Els Torreele - Academia.edu (original) (raw)
Papers by Els Torreele
PLOS global public health, Apr 25, 2024
The Lancet
Democratic Republic of the Congo, and Central African Republic for many years, it was only when t... more Democratic Republic of the Congo, and Central African Republic for many years, it was only when the virus spread globally during 2022 that high-income countries focused on the disease, with people in wealthy countries getting access to mpox vaccines and therapies. 6 Governments and the global community must urgently tackle difficult questions about why, how, where, and when diagnostics, treatments, and vaccines are produced, and about who is in control of their availability and distribution. Epidemics present unique and complex scientific, health, socioeconomic, and international cooperation challenges that require a fit-for-purpose response. 7 Current market forces cannot provide the tools to stop disease outbreaks. We propose a new framework that is designed in the public interest and rooted in equity from start to finish to create a sustainable ecosystem for medical countermeasures to outbreaks, based on the sharing of knowledge and technology and governed and financed through a global commons approach (panel). This conversation and some actions are already under way. Hard lessons from the Access to COVID-19 Tools Accelerator (ACT-A), which despite efforts failed to reach targets, are spurring discussions. 8 WHO's mRNA vaccine technology transfer hub in South Africa and other related initiatives in Africa, Asia, and Latin America, offer promise. 9,10 Public-private partnerships are building vaccine manufacturing capacity in some lower-income countries. But these efforts, without innovative approaches linked to governance and finance, will not produce the equitable start-to-finish or "end-to-end platform" that encompasses every stage from research and development to manufacturing, distribution, and access, recommended by the Independent Panel for Pandemic Preparedness and Response in its May, 2021 report and demanded now on many continents. 11,12 The most promising opportunity lies with research and development efforts that allow scientists to rapidly create new medical countermeasures on the basis of existing technologies, as was done successfully for COVID-19 vaccines, treatments, and testing. 13-16 Enabling scientists in every region to build on existing knowledge and promptly adapt technologies to respond to epidemics when and where they occur could be transformational. Given the limitations of current market-based incentives and of donor-to-recipient aid models, we have considered how to deliver appropriate health technologies and equitable access where and when they are needed. 12 As
Vaccines, Mar 17, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Routledge eBooks, May 15, 2017
European Journal of Public Health, 2013
The Lancet Infectious Diseases
Tropical Medicine & International Health, 2015
The Author(s) 2014. This article is published with open access at Springerlink.com Background and... more The Author(s) 2014. This article is published with open access at Springerlink.com Background and Objectives Fexinidazole is a 5-nitroim-idazole recently included in a clinical efficacy trial as an oral drug for the treatment of human African trypanoso-miasis (HAT). Preclinical studies showed it acts as a pharmacologically active pro-drug with two key active metabolites: sulfoxide and sulfone (the most active metab-olite). The present studies aimed to determine the best dose regimen for the treatment of stage 2 sleeping sickness patients, which could eventually also treat stage 1 patients. Methods Fexinidazole was assessed in 154 healthy adult male subjects of sub-Saharan African origin. Three initial first-in-human studies and two additional studies assessed a single ascending dose and multiple ascending doses (both
Health and Human Rights, 2021
The inequity in access to COVID-19 vaccines that we are witnessing today is yet another symptom o... more The inequity in access to COVID-19 vaccines that we are witnessing today is yet another symptom of a pharmaceutical economy that is not fit for purpose. That it was possible to develop multiple COVID-19 vaccines in less than a year, while at the same time fostering extreme inequities, calls for transformative change in the health innovation and access ecosystem. Brought into the spotlight through the AIDS drugs access crisis, challenges in accessing lifesaving medicines and vaccines—because they are either not available or inaccessible due to excessive pricing—are being faced by people all over the world. To appreciate the underlying framing of current access discussions, it is important to understand past trends in global health policies and the thinking behind the institutions and mechanisms that were designed to solve access problems. Contrary to what might be expected, certain types of solutions intrinsically carry the conditions that enable scarcity, rationing, and inequity, an...
Tropical Medicine & International Health, 2008
Bulletin of the World Health Organization, 2019
The Lancet Infectious Diseases
Three years since proving effective for Ebola virus disease in a clinical trial, two breakthrough... more Three years since proving effective for Ebola virus disease in a clinical trial, two breakthrough treatments are registered and stockpiled in the USA but still not registered and generally available in the countries most affected by this deadly infection of epidemic potential. Analysing the reasons for this, we see a fragmentation of the research and development value chain, with different stakeholders taking on different steps of the research and development process, without the public health-focused leadership needed to ensure the end goal of equitable access in countries where Ebola virus disease is prevalent. Current financial incentives for companies to overcome market failures and engage in epidemic-prone diseases are geared towards registration and stockpiling in the USA, without responsibility to provide access where and when needed. Ebola virus disease is the case in point, but not unique-a situation seen again for mpox and likely to occur again for other epidemics primarily affecting disempowered communities. Stronger leadership in African countries will help drive drug development efforts for diseases that primarily affect their communities, and ensure all partners align with and commit to an end-to-end approach to pharmaceutical development and manufacturing that puts equitable access when and where needed at its core.
