Clinical Trials as a Global Industry Who Benefits and How | ACRN Podcast EP05

In this episode of The ACRN Health Podcast, we sit down with Dr. Huwaida Bulhan — physician, public health expert— for a powerful conversation on “Clinical Trials as a Global Industry: Who Benefits and How?”

Together, we unpack the realities behind the global clinical trials ecosystem, a market worth more than $60 billion, and ask the difficult but necessary questions:

•  Who truly benefits from clinical research?
•  Why does Africa currently represent only 1% of the global clinical trials market?
•  What does it mean for Africa to move from being an “end user” to a full participant in healthcare innovation?
•  And what would success look like for African-led science and medicine?

Dr. Bulhan shares her deeply personal journey from working in underserved healthcare settings in Kenya to leadership roles in global clinical research, while exploring the future of African participation in medicine, research, and healthcare systems.

This is a bold, thought-provoking conversation about equity, innovation, science, and Africa’s role in shaping the future of global health.

Listen now and follow The ACRN Health Podcast for more conversations at the intersection of healthcare, research, innovation, and Africa’s future.

Transcript

SPEAKER_00 0:00

The global clinical trial market is well over worth 60 billion US dollars. 60 billion. 60 billion with a B. Right?

SPEAKER_02 0:11

Where does Africa sit in that 60 billion?

SPEAKER_00 0:14

Currently? Yes. 1%. And so when I think about clinical trials as an industry, I think about an industry that has extraordinary potential. Yes. Without that process, without clinical trials, medicine is theoretical.

SPEAKER_02 0:42

This week on the ACRN Health Podcast, we are joined by Dr. Huey Da Bulhan, a physician, public health expert, and African researcher for a powerful conversation on the future of global clinical research. Together we unpack the topic clinical trials as a global industry. Who benefits and how? Together we will explore who drives the industry, who profits, who gets left out, and why Africa's role in clinical trials is becoming more important than ever. From ethics and equity to innovation and access, Dr. Bullhan brings deep insight from years of leadership across healthcare and clinical research on the African continent and beyond. Don't miss this important conversation. Listen now, follow the ACR and Health podcast, and share this episode with your network as we continue shaping conversations around the future of health research in Africa and beyond. And today we are going to go into a topic which we've kind of hinted about in the previous episodes where we've been referring to clinical trials as an industry. And so I thought it it's a good time for us to stop hinting and actually get into it. And I'm joined by uh Dr. Ueda uh Bullhand. Did I get that right?

SPEAKER_00 2:32

Yes, you didn't you didn't butcher it.

SPEAKER_02 2:35

She's been in the space for quite a while. Um having moved around the world and um settled back here in Africa, and I think she is perfect to give us the different perspectives that we need for this podcast. So welcome to our podcast.

SPEAKER_00 2:59

Thank you, Wilfred. Thank you for having me.

SPEAKER_02 3:03

So I didn't do the usual where I kind of read off a script and I kind of uh mentioning a person's accolades and yeah. I know yours is three pages long, but in the shortest possible time, tell us who is Dr. Hueda and what has she done? What's what is she all about?

SPEAKER_00 3:24

Okay, gosh, that's uh that's kind of like those interviews for tell us a little bit about yourself, right? You know. Which is not usually an easy, easy space to be in. So who am I? Um I'm a physician by training, and I'm I'm an African woman. Um I grew up and uh did all my schooling in Nairobi, Kenya, so that's uh my hometown. I did my medical training there as well. Okay. Um and my career started off as a doctor in the public health care system in Kenya, so working for the Ministry of Health.

SPEAKER_03 4:04

Okay.

SPEAKER_00 4:04

Uh in the capital in Nairobi initially, and then um in a very rural, underserved community far away from the city.

SPEAKER_02 4:14

Which one is that?

SPEAKER_00 4:15

In Garissa. Oh, okay. Yes. So the northeastern part of uh the country, which uh largely still has challenges and still remains underserved. But I think you can imagine two decades ago, it was, you know, a lot has has happened since, but it really was in a much different space.

SPEAKER_03 4:35

Okay.

SPEAKER_00 4:36

Um and and so that's where I saw patients who really had very few options. Um, but even more so the healthcare workers there having also very few options to serve.

SPEAKER_04 4:50

Okay.

SPEAKER_00 4:50

The community that was there. And this was a referral hospital where you had people coming in from much further off, much more interior into the uh from the country. Okay um coming to the one big hospital for them. Right, right, but just because there was nothing else where they were. And that experience is really what fundamentally changed everything for me.

SPEAKER_04 5:18

Okay.

SPEAKER_00 5:19

Uh changed, I think, my worldview, my sense of self, my purpose, and what I imagined a career in medicine was going to be like. Right. Because that experience pushed me to ask questions that I had not been confronted with prior to that.

SPEAKER_02 5:38

It's not like the movies, right? No. You know, like the series, uh, you know, the the life of a doctor is yeah.

SPEAKER_00 5:46

And so the question that I constantly had in my time there was how do we actually change the evidence base that is driving how we are delivering healthcare?

SPEAKER_02 5:59

That's a that's a deep question.

SPEAKER_00 6:03

Who makes these decisions? Because I was a young doctor but very frustrated. Okay. And frustrated with everything, and frustrated that I couldn't execute my role in my mandate in the vision that I had. And I realized I felt very much like an end user as a doctor.

