Q&A: From lab to last mile — the value of co-creation

Too often, innovation in technology and data analysis that could contribute to pandemic preparedness occurs in siloes, which limits scale and sustainability, said Theresa Pattery, head of disease management programs at Global Public Health R&D, Janssen Research & Development, LLC.

Pattery believes co-creation, which cuts across sectors and creates real results, especially in resource-limited settings, should be paramount in tackling global health threats and could be key to achieving universal health coverage by 2030.

“Co-creating disease-agnostic digital solutions in data science and analytics can actually help us to prepare, as best as we can, for future pandemics, thereby investing in real-time surveillance of emerging threats, faster insights, and the generation and implementation of the right solution, while building a more adaptable and resilient health care system,” she said.

As it stands, Uganda is in the throes of an Ebola outbreak — 55 people have died since Sept. 20 — while much of the world continues to struggle with the impacts of COVID-19.

Corporations, governments, civil society, and academia are likely to have more impact in tackling future outbreaks together, Pattery said, citing the example of J&J’s Vxnaid, a digital platform that supports effective vaccine administration campaigns for multidose regimens that has been recently certified as a Global Public Good on the DPG Registry.

“The same platform is being used by the World Health Organization for its COVID-19 solidarity trial as well,” Pattery said, explaining that this is an example of scalability and impact through co-creation.

Speaking to Devex ahead of the Africa Centres for Disease Control and Prevention’s International Conference on International Public Health in Africa, Pattery shared the lessons Johnson & Johnson has learned through co-creation thus far, the role this can play in tackling disease outbreaks such as Ebola, and why collaboration is even more vital in resource-limited settings.

This conversation has been edited for length and clarity.

The idea of collaboration is nothing new. Why do you think it’s paramount that co-creation between organizations and governments, rather than siloed work, is key now?

In resource-limited settings, it’s critical that public-private partnerships co-create together to enable the development of optimized sustainable insights and solutions that can leverage different expertise and experience. In most cases, both parties really have awareness at different levels of the unmet needs and the burden of disease within a country. By co-creating, we’re enabling the proposed approaches to become more relevant and appropriate for local health systems’ needs. And we’re bringing the best of the different organizations’ capabilities together, co-learning from that experience and creating significant economic value in the health care system as well. These collaborations can help convert a fragmented health care system into something that is more aligned and smooth, which helps people have a better experience and helps providers have access to technologies that are sustainable and adaptable.

How might co-created technologies and data strengthen pandemic preparedness in particular?

Recently, PATH convened a meeting on the WHO’s Digital Tools guidelines for resource-limited settings, where strategies to reduce duplication and increase structure to introduce new technologies were discussed. Digital Square is leading the way here, evaluating what’s in the ecosystem now that has limited connection and interoperability, and how we can more effectively align before introducing more tools to the space. The question was how we could convert a digital jungle into a digital garden? Co-creation is an important component of it.

This can only be achieved by the coalition of the willing, as PPPs work together with each other's strengths to contain a disease flare before it starts to spread. Co-creating as a strategic practice generates more trust as well. There's better awareness and understanding of partner organizations’ capabilities and how existing technologies and solutions can be leveraged or repurposed to address our most pressing needs.

Do you have examples where such co-creation is already being done and having an impact?

A great example is our open-source disease agnostic medical record system platform Connect for Life, which is active in several countries across Africa and Asia. It was originally designed to enhance patient adherence to treatment regimens, patient retention, and educate patients on their disease to raise awareness in Uganda. We worked with innovative local partners who understood the capabilities of the solutions enabled to them. They were able to repurpose the tool for COVID-19 surveillance, and so Uganda was ahead in monitoring international travel in airports before Europe was even able to start.

Today, the same tool has been customized to protect community health workers by helping them recognize signs and symptoms of Ebola in Kampala and the suburbs. These are great examples of how co-creation works; we developed the technology, handed it over to local collaborators — the Ministry of Health and the Infectious Disease Institute — and they ran ahead and used this disease agnostic platform in a sustainable, adaptable way.

What lessons has J&J learned through the co-creation process that might be useful for others?

One of the biggest challenges we have is upscaling from a field project targeting a set of communities facing a specific disease [RK[5] to a countrywide program. That needs several partners to work together. It needs the organization or the institution that built that innovative platform to make it open source. It cannot be provided on a commercial scale because, in resource-limited settings, affordability and accessibility of the products, diagnostic and tools require too many resources.

The next component is to make sure that the system is interoperable, which means it can work within the country's electronic medical record system, and it can convert from paper-based to paperless. It must be a simple tool, easy for health workers to use, and the value has to be clear. Thereby you're reducing the number of resources working in these systems, taking it to a step where health care workers can prioritize managing and supporting their patients rather than filling in forms.

It takes a village to effectively implement these tools and that's where regulators, ministries of health, public-private partnerships are critical, even mobile network connectivity is important because without a connected world, none of these solutions would work. That’s the only way we can actually go from lab to last mile health, as I call it, where the whole world is benefiting from these pandemic preparedness toolkits that we have built.

What would your call to action be for the global health community about how to progress toward UHC?

Considering the financial and human constraints the health care sector is facing globally, we need to accept the fact that no one organization or institutional body can single-handedly address all the challenges. Partnerships, at both the global and country level, are crucial to ensure we continue to improve health care outcomes. By working together, we can unite individual organizational capabilities to develop and implement innovative solutions that can address significant health needs at a scale.