Health and human rights, 2021
ET and JA: Thank you all for participating in this virtual roundtable. Let's get started with two... more ET and JA: Thank you all for participating in this virtual roundtable. Let's get started with two questions: How unprecedented is the current situation? Compared to other challenges (for example, HIV drugs and expensive cancer therapies), what makes COVID-19 vaccine access inequities different? Carolyn: Related to both questions, it's clear that the emergence of the COVID-19 pandemic was more sudden and more urgent and more widespread, impacting everyone around the world directly. e. torreele and j. j. amon / virtual roundtable, 273-288
Molecular Therapy, 2022
Lessons drawn from successes and failures with Covid-19 and Ebola should help shaping a robust he... more Lessons drawn from successes and failures with Covid-19 and Ebola should help shaping a robust health innovation system for infectious disease epidemics. Epidemic response research and development (R&D) can be mobilized quickly for public health priorities and yield medicinal products within months. However, to resolve epidemics, technological advances must be equitably accessible and deployed, and these examples expose the limitations of a supply-driven, fragmented R&D ecosystem relying primarily on the private sector to deliver health products. Efficient epidemic response requires a coordinated public health-focused, end-to-end R&D ecosystem for the development, registration, availability and use of pharmaceutical products. Since pivotal clinical trials can only be conducted during outbreaks, significant preparation must be done beforehand: strengthening clinical research capacity, developing pre-positioned trial protocols and clinical characterization protocols, as well as conducting discovery and pre-clinical research, manufacturing, and early clinical testing of candidate products. This will allow for speedy execution of clinical research early into an outbreak and delivering products within a short time. Effective interventions should be adopted and deployed ensuring equitable access during the ongoing outbreak. Measures to make products available where and when needed must be integrated throughout the R&D value chain.
Nature, 2022
[...]is the slow pace of progress in some areas, such as Alzheimer's disease2. [...]is the ri... more [...]is the slow pace of progress in some areas, such as Alzheimer's disease2. [...]is the risk of harm, such as adverse drug reactions. [...]mission-oriented' approaches require public stewardship5. Because setting priorities involves value judgements, it must not be done by technical experts alone. By the timely sharing of research inputs (such as specimens, compound libraries and data sets with appropriate protections), processes (such as protocols, trial designs and cost data) and outputs (including trial results and publications).
PLOS global public health, Apr 25, 2024
The Lancet
Democratic Republic of the Congo, and Central African Republic for many years, it was only when t... more Democratic Republic of the Congo, and Central African Republic for many years, it was only when the virus spread globally during 2022 that high-income countries focused on the disease, with people in wealthy countries getting access to mpox vaccines and therapies. 6 Governments and the global community must urgently tackle difficult questions about why, how, where, and when diagnostics, treatments, and vaccines are produced, and about who is in control of their availability and distribution. Epidemics present unique and complex scientific, health, socioeconomic, and international cooperation challenges that require a fit-for-purpose response. 7 Current market forces cannot provide the tools to stop disease outbreaks. We propose a new framework that is designed in the public interest and rooted in equity from start to finish to create a sustainable ecosystem for medical countermeasures to outbreaks, based on the sharing of knowledge and technology and governed and financed through a global commons approach (panel). This conversation and some actions are already under way. Hard lessons from the Access to COVID-19 Tools Accelerator (ACT-A), which despite efforts failed to reach targets, are spurring discussions. 8 WHO's mRNA vaccine technology transfer hub in South Africa and other related initiatives in Africa, Asia, and Latin America, offer promise. 9,10 Public-private partnerships are building vaccine manufacturing capacity in some lower-income countries. But these efforts, without innovative approaches linked to governance and finance, will not produce the equitable start-to-finish or "end-to-end platform" that encompasses every stage from research and development to manufacturing, distribution, and access, recommended by the Independent Panel for Pandemic Preparedness and Response in its May, 2021 report and demanded now on many continents. 11,12 The most promising opportunity lies with research and development efforts that allow scientists to rapidly create new medical countermeasures on the basis of existing technologies, as was done successfully for COVID-19 vaccines, treatments, and testing. 13-16 Enabling scientists in every region to build on existing knowledge and promptly adapt technologies to respond to epidemics when and where they occur could be transformational. Given the limitations of current market-based incentives and of donor-to-recipient aid models, we have considered how to deliver appropriate health technologies and equitable access where and when they are needed. 12 As
Vaccines, Mar 17, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Routledge eBooks, May 15, 2017
European Journal of Public Health, 2013
The Lancet Infectious Diseases
Tropical Medicine & International Health, 2015
