Here.

I say.

It's all right.

So for you.

To.

Receive my.

Research.

On my.

Site.

All.

Right I've.

Heard so far so
say the science science technology.

Part is deciding in my.

First decade of it hard
to see your book I.

Have to listen to sources for

this it will last the season the States
but it's very hard for you to read.

It all you.

Want I think.

That it is a.

Very very insistent and
tough story line for the goals.

He's right.

Thank.

You.

So thank you so much for the introduction
and thank you to all of you for

showing up early in the morning during
fall break to hear a little bit about of

promises and challenges of trying to
redraw the map of drug discovery such that

it can include a place like South Africa
so Troy has already given you a little

bit of an introduction but I'll just
elaborate a little bit more on that so

my own field is called Science Technology
and Society this is an end to discipline.

They're a field that tries to
understand how it is that science and

technology shape the world in which
we live and then also the reverse so

how the world in which we
live feeds into science and

technology the way that it develops who
it serves and more so I'm currently the.

Coordinator of the graduate certificate in
Science Technology and Society I will soon

be passing that along I'm now the director
of graduate studies in literature media

and communication but we have had a few
Being Me students take the courses and

it can be an interesting opportunity to
start to learn about the ways that you're

kind of the rest of the world connects to
the work that folks are doing in the lab.

And the way that the rest
of the world even shapes

the work that's going on in the lab so
you can find more information here

as time mention did study at MIT in
Science Technology and Society and

there it's more history in anthropology
here it also has a lot of public

policy as well as well as humanistic kind
of elements so students in the room might

be interested in that I'm currently
teaching a graduate certificate course in

feminist theory and S.T.S.
one more piece of background.

As was mentioned the introduction as
well I am one of the on a grant race and

biomedicine so money Platt Lewis we and
I founded a working group

back in twenty fifteen with funding
from the Georgia Tech Provost in order

to draw together interdisciplinary
researchers from actually across Atlanta

institutions who share an interest
in understanding race racism and

biomedicine so that it comes out
of my first book which you can't

see the subtitle in the picture or
the cool heart in the background here but

this book was my first book which was
published in two thousand and twelve.

And really shapes my kind
of ongoing interest and

how we understand race and
biomedicine historically and today.

And out of this work came
an interest in this question of

who is making pharmaceutical knowledge
one of the things that was striking to me

in the conversations about race in
biomedicine in the United States

at the time so over the twentieth century
was that there wasn't a lot of attention

to the role of Black Cardiologists
in shaping this debate and so

this was one of the kind of primary groups
that I looked at was understanding how it

was that black physicians researchers were
saying you know what we need a space at

the research table because we have access
to populations that need to be studied and

so making a case that black people could
get heart disease was important in that.

As heart disease became increasingly
important field of study and

that led me to be interested
globally as well so

how as science tries to become a more
global project various folks try to

make it a more global project how
are African scientists among others trying

to articulate a role for themselves
in the space of global science and

that led to what I've been working
on now so this is a larger project

South African drug discovery supported
by the National Science front.

Ation I've published one article about
the project in the social studies of

science which you can read now many
scientists actually prefer to visit

the web based interactive narrative
which you can like click through and

see some interviews of scientists and
some stuff about the.

Geography of scientific innovation
that's at mapping attempt dot com But

right now I'm working on revising the book
manuscript on the project so this.

Has gone through is going to you know
has gone through a peer review I have

the feedback now I'm working
on implementing the changes

about this book which is called
synthesizing hope matter knowledge and

place in South African drug discovery so
the reason it's called synthesizing hope

is because attempts means hope in Zulu and
I did

field work at a pharmaceutical company
in Johannesburg that was called a temp.

And so there synthetic chemistry company
there called Hope it's like cool right

but spoiler alert the company failed and

so it failed in twenty fifteen I started
this project in two thousand and

ten the company started in two thousand
and nine and the company failed.

However there are the Afterlives of
hope that I also will talk about but

so what I'm going to talk with you about
a bit today is not so much the story in

the order that it's told in the book
although I'm happy to answer any questions

that you may have about that but
instead looking at these tensions between

what are the things that constrain the
ability of South Africans to participate

in global drug discovery and then what
are the things that make it possible and

so one of the things that is kind of
peculiar to me is that those actually I

would suggest are the same thing so this
is of this is a ten by pharmaceuticals so

it's very typical Johannesburg winter
which of course is in July and

I'm off of there and May June July and
so we have like some security theater

out there in the suburban office
park where this little lab building.

Here is their.

Website that was from
their kind of heyday.

And it outlines a lot of the things that
I've already talked to you about about so

means hope in Zulu.

It's a research based
drug discovery company.

