Global Perspectives on Digital Health

Alain (00:03)
One that's also very much neglected in many parts of when we think about infrastructure, we think about electricity and connectivity and broadband. But the one that always gets left behind, and I think it is a foundational piece of the puzzle, and that is identity. Not having an identity.

remains a challenge for hundreds of millions of human beings on this planet, whether that is in the form of a recognized national ID card or some kind of a recognition that you even exist. And it's one of the drivers of the tragedy that we have so many deaths that happen that go uncounted because those people don't have a...

Shubhanan Upadhyay (00:47)
we don't even know about.

Alain (00:51)
foundational identity. There's no birth registration, let alone death registration. And that those are some of the foundational injustices that I think we do need to continue to fight for.

it's very easy when you are working at the policy level or working at the level of population scale data to get lost in the indicators and to get lost in the the vastness of

off the topic that you're dealing with. And a lot of these things can rapidly become very impersonal and generic. And I think the constant struggle and challenge that we all have to really prioritize is remembering that every data reflects a human life. And I think that's something my professor of biostatistics

drilled into us decades ago when I was knee high to a grasshopper. And the idea was really to always remember that what you do ultimately will have an impact on individual human lives. And that's not something to ever take lightly.

Shubhanan Upadhyay (02:09)
Global Perspectives on Digital Health podcast, welcome. This is the podcast that breaks you out of your bubble and gives you the truly global picture on digital health, focusing on underserved communities around the world. Today we have the Alan Labrique Digital Director of the WHO, the World Health Organization.

Um, spoken to quite a few people in the last few weeks about the current state of global health. but to get the insights of someone who's at director of digital health level at WHO, given that the WHO themselves have also been affected as an institution, this is a great opportunity to speak about a what

needs to happen in global health in general. How does digital support that? And also what is the future of the WHO? How does the WHO create the right impact in a changing world and situation?

It really helps if you can subscribe, link, follow and share this podcast to reach people. share it with your colleagues, write us comments leave us reviews. It really helps it get to the right people and helps us to grow. I'm doing this

because I really believe in the responsibility that we all have to reach underserved populations with well implemented technology. Without further ado, let's get into this podcast Thank you.

Shubhanan Upadhyay (03:40)
Alain Labrique I am so thankful to have you on the Global Perspectives on Digital health podcast. What a time to be able to talk to you. Thank you for taking the time to do that. And yeah, it's a real pleasure to have you here.

Alain (03:53)
My absolute pleasure to be here, Shubs. It's been great to follow your podcast and listen to other luminaries on this. And so I'm quite honored to be among that crowd. So fantastic to be here.

Shubhanan Upadhyay (04:07)
Thank you. And really great to know that you've had a chance to listen as well. to get your insights on here for the people who listen to this will be so valuable.

Alain, I would love to start with hearing a little bit about your background and your journey of getting to being the digital director of the WHO.

Alain (04:29)
Well, absolutely. I think the first thing I've in my many years as an academic, I would always tell my mentees and my students is that there is no linear path to where life will take you. So you have to always be ready to see what doors open and grab the ones that make the most sense to achieve your goals and vision for how you can contribute to improving the world.

So I'm a bit of an international mutt. So I really have found a very good home here in the UN system because I'm a Belgian Indian Bangladeshi. I was born and raised in the streets of Dhaka. I grew up traveling around the world and I see the opportunities to work.

in WHO as being really an extension of how I've lived my entire life. I lived and worked in rural Bangladesh as a field epidemiologist for almost a decade ⁓ and spent many years as a professor at Johns Hopkins teaching public health and conducting large scale randomized trials in low resource settings in collaborations with ministries of health and local institutions.

to try and find ways ⁓ to reduce maternal and neonatal mortality. That's really been the focus of most of my career. And

as I was working in rural Bangladesh and we were looking at different ways in which strengthening health systems, but also strengthening fundamentals like micronutrients could really ⁓ change the trajectory of survival for these highly vulnerable groups of people. And as we were working out there in the field in the early 2000s,

we began to live through what I call the mobile phone revolution, right? You saw that this disruptive technology introduced in remote rural parts of the globe that completely upended how people lived and how they saw their place in the world and their capacity to be much more connected, much...

