Pioneering Global Health Solutions with Dr. Luis Pizarro

• Pizarro became passionate about democracy and social justice after growing up under Pinochet’s dictatorial rule in Chile in the 1970s and 80s. Later, his global health work in West Africa helped him understand the value of strengthening public health infrastructure through deep listening and partnership, versus merely superimposing foreign models.
• As CEO of Solthis, Pizarro helped transform the NGO from its original focus on HIV-AIDS services to a powerful vehicle for strengthening health systems from the inside-out across West and Central Africa. Instead of a “drop-in” model, Pizarro expanded the NGO through partnership, training and sustainability.
• At UNITAID, Pizarro began a new path in leadership centered on evaluating and funding global health projects, rather than simply implementing them. The experience gave him a broader systems view of how innovation pipelines work in public health, as well as an understanding of the enormous responsibility of deciding what gets funded. 
• At DNDi, Pizarro leads the organization in research and developing treatments focused primarily on patient needs, as opposed to bowing down to a profit driven model. In developing drugs for neglected diseases, emphasis is also placed on affordability, practical concerns like local storage, and cultural acceptability. A complex coordination across sectors is also required, including biotech companies, academic labs, public health institutions, funders, regulatory agencies, and of course, the affected communities. 
• In offering advice to those entering the field of global health, Pizarro emphasizes the importance of understanding your role — are you an expert, a facilitator, a CEO? He also advocates for interdisciplinary thinking as well as developing management and leadership skills. He shares that “global health” is not simply working in healthcare in other countries but about building long-term partnerships with complex communities through deep listening, humility and shared learning.

[00:00:00] Dr. Rob Murphy: Welcome to the Explore Global Health Podcast. I'm Dr. Rob Murphy, executive director of the HA Institute for Global Health here at Northwestern University Feinberg School of Medicine. Today we are thrilled to welcome Dr. Luis Pizarro to the show. He's currently the executive director of the International Nonprofit Medical Research Organization, drugs for Neglected Diseases Initiative uh, commonly referred to as D-N-D-I-A medical doctor and global health expert who was born in Chile, studied in France. He holds not only a medical degree from the University of Paris, but also a Master's degree in political science from Seance Pole and an executive MBA from a joint program of. E-H-E-S-P School of Public Health, the London School of Economics and ESCP, European Management School. After working as a clinician early in his career, Luis led medical projects for several years in Western Central Africa, in Francophone countries and leadership roles at Global Health Nonprofits. Since September 2022, Luis has been the executive director at DNDI, which is based in Geneva. DNDI Discovers develops and delivers medical treatments for neglected populations. Today we're gonna trace Luis's career journey from his clinical roots to his current role in global health leadership, and learn how his experiences shaped our commitment to building common good for the future. Welcome Luis.

[00:01:42] Dr. Luis Pizarro: Thank you very much Robert for your invitation. I'm very happy to be here.

[00:01:46] Dr. Rob Murphy: Thanks for joining us today. Let's go back to the beginning. Your early years as a child growing up in Chile. This is the part actually I know the least about you. Tell me about your family, your upbringing. What led you to eventually leave Chile and pursue a medical degree in Paris?

[00:02:03] Dr. Luis Pizarro: Yeah, a long time ago, but it's an important I think historical moment. We can remind that now because I was born in 1973 when Pinoche did the cita in Chile. So I spent my first 18 years living under. A dictator in Chile with an important social movement, you know, not only for democracy but I would say also for a more social justice in the country. So definitely my first 18 years in this country were fundamental, I would say, for my willingness to spend my career working against those injustices. I had the chance to have a grandfather who is French. And so get the French nationality. So I had a possibility to go to France to do my medical studies and being you know, in Paris. During my medical studies, I met colleagues from and Frontier Doctors without borders. And I understood that you know, everything people call humanitarian action emergency medical interventions was a very, very exciting and very inspiring aspect of the career. So probably those are two important elements that explain why I'm here today.