SPEAKER_02 6:26

Right. It's a good phrase. End user.

SPEAKER_00 6:30

End user in a system that it didn't matter how brilliant you were. And in our training, that's what we're pushed for, right? That you know you have to get it right, as few errors of judgment as possible. It's a little bit more of perfectionism, but it is to be a good doctor, you're not gonna make mistakes. But then you come then into the real world in a system, in a setting that's it doesn't matter.

unknown 6:56

Yeah.

SPEAKER_00 6:57

How fantastic your knowledge skills are when you're in an environment that cannot let you deliver.

SPEAKER_02 7:05

You know what you're saying is um unfortunately for us, it is the I don't want to say typical, but almost the stereotypical African story.

SPEAKER_03 7:16

Yes.

SPEAKER_02 7:17

It doesn't matter which part of Africa you it's it's the same story. You could you could substitute and put a different country, different. Unfortunately, he's talking about 20 years ago, but I think even up to now, yes, we still have the same issues.

SPEAKER_00 7:34

Yes. And so in that's why I said it was sort of uh my quarterlife crisis, that's what I call it. An existential awakening moment. Right, right. But it really, the question I kept on asking was so who writes the guidelines? Who's telling us to deliver this way? This is not serving our patients, it's not working. And of course, then led me down the path to realization that if the evidence that's there that is directing how we're delivering healthcare does not include African patients, right? It doesn't include the African context, it has no understanding of our biology, then the medicines and the systems that are there that are continuously being built or improved with all the best intentions are designed to fail.

SPEAKER_02 8:32

Ah. Right. Designed to fail.

SPEAKER_00 8:39

Yes. So that was my quarterlife crisis.

SPEAKER_02 8:42

And I'm sure I think even at a young age, I'm pretty sure you'd get pushback because there are very few endeavors where people set out to fail. I mean, they consider failure to be correct an option. But I I I'm hard pressed to think of an example where you kind of set out deliberately at the onset of anything to say, I want this to fail.

SPEAKER_00 9:07

And that was the that's why I said with the best intentions.

SPEAKER_02 9:10

Yeah.

SPEAKER_00 9:10

But it was clear to me it's not working.

SPEAKER_02 9:15

Okay. Right. So why isn't it working? Why isn't it?

SPEAKER_00 9:19

Yes.

SPEAKER_02 9:19

So you're young, you have all these questions.

SPEAKER_03 9:22

Yeah.

SPEAKER_02 9:24

Right. How did it, you know, one like to say one thing led to how did the one thing lead to the other?

SPEAKER_00 9:31

Well, the pursuit of finding answers is what then led me into clinical research. Ah, right.

SPEAKER_04 9:38

Okay.

SPEAKER_00 9:38

Yes. Then that's how then my career trajectory seemed to morph and take a very different path, sometimes a path with no blueprint.

SPEAKER_04 9:49

Okay.

SPEAKER_00 9:50

But it was to try and get to the heart of why isn't it working?

unknown 9:56

Okay.

SPEAKER_00 9:57

And why does it seem to be working elsewhere?

unknown 10:01

Okay.

SPEAKER_02 10:03

I guess that's even more frustrating, right? Where you can kind of look across and see that it's working over there, but it's not working over here. Yes. And you've got the. Yes. Okay. Yes. Now, you've got all these questions, you've set off on this journey in clinical research. Now, there are multiple ways to engage in clinical research. How did you end up where you ended up?

SPEAKER_00 10:31

So, um in trying to uncover how evidence is put together that is guiding healthcare, then I felt, well, I need to understand the system or how evidence is put together. Okay. Because for me, as we have just discussed, nobody is setting out to fail. Nobody's designing something to fail. So the problem must be with the information that they have and the information that they're using as their basis to make judgments.

SPEAKER_02 10:59

Okay. All right.

SPEAKER_00 11:01

At least that was and still remains, yes. Inherently, I do not believe that anybody is designing anything to cause harm.

SPEAKER_02 11:12

Okay. Fair enough.

SPEAKER_00 11:15

So that means the information that you are making your decisions from is either wrong, flawed, or incomplete.

SPEAKER_02 11:26

Let's let's wrong, flawed, incomplete. Okay. There's a problem. I'm gonna I'm gonna I'm gonna take this up later. Wrong, flawed, or incomplete. It's the character, you know, you could you could do an African movie just on unless something wrong, something flawed. Flawed.

SPEAKER_00 11:49

Yes. Yeah.

SPEAKER_02 11:50

Okay.

SPEAKER_00 11:51

So how do I go about fixing that? Okay. But first I felt strongly I need to understand what does good look like?

SPEAKER_01 12:00

Yes.

SPEAKER_00 12:01

What does good look like?

SPEAKER_01 12:03

Yes.

SPEAKER_00 12:04

So that meant I needed to leave home. Because from the perspective that I had, it seemed to be working elsewhere. Yes. In in the global north. Seemingly they figured it out.

SPEAKER_03 12:19

Okay.

SPEAKER_00 12:20

Things are better. I I say better now because obviously I have more context, but at that time it was things are working for them, right? It's they don't have the same problems we're having. Yes. They don't have stockouts. Yes. Their issue is not money. Yes. Right? They can just be study and be brilliant. Yes. And come up with innovative new ways of doing things.

SPEAKER_02 12:41

You know, definitely from an outsider looking in. That's what it looks like.

SPEAKER_00 12:45

That's what it looks like.