more empowered as agents of their own destiny and fate and being able to tap into resources far beyond what they might otherwise have had access to, both in terms of information, human and financial capital, and also, you know, emergency support. And so as we were studying maternal and child deaths, we began to see how a simple phone call

at the right time and the right place could be the determinant between death and survival. And then, rapidly we began to see how it wasn't just phone calls, but also being able to capture structured data in a digital format in communities to be able to do rapid assessments, to be able to ⁓ increase accountability for services delivered, goods and public health commodities delivered.

the possibilities just continued to open up. And I think that's what led me to really develop this passion for what was then a very, very emergent field of m-health and that eventually became digital health, merging together with long-standing disciplines, including telemedicine, e-health, and other previous efforts that were looking at the use of

technology applied to public health and clinical problems. And so that led me within, as a professor at Johns Hopkins, to launch a new center, which was the Center for ⁓ Health. We called it the Global M-Health Initiative, which today is known as the Center for Global Digital Health and Innovation. And that really set the

the foundations for collaborations with government, collaborations with the WHO, where these things that were happening in the ecosystem were not lost on policymakers here in Geneva, who began to ask, well, how do we systematically study this space? Which led us to then Hopkins working together with many others, NGOs and partners in ministries and the WHO.

to start to define this space a little more clearly. What words do we use to talk about this? How do we refer to digital tools being used for clients, for providers to strengthen systems? And eventually I was privileged to work on a lot of these early structural foundational documents that have now ⁓ underpinned this field from the

the fundamental taxonomy of how we speak about digital health to the guidance on how to do research in this space. How do we structure a randomized controlled trial on a digital health intervention? What are we testing? How do we define the unit of intervention? And what is exposure and control mean in this space? And that led to my work chairing the first ever official

WHO evidence-based guidelines on digital health as part of a very large effort with experts from around the world really asking what does the science tell us after a decade or so of experimentation and measurement in this space? What can we advise governments to invest in in digital health that is a so-called safe bet, you know, in terms of

minimum risk, high return, contextual appropriateness, and something that's driven by data, driven by science, that it's not just technology for the sake of technology, it's not just investing in shiny objects because it looks good to a donor, but because this can have such an impact on how we deliver care.

I continued down that journey for quite some time and then WHO launched a new department on digital health and innovation. And I got a call one day and was asked to put my name in the hat and the rest is history, as they say. And so now we are, you know, I have the really great privilege of serving a team that really covers a lot of exciting work.

globally so what's exciting to see is we're at a state now where

Decades ago, we were playing around with these ideas as exciting future opportunities. And now we not only have a Department of Digital Health at WHO, but 144 countries have an articulated digital health strategy. 74 % of countries have taken that first step. And many have taken many other steps beyond that, building infrastructure, building national

policies and regulatory environments. And so this has really become an important pillar of how we think about health systems of the future,

Shubhanan Upadhyay (12:05)
Alain, thanks for giving that really broad overview of your career. And refreshingly for me, your career having started in exactly where you want to have the impact, right? And having seen that and lived that to then trying to wrestle through academia and research of like, how do get this right? And incidentally, we also spoke to Smisha on who now directs the center, right? At Johns Hopkins.

So we've had her insights on the podcast and she's taken the baton on from you, right? So it's been really great to be able to speak to her and get her insights as well.

Alain (12:41)
She

is just a phenomenal colleague and just someone who has led the field in ⁓ ways that I could only imagine. So it's just been a privilege to work with folks like Smisha. The key here, Shubs, is that with every new innovation, with every new technology,

especially in the health space, there's always shiny objectism, right? And I think that's one of the things that we collectively, those of us either in academia or in public health, in the policy space, have to guard ourselves fiercely against, right? It's important to understand the space of enthusiasm and newness and shininess and...

and be aware of the emergent ⁓ possibilities that come out of new technology. But I think when we talk about global health, we're often talking about ⁓ governments and countries who have very limited budgets, first of all, ⁓ to invest in health. We're talking about populations that also have limited disposable income. And we are talking about

a zero sum game in terms of the resources available to invest in new ideas. So it's usually going to be a situation of invest in this and invest less somewhere else in order to be able to pay for this. So you have to be able to make the case that the new thing you're investing in can augment, amplify, improve the goals of your health system.

while also being cost effective and sustainable within the budgetary envelope that you have. So I think it's really critical that we embrace the new, but we also temper our enthusiasm with science, data, evidence, and robust foundations. And that's really sort of a formula for sustainability, which has been a...

a frustration in many of the folks who've invested in this space over the years.