It's in the outskirts of Johannesburg
in a place called lot of hunting.

And what they wanted to do was to discover
new drugs for TB HIV and malaria.

So they were doing some kind of chemistry
and they had this multinational group of.

Vick advisors so some of these names
may of course be familiar to people in

the room especially Dennis Leo
who's big brother was here for

many years and I guess his retired fish.

Sorry but still teaching I'm still
president and still doing work yet so

Dennis is not even pretending he's retired
yet but this is one of the projects that

Charlie go to his baby brother Dennis
was very involved in trying to set up.

It also emphasizes the South African
most of the company so the company was

fifty percent founded fifty percent
funded by the South African government so

they provided the start up funds and

they took ownership as a result
the technology innovation agency and

it's also of course South African and
other sciences because the idea being that

they were studying diseases that were
relevant for South Africa malaria is

actually not very relevant in South Africa
it's more relevant further north.

But HIV and TB are absolutely
primary concerns in South Africa and

so they're trying to emphasize the South
African This is the company with Africa in

the logo as well as
a course the Zulu name and

start up funding from the South African
government but they're also pointing to

their global connections as well right and
emphasizing that and for

audiences in the know this is a very
esteemed group of scientific advisors.

So that and this combination actually
is a really interesting one that makes

it that creates certain opportunities
in trying to achieve this goal so

their goal is inexpensive therapy for
infectious disease through innovative

chemistry which is not an easy
thing to try to do and

they did so in a way that was
simultaneously local and global or

they tried to do this so I want to talk
about the conditions of possibility and

the constraints and
there's three areas and

they're the same so one is infrastructure.

One is democratic imperatives and
one is global interest

so the infrastructure piece
was probably the most

surprising to me when I started
this project initially.

I was kind of surprised to find that in
this suburban office park in Johannesburg

it was the grounds of a historic dynamite
factory which was the biggest Nobel

factory in the world in its early
twentieth century heyday this was a place

that made a whole lot of dynamite
that was really vital for

colonial wars in Africa and
of course the extraction of minerals.

And so that this is all owned by the
African explosives and chemical industries

and this infrastructure is part of what
creates the possibility actually of

drug discovery in South Africa because
what this does is creates a bunch of

indigenously trained chemists with
kind of diverse sets of skills and

that also means that the area where
the office park is never loses power.

This is a huge deal in sub-Saharan Africa

one of the biggest barriers
to the ability of Nigeria for

example to actually manufacture its own
pharmaceuticals is the unreliability of

the electricity grid if you have to make
your own electricity in order to be able

to manufacture reliably That's
extraordinary expensive but

this South African company can't rely on
the robust electricity grid at least for

its industrial areas if not for
its residential areas so there are many

people in South Africa citizens who do not
have access to reliable electricity but

companies in South Africa in
places like this absolutely do

so this infrastructure is part of
what kind of creep makes it possible

to even try to do drug discovery research.

There's also another piece of
infrastructure that might be more familiar

to you all which is university
infrastructure is that we don't always

think of universities as part of
the infrastructure but they are.

Because South Africa was for it was
founded in its current form as a settler

colony right it was set up in such
a way that white South Africans

would have access to university education
that would allow them to participate in

what's called the Commonwealth of science
so the idea being South African scientists

like American scientists or Australian
scientists should be able to participate

in the global research enterprise and
there were research universe.

These set up with this in mind.

These are historically
white universities and

they still are problematically white
university so my collaborator money and

I were just talking about this about
how it is possible in a country

that is eighty percent black to
have labs that are all white.

And to have or maybe they will have a few
South Africans South Asian descent or

more common in this area is that
they're predominantly Africans

from other parts of Africa so there's
a lot of Zambians who are being trained in

South Africa as well as well as
folks from Zimbabwe and the R.C.

other put the Democratic Republic
of Congo and other places so

what this does is that it creates So
unlike other parts of sub-Saharan Africa

there is a pool of trained scientists
who are trained locally and so this

makes it possible to set up a research
enterprise in a different kind of way then

you can if you're trying to work elsewhere
in sub-Saharan Africa where many of

the scientists are trying to brought and
then have to be kind of conned back right.

Or incentivized back or
whatever it might be and

these universities I mean we might not
think of them now I mean they're not you

know they're not MIT they're not Georgia
Tech but they are entering answer research

universities that serve the continent
as a whole and so this is part of

the infrastructure that makes it possible
to do this kind of work in South Africa.

Another thing that makes it possible and
this was hinted at with funding from

the South African government is but
existence of democratic imperatives so

historically science in
South Africa was for

the white elite and for the global
elite So probably the most famous

scientific advance in South Africa
is the first heart transplant so

this is like an iconic kind of example
right so a heart transplant required.

