A conversation with Sir Jeremy Farrar, WHO’s new Chief Scientist

Our guest this week is Sir Jeremy Farrar, the World Health Organization’s new Chief Scientist, who took up the role earlier this year.  

As Chief Scientist, Dr Farrar oversees WHO’s science division, bringing together the best brains in science and innovation from around the world. 

Prior to joining WHO, Dr Farrar was the director of the Wellcome Trust, and prior to that he served as the director of the Oxford Clinical Research Unit at the hospital for tropical diseases in Vietnam for 17 years.

In this episode, we discuss:

• Dr Farrar’s priorities for the science division at WHO over the next couple of years.
• What he sees as key innovation and research challenges and opportunities for WHO.
• His views on the governance of public good R&D for global health products, how the system could be improved, and the opportunities for WHO to influence that space.

You can read more about WHO’s science division here: https://www.who.int/our-work/science-division

We encourage you to join the conversation at @CentreHealthSec. You can follow Australia's Ambassador for Regional Health Security Dr Stephanie Williams at @AusAmbRHS and Dr Jeremy Farrar at @JeremyFarrar.

Transcript

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The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government. 

Dr Stephanie Williams 00:29

Welcome to Contain This. I'm Dr. Stephanie Williams, Australia's Ambassador for Regional Health Security. I'd like to acknowledge the traditional owners and custodians of country throughout Australia and our region. We recognise the continuing connection to land, waters, and community and pay our respects to Elders past and present. Today I'm thrilled to bring you an interview with Sir Jeremy Farrar, the World Health Organization's new Chief Scientist who took up the role earlier this year. As Chief Scientist, Jeremy oversees WHO’s science division, bringing together the best brains in science and innovation from around the world to scan the horizon and identify promising technology to set research agendas with equity at their core, and promote critical norms and standards to support the use of existing evidence to improve our health and health systems. Prior to joining WHO, Dr Farrar was the director of the Wellcome Trust, and before that he spent 17 years as the director of the Oxford Clinical Research Unit at the hospital for tropical diseases in Vietnam. I hope you enjoy the discussion.

Jeremy, you're familiar face and trusted expert in global health and science, most recently as the director of the Wellcome Trust, and previously many years in our region in Vietnam. Now, you're the Chief Scientist at WHO, the second person to have that role. I was wondering if we could start with you bringing that role to life a bit for us, what do you actually do? 

Dr Jeremy Farrar 02:02

I'm still finding out. I'm not yet at three months. So I'm, I'm still a newbie here. But I will pay tribute to my predecessor, Soumya, who, as you say, was the first person in the role. Where to start? I think if the last three years have taught us anything, it is the critical, critical nature that public health bodies, medicine itself, clinical medicine, primary care, that has to ultimately be grounded in science. And that science is diverse. It's not just medical science, it's social sciences. It's behavioural science. It's economics. It's understanding implications indeed beyond the health sector implications and the influence of education, on health, on health, on transport, and things. So I mean science broadly. But ultimately, the World Health Organization has to be a science-centred organisation, as the hopefully trusted voice of independent advice around the world. And I, you know, I hope that's what we can build on in the coming few years whilst I'm whilst I'm here. 

Dr Stephanie Williams 03:12

There are various descriptions of the Chief Scientist as the face of communication for science at WHO, but also, you lead the science division, I’m interested in how you set your priorities or agenda, or the other way of asking that question, what are the issues that right now a bubbling right to the top in terms of innovation or research challenges and opportunities for WHO if we look over the next couple of years? 