Shubhanan Upadhyay (15:01)
Yeah, absolutely. And at the end of you talking about your journey, you kind of painted a picture of like the vision of where we want to get to. And just now you've also talked about, I think what we've talked about a lot in this podcast of like starting with the health outcomes that we want to reach. And then against that judging, how will this tool, any tool then help us get there rather than what ends up happening with shiny new object syndrome is how can we shoe-horn this new thing?

into places How do we even have the capacity to absorb this? What does this even mean? And so thinking about it in that way makes a lot of sense. We are in a backdrop of

a big threat to global health right now. Many, many health facilities, access to care, their access to medications, their ability for people to deliver care. And then around that, digital infrastructure that is helping countries, governments, health systems, people to kind of leap forward to the next step.

And here we are now from in the last few months, government funding has been cut from multiple countries. Can you, you must have had a view through the work that you're doing, through partnerships that you have on what that looks like. Can you tell us a little bit about the impact that you see?

Alain (16:25)
Yeah, no, no, it's a very good question. ⁓ And one that keeps us up at night, very frankly. And I think to better understand where we are now. It's worth maybe just stepping back a little bit to what I speaking about earlier is this state of ⁓ unfettered experimentation that characterized the mid to late 2000s, ⁓ where we began to see different applications of

of digital technologies be applied to health system problems in a very bandaid piecemeal type of fashion. it wasn't, it was rare to see a very concerted architected approach to this. Rather you would see, you know, a text message system embedded into a malaria program or a digital follow-up system or an application.

provided to frontline health workers to strengthen their capacity or just-in-time training, et cetera. So it was the program and a digital component added into that program. And over time, we've seen countries begin to respond to the fact that those systems were very reliant on the grant that

funded that program's ⁓ inception and survival for a two, three, four year period. And we were in the process over the last decade, I would say, of a number of first mover countries, ⁓ India, Indonesia, Malaysia, Tanzania, Kenya, Rwanda, starting to put into place Brazil, what I would call the

pillars, the foundational pillars of an architected ⁓ national digital transformation of health approach. So not so much a piecemeal experimentation approach, but one that is really looking at ⁓ building robust foundations, setting in place an architecture, putting down what we now call digital public infrastructure, right? So it's things like identity schema and

data exchanges, interoperability standards and so forth. But there were very few of those countries ⁓ who were actually able to invest in that kind of an infrastructure, but also who had the political will and the scope to actually put together that kind of a roadmap. And so in the last...

three to four months, what we've really seen is, as you mentioned, this collapse of overseas development assistance has had a knock-on effect, a cascade effect on systems that were extremely reliant, either obviously because the system or a program was entirely stood up by an external agency to support

their particular investment or their particular program, or I would say less obviously, subtly dependent on that external assistant. So perhaps the cost of a server to store data was being covered by a cloud server, right? So being covered by a grant from another country.

possibly the technical staff who were assigned to a clinic to process data or to manage data or to manage the system were also on the payroll of that particular Overseas Development Assistance funded grant. And so when either that whole system or critical elements of those systems were removed,

we immediately started to see the dominoes tumble. And I think what we've heard in the media is a lot of discussion about the impact to people, which I think is where the attention should be. People living with HIV AIDS not receiving medication in a timely fashion or at all. Pregnant women not being able to access a clinic in order to get antenatal care. I mean, these are real lives and...

people who this assistance was formerly serving. And now all of that is beginning to unravel. But it does speak to the important systems that were supporting those functions. So one of the reasons why a patient may not get the drugs in a timely way is because the supply chain management system, the electronic logistics system or supply chain system,

is the thing that unraveled making it difficult to know where the supplies are and where there are gaps and where there needs to be a replenishment. Registers or patient lists or electronic health records that preserve the continuity of care for patients disappearing overnight.

So we've seen, you know, everything from electronic health records go down to laboratory information systems, point of care decision support tools for frontline health workers. And this has happened across all of the six regions of WHO, primarily though in the global south, we've seen fairly dramatic impacts in

on the African continent as well as in South Asia, Southeast Asia, and to some limited extent in South America. I think that's where we want to really focus our effort and energy is in saying, we have to learn from this. We have to build back better. And we have to make sure that this can never happen again.