Advanced biomedical research it
requires a kind of an infrastructure

that is at first world standards right and
so

that is historically who is South African
science served since South Africa became

a democracy in one thousand nine hundred
four there has been increasing demand for

it to have science in the service of
the people so this image here this

is some AIDS activists who are demanding.

Treatments for HIV AIDS This is
actually not the scientists but

I study this is a stock image but
they are.

I don't very few of the scientists I've
actually revealed their identities

it's awkward when you're doing
research in a small company.

And they're all talking like you have to
assure their privacy in order to work with

them because you know office politics
being what they are they you don't want to

like say such and such a scientist talked
about the leadership of the company

in this way and you know you don't want to
go there right so this is actually a stock

image although you can see a couple of
the scientists on mapping attempts.

And I had to do some of them
have become public figures and

I do talk about them but
in general they are.

Private identities of the scientists but
I still think that this image

capture is something right so the idea is
that this should be related to this so

rather than these folks just serving
global markets in the global north

these folks should be serving
the black majority of South Africa and

this creates a possibility because
the South African government sees this as

part of their job to say OK now we're
a democratic country rather than serving

the minority let's serve the majority and
so this creates a condition of possibility

to develop drug discovery
science there's also

actually I wanted to just mention this too
that in this space it's notable that they

saw in South Africa there's a very
expansive notion of who is an African so

Africans for a company like attend but
is offering African solutions for

African problems includes white
South Africans includes black colored and

South Asian South Africans and

also includes black Africans from
elsewhere on the continent and so

this is like this kind of expansion of the
way that South Africa even has articulated

itself right so we do have the Rainbow
Nation at the bench which is exciting and

this speaks not only to us in this room
but even to the scientists themselves so

you know of these kinds of cartoons
really speak to the young scientists at

a company like a temple so who
are the rainbow nation at the bench and

they will say I mean so
none of them are born free

which is the term that South Africans use
to describe people who were born after

the transition to democracy they're
still a little bit older than that but

they came of age during the period
of the rise of democracy so

this kind of thing speaks of them
they're like you know what I want to

build a new South Africa I want to
build a South Africa that follows

democratic a paradox and I want to use
my scientific training to do that.

International connections of course
are also important in why this works so

I first heard about this project from
Dennis Liotta when he was speaking at

a conference on drugs like access to
medicines as a human rights issue and

he was talking about founding a temp
this is how I kind of found out about

Originally this was back in two thousand
and eight that I heard him speak and

he was talking about you know like the
problem according to him with access to

medicines was not
intellectual property per se.

As people may know he discovered second
generation anti-retrovirals as well as

very expensive very lucrative hepatitis C.

oral medications so.

You know he has an interest right and
intellectual property perhaps but he also

authentically believes that the problem is
and not intellectual property per se but

that all the intellectual property is
owned by people in rich countries so

therefore it doesn't serve
the needs of poor countries and

therefore it doesn't is not
available to them so he hasn't

had a long term commitment in South Africa
to trying to create the capacity for

South Africans to discover
the solutions to their own diseases so

these global actors have been inspired by
the South African story so this kind of

same thing that inspired the local
scientists also inspires global scientists

and he of course observed at the
transition to democracy in South Africa.

Being inspired you know like wow there's
a peaceful transition to majority rule

let me be a part of this and

when he started trying to set things up to
have kind of global exchange programs and

so on in order to try to build capacity
in South Africa for research he

described that to a person the people
in his sign to scientific networks were

also inspired by South Africa were also
like yes I want to participate in helping.

South Africa to succeed in helping
African sayas to succeed and so this

kind of global interest is a big part of
what creates the condition of possibility.

He started his kind of building
research capacity in South Africa

with an exchange program so
he would bring South African postdocs

to his labs at Emory and train them
in drug discovery science and then.

You know kind of build capacity that way
and he has a tremendously successful

flat rate so they can get exposure
to world class knowledge making.

But there's a problem with this.

If you just train scientists you
just take them out of South Africa

bring them to Emory and

give them the skills what's going to
happen they're not going to go back.

If you don't if there's nowhere
that can apply them back home

there's no way they're going to go
back right they're going to have to

stay they're actually going to be skilled
out which is actually what's happened

to a lot of sub-Saharan Africans from
other countries in South Africa so

they come to South Africa to be trained.

But then they can't even work in Zambia
much less Democratic Republic of Congo.

Or Zimbabwe so you know so
if you just do this

without some other piece you just read
brain drain so you know does idea.

Was was a Temba.

