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EF: If 2020 was the year of diagnostics, and 2021 was the year of vaccines, what do you think 2022 will be the year of?

SN: 2022 is a year of digital health solutions as seen with artificial intelligence and machine-learning-enabled diagnostic systems that can identify the quality of a patient's health through bodily parameters. It is a year where we will see more movement and focus in the digital health direction and the deployment of technologies that allow and enable early-stage prevention and diagnosis.  

The second thing that's happening in the background is, that although 2021 was focused on vaccines primarily and 2020 on diagnosis, these two years highlighted the need to move away from dependence. We are now closing that gap by ensuring we have the product available closer to the area of need. There is a lot of money flowing into the continent – for example from the European investment bank and DFIs, and local production is a priority in the healthcare agenda of the region. The Gates Foundation is investing money in regulatory systems and there are many more examples of these investments in African health systems. Those are the two major elements that I see for 2022 and possibly going into 25 and beyond.  

EF: What factors make South Africa prepared for the coming wave of COVID?

SN: One factor is that we have an excellent educational and healthcare system as well as world-class experts. Those are some of the factors that put us in a good state. We have a scientific community that is not only able to identify and flag illnesses early (internationally), but also describe the disease and its clinical profile while assisting not only local but international clinicians with management thereof. The second thing is from a pure research skill standpoint. Our people have been at the forefront in describing the evolution of these new variants.  

EF: What advice would you give to other executives for keeping these collaborations going into the future?

SN: The case for collaboration makes itself. Pre-COVID-19 a lot of people in the industry knew that the days of ruthless competition were over and that we need to move more towards co-opetition. The market is big enough for everyone, and no company has the full suite of solutions, so collaborating offers these solutions.

The other thing that we are seeing is that there are a number of continental initiatives that are also pushing us towards collaboration. For example, the African Medicines Agency, to the African Continental Free Trade Area.

The impact of COVID-19 got the industry talking across national borders to find who has what, who has the capacity and for what, and what we can do to collaborate. The climate is rich and fertile now for collaboration as the new world we are living in calls for combined efforts.

In our own partnerships and beyond COVID-19, we currently offer contract manufacturing and or packaging and have clients such as Sandoz, Cipla, Trinity and Servier, and looking to add to one or two more multinational clients.

EF: How do you see AI and data-driven approaches improving healthcare in South Africa?

SN: There had already been some work going on, but COVID accelerated it due to a variety of reasons. Going forward we are implementing this process more. For example, AI now enables you to triage patients and do remote diagnostics and remote monitoring. The focus was on COVID but going forward this can extend beyond that to become part of the day-to-day clinical management. From the perspective of a health insurance firm, there is a range of possibilities to pick up issues early; patients can be monitored virtually in such a way that you could dispatch an ambulance, and the firm can have a patient picked up and brought into an emergency unit to get the care they need in the very earliest stages of any clinical condition. This could be extended to a range of areas, including cancer and maternal care. It allows one to safeguard the patients they have. It assists the process in many ways such as reducing hospital capacity utilization, saving lives, and reducing the financial obligations of all parties involved.

EF: How is Kiara Health using digital solutions to tackle key health issues in South Africa?

SN: We started before COVID. In a continent where there are infrastructure and human resource challenges, the cost is always an issue as the healthcare budgets are constrained. Technology allows us to leapfrog these challenges.

The first device we introduced was a disinfection robot that helped reduce hospital-associated infections wherever deployed. The second is a remote patient monitoring system that can be used to diagnose different diseases and signal a cardiologist or doctor when a patient has any complications. The third is used in neonatal ICUs, and it predicts neonates that are at risk of developing sepsis or necrotizing enterocolitis or intraventricular haemorrhages. It computes the normal measures gotten an ICU monitoring equipment, and then comes up with a score and then notifies the neonatologist if the neonate is at risk, which allows them to intervene early.  

There is one that we are going to introduce to the market, which is cancer-screening technology. At the point of care, it has a repository of close to 700 000 images, that uses Artificial intelligence and machine learning to diagnose in seconds. You take a picture of the cervix and within 30-60 seconds you receive a diagnosis. The use of these kinds of technologies is something we implicitly believed in even before COVID-19, as that is how you democratize healthcare.

EF: Are physicians ready to adapt to new technologies, and are you working on educational programs for them?

SN: I do not think that physicians are necessarily afraid of technology. With anything new that challenges an established way of doing things, it takes a bit of time to adapt. There are the first group of early innovators, who will adapt immediately, and then there will be the second group of perhaps fast followers, and a third group which will adapt more slowly. But with the right education and right clinical evidence base, the entire process of switching is easier for everyone.