SPEAKER_02 12:46

And and from everything that has been we've been shown. I don't think I'm trying to think. Have we ever a movie or series from like that perspective, that like global node perspective, where they talk about stock-outs. No. It's not right. It's about trying to get to the heart of the problem and what are what all the drugs are there, all the equipment. Everything is there.

SPEAKER_00 13:08

Electricity, everything ask for anything and it's produced in instantly.

SPEAKER_02 13:12

Even lab results come out on top.

SPEAKER_00 13:14

Exactly. Everything is working like this. So you can, all you need is the brilliance, right? Yes. Yes.

SPEAKER_01 13:22

Right.

SPEAKER_00 13:23

Okay. So that took me away from home. I felt strongly that I needed to understand better then why is it working where it seems to be working?

SPEAKER_04 13:33

Okay. Okay.

SPEAKER_00 13:34

And so I my first stop was the UK. Okay. Where then I went and studied public health. My focus was global health and health systems. Right. Actually, to understand the system, because I was frustrated by the system.

SPEAKER_01 13:48

The system, yes.

SPEAKER_00 13:49

I did not think that our issue was with our training or our knowledge and our skill level. It was the system that was not allowing us to deliver care the way we want it.

SPEAKER_04 14:03

Okay.

SPEAKER_00 14:04

To give us the outcomes that our patients deserve. So for me it was it's a health system issue. That was at least my perspective early on, still remains my perspective.

SPEAKER_02 14:17

I'm inclined to agree with you. It's just I find that uh when you talk systems, it's it's it's you.

SPEAKER_00 14:25

Yes, it's you. It's a monster. Yeah, but yes, so it was with uh a very naive perspective of what the health system is. That's why I said my perspective remains the same till now. Okay, but of course, now understanding that system has very many layers, players, nuances, complexities.

SPEAKER_02 14:50

That was quite poetic. Layers, players, yeah.

SPEAKER_00 14:56

It's a reality. Yes. Yes.

SPEAKER_01 14:58

Uh-huh.

SPEAKER_00 14:59

So um, and then from the UK, I I moved to the US. Okay. And um, in trying to figure out where research live and work, up until that point I really didn't have a healthy understanding or appreciation as to actually how big the private sector industry, I really I still didn't up until I got to the US.

SPEAKER_02 15:24

Then you got to the size of the market.

SPEAKER_00 15:28

And your topic, the clinical research industry. Up until then I didn't I didn't know. Okay. Yes. And so I felt again that I need to understand this world because it was very foreign to me. So I started off as a clinical research associate for a medical device contract research organization. Okay. And that was interesting because it's not your typical pharma therapeutic drug discovery pathway. Right, right, right, right. It's medical device and biologics. And biologics and biologics, even before biologics were biologics. Biologics, as we're talking about them today, which is sort of like so mainstream now. It was so novel at the time. And that's how I started. I think it was very fruitous for me because the trials that I was monitoring were based in the US and in Canada. And it really got me to understand the differences in healthcare systems.

SPEAKER_02 16:36

Okay. Yeah.

SPEAKER_00 16:38

They're very different.

SPEAKER_02 16:39

They're very different.

SPEAKER_00 16:40

They share a border. Two countries that share a border completely different. And it was very different from the UK. Yes. And when I was in the UK, I worked at uh a hospital, a pediatric hospital. I worked part-time as a clinical research coordinator.

SPEAKER_02 16:55

Ah. Okay. Yes. So the bug had bit from the case. So the bug had bit.

SPEAKER_00 17:01

Yeah, yeah. The bug had bit, but now we're seeing it from a different lens then, because then it was multidisciplinary teams, delivering care, making decisions about patients. And I was like, why can't we do this? Literally, it means just different departments talk to each other. Yes. It has a fancy word, MDTs.

SPEAKER_04 17:21

Okay.

SPEAKER_00 17:22

But it is that specialty, this specialty, same patient. Why are we treating different organs? Why are we not treating the patient? So that gave me that insight. Okay. Alright? So in the big system again, where's the patient? But how are we addressing that patient holistically? So that also gave me that perspective. Then, you know, moved to the US and then now getting into the understanding of industry. So it started off medical device, biologics. After two years of doing that, moved into a bigger uh company organization, now firmly in phase three, late stage development, therapeutic trials or pharma of what most people know. This is the game.

SPEAKER_02 18:11

This is uh uh the the poster child.

SPEAKER_00 18:14

The poster child. This is what we know exactly. This is what we know. Um and and so, yes, that that experience. And then from there, interestingly, I got an opportunity then to get into academia.

SPEAKER_02 18:29

Okay, which is I'd asked you, remember? Yes, the you know, because that's you're almost um anyone young thinking about getting into clinical research, I guess that's is that can I say that's the default?

SPEAKER_00 18:43

That is the default.

SPEAKER_02 18:45

You become the researcher, this academic.

SPEAKER_00 18:47

Yes.

SPEAKER_02 18:48

Right?

SPEAKER_00 18:49

And and I joined again, fantastic team at University of Michigan, who just what you described was their experience and their knowledge, but now they were getting an opportunity to partner with industry.

SPEAKER_02 19:05

Okay. Now when you say they're partnering with industry, this is pharmaceutical companies.

SPEAKER_00 19:10

Yes.

SPEAKER_02 19:11

Ah, okay.