Shubhanan Upadhyay (22:12)
Yep.

Alain (22:20)
So we realize that that's not something that can be fixed with a simple technology solution. It requires us to fundamentally rethink what it means to have a resilient, essential digital health infrastructure. And we actually came up with an acronym for that, REDHI, R-E-D-H-I, Resilient Essential Digital Health Infrastructure. What is the minimum core set of

Shubhanan Upadhyay (22:41)
Nice.

Alain (22:49)
systems and backbone infrastructure that a country needs to set up, but also needs to be able to operate, own and pay for within their capacity. And I think that's where we're really excited to see the world moving towards is the political will is there, the recognition of what goes wrong if we don't do this, the cost of inaction, if you would.

but also then who needs to come to the table in order to make that happen. And I think fundamentally this is about shifting the nexus of responsibility and control to local production. It means we have to empower local entrepreneurs, local innovators, local coders. We have to empower governments and ministries of health and the public sector.

NGOs and the private sector partners who support the government to actually help build those infrastructural solutions and stand them up so that they can continue to be resilient to the vagaries of global geopolitics.

Shubhanan Upadhyay (24:01)
And just to pick up on one of the things that you mentioned, I mean, you can somehow paraphrase what you're saying as a, a key pillar is this actually will shift global power dynamics. If you can say that in WHO, right? I mean, they are there. That's part of the mechanism of global, development funding. It is in the interest of the

donor country. And so to me, this is, you know, a lot of people are talking about the opportunity that this brings. And ultimately, what it looks like is actual decisions get to be made on the ground for people. where it matters.

rather than in, comfortable offices in Europe or the US.

Alain (24:43)
No, mean, look, this is not a new conversation, right? The Paris Declaration, the Accra Accord, these are things that have been reaffirmed over decades, that countries need to be in the driver's seat of their own development agenda, their own health and other sector priorities. The earmarking of assistance has to stop.

and has to then go into the control of national democratically elected governments who are empowered with the task of determining how the funds they have access to are spent for the good of as many of their people as possible. it's why one of WHO's main

mandates is to develop science-based norms and standards to help countries make those science-informed decisions ⁓ about technical program areas, malaria, TB, HIV, but also about health systems and how to set up regulatory systems, how to implement digital health infrastructure, the use of standards to minimize

costs and reduce redundancy to reduce, you know, duplication as programs come in. And I think you're absolutely right, Shubs. mean, despite having all of these good intentions for so many decades, it has continued to be difficult to separate the priorities and the insistence of those providing the funds.

from the autonomy that countries were insisting they be given. And so I think...

that you are going to see a lot more, I think, strong pushback from governments, especially those who have been hit hard by this sudden shock, to really say, no, this is now something that we are going to be less keen on negotiating. We need these resources for these priorities. And that's how, if you would like to support us as a country,

then allow us to use those resources as we see fit. I think countries are recognizing that those investments must be made in durable infrastructure. They have to be made in ways that build long-term capacity. And I think that there's shifts happening all across the landscape, right? Shifts in terms of how do we finance?

What do we finance and how do we actually ensure sustainability? What's the role of the private sector? Not just the global ⁓ industrial giants, but also domestic entrepreneurship in standing up and supporting these pieces of infrastructure.

Shubhanan Upadhyay (27:44)
The podcast I've just recorded before was with venture capitalist from Africa Health Ventures. And it was really refreshing to me to see Rowena, who I was talking to, challenge some of my assumptions that venture capital maybe is thinking about things in a short term view. But she changed my mind that actually there are venture capitalists or funds out there that

are there to invest in long term sustainability and also meet local need where it's at. And so I kind of link that to like, do you create a sector infrastructure that allows this to flourish? I mean, in some ways, that's already there, right?