That OK well I'm going to create this
commercial capacity at the same time that

I create the intellectual capacity and
it's not a one to one thing like it's not

like you have to do the post office
in order to work at Tampa but

it's like OK I'm going to both build
a commercial kind of sphere and

I'm going to build the training sphere so

this is kind of his idea
of how this would work.

So this is part of what makes it
possible to do this research because it.

Makes it so that the.

That this kind of global interest peace
is oriented toward fostering success for

South African projects and many people
have a desire for South Africa to see.

It so
I've talked about these possibilities so

in these like kind of
few different areas so

infrastructure Democratic imperatives and
global interests but

now I want to circle back and
do the same thing about the constraints.

So this is a map it's a little old now but
it hasn't changed much

of drug and
pharmaceutical investment globally and

so as you can see South Africa
is relatively large for

Africa but is extremely small globally and

this actually has really big
infrastructural impacts.

Most of the infrastructure of
our Indian South Africa Service

the extraction industries it is not
serving things like drug development.

And sorry.

Yes most of the markets
are projection is flawed Yes Africa is

much bigger than it looks
in this image is true.

But I do like the pie charts here.

The pie charts are sure and
those are to scale right so even if

the land mass is not to scale in Africa
is much larger than is recognized that.

The pie charts are to scale and
this is so.

Maybe.

So.

You have actually and I would emphasize
what I'm going to say now which it is

thank you which is that one of
the problems of when you're this far

away from other centers of pharmaceutical
production it's more difficult for

you to get things like reagents
to get your machine serviced

to get all of these kinds of things that
you all know it takes to make a lab run

right many people outside of science and

imagine that OK well now we can
just have virtual connections so

we don't need kind of physical connections
anymore in order to do science.

And certainly virtual connections
are possible right so

the bench time to have access to them and
Liotta and other leading scientists

in order to get feedback on their
problems and stuff but when they needed.

To get their machines I rest.

It was very expensive right and
there's not a lot of capacity to service

the machines and when they needed to
order religions they would have to do so

significantly in advance so
even in places like India and

China there's a lot that you can order and
how deliver it next day.

In South Africa that's not true so

you generally much like Plan your
reactions much more carefully.

And so this is a picture
of their supplier closet.

And you have to kind of
anticipate a little bit more.

The challenges that you're going to face
as you're working through your synthetic

chemistry reactions.

As you might have to order things
two weeks in advance another thing

that kind of comes up too is that a lot
of these ingredients are explosive and

so you have to factor that into shipping
costs as well or sometimes they have to do

work around so that that where they're
not using volatile ingredients so

that that way they can you
know have cheaper shipping.

In order so
they might have to do a longer reaction or

more complex reaction because they have
to use regions that are non-explosive So

there's all of these ways that they
like physical geographic isolation

of a drug discovery kind of enterprise
matters and I don't think that you

guys are as likely to forget this
as my digital media colleagues.

But things in space take time and
it's a huge it's a huge barrier for folks.

Another problem of course
is government corruption.

And this is a cape This is
the case throughout Africa and

of course it's also the case here we have.

The pharmaceutical industry is no stranger
to corruption in the United States or

elsewhere.

I do think it's worth noting that
this is not a new problem so

South Africa has had corruption alongside
super successful industries for

a long time so there was a ton of
corruption and dynamite and yet

it was still successful so
I don't think that.

The corruption issue
is quite as important.

As a more are kind of.

Mundane one of government interaction
which is that if you're working for

a democratic funder if the minister
who loves your project

is now moved to another department and
is not funding areas your area

of research anywhere like that actually
makes it harder to do your research and

so if you're doing a three year grant and
you're lucky to be getting three years

right but they give you three years of
seed money by the time you're done with

the three years and we know that the Drug
Discovery Enterprise is longer than that.

The next minister might be like that's not
my project I don't care about your project

like that's the other guy's going to get
credit for that anyway and I see this new

this new kind of interest that I'm more
interested in and one of the things that's

happened to the technology
innovation agency in South Africa.

As though they have increasing
pressure to actually make money

to support their research so
they say OK well.

We want return on investment and we need
to be able to see a return on investment

and we need to be able to see it within
the amount of time that a researcher or

that a government minister is in office so
that's extremely hard to do

in drug discovery and so what it winds up
doing is making more funding available for

things and information technology for
example where people can just make an app

within six months can get it to
market can you know kind of do

this work and it creates this incentive
within the government agencies

to put money in lower risk
lower time by shorter time line

projects than drug discovery and
this is like super unfair for

democratic South Africa because under
apartheid the South African government was

willing to fund catastrophic we
dispense of high risk research so

South Africa another one of its kind of
more famous scientific innovations is that

they found a way to turn
coal into liquid fuel so

this is like a huge innovation right
which was catastrophic Lee expensive and

for apartheid that was possible but

for democratic imperatives
we have to be niggling and

die making and saying like where's your
return on investment and I gave you

that money eighteen months ago and you
still don't have anything for it right so

there's a there's a kind of a bitterness
to the way that the scientists and

drug discovery talk about this problem.