The Author(s) 2014. This article is published with open access at Springerlink.com Background and... more The Author(s) 2014. This article is published with open access at Springerlink.com Background and Objectives Fexinidazole is a 5-nitroim-idazole recently included in a clinical efficacy trial as an oral drug for the treatment of human African trypanoso-miasis (HAT). Preclinical studies showed it acts as a pharmacologically active pro-drug with two key active metabolites: sulfoxide and sulfone (the most active metab-olite). The present studies aimed to determine the best dose regimen for the treatment of stage 2 sleeping sickness patients, which could eventually also treat stage 1 patients. Methods Fexinidazole was assessed in 154 healthy adult male subjects of sub-Saharan African origin. Three initial first-in-human studies and two additional studies assessed a single ascending dose and multiple ascending doses (both
Health and Human Rights, 2021
The inequity in access to COVID-19 vaccines that we are witnessing today is yet another symptom o... more The inequity in access to COVID-19 vaccines that we are witnessing today is yet another symptom of a pharmaceutical economy that is not fit for purpose. That it was possible to develop multiple COVID-19 vaccines in less than a year, while at the same time fostering extreme inequities, calls for transformative change in the health innovation and access ecosystem. Brought into the spotlight through the AIDS drugs access crisis, challenges in accessing lifesaving medicines and vaccines—because they are either not available or inaccessible due to excessive pricing—are being faced by people all over the world. To appreciate the underlying framing of current access discussions, it is important to understand past trends in global health policies and the thinking behind the institutions and mechanisms that were designed to solve access problems. Contrary to what might be expected, certain types of solutions intrinsically carry the conditions that enable scarcity, rationing, and inequity, an...
Tropical Medicine & International Health, 2008
Bulletin of the World Health Organization, 2019
The Lancet Infectious Diseases
Three years since proving effective for Ebola virus disease in a clinical trial, two breakthrough... more Three years since proving effective for Ebola virus disease in a clinical trial, two breakthrough treatments are registered and stockpiled in the USA but still not registered and generally available in the countries most affected by this deadly infection of epidemic potential. Analysing the reasons for this, we see a fragmentation of the research and development value chain, with different stakeholders taking on different steps of the research and development process, without the public health-focused leadership needed to ensure the end goal of equitable access in countries where Ebola virus disease is prevalent. Current financial incentives for companies to overcome market failures and engage in epidemic-prone diseases are geared towards registration and stockpiling in the USA, without responsibility to provide access where and when needed. Ebola virus disease is the case in point, but not unique-a situation seen again for mpox and likely to occur again for other epidemics primarily affecting disempowered communities. Stronger leadership in African countries will help drive drug development efforts for diseases that primarily affect their communities, and ensure all partners align with and commit to an end-to-end approach to pharmaceutical development and manufacturing that puts equitable access when and where needed at its core.
Health and human rights, 2021
ET and JA: Thank you all for participating in this virtual roundtable. Let's get started with two... more ET and JA: Thank you all for participating in this virtual roundtable. Let's get started with two questions: How unprecedented is the current situation? Compared to other challenges (for example, HIV drugs and expensive cancer therapies), what makes COVID-19 vaccine access inequities different? Carolyn: Related to both questions, it's clear that the emergence of the COVID-19 pandemic was more sudden and more urgent and more widespread, impacting everyone around the world directly. e. torreele and j. j. amon / virtual roundtable, 273-288
Molecular Therapy, 2022
Lessons drawn from successes and failures with Covid-19 and Ebola should help shaping a robust he... more Lessons drawn from successes and failures with Covid-19 and Ebola should help shaping a robust health innovation system for infectious disease epidemics. Epidemic response research and development (R&D) can be mobilized quickly for public health priorities and yield medicinal products within months. However, to resolve epidemics, technological advances must be equitably accessible and deployed, and these examples expose the limitations of a supply-driven, fragmented R&D ecosystem relying primarily on the private sector to deliver health products. Efficient epidemic response requires a coordinated public health-focused, end-to-end R&D ecosystem for the development, registration, availability and use of pharmaceutical products. Since pivotal clinical trials can only be conducted during outbreaks, significant preparation must be done beforehand: strengthening clinical research capacity, developing pre-positioned trial protocols and clinical characterization protocols, as well as conducting discovery and pre-clinical research, manufacturing, and early clinical testing of candidate products. This will allow for speedy execution of clinical research early into an outbreak and delivering products within a short time. Effective interventions should be adopted and deployed ensuring equitable access during the ongoing outbreak. Measures to make products available where and when needed must be integrated throughout the R&D value chain.
Nature, 2022
[...]is the slow pace of progress in some areas, such as Alzheimer's disease2. [...]is the ri... more [...]is the slow pace of progress in some areas, such as Alzheimer's disease2. [...]is the risk of harm, such as adverse drug reactions. [...]mission-oriented' approaches require public stewardship5. Because setting priorities involves value judgements, it must not be done by technical experts alone. By the timely sharing of research inputs (such as specimens, compound libraries and data sets with appropriate protections), processes (such as protocols, trial designs and cost data) and outputs (including trial results and publications).