Alain (28:23)
But let me let that

you've hit the nail on the head there, ⁓ Shubs, because one of the biggest myths that we have about the private sector, and I've said this many times, right, it's ⁓ the private sector thrives in chaos, right? People seem to imagine that, you know, whether it's big multinational corporations or domestic ⁓ enterprise that

they're waiting for a situation of chaotic lack of rules and regulations so that they can go in and just profit uncontrollably from that situation. And the more I speak with private sector leadership, the farther I realize that is from the truth, right? It's absolutely untrue. What brings private sector and investment to the table?

from venture capital and other sources is the reduction of risk, right? When there is clear structure, when the rules of engagement are well-defined, when there is a regulatory pathway to propose and have cleared new technologies and new medical innovations. And I think where...

a lot of the work that we do at WHO in terms of helping governments establish those robust foundations, good governance, clear policy, a strong regulatory environment, standards, know, technical standards so that those ⁓ companies that are developing software understand that, okay, this is a national technical standard.

This is the national backbone from which we have to draw data and to which we have to contribute data. That gives us a sense of how we have to build this system so that we will fit within this playground, if you would. If we don't know the rules of the playground, we risk getting sand thrown in our face. And we end up with a lost, a sunk investment three years down the line when the rules change. So I think.

You know, that's why we see the role of government, the role of ⁓ normative agencies like WHO is a very strong one for exactly those reasons that you mentioned. It's helping to create the conditions under which entrepreneurship and private sector partners can really thrive. And I think we have to begin thinking about not this dichotomy of public versus private.

It's a partnership and we have to be able to think about what constitutes responsible partnership from the private sector, right? It's not always about exploitation and manipulation and all of the other sort of bad stereotypes that we usually ascribe to the private sector. It's really to say, let's identify the norms that

we expect from private sector playing in the sandbox that involves developing ⁓ solutions for the good of a population. so once we get that formula right, it can be a powerful thing. We're seeing right now how large and small private sector entities alike are actually helping governments achieve their goals. I'll call out the example of India.

just as one model where there is a national digital health mission that has defined a lot of these ⁓ rules of engagement. And they even have created sandboxes, test beds, where software companies can come in and evaluate their compliance to national standards and their ability to exchange data with state and national systems.

On top of that, they've also created incentive schemes where there is an actual revenue model or financial model to engage in supporting public sector goals. And so what that does is now open up the landscape for a whole new scope of actors beyond just the usual actors to participate in strengthening the health system.

Shubhanan Upadhyay (33:03)
And you've talked a lot as well. And thanks for those examples. No, no, I meant to say you've talked a lot about within this thread about the role that WHO plays. And we've talked about a lot about the global context. And within this context is the backdrop of,

Alain (33:07)
I have talked a lot. I'm sorry about that.

Shubhanan Upadhyay (33:28)
a lot of questions being asked about the WHO and the WHO itself has seen a lot of challenge to it in this time. And so from what you've talked about the role that the WHO can play and the situation that you're in where a huge chunk of funding has been cut and you're having to do, you know, more with a lot less.

How are you looking at that? What are you prioritizing? How has that changed your thinking within the WHO?

Alain (33:58)
No, it's a good observation and times like this really do force you to prioritize. So we have to examine all of the things that we do and differentiate what we want to do from what we need to do. And I think one of the things that we hear

loud and clear. mean, WHO is the custodian of something called the Global Strategy on Digital Health. It's a document that was created in 2020, a five-year vision penned by the 194 member states to actually lay out a roadmap of things that countries aspire to, activities and objectives that partners

in the ecosystem, private sector, NGOs, are expected to contribute. And lastly, what the Secretariat, WHO, is supposed to undertake. So there's a very clear articulation within that global strategy that I'm delighted to say that our member states who drive this member state organization

agreed to extend that strategy for another two years, as well as seek a renewal of the strategy for another five years to 2034. So that's a really exciting declaration of mandate that countries see the importance of having this sort of structured ecosystem where it's not a free for all. We're not just all out there doing whatever we need to do.

But there's actually a set of priorities that have been set. And to answer your question, the first and most important priority is that robust foundation. We can't build high-rise buildings if you haven't invested in solid groundwork. And so what does that mean? That means first and foremost, human capacity. So making sure we have the training for policymakers,

programmers, planners, and people of how to think about their roles in a digital health world. ⁓ The next is policy. So we have the capacity and then policy, governance, and regulatory environment. So at a country level, if there isn't a national strategy, if there isn't an architectural plan, if there isn't a blueprint that describes where you're going,

you will continue to have a state of fragmentation and often chaos. Because without the blueprint, folks will come to the table with different resources and say, hey, I'd like to build this, or I'd like to build that. unless you have the diagram of what the house should look like, you can't direct those resources in a way that makes sense.