[00:03:25] Dr. Rob Murphy: Which medical school did you uh, attend in Paris and how did you end up at that school?

[00:03:31] Dr. Luis Pizarro: I ended to be honest, without knowing too much in Paris, and I went knock onto the door and asking which one would accept me . I was lucky enough you know, to get one call. Kohan that in center of Paris, well known for infectious disease but also for rheumatology and other specialties. I learned that sometime those universities are very far, I would say, from where the medical family doctor will do, a gp will be practicing in his daily life. And obviously the medicine uh, was learning was very far also of the needs of many of the population in the world. So, I think it was academically very important for me and brought very scientific perspective to my career. But definitely what I do today, it's a mix between that and what I have learned in my different professional experiences.

[00:04:36] Dr. Rob Murphy: How were you first exposed to the idea of global health and was there a turning point or some kind of spark or an event that made you want to pursue global work? As a career instead of staying in Paris or some area in France and practicing medicine.

[00:04:54] Dr. Luis Pizarro: I would say in the nineties when I was doing my medical studies global health as a concept was not really there. So what people were using, sometimes tropical medicine or international medicine. And for doctors it was more about practicing you know, in low and middle income countries, to be honest. So we had the example of NGOs, like as I said, MSF doctors without borders. And we thought that our mission will be to go treat people that were abandoned let's say by their health system, the real global health concept that it's not you know, being interested in health in other countries. But think about transnational issues of health came to me later. In 2010, after being in Niger for two years, because I understood that more and more we have health issues that cannot be managed by one Minister of health or within you know national borders and need an international corporation, international solidarity. So I would say probably two steps. The first one was to go and try to work where the needs were bigger. And the second one came after understanding those international connection interlinks you have in global health.

[00:06:32] Dr. Rob Murphy: Let's jump up to 2004 when you joined Soltis, now that's an acronym you're gonna tell us what that is. It's an organization still exists doing very well initially involved in the fight against hiv aids in Africa. You already mentioned you were first head of the mission in Niger and then you became CEO in 2006, and I think that's about the time we met. A role you held until 2020. So tell us about Soltis and how you helped that organization evolve, over the 15 years or so that you ran that group.

[00:07:06] Dr. Luis Pizarro: In the early 2000s, the international community understood that it was not possible to keep this situation with most of the HIV patients were in low and middle income countries, and particularly in Africa, and the new treatments that were you know, saving lives that were really breakthrough in the medical space where only for American and European patients. I think we were part of this movement that was trying to break this absolutely unacceptable situation and try to make reality treatments for the most neglected. So I had the chance to meet in Paris in the PTs Petria Hospital. Very, very inspiring and motivated group of doctors like Christine Kalema, like who had the chance to receive from a private foundation uh, bean co foundation resources to support West African countries in order let's say to implement therapeutic programs for HIV. At the beginning the model everybody had in mind was the MSF model. So, people were thinking, we'll go to Mali, we'll go to Niger or to Benin. We'll put in place some treatment, you know, programs. With the treatment facilities we will hire doctors. We'll buy drugs, we'll buy tests and we'll start treating patients. and when I arrived in Niger, with that in mind, I realized very quickly that the Niger doctors were not looking at this. They said, but why are you gonna do that? Why you don't help our hospital, our national program, to be sustainable and to do that ourself. And we immediately switch what we had in mind and we transformed this program into a sort of health systems strengthening program. So we started training all the health workers. We advocate with the World Bank at the time, the global fund, who was just starting at this time to say the money has to go to the national program, to Nigerians, and we'll be there as sort of technical assistance supporting to select the best guidelines, the best test, and after five, six year being able to, to leave and let you know, those colleagues working alone. That was absolutely fundamental, I would say in my career, is to understand that if you want to do something that is really sustainable, you need to start by listening those you want to help because you don't know better than them. And you need to work really at the roots of those national programs to support in a very I would say. National ground based approach the work we're doing. So really key in my career.