Of kind of trying to do science
in a neo liberal environment

rather than the previous one which we
might call a liberal environment even

though it was only liberal for
the white minority.

But this is this is one of the kind
of the fundamental problems that

the South Africans are facing so
this need for

the quick return on investment
by government funders.

So.

This other piece is about
the global interest so

I mentioned that South Africa is a super
inspiring space for a lot of people.

One of the things that's kind of
interesting being down there is

that Atlanta is also a space
that Africans mobilize so

you know they'll say
Martin Luther King Mandela right

some of these things are easier to
kind of lionize from a distance.

And so there certainly is a desire for
South Africans to succeed and there is

this kind of idea of South Africa as a
possibility for a shining star of Africa.

But that doesn't necessarily translate
to all sectors so that folks may know.

South out there was a big case in
the late one nine hundred ninety S..

It went by the moniker
Big Pharma versus Nelson Mandela

which was bad optics right like
you don't want to be the one

saying versus Nelson Mandela in
the late one nine hundred ninety S.

right but what
the Treatment Action Campaign which was.

Social movement that wanted to do
parallel importing of pharmaceuticals

to South Africa to address
HIV in South Africa

in the late one nine hundred ninety S.

they made this case and
they were successful

in saying that South Africa should be
able to import pharmaceuticals for

HIV without having to pay them
that kind of the brand price

which is what South Africa had previously
had to do because South Africa joined

the World Trade Organization before it
was democratic So it was a white minority

government it was a developed country and
it has strong intellectual property

in the same way that you would expect
in Europe or the United States but

then they have a disease burden that makes
that very difficult and the transition to

democracy is happening at the same time
as the crisis of the uni so they won.

But they didn't win the access
to make pharmaceuticals

they want access to import them.

And so this made a lot of sense at
the time because it was urgent right and

Indians and Thailand and so in India
Thailand Brazil other places India mostly

for the case where they're actually
importing from they have already developed

the capacity so South Africa has one of
the highest rates of HIV in the world is

having a huge problem of people dying and
the urgent action is to get access

to importing from companies that are they
have the capacity to make them but

what this winds up doing in terms of the
global interest is hey OK we'll just keep

importing from India then we don't need to
create the capacity of South Africans in

order to foster the treatment of HIV We
want so funders global funders so

Gates Clinton and others they want to
buy from the cheapest source possible

that she was sourced possible is the one
that already has economies of scale and

so they are saying buy from India and
this is certainly what.

Clinton himself has done so through chai.

And so it's very hard for a domestic.

Manufacturer to develop the capacity to
make drugs if you're having to compete

with Indian companies they do actually
have South African generic companies but

they all import the active
pharmaceutical and radians.

So they don't advocate they don't make
the active pharmaceutical gradients for

HIV for example so this is a this turns
out to be very difficult to enter

if they're already is this affordable
source of pharmaceuticals.

And then on the other hand Bill and
Melinda Gates so they they both support

access so they buy a lot of things they
contribute to the Global Fund and so

on but one of the things that they do
is that they also fund new research but

one of the problems with the way
that they from the research is

that they like to fund
scientists with track records.

Which makes sense so you want to fund
innovative research you find someone who

has successfully done innovative research
before and so they've got a great track

record of success you have
a very likelihood of success but

what this does is actually in trenches
global inequality so that Gates

the Gates Foundation and others like it
are funding scientists in the global north

to solve these problems rather than
funding South African scientists or

scientists elsewhere in Africa because for

in the kind of the system of intellectual
property that Bill Gates is a part of

he cares a lot about the defeat
of technologies so like spreading

the technology availability to the global
south but he's not that interested in

the spreading knowledge making he feels
like you know OK well you know we might as

well do it where it already is because
that's the most efficient way to do it and

it also helps to prop up high
prices in the global north as it

makes things affordable in the global
south but that's kind of another issue.

But this is like a fundamental
issue this idea that.

That there is no problem with the map
of global knowledge making So

the university is alive for essential
medicines is an awesome organization but

I want to highlight there's a problem
I think with their motto our drugs

our labs our responsibility because
what that suggests I mean on

the one hand that's awesome right so
you are doing biomedical research you have

a responsibility to make sure that it
gets out there to the people in need.

But one of the things that this location
does is assumes that the only place that

knowledge can be made and the only place
that responsibility can be located it

is in the global north and
that's a problem for

African scientists because it kind of
excludes them from the entire picture.