Dr Jeremy Farrar 03:37

The sort of first thing I'd say there is, I think, every organisation whether you're a government ministry, you’re the World Health Organization, indeed, if you're a big philanthropy or you are a company, you've got to sort of appreciate what is your core function. What's your core mandate that you've been given by the member states, for instance, in WHO’s case. And I think you've got to make sure you're good at that. Because I think in a way, that's, that's, that's, you're held in respect, hopefully, because of that core mandate. And doing that, well, is difficult, but it's absolutely crucial. And in a sense, it gives you then a license to operate and offer advice and learn from and support beyond the very core functions. And if I look at WHO, before I joined, what are some of those core functions? It's yes, a voice of science and making sure broadly defined, as I said, and that that science is available and accessible to as many people in the most equitable way, that has makes a difference to people's lives and particularly their health. But then, if you delve below that, I think one of the core functions for instance of WHO are norms, standards. In other words, if you're going to prevent heart disease in Australia, you know, what are the global sort of standards that you can look at to learn from and then of course interpret in the context of Fiji or Vietnam or, or indeed Australia. And I think establishing those norms and standards, not the WHO does it itself, but it works with many, many 1000s of external experts to try and define what those standards are, and the normative functions behind WHO. And then of course, as things get developed, maybe getting developed into a test or a treatment or a vaccine, then WHO also provides critical functions in pre-qualification of products that may come at the other end. So I think being good at that function is critically important. And that's one area of immediate focus. The other area, I think, of critical, is science is forward looking good. It is about implementing what we know already. And obviously, if we just implemented what we know already, scientifically, frankly, we would be in a much better health state globally, there's no doubt about that. But science also has to look forward. And I would argue we’re in a scientific Golden Age, really, and the COVID vaccines in some ways, and tests and genomics demonstrated that. But we need to make sure that we are thinking ahead, we're anticipating what science might be coming and making sure that society, communities, politicians, diplomats, non-technical people, are aware that these things are coming, and therefore we can hopefully maximise their benefit and minimise their harm. So horizon scanning, thinking forward, and then how do you ensure that science is equitably done? And, you know, this is a lot of work you do, making sure that that science is available and accessible to politicians and policymakers in ways that they can interpret so that they can hopefully make the best evidence-based decisions of what they're doing. So those would be the three areas that sort of the moment focusing on the basic functions, the core functions, normal standards, looking forward, what research and science is coming, that we can maximise benefit of. And lastly, how do we make sure that scientific evidence is at least made accessible and used in the political space so that better decisions can hopefully be made.

Dr Stephanie Williams 07:12

And so, you know, links to the horizon scanning piece and the norms and standards in sort of setting research agendas. And you've previously described the, the COVID vaccines at their earliest point is a true global public good. And, and I granted you’re three months in the role, but I am interested in your views on the governance of public good Research and Development for global health products. It has been described as donor driven from funding to product and I'm interested in how you think the system could be improved and the opportunities for WHO to influence that space. 

Dr Jeremy Farrar 08:04

Yeah, and there's many, many, maybe people listening, but you yourself will certainly know, there's a very complicated series of negotiations going on, including, obviously, with WHO around the inside governmental negotiations around a future pandemic treaty or accord and things like that. And it's critical that that process goes ahead, and that members of governments around the world, all of them, come together and say, having learned the lessons from COVID, we're going to do things differently in the future. And that is a complex set of negotiations. We should never undertake, I mean, you mentioned the COVID vaccines. People often say the COVID vaccines were developed in a year I - that's not true. The COVID vaccines were built off 20 years of investment in discovery science, that nobody thought would take us forward to a COVID vaccine 20 or 30 years later. And, and so one thing I'm trying to get across is that is that you sort of reap what you sow, but you sow it over many years, through investment most critically in people, through your universities, through your institutions, that people feel they have a career in science, and that they can make a career out of it. Whether staying in science or going into politics or going to the media or going into companies. All of those are great outcomes. But if we don't invest in the basic science infrastructure, and critically, the people of it, then we won't have the breakthroughs that for instance, COVID vaccine is portrayed as, it's after many, many decades of work. And then last thing I'll say is we must never underestimate that yes, companies are absolutely critical, in my view, to making sure that products are manufactured with high quality and regulated and all those things, but never underestimate the critical role that public funding plays in that. Most major breakthroughs that come through the commercial sector are based on discovery science and training of great people in public institutions around the world. And therefore, I think we shouldn't underestimate the public resources that go into the breakthroughs which subsequently might be made in the industrial sector. And we've got to make sure that we, if you like, gain the benefit of those breakthroughs, and that the public investment in that basic infrastructure is, is seen through when we then, let's say, buying products from companies that might have been developed for it. And I think we've probably got that out of kilter a little bit at the moment. And one way of ensuring more accessible, more available, and more equitable future is to make sure that we realise the public investment is so, is so important.

Dr Stephanie Williams 10:49

And one of the offshoots of COVID as well as that there are questions from countries that typically haven't had Research and Development and manufacturing sectors, you know, when we talk about more equitable distribution of where the science is done, and where the products are made. Is, is are you in your role, or is WHO are being pulled into an advisory function for member states that say, hey, we need to grow this sector. Is that that? Are you engaged in those discussions at all? From on a very practical level, leaving treaty discussions aside, just practically.