If you have a blueprint, can then say, guys, we need a roof, we need two windows, we need this. Please put your efforts towards that fundamental infrastructure that we've collectively decided upon. Then you need governance. And we've seen, and I love giving the example of Kenya, which was the first country in Africa to actually have a national digital health.

act and now law that describes the roles of a digital health agency that has clear mandate, budget and tasks to manage and maintain this ecosystem. Because if you don't have a foreman or a construction superintendent overseeing this, then once again, you have a lot of resources coming to the table and there's no, they might have an architectural plan.

But nobody's really there to make sure the pieces are being put together in the right way. so I would say that's really where building capacity, making sure that the policy governance and roadmaps are in place. That's really where a lot of effort needs to be spent right now. And then I would say the other area that we're seeing a lot of excitement is in bringing people together.

serving and then that's a big role that WHO has always played is as the neutral convener, right? Bringing together these different stakeholders within that ecosystem and making sure that there is alignment, making sure that people are listening to each other across these various parts of the ecosystem. And I think what that means is helping to set the priorities for the conversation.

and then making sure that there's a lot of listening going on. Because when that listening happens, that's when you start to have, you know, breakthrough conversations. And so we have actually two global initiatives that were launched in the last two years. We have a global initiative on digital health that was established in 2023 as an outcome of the Indian presidency of the G20. And that's led to now a really exciting platform.

for this cross sectoral dialogue, but also to focus collective efforts at the country level on what the countries need. Making sure that the resources and the efforts that are being put into country X, Y, and Z are being put to advance that country's priorities and objectives. And the second initiative is the Global Initiative on AI for Health, which is similarly in this

rapidly rapidly moving space to make sure that we again are helping to drive by science and by the the best data available what should be the the ground rules for responsible AI for health and that means you know what does what is what is what are the ethical considerations for AI what are the regulatory

approaches that we can and should use for the rapidly evolving types of artificial intelligence, whether it's generative or non-generative. And now we're entering into an era of agent-based models. how do we evaluate what works and what doesn't work in that space and then advise governments to make decisions? Because once again, like we talked about at the very beginning of our conversation,

With any new technology, you often have a burst of enthusiasm and most governments will have a line out the door of vendors and folks pitching that their solution is going to solve most, if not all of the problems that have been plaguing that particular ministry for years. And so we're getting a lot of questions from ministries to say, help us differentiate.

what works and what doesn't work. Help us build the regulatory systems that can assess and review and determine which of these tools are worthy of investment and which of these tools are safe to include within our health systems.

Shubhanan Upadhyay (41:10)
Hmm.

Yeah, absolutely. And that, I mean, that to me is a great manifestation of what you talked about, which is this pillar of bringing people together. And incidentally, the previous incarnation of the the global initiative AI for health, I was actually part of the focus group AI for health and was in those meetings, co-chairing the clinical evaluation working group that worked horizontally across.

Alain (41:46)
Absolutely.

yes, yes.

Shubhanan Upadhyay (41:54)
And it, and just to say, it was a great place to have people listening, bringing together their context. What I loved about it, which also was a real galvanizer for me to start this podcast was there were so many examples of people doing amazing implementations and creating the conditions, like you had said, within the middle and country context. And I was like,

Alain (41:58)
Mm-hmm.

Shubhanan Upadhyay (42:19)
man, we need to, we don't hear about this stuff. ⁓ In my bubble in the West, I'm hearing about all these great technology and implementations here, but hey, we should be learning from people in this space. And so that was such a great place to bring out those insights and learnings. And that was very formative for me to continue this work forward. So I'm really excited to see how both of those initiatives go forward. Yeah.

Alain (42:22)
Yeah.