And you know this kind
of framing you know like

there's a lot of good that happens
from these kinds of campaigns but

there's a problem in there's
like this invisibility.

African would be scientific knowledge
contributors as well in these kinds

of movements so
there's been a lot of kind of activism

around protecting the ability of
India to make generic pharmaceuticals

even as it's come in strips compliance
which I don't know how many how much folks

know about all of that but you don't
need to go too far into the weeds but

basically developing countries had longer
time to get into intellectual property

compliance than others but now India is
complying and so there's a question of

will the global south still have access so
what's been the response is to say we

need India to be able to kill it continue
to make generic drugs and they have.

But the idea of India as
the pharmaceutical you know so

they talk about this as the pharmacy
of the developing world right so

if India is the pharmacy the developing
world then nobody else gets to be right so

Africans are kind of
excluded from the role and

this is a huge problem for would be drug
discovery company in South Africa because

if they are trying to organize so they
were trying to do some manufacturing to

kind of pay the bills while
they were doing their work and

if Indian companies notice that you're
ordering a lot of a particular ingredient.

Check of the practice to
make it difficult for

you to do the research the small number
of companies that are doing this so

if those kind of reagents become desirable
they can do that and that's possible

because of the kind of global
consolidation that this has made possible.

So you know as as much as I think that
it's important that we do advocate that

India continue to provide generic drugs
for people in the global south and

actually for people in the United States
as well this kind of framing

excludes as well as includes so.

Kind of question and that I want to leave
you with an open up to questions is.

OK So this particular company of
a temple pharmaceuticals where I

did my research failed.

And so it's still kind of
an outstanding question of how

might this particular map
be redrawn Thank you.

Thank you.

Question.

Yes Mark and then money so
thank you for this.

So I just read it for
like the government just see this.

Was.

Not really I mean so am I supposed to be.

There.

So what happened was that in there in
one thousand nine hundred six there was

an agreement that the companies that
were coming into trips compliance later

would have more time so
they would be allowed to reverse engineer.

Drugs but then they could use for

their own populations or export to other
countries that also had extra time so

less developed countries had extra
time in order to develop their.

Compliance with intellectual property and
India had a lot of scientific

acidy already so it was like kind of in
a sweet spot there was very much private

industry in India that got involved in
the space that's different from Brazil

where it is much more state driven but
both India and Brazil took advantage

of trips flexibilities in order to
develop major industries China two.

But yeah it was.

Kind of accidental or like these were
the developing countries that had the most

capacity to enter the space and then
it became like a self-fulfilling thing

where once you kind of started to access
the space then you could do so more.

Mark.

I.

Don't know.

Why.

You.

Don't.

Go over the question of Walker
which is why she's so yeah.

Yeah that's a fair question.

Well so yes it was.

Yeah.

Yeah.

That's creating major crisis right now
in terms of the supply chain but yes.

It's actually not it's actually
not a separate issue because

one of the problems is from
the perspective of South Africa and

this is interesting that I just heard
from myself and I saw South Africa which

I did some of my African students actually
think are you South African you know like

in the same way that
I'm Nigerian No I am not but they one

of the problems is anti-retrovirals
are not a huge priority for India it

could happen that Indian companies might
decide you know what I'm going to focus on

much more expensive drugs
that are higher margin and

that's where I'm going to put
to my kind of emphasis so

this creates vulnerability for
South Africa because then they are not

making their own active pharmaceutical
gradients for the stuff that they need.

And it creates one ability and I think
that the Puerto Rico case actually is

opening that up I mean like it's all well
and good to be super efficient in terms of

your supply chain but that creates a lot
of honorability So we're going to have

some major pharmaceutical shortages as the
active pharmaceutical and gradients that

are made in Puerto Rico currently are not
being made we're going to have like major

shortages in eighteen months because a lot
of them are only made by one company and

if you're relying for your major
public health means on one company.

And that company has a hurricane or
is that

decides to change its priorities that's a
tremendously vulnerable position to be in.

OK.

OK so.

Just.

So long as you're so
right but if you know so.

Yes.

Watch this.

Yes or.

No that and this is absolutely many
people in the technology innovation

agency make exactly this case so one
thing that they'll say is look we have so

many people with urgent unmet health means
we don't have time to do the research and

development for
potential future needs or even the time

to build manufacturing capacity in
a more robust way than already exists we

have such a it's an emergency and we need
to focus on the emergency right now.

And that is certainly true.

I guess one question is So
there's a couple of problems I mean one

yes the United States is a wealthy country
and can afford to spend a lot of money but

we also have a lot of patients
with urgent unmet health means and

we still decide we can afford it right I
mean there's a kind of an Orientalism in

this idea that like kind of projecting
like they can't afford things and

somewhere else can afford things right
it's like OK everybody has unmet needs.