[00:10:20] Dr. Rob Murphy: Yeah, that was uh, simultaneously in the United States, the beginning of pepfar. The President's emergency plan for Aids, AIDS Relief, which was a fantastic public health program that I was the country director in Nigeria. And it was the same thing. It's impossible for a group of doctors to go over there and take care of the entire country. It's not gonna work. and we had to increase the capacity.

[00:10:42] Dr. Luis Pizarro: And I think what, what we understood also is that many people have, you know, very, vague ideas about the African situation , the Latin American situation or the Asian situation. And they think when they, at the time they were talking about hiv aids, that the situation was the same everywhere. You remember Robert people saying HIV in Africa. And we realized that. That means nothing at all. Because what you were seeing in Nigeria was completely different from the situation in Niger and was different from the situation in South Africa. So the need to be extremely ized, I would say in the, in the way we approach that and try to, to stick to the needs we discover in each place. It's absolutely fundamental for the work we do.

[00:11:37] Dr. Rob Murphy: Can you tell us what the acronym Solthis is? What does it actually stand for?

[00:11:42] Dr. Luis Pizarro: Well, at the beginning in French you'll say solidarity therapeutic, so, so initiative, for. S was CDA is aids, hiv aids. After five years, as I said before, we realized that not only we needed to work, you know, at the roots of. HIV national program, but in a country that is facing so many health issues, from sexual and reproductive health, infectious disease, and more and more, some non-communicable diseases like diabetes and others, we couldn't only live in a bubble and focus on HIV. And when you look at the situation today with, you know, the complete stop of some international funding, I think everybody now understands that we need to work on the health system with domestic resources and have a very sustainable program in the long run. So at the end of the day, we change, it's still Solthis, but it's more focused on a sort of solidarity for the health system in the long run.

[00:12:59] Dr. Rob Murphy: When you became CEO in 2006, It was a relatively small organization, I believe, and then when you left in 2020 I think it was uh, had grown quite a bit. Can you tell us a little bit about the growth of soltis under your direction?

[00:13:14] Dr. Luis Pizarro: The impact is what was driving this growth, I would say. Another good example for me was Guinea. and the example of Niger started to be known in West Africa. So I received colleagues from Guinea who came to Paris and said, listen, in Guinea, everything is managed today by international organizations. The German, the Americans, the Italians but none Guinanea health teams is in charge of HIV patients. What can we do together? And I remember to go there discuss not only in in the capital, but also you know, we went through the different places near the mine sites because you have a lot of sexual and reproductive health issues around mines, as you know, well. And we decided you know, to start training people and put in place real national health facilities to work here. And this example was spreading more and more. So after that we went to Sierra Leone we went to Burundi, we went to Ivory Coast, et cetera, et cetera. I think when you are able to show, you know, results, when you're able to show the impact of what you're trying to do, it's definitely the best way to expand the work your organization is doing. And maybe the second also good driver of that was when people feel you are solidaire with them. But really solidaire. So when we were in Guinea and Sierra Leone, The Ebola crisis started and many, many organizations left because it was dangerous, because people were absolutely scared on this situation and it's normal. We were all scared about that. But when you try to, to do your best to stay, to support national colleagues, national authorities, you know, to do whatever it's possible in this absolutely enormous crisis. People after that know that they can count on you when the situation is going back and you are not just there, you know, to get this international funding. That was enormous at the time, but that you are really working with them in daily life and trying to address local problems together. So. As you said we were lucky enough to bring more countries to work with us to expand this international solidarity approach. And we were lucky to have international organizations who supported our work. We started with this foundation. Then we had a very, very good partnership with UNITAID. We had also a very good partnership with French actors, the French development agency or like, expertise France And we had this very good collaboration too with the Global Fund. So it's a mix of showing impact, having a close relationship with the people. You are here to support. And being reliable too.