SPEAKER_00 19:12

With therapies and with uh medical devices. Okay. And this was for cardiology cardiac surgery department. They were working together and and they needed somebody who understood industry trials. Because, from an academic sense, they did not even have the SOPs, they didn't have the framework, the knowledge. How were they going to run an industry trial in an academic center? Very interesting that such a big university, a medical training center, one of the in the top 10 in the United States, had that gap. But that made me feel better. Yes, because you from an African perspective, saying, Hey, guess what? Oh, if these guys also have not figured it out, so why can't we also then bridge the gap on the African side? What is stopping our universities from doing the same, from working with industry?

unknown 20:15

Right.

SPEAKER_00 20:16

So maybe that will now explain how I go about things in my current day-to-day work as well. So yeah.

SPEAKER_02 20:24

Now you are on the fast track, so to speak. With your academic um journey.

SPEAKER_00 20:34

Yes.

SPEAKER_02 20:36

What then persuades you or moves you away from from that?

SPEAKER_00 20:43

I think it was probably working at um University of Michigan was where I got my biggest hides because I was close, not close, I was right there with the people who were thinking of the science.

SPEAKER_01 21:00

Yes.

SPEAKER_00 21:02

Who were solving for it. They were getting industry financing to support them, but the scientific thought leadership was I had got to the nucleus of it.

SPEAKER_02 21:14

You're there as an idea is an ide exactly. You know, it's being discussed, debated.

unknown 21:21

Okay.

SPEAKER_00 21:22

And that really, really excited me, but also made me then quite sad. Oh. No, that again thinking of back home that people are not getting this opportunity. Okay, so you keep So I was always in two hearts.

SPEAKER_02 21:42

Yes. So I want you to tag that a bit. You are you've left Kenya, you have been through the UK, you are in the US.

SPEAKER_00 21:50

Living the American dream.

SPEAKER_02 21:52

What is the tug? What is the the pull? What is it, is it strong family ties? Is it what is it that? Keeps you connected to Kenya?

SPEAKER_00 22:03

Very much so strong family ties. And I think it was always the realization that I am living such a charmed, privileged life. But tomorrow, if my mom got sick, then she would have to. How is this gonna help her?

SPEAKER_02 22:24

Okay.

SPEAKER_00 22:26

And I don't know why I felt very compelled with that. Okay. That either of my parents got sick, if any of my siblings got sick, it wasn't comfortable for me to say I'm okay and they won't be.

SPEAKER_02 22:44

You know, you've just um explained in a in a few words uh the diaspora dilemma.

SPEAKER_00 22:52

Yes.

SPEAKER_02 22:53

I'm okay, I'm eating well, but back home people don't have access to this.

unknown 22:58

Okay.

SPEAKER_00 22:59

That ate away at me. And I think when I had my my first child, my oldest daughter, completely, I think emotionally now that's becoming a parent, I couldn't then delink myself from home.

SPEAKER_02 23:21

From home. Just as an aside, yeah, in the Kenyan culture, when you have your first child, does your mom come over? Do you go to your mom? Oh I'm just curious. Uh so granny came over to take care of Granny tried to come over. Okay, don't don't tell me visa issues.

SPEAKER_00 23:44

Visa issue. She got denied a visa. And it's not, it wasn't her first time going to come to America. She had been there to visit me twice before, so it was quite a shock for her.

SPEAKER_02 23:57

Okay. And not uh the whole family, I'm imagining.

SPEAKER_00 24:00

Yes. Okay. And this is my first child. I could not imagine as well not having my mother there.

SPEAKER_02 24:12

So what did you do? How did you, you know? It's all part of our discussion. I'm not curious. I'm not curious. Did you did you did you come it was okay?

SPEAKER_00 24:22

So my my mom has a has a brother in Canada.

SPEAKER_02 24:28

Right.

SPEAKER_00 24:30

So I went with my baby to my uncle's house.

SPEAKER_04 24:34

Okay.

SPEAKER_00 24:34

And mom went to Canada. Ah, okay. Okay. So then I spent so my maternity leave in Canada. In my uncle's house.

SPEAKER_02 24:46

Story has a happy ending. That's good.

SPEAKER_00 24:48

Yes, we we we made it work. We made it work. Thank God for uncles from the uncle, yes, from the mother's side too, exactly. Yes, yeah.

SPEAKER_02 25:03

Okay. So I'd asked what then kind of derails because now you're on track to become an academic. By now you'd be professor or double professor.

SPEAKER_00 25:17

No. I sometimes think about that.

SPEAKER_02 25:21

So what then kind of yeah pulls you off that track?

SPEAKER_00 25:26

So so definitely, so two things. And we talked about the one just thinking, well, where does that leave my family? Because I feel like an outlier. Yes. But then two, the experience of not having my mother there. Um, I felt the link to my family was under threat.

SPEAKER_04 25:47

Ah, okay.

SPEAKER_00 25:50

And so I was not comfortable with that either. It was all well and good when she could get on a plane and could come and see me whenever, but I guess it never occurred to me that she couldn't. She could, she could actually or any of my family members. And I felt very vulnerable. And so I took a holiday when my daughter was 11 months old. And I went to Kenya for six weeks. I took all my leave, I combined it with Christmas break and everything from the university.

SPEAKER_02 26:25

And just and I just went home.

SPEAKER_00 26:30

And I had very long conversations with my parents. They were obviously surprised at at how I felt and that this was my thought process. And and that was the first time that I voiced, what if I come back?