They're at different scales.

But that's certainly you know one argument
it's like OK well we don't have time we

don't have money we can just rely on the
U.S. But another problem is as the U.S.

as this investor.

That also makes South Africa vulnerable so
you know as the U.S.

companies and
global pharma decrease there are indie So

again historically that's
worked just copy from the.

But.
Well if the global north decides to

disinvest that makes South Africa
vulnerable as well and

they will eventually need to be
third generation antiretrovirals and

look TB It's a success there is
treatment but it's a risk it's

all to it's a very it's ripe for
I mean kind of irrelevance as we get

multi-drug resistant to TB So and it's
not clear that the global north is doing

that work I mean sure there's Bill Gates
in the space there are some others but

it's not clear that you can rely on it so
it's it puts you in a position

of vulnerability to rely on someone
else to address your own priorities.

Yes.

Correct I mean now they are starting
to they've gone into compliance now.

Yet Egypt Egypt is the is
currently the biggest now but

in much of Africa really it's the the
power grid that holds that back a lot and

also the bureaucrat the bureaucracy so
if there's insufficient bureaucratic

development like normal you think of
bureaucracy is a bad thing right but

like you need somebody to like
authenticate that the things are pure and

Nigeria would be the next most obvious
place so Nigeria is the next it is

the biggest economy now actually major
areas economy has outpaced South African

economy with the fall in
commodities prices so but

Nigeria does not have the regulatory
infrastructure to make that possible so

that they don't have the kind of like you
need like a government authority that will

authentic eight ingredients or

pure in order to be successful in this
space and idea does not have that and

it also doesn't have electricity grid
where water or other like the other kinds

of things that you need in order to do
this kind of manufacturing on the scale.

But it is possible I mean there is some
discussion that maybe Zambia would find

a space in the space it could
happen Botswana could do it but

Swan is also a middle income
country similar to Iran so

it could which is not in significant
there as well it could happen.

But you know all those other elements of
infrastructure the research universities

the power grid and
the global enthusiasm interest are.

Are less present in any
given other part of Africa.

Yeah I don't so question when we think
about clinical trials of the body

like the child that's absolutely
remembers is that most of the go of those

countries like access to clinical trials
with infrastructure so that you could.

Take a break in the water and.

In that people if you like.

So maybe in East Africa you can do that
and Uganda Tanzania and Kenya maybe.

Those are really small so you know.

Visible I don't know how strong everyone's
map of Africa is but East Africa also has.

I mean some of them are stable
dictatorships some of them are relatively

stable democracies that could
potentially build this so

we hear about like the silicon
Savannah in Kenya that does a lot

of information technology research in
theory they could do this as well but

they haven't prioritized doing is
going to stand for the company.

With it at least you know getting
them one of the five of the five that

this would it would just be records
of what it cost me because I'm

reading the cost of
those things you should.

Think like there's a reason that it's
just governments that build power grids

they're hard to build
they're hard to maintain.

But if you focus.

On our.

Work.

There I think that we lack.

Knowledge and people that are trained.

You're going.

To have to get out there
to do the research.

Seems like somebody yeah but
you can do that.

For.

It's very hard to get out
of the I think right so

there's all this discussion
about leap frogging you know so

South Africa Africa and general
leapfrogged in terms of telephony right so

over all the continent never I mean
South Africa does have landlines but

many parts of Africa don't
have landline telephone so

they just leapfrog directly to cell phones
right and so there's this question about

whether they could leap frog into other
areas and one of the ways that it's

thought about doing that was through
flow chemistry technology so

right now not very many pharmaceutical
active pharmaceutical gradients are made

using continuous flow which is less
polluting and has lots of other advantages

less space intensive than standard
batch production process is that one of

the things that South Africans looked into
doing is OK Well could we go innovate in

this space so we leapfrog the highly
toxic highly wasteful current

manufacturing processes go on to the next
step and then build that and there's

some discussion in that you about things
that are bought by the E.U. would have to

take into account their externalities So
you basically would have to pay more for

more polluting technology so you would
have like an incentive if you're the E.U.

to buy from a green
pharmaceutical company right and

this is something that they export you
know that you could maybe Leap Frog and

do the new technology that will probably
be there in the future rather than

try to build the existing infrastructure
which is too hard to build I mean so

continuous flow technology you can put it
into like a container ship ran you know

put a container on a ship and put your
materials there and ship it somewhere and

you can you know run in smaller kind
of spaces use less ingredients.

A lot less toxins and so on.