[00:16:28] Dr. Rob Murphy: So after Solthis, you move to UNITAID also based in Geneva unit, part of WHO, this group focuses on making new health products available and affordable for people who need them. What was your role there? Tell what was it like working for, um, the agency of the WHO?

[00:16:46] Dr. Luis Pizarro: I moved from, let's say an NGO doing the work we do in different countries and also looking for fundraising 'cause. Let's be very honest. When you are the CEO of this type of organization, a big part of your time, it's about mobilizing resources to be able to implement those programs. And now, coming to UNITAID, I changed because I was in the donor you know, position. And you have a very, very, very important responsibility because you are funding many organizations that have real. At unit. What was also absolutely exciting for me is that it's not just a classical donor, you know, giving money to an NGO to buy treatments or treat patients. It's promoting. Innovation in the health and scientific field. So I was trying to scan the most interesting innovations in terms of infectious disease mostly, and trying to see how we can bring this innovation to. The patients who need the more and build this sort of, you know, value chain. Trying to think about you know, what will be the cost of this, how to register those drugs into regulatory agencies. What are also the best programs to implement that? Because you can have, for instance, a self test for HIV. An oral self test. So this is a revolution people can test. I mean, you need to confirm. Of course. but it's a revolution you know, in the HIV program. But what is the best way? This test to the patient? Is it through the classical public health program? Is it through hospitals or very small health facilities? Do you need to go through the community and civil society organizations and once the patients are tested? How you ensure that they will come back for treatments because you want them, of course, to be treated and to be in good health. At the end of the day, this is the final impact. You're looking for that. So you need to think about different ways of implementing that control, get some information on this and inform WHO guidelines and national guidelines on how to do a good test and treat program. So I was in charge. Everything related to HI to sexual and reproductive health. I worked a lot also on IP, intellectual property and access like for instance. The medicine patent pool. We were funding and supporting very interesting programs. And during those two years also happened COVID crisis. So, he asked me to follow how we could strengthen health systems. This COVID crisis and how with colleagues in fine and in other institutions working on diagnostic, we could, you know, improve and access to COVID tests during the pandemic.

[00:20:08] Dr. Rob Murphy: Amazing. And now you're executive director of DNDI. You lead an organization rooted in equitable patient-centered research and development. What drew you away from unit to DNDI And what sets this organization apart from the other global health, not-for-profits that you, you've worked with?

[00:20:29] Dr. Luis Pizarro: You have, of course, the classical public organizations, bilateral agencies UN agencies like WHO or unicef and you have those groups like the G seven G 20, all of them will be hundred percent government driven public actors. You have another one is the private sector. Private sector like NGOs, foundations, philanthropists, and of course the for profit one, like, the pharma sector consultancy you know them very well and. In between those two groups, we have public private partnerships. In global health we call also global health initiatives. Within those global health initiatives, there are the funding mechanism, like the Global Fund Gavi unit I mentioned before that are channeling. Funding from those big governments to local authorities and actors in the field. And you have what people call product development partnerships. So organizations that are investing you know, their time, their expertise to develop new health products like vaccines. You have IVI Ivy, you know them, probably some others working on diagnostics like fine and some others. Working on therapeutics is the case of DNDI for neglected diseases. MMV for malaria or TB Alliance based in New York for tuberculosis, right? So our mission is really to address the gaps, the classical. Pharmaceutical r and d model driven by of course profit the gaps. This model is not addressing at the time. If you take neglected diseases, for example, when DNDI was created 20 years ago, neglected diseases were affecting 20% of the global population once a year minimum. 20%, 1.6 billion people in the world, and less than 1% of the total research was focusing on those diseases. We call that the fatal imbalance. And that was the reason why MSF receiving the Peace Nobel Prize said it's unacceptable. They went and look for. WHO research institutions in Brazil, Kenya, India, Malaysia, pastor Institute, and they said, people, let's come together around the table and let's think about what can we do you know, to address this Absolutely unacceptable and balance solution can be maybe simple for you. But now it's working. Was to say that at the end of the day, none organization will do alone, these amazing work. So we need to be able to bring around the table different institutions, the philanthropists like the Gates Foundation, pharma companies like Sanofi for instance, or Novartis that are working with us, the academia. And of course the patients, the communities, the countries where those diseases have the strongest burden and it works. So this, I would, what we do at DNDI and what we try to promote.