The key challenge then becomes the health insurance firms willing to reinvest in technology and reimburse it because physicians are not going to use something expensive that then shifts the burden to a patient. If it is something that clearly makes their job easier and makes it easier for them to manage their patients, and reduces risk and mortality, then they will adopt it. People in the industry are now aware that the future of care will probably shift more to the home, with more virtual care than anything, so technology will have a wide acceptance within the medical fraternity.

EF: How do you see this technology advancing these processes forward going into the future for clinical trials?

SN: From the point of enrolling patients, these technologies can help you by dramatically reducing enrollment timelines. They make sure you get the right people on board so your chances of having to exclude patients down the line decreases because you uncover conditions, they have that exclusion criterion. This leads to much cheaper clinical trials. The significant blood work that needs to be done would probably be reduced with the use of these technologies.

Some patients are also reluctant to get into clinical trials because these are new untested therapies. However, if there is a technology that gives them peace of mind by signalling if a problem occurred, they would be more likely to participate. If you are using AI-enabled, cloud-based platforms to access info, it just makes the experience easier for everybody whilst truncating the length and the cost as most trials are multicenter and multi-country.

For example, Pebble is a platform that can be used to diagnose COVID and influenza A that has pharmacogenomic capabilities as well. You can test responses to certain drugs and do a lot of other tests to come with time. Anybody who can operate a smartphone can operate the device as it does not require extensive training or expensive lab equipment and reagents to operate.  

Our Pebble initiative is also a demonstration of our technological capacity in manufacturing. We have completed a technology transfer for the manufacturing of the Pebble device at our facility, and will shortly be getting our ISO 13485 to begin commercial manufacture.

EF: Do you see home-based healthcare as the future for healthcare access, for example, the Pebble initiative?

SN: The developers of Pebble were thinking of exactly that, and in the future, it is a platform that will give you the ability to diagnose certain things at home. Ultimately, healthcare will shift more to home-based diagnostics, and home-based systems are important for a lot of reasons. One of which is they will be able to keep patients and parents at ease and provide "overuse of the scarce clinical resources".

Telemedicine provides the opportunity to overcome significant infrastructural challenges, these technologies allow the patient to use the cellphone to transmit pictures to your clinician which they then can diagnose on the spot. Going further and thinking about teleradiology or computational digital pathology, addresses the issue of scarcity of pathologists and will facilitate early AI-enabled.

EF: How is the role of South Africa as a healthcare hub?

SN: South Africa has a significant opportunity to really play the kind of role that we have seen in countries like India, the UK, US, play for some African countries, because we know that every month thousands, if not hundreds of thousands, of African citizens, fly overseas to access care in other parts of the world. Now, we have well-developed medical tourism tied with our excellent national parks and other attractions. South Africa can do more to embed itself in delivering specialist care to other African countries and patients.

South African healthcare companies have the opportunity to forge partnerships and gain acceptance because of the quality of the clinical skills we have. From a continental perspective, there is significant scope to come in and supply other countries, especially those that do not have any local manufacturing capability and fill in the gap or occupy the space that has historically been occupied by India, China or Europe. Going forward, this should be a focus for us.

As a company, we have always had Sub-Saharan or Panafrican ambitions. We are currently supplying Lesotho, Swaziland, Namibia, and Botswana, and are now going further up, and there are some things that we are doing to that extent. We aspire to form these collaborations and partnerships with other entities in different parts of the continent and begin to supply there. We need to build that level of self-sufficiency whilst creating bigger markets for all of us on the scale that we need to operate alongside players from the East.

EF: How is your new future work environment in Kiara Health?  

SN: For us, it has to be a hybrid model. We obviously operate a manufacturing plant, so by virtue of having that, you have to have people on the ground doing the physical production. From a marketing or finance perspective, for example, working from home is not a challenge and productivity is still at 100% output. We will never fully have a 100% physical workforce, and now, this gives you the possibility to scrutinize roles and say, "Can this be delivered remotely?" If it can be then it should be done.

EF: When hiring a new employee, what skill sets are you looking for these days?

SN: Alongside the basic skills needed for the specific role there are certain qualifiers required. One, I think companies need to or will need to look at someone who is versatile and has agility and adaptability skills. Two, strategic yet solution-oriented people with a can-do mindset and a willingness to go where no one has gone before, to venture and find new solutions for the company and the company's clients. These are self-driven, self-motivated and self-directed people willing to find solutions wherever they may be found.

April 2022
South Africa