But that turns out to be to be challenging
to because they needed a lot of investment

up front from the government and
it was not happening and

maybe a guaranteed tender at the beginning
so one thing that probably would have

made this work is if the government had
given a strong promise that they would buy

whatever it was that they made right so if
you have and in South Africa they do have

public provision of anti-retrovirals
if you had a buyer like the government

say we're going to buy what you make you
can get it becomes a fusible business

model because you know that they're
going to buy at a particular price but

the South African government can only buy
the company globally competitive price and

the same thing happens for the donors
who buy a lot of enterovirus as well for

the rest of the continent so
you know where the Global Fund and

others like they will.

Buy at the cheapest price so it's you
can't kind of say Well mine's greener and

we kind of get competitive
advantage that way challenge.

Yeah.

You.

Know.

It's a very.

Critical Mass Yeah it's really hard and
they joke about it too like for

you go to so you know I don't know if you
know much about how ethnography works but

basically what happens is so
I just hang out at the last

writers go to the meetings I
interview people I you know.

So just see what they're doing and so

that when they're talking at like in their
lab meetings about problem solving so

you know they would say OK so
where you going to get that ingredient and

they're like OK I'm going to order it from
India and when that turns out to be sugar

and then order it again from a different
company and then I will still get it

done within this time frame right so it's
like they are like but it's a problem.

I'm although they do actually have like so
and

a mark like so one of the so South Africa
is the only place with significant and

market acidy they finally
had once they were six and

a Mars in this area of Johannesburg
there was a technician.

So once you had like so
like a technician like I think you reverse

immigrated you know so that he had
been living abroad and came back and

was like OK I can support myself you
know because now that they're six

you can't support yourself
with one of them are.

At the beginning attempt I had
to share it's AND I'M are with

the governments research institute
like they would go to the council for

Scientific and
Industrial Research the C.S.I.R.

in order to you know do any
analysis that they needed.

So but

it's got its chicken egg problem right
because you can't get the technicians you

can't get the supply until you have
enough commercial investment but

you can't get the commercial
investment until you get the supply.

It's a conundrum Maybe Mark's right
maybe they just didn't do it yeah.

OK so.

It's an interesting question and it's
different from the one I mean normally in

science technology studies we don't answer
what are called normative questions so

where we're not like prescribing like this
is what you should do we tend to answer

just descriptive questions rather than.

Yeah I mean I think so a lot of it is
where we have talked about I think that

the lack of long term government
support is huge but there are other

issues too like they definitely
had it's hard to find a talented.

Kind of chief operating officer right and

that is just key I mean
most startups fail and

they fail because there's a lot of things
that can go wrong in this right so you.

You need like your H.R. It has to be
like on point you need to hire the right

people and you need to be able to
incentivize them well you need to

have a be compelling to your investors so
in this case the government and

then also the international scientists and
you need to stay compelling to them and

like that it's hard I mean I
think in some ways like it's much

easier it's it's because
failure rates are so high.

You need less explanatory basis for
describing my things fail them I

think succeed when they succeed it's like
a perfect storm of like we have a talented

leader and we have a government funded who
believed in us or some other address or

who believed in us and we had like
a talented advisor from abroad or

we have got all of these things together
so maybe the answer is just scale right

like so you just need more attempts so
that way in the context of a high failure

rate they one will be successful or
more than one will be successful and

the more attempts you have the higher
the success rate becomes And so but

this gets back to this
question about critical mass.

So people.

Are.

Not in that particular space but modern
Fontayne has huge so this is if folks

are familiar with your hemispheric like if
you take the train from the airport into

the city you go past a lot of heavy
manufacturing that's all where this

is because originally it was set up well
outside of the city because they didn't

want to have obviously explosions of
the dynamite factory in the city so

but now Johannesburg is a huge megalopolis
So the city has grown and is filled it

all in right so now there's like there's a
golf course there and the nature preserve.

Alongside the heavy manufacturing and

then there's a lot of gated communities so
it's really not.

Not dissimilar from like
the northern suburbs of Atlanta

you know where you'll see like these
gated communities of single family homes

that are filling the hillsides in between.

But no actually the building
of the building is empty but

that's because it's owned by
the government and it's complicated.

You know.

So there's a you know so
that particular building is empty but

that area is absolutely
developing especially with

the role of the airport as a mode of
transportation you know like so kind of

ease of access to the airport it's very
close to the airport is very appealing

ease of access to the train is appealing
it's also very close to Alexandra

which is a township where Nelson Mandela
grew up and I mean he's more famous for

his work and so at zero but
before that he was in Alexandra and

so you have also access to labor so
for heavy manufacturing.

So.

And the last question.

Well thank you so much for coming so

early in the morning on fall break and
I really appreciate the conversation.