Yeah, no, absolutely. I'm delighted to hear that you had a good experience and hopefully you're continuing to have such an experience. ⁓ But I think fundamentally, it does illustrate the fact that none of these problems are small enough for one agency or one department or one group of folks to tackle single-handedly. The initiative on AI for Health, for example,

brings together ITU, the World Intellectual Property Organization, WIPO, and WHO together in a tripartite way with a lot of academia and others ⁓ to advance this ⁓ conversation. But just as an example, coming up in September of this year, we have the AI Regulatory International Symposium happening in Seoul, Korea.

where together with the MFDS, the Korean regulatory agency, we're bringing together a lot of regulatory agencies from around the world who have health AI in their portfolio to really keep moving forward with this discussion of regulatory alignment within that space of health AI. Making sure that the reason why a technology that is refined and

and developed in country X can't be rapidly adopted in country Y, its neighbor, because of a completely different regulatory pathway. That there should be ways in which we can, for the solutions that actually can demonstrate impact, that are able to pass the safety and ⁓ efficacy barometers of success, that those technologies are rapidly distributed.

among the populations that would benefit from them.

Shubhanan Upadhyay (44:44)
Yeah, and absolutely. And historically it's been, you know, again, like the FDA, the EU MDR, the MHRA, which have kind of, I guess, taken the lion's share of the conversation. ⁓

I mean, even within the International Medical Device Regulator Forum, I spoke to a couple of regulatory experts on the podcast as well. Generally, low and middle income countries are underrepresented at this forum and to be able to then use these types of conversation and bringing people together to then allow everyone to be at the table, I think, and have those contexts represented in these types of considerations.

to me is so important if we want to get to realize those and create the conditions for responsible AI actually occurring and being created.

Alain (45:32)
I mean,

maybe that's another silver lining of what we have seen happen ⁓ with regards to development assistance is sort of it reaffirms this reality that no country is an island and that we're all interconnected and the chaos and crisis in one country has run on effects to its neighbors and to entire regions.

and even the globe. I think that's the important sort of, I hate to say epiphany because one hopes that it didn't take this kind of a crisis to make people realize that we're connected, especially coming out of a major epidemic, just a few years ago.

Shubhanan Upadhyay (46:16)
pandemic.

Alain (46:21)
Hopefully this will herald a new era of collaboration, of scientific sharing and South-South capacity development. I was really excited to see just over the last few months the number of opportunities and actual collaborations that are beginning to be formed between ⁓ our teams in the African region and our teams in the Southeast Asian region, where there's

mutual challenges and mutual opportunities to share things that are being creatively developed in one part of the globe with another part of the globe, but across the global south. And I think that's really something that I've always hoped to see more of in global health. And I think we're beginning to see that increase quite exponentially.

Shubhanan Upadhyay (47:11)
and maybe failures as well or things that have gone wrong so we can learn from those. Would that be part of it?

Alain (47:15)
Yeah, absolutely. Absolutely.

think, you know, we don't talk about that very much, right? The importance of learning from what doesn't work. But I think in this space of digital health, it's almost as important to make sure that we celebrate failure and really use the opportunity to deconstruct why something didn't work.

Was it a contextual factor? Was it a human capacity? Was it part of the enabling an ecosystem? And I think maybe that's one of the important last points to bring up, Shubs, in terms of the fundamental infrastructure that's needed for equity to be delivered.

That is to say, you know, we have more than 8 billion people on the planet. And what we want is to ensure that these breakthroughs, whether it's the benefits of artificial intelligence or the opportunities afforded by digital health, we want to make sure that irrespective of where you live on the planet, if you have a need that can be appropriately addressed by a technology innovation, you should be able to have access to that innovation.

you know, where I think the last figure was almost two billion people who still are not connected to any kind of network broadband or otherwise. We still have a swath of the globe that remains without electricity. And yes, there are creative solutions that people have come up with in these communities to be able to charge their phones with solar panels and car batteries, et cetera.

But that doesn't necessarily create the infrastructure, the fundamental infrastructure that's needed. And then One that's also very much neglected in many parts of when we think about infrastructure, we think about electricity and connectivity and broadband. But the one that always gets left behind, and I think it is a foundational piece of the puzzle, and that is identity. Not having an identity.

remains a challenge for hundreds of millions of human beings on this planet, ⁓ whether that is in the form of a recognized national ID card or some kind of a recognition that you even exist. And it's one of the drivers of the tragedy that we have so many deaths that happen that go uncounted because those people don't have a...

Shubhanan Upadhyay (49:53)
we don't even know about.