SPEAKER_02 26:46

Oh.

SPEAKER_00 26:47

Yes.

SPEAKER_02 26:48

And I'm sure they kind of looked at you long and hard and like.

SPEAKER_00 26:55

So they were supportive, but they said, but you need a plan.

SPEAKER_04 26:59

Okay.

SPEAKER_00 27:00

You can't come and just wing it and say, you know, first of all, your personality will not allow you.

unknown 27:06

Okay.

SPEAKER_00 27:07

Uh, two, that's not what we want for you after all this. All this. Right? And how much work you've put in and and everything that you have learnt and achieved so far. Right. So figure out a plan. When you have a plan, then you can come back home. Okay. So it wasn't a no. But it was not, yeah, just come back and then we'll figure it out. No, figure it out first and then come.

SPEAKER_04 27:33

Then come.

SPEAKER_00 27:34

Which I really appreciate that they, as always, have grounded me in that because I would have made an emotional decision at that point and then not set myself up for future success.

SPEAKER_02 27:44

Right.

SPEAKER_00 27:45

So what I did then the rest of the time, I think half that time was just holiday downtime and spending time with my family. And then the remaining three weeks was okay, now I'm gonna network. And and actually I'm gonna find out where is the clinical research infrastructure in Kenya?

SPEAKER_04 28:04

In Kenya.

SPEAKER_00 28:05

And surrounding. I didn't lock myself to Kenya by the way. I was very open. I knew South Africa was where things were far more advanced in terms of research. Um, and I was open to South Africa as well because it's just a four-hour flight to Miripi from Johannesburg. So that was close enough. Um so I was I was willing to entertain that as well. And um, and so I I started reaching out uh to people on LinkedIn uh randomly. I was stalking people on LinkedIn. Um that works. It it does work. Trying to set up meetings, some came through, went, introduced myself, said I wanted to learn what was happening, and it was from all sectors, from industry, from academia. For I was like, actually, I really need to understand how far have we come and what has has happened since the time that I was away. Um and so one of those contacts, I went back, holiday ended. You had to go back to go back, come back to reality, um, got back, and um, but still kept on communication and took more interest, um, did my research, did my research. Um, and um and took it in stride, understanding that the ecosystem was not yet as mature as where I was.

SPEAKER_03 29:23

Okay.

SPEAKER_00 29:23

Um, and so gave me an understanding that if I was to come back, then I I need to have clarity that I need to be part of what needs to be built.

SPEAKER_02 29:34

Okay, okay. I'm not coming to look for a job. You have to be willing to have to be willing. To go into the trenches, yes, get your hands dirty, correct, so to speak.

SPEAKER_00 29:44

Yes.

SPEAKER_02 29:45

Okay.

SPEAKER_00 29:46

So that perspective was all has always been what I've remained with. And um, and so then one of the contacts that I had made, who interestingly was also a returned Kenyan. Okay, um, a few months after I went back after that holiday, uh, sends me an email and says, hey, there's a position um that's an EMEA position, but I think they would let you, you know, n be in Nairobi for it. If you're successful, are you interested? I could refer you into a system. And so started off, you know, a whole interview process. Concurrently, somebody else reached out for another position. So I was interviewing for two. After I think six just six months after I went back, I had two offers.

SPEAKER_02 30:31

Oh wow.

SPEAKER_00 30:35

So that was very quick. Um and then the reality hit that am I really going to do this? Because am I am I really going to now approve my life again and go back home? Um, but I made the decision to do so.

SPEAKER_02 30:50

Right.

SPEAKER_00 30:51

Yes.

SPEAKER_02 30:51

Now that you've been through this journey, yeah. And I like how you you you distinguished between industry, academia, but we've been putting it to our to our to our listeners and our viewers that you know clinical trials or clinical research is an industry. So, how should we think about clinical trials then when it comes to this whole industry? Should we be allocating it to say, oh, there are some clinical trials, but those are more academic, there are some clinical trials, but these are more industry. Just unpack that a little bit.

SPEAKER_00 31:30

Okay. So uh clinical research, clinical trials at their core is the engine that drives medicine in healthcare delivery.

SPEAKER_02 31:46

I think we need to say that again because a lot of people don't realize that. So say that again.

SPEAKER_00 31:54

Clinical trials is the engine that drives medicine. Medicine, modern medicine. Every drug, every vaccine, every medical device, every lab test equipment went through a process of development, testing, validation, repeating, testing for validation.

SPEAKER_01 32:23

Yes, yes, yes, yes, yes, yes.

SPEAKER_00 32:24

Right? The accuracy, reliability that you're gonna have a certain outcome. That's the research process. Yes. That's what we do in clinical trials. Every single part of what we consider normal in day-to-day has gone through that process. So that is, that's why I say that is the nucleus for me of modern medicine.

SPEAKER_04 32:50

Okay.

SPEAKER_00 32:50

So we cannot run away from it. And so without that process, without clinical trials, medicine is theoretical. It is, it's just theory, it's just an idea that I have or an opinion, as I'm sitting here and sharing with you.

SPEAKER_02 33:13

Okay.

SPEAKER_00 33:14

If it hasn't been tested.

SPEAKER_02 33:15

If it hasn't been tested. How about those who then say, you know, traditional medicines, traditional knowledge systems? How do they fit into what we've just come out of, what we've just unpacked?

