health system so that it is able to test and treat patients in a highly decentralized manner. I expect to continue to work on such problems with DNDi.

What else do you hope to achieve as the leader of DNDi?
 

First of all, I should say that I am a very lucky man because I am the successor to an amazing global health idol: Bernard Pécoul. I thank him not only for founding DNDi, but also for setting up a transition process that has given me all the tools and space I need to succeed as I step into his shoes.

The next thing I am grateful for is the roadmap DNDi laid out some years prior to my arrival. We have a strong pipeline of upcoming drugs, and a lot of ongoing R&D. My first personal objective is to support this pipeline and continue pushing ahead in the work we are doing on important diseases, such as leishmaniasis, sleeping sickness, Chagas disease, and mycetoma.

I’m also very excited about tackling new diseases and topics. Last year, we launched a dengue initiative between Asian, African, and Latin American countries. We want this to be more than a South–South scientific collaboration – we also want to see financial investments from these countries to make sure the scientific and pharmaceutical work succeeds. Beyond dengue, we are also setting our sights on treatments for rabies, snake bites, and more – we have a lot in the basket!

What challenges do you see ahead?
 

In 2023, DNDi will celebrate its 20th anniversary. Looking back to 2003, the pharma-for-profit model was virtually the only way to produce new drugs. After 20 years of running DNDi, we have shown that R&D can be done differently – we can rally the partners we need to run an alternative model. But now, in the next 10 years, we will need to prove that our model is sustainable.

Right now, the model is mostly based on philanthropy and the generosity of the governments of high income countries. What we would like to propose is that R&D on neglected diseases is a common good. We need a new way of thinking and a new mode of governance at the global health level to make this happen; to push forward this notion of the common good, to ensure that our projects will be sustainable in the future, and for national and regional organizations to invest in R&D for their own populations. 

And what about the challenges posed by climate change?
 

Firstly, conditions transmitted by mosquito bites are going to expand massively during the climate crisis and become much more prevalent than in the world we once knew. Secondly, we know that climate change will produce climate refugees that will be exposed to new pathogens. That will allow diseases that are currently isolated and concentrated in particular geographic spaces to spread. In fact, it’s already happening.

Dengue is one such disease that will “benefit” from climate change – and its spread will damage people’s lives in ways that extend beyond bodily health. Like many neglected tropical diseases, dengue affects people who live in very poor conditions. Poverty makes one more susceptible to disease. If you catch a neglected disease, you may lose your job and you will still have to pay for the drug you need. In short, you’ll fall even deeper into poverty. It is a vicious cycle, and to address it we must work with both scientific and civil society in the countries where dengue is endemic, including India, Sri Lanka, and Brazil. These are middle-income countries, and some are even at the low end of high-income. We’ll be engaging with their governments and also regional organizations, such as the Pan American Health Organizations and the African Union. 

Twenty years on, can you sum up why DNDi’s mission is still relevant?
 

I must say again how humbled I feel to be stepping into such an organization. Regarding its relevance, the two years of COVID-19 pandemic that we endured highlighted the inequalities in access and capacity faced by most of the countries in the world today. There is inequality in research, development, tools, drugs, techniques… And the gap remains huge.

When a global emergency arises, we have seen that the international community is absolutely not ready to respond. In the face of a crisis, it cannot deliver an equitable public health approach that treats access to the necessary care as a human right.

In light of that knowledge, we at DNDi need to not only continue our work in neglected tropical diseases, but also commit to working on other areas with neglected patients who are in need, such as HIV and pediatric treatments. We need to think alongside stakeholders about what can be done to continue producing drugs, bringing them to market, and ensuring that they are accessible and relevant for the people who need them.

We will also need to think about how R&D should look in the face of the next pandemic and the new diseases to come. We need to consider how funds can be intelligently allocated. It is not good enough to simply sit and wait for the next crisis without establishing international solidarity.

All the above demonstrates why DNDi and its mission are still relevant.