Piot, who is a special advisor to the EU on health security and EU Chief Scientific Advisor on Epidemics, was in Hyderabad last month where he was a part of life sciences and healthcare conference BioAsia. Piot, an independent director of Biocon Biologics, highlighted the need for regulatory reform to accelerate biomedical innovation, and deeper research ecosystems in countries like India. He said climate change will reshape infectious-disease patterns. Edited excerpts:
Q) How do you assess the world’s current pandemic preparedness? Are we genuinely better prepared now than before COVID-19?
A: On a technical level, we are much better prepared. One of the big lessons from COVID was the power of innovation and we developed vaccines in record time. The regulatory environment also showed that it can be in sync with innovation. In a few months we had vaccines, something that normally takes years, not because of shortcuts but because everyone was doing their job.
That’s a big lesson because you wonder if it could happen then, why can’t we do it now? For India, that’s a fantastic lesson to harmonise, because when you consider that in China it takes only 30 days to have approval to go to the next step for a trial while here it takes months.
In Europe, we have a similar problem. So, we have better platforms, we have better technology, but whether we are better prepared as societies, I’m not so sure. In Europe and the US there is mistrust, not only in vaccines but also in technology and government.
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Q) What emerging health threat do you think the world is underestimating right now?
A: The biggest health threat is really a tsunami of diabetes and obesity. I’m part of a Lancet Commission that looked at the major health threats for the rest of the century, and number one was obesity and diabetes. When you consider that in a state like Kerala already about 25% of adults have diabetes, you see how fast it’s moving. It’s not only India – it’s global. For me, it’s an epidemic, a real tsunami.
Q) How do you see the new generation of anti-obesity drugs such as GLP-1 therapies?
A: They are enormous blockbusters and clearly meet a huge demand. But most people who need them still don’t have access because they are expensive. The patents will expire soon, and this is only the first generation. There is a lot of innovation happening, including in India, to develop oral versions rather than injections. And here again, it’ll be competition between China and India for mass production. But I would not only think of cheap manufacturing, but also of innovation there. There’s a lot of innovation that’s needed.
However, these drugs alone won’t stop the epidemic if people continue to be surrounded by unhealthy food and poor lifestyle choices.
Q) What strategic priorities should India focus on in vaccines and biopharma innovation?
A: India has done a fantastic job in high-quality, lower-cost manufacturing. Innovation has been strong on the engineering side. But now, with the human capital and strong academic institutions, it’s time to push much more on discovery and innovation. For that you need an ecosystem between research institutions, academia, industry and investors. The ideas and talent are there, but they need to be brought together with regulatory certainty and investment.
Q) How will climate change affect infectious diseases?
A: Climate change will clearly have an impact. Take dengue, mosquito-borne diseases will spread into regions that were previously too cold. As temperatures rise, what were once tropical diseases will move northwards.
But climate change will also affect pregnancy outcomes and cardiovascular disease during extreme heat. These are complex problems that cannot simply be solved by a vaccine or a drug.
Q) Which technologies hold the most promise in health today?
A) Artificial intelligence will accelerate innovation and development, but only if regulatory systems evolve with it. But if we have the same rules for regulatory approval and trials, then AI will not make much difference.
On the biomedical side, mRNA vaccines are extremely promising. Another area is cell and gene therapy. We see very top levels of cell gene therapy, which is going to be very useful for cancer. But the challenge is cost as these therapies are still extremely expensive, though prices are starting to come down. It has to come down more and save lives.
Q) If another pandemic begins tomorrow, what would you do differently?
A) We now have much better surveillance, including wastewater monitoring, so we will detect outbreaks much faster. But that only helps if countries share information with each other.
The biggest lesson for me is communication. Technologically we were prepared, but socially there was polarization and misinformation. Investing more in communication and trust should be a priority.
Q) What gives you hope for global public health in the coming decade?
A) My biggest hope is that we can end child and maternal mortality. We already have the tools, vaccines, better maternal care and basic health systems. In the past 20 years the number of children dying before age five has been cut in half even as the global population increased.
The next challenge is healthy longevity. People are living longer, including in India, but the healthy years are not increasing as fast because of chronic diseases like diabetes.
Q) If you could advise heads of states across the world, what kind of single policy change would you recommend for global health resilience?
A) One very specific one, I think is smoking. For instance, in India oral cancer is a big thing. So, yes fight that as much as you can. Because, of course, governments get a lot of money from that.
Make health like a national security issue. And an issue not only as a cost, but as an investment in talent, and in the economy. So that health is a top thing. India is not spending much money on health at the moment. It could do much more.
