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VOLUME 7
Photo Pascal Guyot
EBOLA
Oluwakemi Lawanson CREDITS Prof. Abdulsalam Nasidi-NCDC Dr. Sani Gwarzo-FMoH Dr. Emmanuel Abanida-NPHCDA Dr. Peter Piot-UNAIDS Dr. S.A. Pattyn K.M. Johnson-CDC Atlanta Mr. Natham Wolfe-Metabiota J.C. Larreche Kieram Corcoran Taylor Woord
The following organisations have demonstrated their commitment to health in Africa by supporting this publication.
FEDERAL MINISTRY OF HEALTH
T H IN S U R A AL
N SCHEME CE
TIONAL H NA E
NIGERIA
N C DC
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1,2,3
critical threshold
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First Consultant Hospital
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Dr Ohiaeri
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Late Dr. Ameyo Adadevoh
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Dr. Ada Igonoh, who credits water for her survival of Ebola
N
Credit: William Wallis
Changing this from an Epidemic of fear to a disease that is treatable is central to defeating this outbreak.
o one would guess that Dr. Ada Igonoh recently emerged from two weeks battling Ebola in an isolation ward in Lagos. Radiating good health, the doctor who was infected at First Consultant Hospital by late Patrick Sawyer, the Liberian-American who brought Ebola to Nigeria, insisted there is no magic formula or miracle cure to thank for her recovery. She credits plenty of water and her own determination to survive for her ability to defeat the deadly virus. Her experience is consistent with other survivors of the disease in Nigeria. A rehydration as soon as they were diagnosed; drinking up to five litres of a solution of water combined with rehydration salts each day. Dr. Mardel, who has examined more Ebola patients than anyone, believes there are important public health lessons to be learnt from Nigeria's survivors. He argues the case that far more attention needs to be given to providing rehydration than is practised in the worse-affected countries, particularly during the early stages of the disease, later it becomes difficult. “With Ebola things multiply-they don't add up he say’s, adding that if you miss a day of water, we have to make up for it the next with twice as much”.
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THE BIG QUESTION
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Dr. Khaliru Al-Hassan Hon. Minister of State for Health
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cases. In regions that are suscep ble to pandemics. It will
Today, the length of me needed for foreign aid to reach
be crucial in the future to coordinate the efforts of
its des na on as well as the ability of countries to rapidly
different branches of government.
and effec vely use assistance pose real problems in need of solu ons. Innova ve financial tools such as parametric
A model for this is Cameroon, where the government has a na onal emergency commi ee for pandemics and epidemics and a na onal program for zoonosis preven on and control, both aimed at infec ous agents including Ebola and others that move from animals to humans. These organiza ons-the product of efforts begun six years ago-help to integrate the monitoring of animal and human diseases, and have advocated in 2014 for dedicated training and early shipment of cri cal equipment in an cipa on of the poten al regional spread of Ebola. The Cameroon emergency commi ee has also helped coordinate efforts in 2014 equipment in
catastrophe bonds, an insurance – like instrument – could at least improve the speed of funding. Payment of these bonds is triggered based on the measurement of an actual hazard, such as wind speed in the case of a hurricane, and so they are paid immediately rather than wai ng for a claim based on damages. In the case of outbreaks, the bonds would require more standardized and widely distributed measures of early detec on, but since such measures are needed anyway, the development of such financial instruments and the push for improved surveillance systems could work hand in hand.
an cipa on of the poten al regional spread of Ebola. The Cameroon emergency commi ee has also helped
Ebola is not the first virus to threaten the world, and it
coordinate efforts in 2014 to fight against cholera and
won't be the last. Stopping the current epidemic is vital,
polio.
but the world cannot afford to go to sleep a er it is stopped. Unless we prepare for the next epidemic, we will
Even when na onal and regional systems are in place, there will be mes when the developed world cavalry will
find ourselves forever nailing down outbreaks just in me to see the next ones pop up.
need to rush to the rescue as it is in 2014, but ul mately there are more important ways that wealthy na ons can assist. For examples, the disease surveillance and diagnos c systems in Cameroon and Congo have been facilitated for more than a decade by financial and technical support from US governmental agencies, groups within the defence department and United States agency for interna onal development. (USAID) implemented in part by Metabiota. More work of this kind is needed, and it is vital that other countries get more involved in this kind of effort.