SPEAKER_00 33:31

So I remember in the definition of science, right? Something that can be tested and it's reproducible, you're gonna have the same results. And in some countries, like Ghana for now, even our traditional medicine practitioners have a pathway.

SPEAKER_02 33:49

Okay.

SPEAKER_00 33:50

Right? To deliver their care in a structured way. Yes. So making it a little bit more scientific. Yes. Right? But even if you think uh our our tradition is an oral tradition, how did they discover that certain herbs worked for XYZ?

SPEAKER_02 34:05

Tested it.

SPEAKER_00 34:06

There was a testing process.

SPEAKER_02 34:07

They did. They did indeed.

SPEAKER_00 34:09

Yes?

SPEAKER_02 34:10

Testing to the point that there would be There was a proof of conflict. Yeah, yeah, I agree. There would know certain seasons, time of the day.

SPEAKER_00 34:17

Correct.

SPEAKER_02 34:18

Yes, to say don't take that.

SPEAKER_00 34:20

So the scientific basis is there.

SPEAKER_02 34:22

Uh-huh.

SPEAKER_00 34:23

However, I think your question was more on the industry part of industry, as when I talk about, you know, I work in industry, right? And so when we talk about clinical research being a global industry, I mean quite specifically, it is an industry. It generates billions of dollars.

SPEAKER_02 34:44

Billions of dollars.

SPEAKER_00 34:45

It's a commercial entity, it employs people.

SPEAKER_01 34:48

Yes, it does.

SPEAKER_00 34:49

Right? Um, it drives valuation of companies. Yes. Companies have to be registered, they're all under mandates and laws and regulations and things like that and how they're running. The industry has supply chain, it has markets, it has preferred geographies, it has commercial incentives. In any definition of an industry, this is an industry. Okay. So it's not wrong to use that term. Okay. And it doesn't vilify it. It doesn't, it means that there's a structured process around it.

SPEAKER_04 35:26

Yeah, yeah.

SPEAKER_00 35:28

And my ask for people is to think about it that it's a very heavily regulated industry because it has a direct bearing on the well-being and livelihoods and health of people. But it is an industry. And we cannot dissociate then healthcare, medicine, the delivery of medicine, the development of medicine, and anything in healthcare away from the financial aspect of it takes as an investment, but also the output that it generates.

SPEAKER_02 36:01

Okay. Could could the hesitation to to view this as an industry could part of it be who ultimately benefits? And that's what I want to ask you now to say currently with the with the current setup, who is benefiting from this industry that we're calling the clinical trials industry?

SPEAKER_00 36:29

So Maria, before we talk about who benefits, um it's worth grounding us a little bit to say, and the reason I'm sharing this statistic is for this to be appreciated with the seriousness and scale of what it is. The global clinical trial market is well over worth 60 billion US dollars. 60 billion. 60 billion with a B. Right? And so when I think about clinical trials as an industry, I think about an industry that has extraordinary potential to transform for good, to transform healthcare. And equally, an equally extraordinary track record, then, which is where your question goes to, of having an uneven benefit of that potential.

SPEAKER_04 37:35

Okay.

SPEAKER_00 37:36

And that's what makes people uncomfortable. It's that disparity.

SPEAKER_02 37:46

Could it be though?

SPEAKER_00 37:46

Yeah.

SPEAKER_02 37:47

And uh could could we make the argument that ultimately everybody benefits from the industry? The the uneven distribution that we see is in that 60 billion. The actual money it's actual the actual money. Well, we could even argue about some of sometimes the drugs. The drugs. But the fact that the drugs are there, you may not afford it, but it's there.

SPEAKER_00 38:13

Well, yes. What do you think? So I think everybody, yes, benefits. Certainly the companies, yes, the organizations that are involved in the drug discovery, in their development, the shareholders. Because that's also something that people will not tell you. I could be sitting here, um, in I could be sitting in Harare, but I'm owning shares or stock in a company, and I'm earning, I am a beneficiary of that industry too. Um, patients, certainly, patients who have access to the medications or to the new innovations, their benefits as well. Um, yeah, and and you know, the people who are working, I'm benefiting, but I have a job your kids' benefits? My kids are benefiting.

SPEAKER_02 39:01

Yes. I hope you're taking care of the the the mom and dad who were so wise and right, yeah.

SPEAKER_00 39:07

We're able to cover for their health insurance because I'm working in this industry. We are benefiting. That is also the uncomfortable truth that we don't want to speak about. We want to dissociate ourselves from from the industry, but we are part and parcel. The industry is part of that ecosystem that we're all part of.

SPEAKER_04 39:30

Okay.

SPEAKER_00 39:31

So the benefit is there. It's it's and it's not a conspiracy. That's also another thing. The benefit is there. It is an industry, they are markets, many people are benefiting. The unevenness of the benefit is maybe the part that yes, is what we need to tackle.

SPEAKER_04 39:51

Okay.

SPEAKER_00 39:52

Um, is what makes people have a sense of this is not fair.

SPEAKER_01 39:58

Yes, yes.

SPEAKER_00 39:59

And the fairness part of it, then we should all equally benefit at yeah. That that is that I think that is the perspective. Perspective. Right? But you know, that unevenness is also governed by um companies will invest where they are assured of returns.

SPEAKER_02 40:19

Oh, yes. Yes. It's um it is return and investment. Yeah, yeah.

