During the Congress in Washington last month we were lucky that Dr Jules Millogo made time to meet for a conversation about his work. He joined the event for two sessions, the first on Merck’s Ebola experience and the second on supply chain technologies. It was a pleasure to meet him and we were glad to learn more about how vaccines can be better implemented in low-resource areas. We hope that you enjoy the interview as much as we did.
Introducing Dr Millogo
Dr Millogo works at Merck, where he serves as the liaison with WHO and other organisations. He is also “the person to go to” for support implementing vaccination programmes in low-income countries.
“In my previous life, I was a manager of a vaccination programme in a very, very poor country.”
Technical challenges
One of Dr Millogo’s sessions at the Congress covered the difficulties of implementing new technologies in the supply chain. We asked about any gaps or areas for improvement that COVID-19 might have demonstrated, and he explored a range of considerations for vaccine developers when targeting lower-resource areas. For example, in the US people worry about cost concerns. In lower-income countries the areas of concern are “not exactly the same”. Thermostability is of greater interest in regions where electricity is most likely to be in the capital city and “scarcely” in other areas.
Another concern is having a product that is “easy to use” by “people who are not professionals at all”. Dr Millogo contrasts the situation in the US, where a patient might visit the paediatrician for vaccines and information, with a place where the labels present a language barrier.
“You have to be able to explain the product to populations that are not necessarily speaking the scientific language.”
Further considerations
As we encouraged Dr Millogo to give us further insights into the challenges associated with vaccine implementation, he emphasised that vaccines are often “inherently” specialised and sensitive. However, he urges developers to seek stability out of the refrigerator and easy administration. From his experience, Dr Millogo understands that vaccinators in some countries may not know how to read, or may never have attended to school. Still they understood the local language and were committed to their task, and were “very competent” in doing so.
Translation is also a concern for Dr Millogo. As he mentions language barriers, he is conscious that terms like “measles” or “respiratory infection” may not mean anything to patient populations.
“There are ways to make sure that by the time the product leaves the manufacturer, it can actually serve the public health goals that it is intended to. But you don’t need scientists…you need people who speak the language.”
Dr Millogo’s conclusion to this point is that people must be prepared to go to “where the people are” because “that is where the diseases are”.
Earning trust
We know that a vaccine is only effective when it reaches and is received by vulnerable populations. How, then, can we encourage these populations to take vaccines and trust those who administer them?
“It is important that the community sees you as part of them…that you know better but you’re not looking down on them.”
Dr Millogo believes that finding people will be reassured if they understand that the person who provides the vaccine is also prepared to take it.
“You are together.”
In his experience, Dr Millogo warns that there is a fear, or a memory, of previous interventions that will dissuade people from accepting new solutions.
“Being close to people is important, and having empathy with them.”
However, Dr Millogo also emphasises that administrators should not take a patronising or superior view.
“Just because they have not been to school does not mean they are ignorant. They understand if you use the right terms, and they understand the value of prevention.”
For communities that have experience with disease, Dr Millogo believes that they will be prepared to accept preventative measures in the right context. He gives the example of the loss of a child; if a parent or community can understand the cause of death, they will be eager to prevent future tragedies.
“Saying, “yes I want to help you prevent the death of the next child” – any mother, regardless of what she speaks, will understand that.”
Seeking profit or positive outcomes
As many of the vaccines that we have been discussing are historically manufactured by organisations in higher resource areas, we asked Dr Millogo about the balance between working for profit and working to improve public health. His insights were encouraging, as he suggests that his experience in the industry has demonstrated that most people have positive intentions.
“I think most organisations, or most human beings want to do the right thing!”
Although Dr Millogo recognises there “constraints” that are “inherent to the for-profit environment”, he suggests that people want to improve public health. He makes reference to the “traditional healer” in a village, who would receive compensation in order to be “in a position to be a healer”. However, Dr Millogo suggests that this profit-driven process should be “transparent”. This will then have financial and public benefits for “most shareholders”.
“It feels good, when you save lives.”
Dr Millogo suggests that “in a competitive environment”, people “want to be competitive”.
“You don’t go into this business just for money, otherwise you go to Wall Street!”
Coming to the Congress
As always we are keen to hear about what our experts are most looking forward to at the Congress. For Dr Millogo the networking is a huge benefit, because “these are opportunities”.
“When you work in the public health environment it’s always important not to be in your silo.”
Dr Millogo suggests that without an understanding of the other players in the community, he will “not be that helpful”! He is “curious to know what is out there”.
“Having these different vantage points help to have a better grasp on what needs to be done. No one has the absolute solution.”
We are so grateful to Dr Millogo for his time and valuable insight. If you would like to learn more about the work he does outside his role at Merck, head to his charity’s website. For more from our speakers at the Congress, subscribe to our weekly newsletter here.