Credit: Nathan Wolfe Founder/CEO Metabiota, which develops systems for monitoring and managing disease spread.
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Gleevec Vasella's eureka moment Despite the seemingly small business opportunity provided by the restricted patient population, Vasella made Gleevec an urgent priority. Credit:J.C. Larreche Healthcare Management Review PAGE Volume 7 108
Dr. Daniel
Vasella
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REFLECTION ON EBOLA DRUGS
D
r. Daniel Vasella. Chairman of
showed an astonishing 100 percent efficacy.
Norvartis, one of the world's largest
The drug had real potential to prolong patients'
pharmaceutical firms, found out in April 1999,
lives.
when he was handed a report on a new drug developed by his oncology division: The results before his eyes were better than goodthey were sensational. Vasella knew this drug will make a difference, not only to his company, but to cancer patients all over the world. The report that electrified Vasella covered the first phase of research on a product then known as STI571, later renamed Gleevec. Developed to treat a form of cancer called chronic myelogenous leukaemia, or CML.
Despite the seemingly small business opportunity provided by the restricted patient population, Vasella made Gleevec an urgent priority. He knew that every day before the product was brought to market lives would be lost. Normally it would take more than a decade to move a new drug from phase-one research to launch, ten years in which patients would continue to die. By engaging employees, customers, and important stakeholders to share his passion, Vasella
At this time, there were about forty thousand
managed to build an internal and external
known CML sufferers worldwide, with a life
momentum that powered a record – breaking
expectancy of just four or five years after
performance. Driven by the power of the
diagnosis. Given the high costs involved and
momentum. Gleevec came to market in less
the small patient population, a purely financial
than three years.
calculation would have shown that it was not worth developing and producing the drug. Set against this the results on Vasella's desk
The story of Gleevec is the story of how the value originated by that drug set Novartis oncology on the path to becoming a momentum powered firm. Healthcare Management Review PAGE Volume 7 110
At this time, there were about forty thousand known CML sufferers worldwide, with a life expectancy of just four or five years after diagnosis. Given the high costs involved and the small patient population, a purely financial calculation would have shown that it was not worth developing and producing the drug. Set against this the results on Vasella's desk showed an astonishing 100 percent efficacy. The drug had real potential to prolong patients' lives.
The key point for Gleevec was the “Eureka Moment”
Great leaders balance and juggle differing demands
when Dr. Daniel Vasella realised the value potential
by originating value targeted at each separate group
of this drug and resolved to follow it all the way
in such a way as to engage them all. By focusing on
through, despite what appeared to be a limited
the needs of key stakeholders, understanding what
patient population. The value he perceived was wide
each valued and what each offered Novartis, Vasella
ranging: for patients, their families, and caregivers,
targeted and engaged significant groups beyond
for the medical community at large, and for Novartis,
company walls to help him harness the full power of
although apparently small in terms of economic
momentum. It required focus and drive, but most of
potential, it was great in terms of social
all, it required ambition.
responsibility and employee pride. “This wonderful story began with the value that This is a crucial point. Momentum-powered firms
Novartis had originated with the drug and the
focus on key stakeholders and understand that the
ambition to realize its full potential. That value and
concept of customer is much wider than simply the
ambition was so strong that it engaged customers,
product purchaser. Vasella knew that the customer
employees, and stakeholders to share the passion
were not just the people buying the drug. Several
that pulled Novartis to record-breaking performance
stakeholders were involved, each offering
with no need to push the drug or spin press releases to
something different to the firm. Because he
a sceptical media. That's how momentum works.
understood the different value Gleevec offered to a
Momentum-powered firms are propelled toward the
wide range of concerned persons, as well as the
new efficiency frontier by first gaining traction
value each group offered the firm, he knew that it was
through powerful momentum design and then
his task to engage all these different customers.
boosting their progress through momentum execution. These are twin engines of momentum.
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“ At Emzor, we are committed to consistently providing Healthcare products that are Affordable, Available and Effective
”
Dr. Stella Okoli, OON Founder and Group Managing Director, Emzor Pharmaceutical Industries Limited