SPEAKER_00 40:23

Correct. Even if I'm going to open a shop, where I open my shop is where I'm gonna get customers.

SPEAKER_04 40:30

Okay.

SPEAKER_00 40:31

Let's think about it that way. And the premise is true as well for company. It doesn't absolve them of responsibility because this is people's lives, but it is a fundamental business foundation. Right? Regulators will approve um new therapies or medications to come into uh the healthcare system based on data. Data that they they can know and trust and find reliable. So that's where things now. This is where things start becoming gray, right? Because as I told you, there's layers.

SPEAKER_02 41:09

There's layers to it.

SPEAKER_00 41:10

And there's layers. Right?

SPEAKER_02 41:12

There we go again.

SPEAKER_00 41:14

So patients advocate for access to therapies in systems where they feel they have power.

SPEAKER_02 41:23

Yes.

SPEAKER_00 41:25

It's another nugget right there. That's another one.

SPEAKER_02 41:27

That's another nugget right there, yes.

SPEAKER_00 41:29

Do our patients feel like they have power to advocate. To advocate in our systems, in our systems, right? So the industry then follows those incentives closely to make decisions about where are they going to expand? And you have a supermarket chain, where they're going to open their next output.

SPEAKER_02 41:53

Next up. But I want to push back a little bit and say what we are describing is almost um a capitalist process.

SPEAKER_00 42:03

Very much so.

SPEAKER_02 42:04

Um is that compatible with African culture, African thinking? Uh, and and maybe is is is is is what we are seeing a clash of that ideology, capitalism versus something else? I don't want to say socialism, but the the the African approach to things, which I I would not classify as capitalist. Yeah. Is that what we're seeing? That that tension sometimes?

SPEAKER_00 42:34

I think Okay, two things from what you've said. Are we capitalist? Not in maybe the modern day definition of capitalist, but even in our traditional past, we had butter trade exchange.

SPEAKER_02 42:54

Yes, we did.

SPEAKER_00 42:56

We had markets, so there was exchange. There was exchange of goods, goods for services, services for services. So there was an economy there was an economy.

SPEAKER_02 43:07

Yes, yes.

SPEAKER_00 43:08

It didn't look like how it looks today with the words and terminologies we use today. But we understand the exchange for something.

SPEAKER_02 43:17

Yes.

SPEAKER_00 43:17

Value correct and value, yeah, yeah, right?

SPEAKER_02 43:21

Store of wealth, and uh yeah, yes.

SPEAKER_00 43:23

So where where maybe I will call out in terms of that unevenness of the industry is where does Africa get to participate?

SPEAKER_02 43:34

Yes.

SPEAKER_00 43:35

In that.

SPEAKER_02 43:36

In that.

SPEAKER_00 43:36

Yes.

SPEAKER_02 43:37

Yeah, I was gonna ask you of that sixty billion, how much of it is you know, where does Africa sit in that sixty billion?

SPEAKER_00 43:49

Currently? Yes.

SPEAKER_02 43:56

I want to say that's too low.

SPEAKER_00 43:58

Absolutely. And I'm keeping quiet because I'm letting that sink in very much. It's too low to be true. One percent. No, it's only one percent.

unknown 44:09

One percent.

SPEAKER_00 44:11

Africa is one percent market revenue.

SPEAKER_02 44:15

Because at one percent, you know, I'm thinking of those tests.

SPEAKER_00 44:19

As an average for the pharma industry. One percent? Yes, one percent. It's shocking. Well, that is why one of the controversial things that positions that I take is we need to we need to develop an entrepreneurial mindset.

SPEAKER_01 44:42

Yes.

SPEAKER_00 44:43

And not rely on or expect donations because it is not serving us not to grow our economies and our markets. It is actually shrinking our economics.

SPEAKER_04 44:59

Our economic.

SPEAKER_00 45:01

So instead of us spending our time and energy to create systems and engines that will allow others to plug in and grow.

SPEAKER_04 45:11

Okay.

SPEAKER_00 45:12

And so in that map, where has Africa played, right? Not just the 1% is the revenue part, which is yes, shockingly low. Can be depressing sometimes, quite honestly. Um, and how do we start making that unevenness? How do we change the trajectory?

SPEAKER_02 45:35

Yes, how do we?

SPEAKER_00 45:36

So Africa has been traditionally in the clinical research space in the industry, a ground for patient recruitment.

SPEAKER_02 45:46

Yes. I want to refer to something you said earlier. Okay. End user.

SPEAKER_00 45:53

End user.

SPEAKER_02 45:55

Aha, yes. End user, right? That's so Africa has been an end user.

SPEAKER_00 46:02

I think if you have followed a lot of conversations that I've been in or heard me speak, I'm always advocating for us to think of end-to-end.

SPEAKER_02 46:12

Yes.

SPEAKER_00 46:14

Not that we have hospitals and clinical research units where you can get patients. No, we're not exporting our people and our data. It is leaving us on the fringes of this where we are supplying, but we are not receiving. We are not part of it. Okay. We're feeding it. But but we are not part of it. We're on the fringes. I am not comfortable with that position.

SPEAKER_02 46:48

Okay, so for Africa. So let's let's turn my shock into something. Yes. We flip it. What does success, what does so Africa is fully participating. It's it's in the end-to-end process, right?

SPEAKER_00 47:09

Yeah.

SPEAKER_02 47:11

What does that actually look like in you in in from your perspective?