Alain (49:57)
foundational identity. There's no birth registration, let alone death registration. And that those are some of the foundational injustices that I think we do need to continue to fight for. It's easy to get lost in sort of what's on the future, but we have to remember that there are inequities that we need to address.

Shubhanan Upadhyay (50:15)
There's some real basics to deal with right now. Yeah.

That's, so insightful and a great reminder that even though there's so much great stuff, there's still a lot of basic work to do. think that's a really good one.

Do you have any advice or kind of a call to action for people who are building in this space? So, you know, the software engineers, the founders of startups who are wanting to prioritize underserved communities,

Alain (50:40)
Yeah, no, I think it's a great question. ⁓ you know, if you are based in the global north and you are a company that has ambitions to help build and support countries that are struggling with these major public health challenges, I would say invest your time and energy in building that local capacity.

invest in such a way, your time and effort that you almost make yourself irrelevant in that setting after a period of X number of years. So I think that's where the greatest reward will lie, when you're able to step back and actually see the ecosystem that you helped to invest in and create. And I think it's not about

you know, charity, it's not about, ⁓ you know, uplifting underserved communities. It's about participating in their struggle, in their journey. It's about listening to what those countries have prioritized, what those communities need. And it's about working with those communities to achieve their goals. So I think the first step of any sort of innovation journey should be listening.

Right? Listening with humility and with deep respect for those populations, you know? You know, I think we live in a very different world today than we were in a decade ago. I love looking at the various maps that look at the dev communities around the world and...

Shubhanan Upadhyay (52:07)
without an agenda, I suppose, as well.

Alain (52:24)
You can drill down into small rural populations anywhere in the world. And there is a developer community ⁓ who meets and upskills themselves and others and is thirsty for participation in solving real world problems. And ⁓ I would say that's where a lot of the excitement really lies.

But then I think at the more macro level, ⁓ identify what the country strategies are and really see what is it that we are producing that can advance those goals that a country has set. And I think that's where the future of this relationship lies. It's not in an imbalanced condition of supporting

Shubhanan Upadhyay (53:00)
Mm-hmm.

Alain (53:21)
an other, but it's really recognizing that we're all part of a shared ecosystem. And how do we together achieve that end? Profitability can be found in many different ways. And I think that's the other question then to ask is, where do we find the return on investment? Because for many private sector partners, that is a key issue. have shareholders and you've got folks who you have to

Shubhanan Upadhyay (53:46)
Mm-hmm.

Alain (53:50)
to make happy and I think that's never an easy task, but you can do good and do well in the same breath.

Shubhanan Upadhyay (54:01)
100%, 100%. Alain, you've taken us on the trajectory of your career. You've showed us the current situation of where global health is and the WHO and the things that you're wrestling with. And you've shown us where the priorities are and where, how, at least from a policy and a governmental level, that focus on infrastructure on getting those foundations right.

continues to be important and we need to continue investing in that. But I really also really liked how you kind of centered this around kind of the impact on people, right? How do we do that? How, if you're also building in this space, do you listen and build with communities? And it was great to get that from you as well, because for me, sometimes when I look at organizations and policy, I always see, ⁓ there's so many opportunities to kind of fill those gaps.

towards implementation and a lot of it kind of rests in a lot of the things that you've mentioned today. So thank you for taking us through that. Any last words?

Alain (55:05)
No, I mean, think this has been just delightful and thanks for, know, clearly we could go on for a lot longer. I think, you know, it's very easy when you are working at the policy level or working at the level of population scale data to get lost in the indicators and to get lost in the sort of the vastness of

Shubhanan Upadhyay (55:13)
for sure.

Alain (55:34)
off the topic that you're dealing with. And a lot of these things can rapidly become very impersonal and generic. And I think the constant struggle and challenge that we all have to really prioritize is remembering that every data reflects a human life. And I think that's something my professor of biostatistics

drilled into us decades ago when I was knee high to a grasshopper. And the idea was really to always remember that what you do ultimately will have an impact on individual human lives. And that's not something to ever take lightly.

Shubhanan Upadhyay (56:21)
That's such a great message to end on, definitely. And we can all take that away. So thank you so much for taking the time to speak to us, Alain I hope that you continue to be able to successfully wrestle against these challenges. And thank you for coming on the Global Perspective on Digital.

Alain (56:37)
Thank you so much. Appreciate it.