Recently named one of the ‘50 Amazing Swiss Women’, Dr Marie-Paule Kieny is Director of Research at INSERM (Institut national de la santé et de la recherche médicale), President of the French Scientific Committee on COVID-19 Vaccines, Chair of the Board of the Medicines Patent Pool in Geneva, and former Assistant Director-General for Health Systems and Innovation at the World Health Organization (WHO). She is also Chair of the DNDi Board of Directors.
How did you get your start in infectious diseases?
As a rebellious and idealistic teenager, I disliked the medical establishment! So I decided to study agronomy, and got a PhD in biotechnology in 1980.
I then joined one of the first biotech companies, named Transgene and based in Strasbourg, France. We applied molecular engineering tools to develop an effective vaccine against rabies that was used to immunize animals, including foxes in the wild. This is what started my career as a scientist.
After 20 years at Transgene I joined INSERM in Strasbourg as the Director of Research, working on molecular biology and vaccines for hepatitis C. In the late 90s, I joined the Steering Committee of the Special Programme for Research and Training in Tropical Diseases (TDR), based at WHO, which was driving vaccine efforts against neglected tropical diseases. I then joined WHO and worked in Geneva until 2017.
What did you do at WHO?
At TDR, I first worked on vaccines against schistosomiasis, leishmaniasis, and malaria. I subsequently served as Director of the WHO Initiative for Vaccine Research from 2001 to 2010.
In 2006, during the avian flu crisis, an intense political battle erupted as wealthy countries were reserving future pandemic vaccines while low- and middle-income countries (LMICs) were left with the prospect that they would not get any. The crisis led to the creation of the Pandemics Preparedness Framework agreement, to build preparedness capacity in LMICs.
We started a technology transfer project for influenza vaccines in LMICs, in collaboration with donors, academics, a dozen countries, and industrial partners. These efforts helped address the global supply of influenza vaccines.
What I learnt from that period is that most projects’ failure or success hinges not on technological issues, but on political engagement. Technical capacity is important, but political commitment from countries is paramount.
During this long and successful career, what particular challenges did you have to face, as a woman, to become a scientist?
I was lucky to grow up in a family where it was obvious that women would have a professional career and are equal to men. My great-grandmother was a midwife. My grandmother was a teacher, a school director, and the head of a teachers’ union. My mother was a doctor specialized in anesthesiology. My parents fully supported my education, and I was not confronted with the fact that simply being a woman could represent a challenge.
But I started to notice gender-based discrimination once I became a student in agronomy engineering. I still remember vividly a presentation given by a director of a well-known French research institute for development, who told all the students gathered in the amphitheater: ‘I’m so happy to see so many young ladies, that means less competition for men!’
This was the first time that I understood that there were barriers for us and that not everybody was equal. But things have improved substantially. Some organizations now strive to improve gender parity. Many attitudes towards women are not accepted anymore. More and more women study medicine and engage in medical research. This is encouraging.
How could having more female scientists impact medical research?
In medical research, like in many other professions, there is a tendency for managers to recruit people that look like them. And we see that mostly males are still at the top, and in board rooms. Fortunately, there is finally a recognition that organizations should strive for gender parity and that women scientists are as competent, if not more, than male colleagues. Hopefully, the days when it was acceptable to see all-men panels in scientific gatherings are over!
There is also a need to include more women in clinical trials, because of physiological differences, including women susceptible to and becoming pregnant and other adult populations. Although women are disproportionately affected by neglected tropical diseases, their specific medical needs are neglected as researchers often do not include them in their trials, to avoid risks and potential liability.
For this to change we need not only forceful regulatory moves but also a mindset change in industry whereby the specific needs of half of the population are fully included in the scope of clinical plans.
What steps could DNDi be taking to promote gender equity and gender-responsive R&D?
DNDi is taking the issue seriously, establishing a Working Group focusing on gender, diversity, and inclusion; holding mandatory workshops on diversity and prevention of sexual misconduct and unconscious bias; aligning compensation; ensuring equitable access to promotion and training; and facilitating flexible working arrangements. While much remains to be done, progress is shared yearly in a diversity report sent to all staff.
DNDi is also developing a proactive agenda for gender-responsive R&D. We promote the inclusion of women in trials and systematically disaggregate data in clinical trials according to gender and age to drive our decisions. We plan to publish this data more proactively, take gender issues into consideration when designing access strategies and target product profiles, and promote the participation of women researchers.
As an encouraging nod to these efforts, DNDi has been recognized as a high-scoring organization this year in the 2021 Global Health 50/50 report published today. It is in the top 20% of organizations surveyed by the report. And these commitments are one of the five strategic priorities outlined in the upcoming DNDi strategic plan for 2021-2028.
You are the Chair of the DNDi Board of Directors. Could you explain your role and mission?
At DNDi, all the work is led by the Executive Director and the executive team. They are in the driving seat and have their eyes on the road. The role of the board is to provide a reality check, look at the overall environment, and identify opportunities for the organization. The board thus helps the executive team reflect on which direction DNDi should take and advises it on its interaction with the outside world. It provides the ultimate governance of the organization.
That is why it is very important for DNDi to have a board that is as diverse as possible. Board members bring their specific competencies from a wide array of expertise, from national health authorities, academia, civil society, or the private sector. Together, they make a diverse board committed to advise DNDi and steer its future. As the board chair, it is very important to me to be sensitive to these cultural differences and make sure that they all have a voice.
What is your perspective on equitable access to COVID-19 health tools?
It is incredible to see the number of effective COVID-19 vaccines that have been developed in so little time, and I really hope that it is possible to move the needle and work on technology transfer projects in this area too. This is what the Medicines Patent Pool – whose board I also chair – is trying to do.
We clearly need to strive for a better equity. High-income countries should not hoard vaccines. Even though Europe and the US have among the highest death tolls from COVID-19 worldwide, this is not an excuse for the lack of equity in access to COVID-19 tools. We should support all countries to immunize their health workers and their vulnerable populations. The less the virus will circulate, the less variants there will be.
Illustration by Mireille Lachausse from the book ’50 Amazing Swiss Women’