SPEAKER_00 47:16

Well, we talked about the equity part of it. So everybody benefiting. Everybody benefiting, yes. But we have to have clarity as to what does benefit look like to us.

SPEAKER_04 47:26

Okay.

SPEAKER_00 47:27

You cannot come to a table, and I'll give an analogy.

SPEAKER_04 47:33

Okay.

SPEAKER_00 47:33

Within my own career, um a senior colleague, a mentor, was like, what do you want to do next, Rider? And I was like, I really don't know. I like what I do, but I want to grow. And I talked and I talked and I went on and on and on and on and on. And at the end she said, You know, you've told me nothing.

SPEAKER_02 47:53

Mentors. They can be tough like that.

SPEAKER_00 47:55

And and and then, of course, you can imagine how I was feeling. Because I've really seen it. I've articulated. She said, I don't know what you want.

SPEAKER_03 48:06

Okay.

SPEAKER_00 48:07

So if you're coming to ask and your ask is not clear, what are you asking for? Yes, true. When I say I want opportunity and I want to grow, but I'm not articulating what is it that I want, who am I to blame if that interpretation by the person across does not fit actually what I am what I'm they will give me what they think. Yes, not what I actually am asking. Right? So for me, I really think success, everything is fixed.

unknown 48:50

Yes.

SPEAKER_00 48:51

In an ideal time. For me, success will be when we have an African child who receives a medicine that was discovered by an African scientist, that was developed here, that the trial was conducted in Africa. It was manufactured in Africa. It was approved by an African regulatory body, and it was priced such that their family could go and procure it and give it to that child.

SPEAKER_04 49:29

Okay.

SPEAKER_00 49:30

And they get better. That for me, when we when we have that, it doesn't have to be something complex. But the day we have the full chain, the end to chain. The end to end that is what I will consider success. Okay. The end to end. So it's like a relay. Everybody along that chain has to play a part. Yeah.

SPEAKER_02 50:11

You know, I think I like the clarity of it. I like the simplicity of it. Knowing that the fact that it's so simple makes it so complex. Because many different things need to come together for that.

SPEAKER_00 50:26

But in that simplicity, then everybody can have clarity. Where do I come in?

SPEAKER_01 50:31

Yes.

SPEAKER_00 50:32

Where do I come in in this story? At which time point? Where do I play my part and do it so well that I hand off to the next person in this chain?

SPEAKER_02 50:45

So we've we've we've run out of time. I was enjoying the stories too much. What would be your take-home message? I love that you've taken us through this journey and you've been very clear what the ask or the vision should be. What is the message you would want to leave our listeners with?

SPEAKER_00 51:11

I really, really strongly feel, and this is coming very much off the backdrop of um attending the World Health Summit in Nairobi. Um I genuinely believe that Africa and as Africans were at a reflection point.

SPEAKER_04 51:27

Okay.

SPEAKER_00 51:29

The conversations that are happening are demonstrating a growing boldness across every sphere of that journey, of that chain.

SPEAKER_01 51:43

Yes.

SPEAKER_00 51:44

Right? Um, and just to reiterate something that the WHO um regional director for Africa, Professor Janabi, said Africa is no longer asking for permission. I think I am really starting to see, hear, and feel that. And for me, I feel this is the moment. This is the moment where we are ready to listen to each other. We're willing to work together, we're willing to consider, we're willing to build bridges and be clear what our ask is from each other and from everybody else who wants to come into our space. So these I feel are real signals. I feel Africa's health future is ours to define. This is the core of where I sit. Okay. But also where I hold myself accountable. If it is our future to define what is my role sitting where I'm sitting, sitting where you're sitting. To contribute to that picture. So I feel we have the opportunity to build on our own terms where we are right now. We don't need to get everything right, but we need to build with an image of dignity, of evidence, and coming back to our roots and keeping our communities at the center of everything. That is our naughty.

SPEAKER_04 53:21

Okay.

SPEAKER_00 53:22

Always. So that is my take-home message. The moment is now.

SPEAKER_02 53:29

Yes, it is.

SPEAKER_00 53:30

The moment is now.

SPEAKER_02 53:33

I think it's a it's a powerful way to end uh the podcast, and I I really want to thank you for your your insights. And uh I felt deeply connected with your journey through, you know, because one of the more humbling things that has happened as as I've worked in the space in Africa, as I've spoken to a lot of people, I'm constantly amazed at just how similar we are in this in this space. As Africans, we are we are more alike, 99% than we are different. So it's the 1% which causes us problems, be it in the industry or you know, as we relate, we look at the 1%, and I wish we had the same agitation for these statistics when they say we're only there at 1%. Yes. As we do the 1% that makes us different. I wish we had the same indignation. So thank you so much for being on the podcast. And um, I'm hoping I can entice you back so that we unpack the the last bit of your message where you said, what is the role of the African, the African scientist, academic, the African uh in the diaspora. What is your role in ensuring that we get to the future that we want?

SPEAKER_03 54:59

Yes.

SPEAKER_02 54:59

And I think it's such a it's such a powerful question to think about.

SPEAKER_00 55:04

So it is. It is.

SPEAKER_02 55:06

So thank you so much. This has been uh another interesting episode of the Ace R and Health Podcast, and uh we can't wait to have you back for the next one. Thank you, and bye-bye.

SPEAKER_00 55:18

Thank you.