Dr Jeremy Farrar 11:23

This would be something I would, I would dearly love to be involved in. It goes back to my comments about the COVID vaccine comes after decades of investment in in people, and institutions, and discovery science. And I think it's all very well to talk about countries, whichever country of any economic value, having manufacturing capacity. But manufacturing capacity is difficult, but in some ways, it's the easy bit. But you can't have that capacity, unless you've got a pipeline of young people coming through a system who understand science, know science, and become scientists themselves, or regulators, or work in the manufacturing sector. So I think the best way of making sure in the long run, that there is more equitable distribution of research, development, and manufacturing is for countries where they can, to use domestic resources to invest in their scientific infrastructure, because that is part of culture, it's part of universities, it's part of universities and institutions being part of urban development and opportunities and, and economic growth. So this is, to me, this is about health. It's about our culture, as in science is part of our culture. But it's also about economic growth and opportunities for jobs in country. So I would love to be more engaged, and hopefully will be, in working with countries to think, how do you construct a scientific ecosystem that can best support the health of your country, but also the economic growth of your country? And all resources at a domestic level are limited, we appreciate that, but how can you best use the resources you have available to have the greatest impact on your population. And you know, I know Australia, I know Singapore, I know the Pacific Islands, I know Vietnam, of course very well. And I think all countries are slightly struggling with thinking how do we create this scientific ecosystem? And then how do we sustain it?

Dr Stephanie Williams 13:03

So, then coming back to WHO’s role in this to a, you know, particular function, you talked about these normative standards and playing an effective normative role. And I understand there are active discussions about the pre-qualification system. And, you know, on the one hand, as you look at R&D, the pace of research and development and technological innovation accelerating, and on the other hand, you look at a, you know, we work with limited resources, especially in some of our larger bureaucracies and organisations. How are you thinking about WHO being able to play an effective normative role in that space, the pre-qualification gateway to uptake and adoption?

Dr Jeremy Farrar 13:43

Something we have already started since I've joined actually is working, because the pre-qualification space at WHO, just to highlight actually sits in, I almost refuse to use the word divisions, I hate the word divisions. It sits in another team at WHO, and we're now trying to work horizontally across the organisation to say, out of the norms and standards and guidelines, which comes in under the science team, how can we ensure that there's a more streamlined, a more efficient link between those and the pre-qualification system that that's in place, because not every country in the world will have a regulator that is that has the resources to be able to look at everything from products to vaccines, therapeutics, diagnostics, increasingly digital needs to be regulated and thought about. And therefore, I think, WHO does provide an absolutely critical function in a trusted space: neutral, independent, to be able to assess what innovations should be pre-qualified so that the Global Fund, GAVI of this world and also countries’ own governments can buy and procure these products. So to me, that's a critical function of WHO. And something which I think what I hope we will do is have a more agile and a more streamlined way of looking at both guidelines, norms, standards, but also the link into pre-qualification. You can see the pace of change of the last three years is not going to get less, there's going to be more innovation happening faster, there'll be more demand from patients, from communities, for those innovations to come and be available to them. And therefore I think all regulators around the world, and WHO is not a regulator, but all people that are looking at the qualification of the regulation of these products needs to fit the dynamic of the way the innovation world is working at the moment, in order to maximise the availability and access and the equity of those products. So yeah, that again, on my sort of priority list is certainly in the top three, in my first year of being here.

Dr Stephanie Williams 15:55

So I'll finish with a final question about what are you enjoying most about your current role?

Dr Jeremy Farrar 16:01

Well, it's very different. So I'm learning, not yet 100 days, the people at the country level in the organisation, the regional offices, I was just on a call with countries from regions and here in Geneva, just as I came to here. The commitment of the individuals within the WHO and then of course, within ministries of health, around the world is staggering. The engagement is phenomenal, something I've frankly not seen in many other walks of life, and the commitment to making a difference. And I think coming out of COVID people have realised just what a difference good public health, promotion, protection of people and provision of health services can make to people's lives. So that I suppose the warmest thing is just is working in an environment of incredibly committed individuals. Now, we all have frustrations, there's bureaucracies there's, you know, I don't necessarily agree with everything that happens. But but but that is really uplifting, I have to say, and, yeah, it was a big decision to come here. But I haven't regretted it.

Dr Stephanie Williams 17:35

Well thanks for making the time with us this morning and reminding us that it's a golden age for science, that we need pipelines of people over decades to grow that science. And that, you know, when it comes down to a committed system, focus on the right issues is something that we all need in in global public health. So thank you for your time, Jeremy.

Dr Jeremy Farrar 17:23

My pleasure, thanks Stephanie.

Dr Stephanie Williams 17:26

You've been listening to a conversation with the World Health Organization's new chief scientist Sir Jeremy Farrar. We spoke about Dr. Farrar's priorities in his first year in this new role, as well as how he sees some of the major opportunities and challenges on the horizon for science in public health and WHO's role in that. Thank you for your company. I'm Dr. Stephanie Williams, Australia's Ambassador for Regional Health Security. Join us in another fortnight for the next episode of Contain This.