[00:24:13] Dr. Rob Murphy: I understand DNDI has delivered 13 treatments and has even more in the pipeline. Can you just walk us through a little bit more how DNDI actually develops the drugs, outside of the traditional profit driven model that you've described?

[00:24:30] Dr. Luis Pizarro: It has always to start with the patient's needs and the patient needs to stay all along. You know, our journey to bring a drug, so we work with. Patients, of course, with health workers. Safety, it's a major requirement for that. It has to be something that is accessible because you bring the best drug, but it's too expensive, of course you're not fixing the issue of neglected population. It has to be also something that it's feasible. So if you develop a drug that you will use in Congo, in Guinea but that need a fridge because it's not heat stable , it doesn't work neither. What is the logistic you'll need to put in place for that? So having what people call the product profile, tpp, target product profile and discuss this with the people who need the drug. It's absolutely fundamental. And after that, well, you'll have of course the preclinical work, the clinical trial work, and then. How you register the drug and how you bring the drug to the patient. And our work will depend. What the science is. If there is nothing we need to start from scratch and we need to discuss, you know, with biotechs, discuss with some pharma companies and with some research academics, how we can do, preclinical work, how we can use today, artificial intelligence, for instance, to go faster you know, in this research and field the pipeline with molecules that will be good candidates for clinical trials. If we're lucky enough to have a molecule that it's already tested for all the diseases, that could be a solution for the disease we have in mind. We can start clinical trial level and boost let's say the work we do with, of course, national health workers, national Health, and honestly. Do the best science, the best clinical trials, wherever is needed. But you need to work, of course, very closely with your national partners . And sometimes it happens that the drug is there, that, you know it works for the disease, but it's not yet. National guidelines, or it has not been registered in the national regulatory agencies. So our work could be much simpler is how we're able, you know, to make this happen and make this accessible for the neglected populations.

[00:27:18] Dr. Rob Murphy: You've shared some critical knowledge in global health that can only be gained by working and engaging directly with patients in their communities. For example when you're talking about the Democratic Republic of the Congo, I understand that through your work with the stakeholders there, that one of the things that was not acceptable to the community was actually tablets that were white colored and that they preferred tablets that were black colored. Can you tell me more about this observation and others like it that help you implement your projects even better?

[00:27:54] Dr. Luis Pizarro: Well. Of course, when we're young we think that we know everything. And when we're a doctor, it's even worse. So, humility, the capacity to listen and not to try to convince others, always. It's something that, well, for me, took time and I have to admit but that I realized today how important it's uh, to be relevant in the work we do. And that is why the example you're giving it's a very good example of you can invest millions, you can spend 10 years working in drug development, but if you were not humble enough at the beginning to take the time to listen to people, what are their needs? What are they really looking to improve their lives? You can completely out of the box and waste your time and your money on that. This is why it's also important to bring social science here. You and I are medical doctors. We are, let's say, the classical scientists working on this, but we know very well. In order to understand those social phenomena, we need our colleagues from social science to work closely with us to understand those topics. I remember when I was in Niger, we were developing a program about PTCT, you know, how to prevent the transmission from mother to child of hiv aids. And we did everything by the books, right? Training people, bringing the best drugs, having the best, everything was there and it was for free so we convinced the nation that work after six, only 40%, percent of pregnant women were coming back to take the drugs. Everybody was like, wow, what is going on? And so we looked for social scientists, you know, that were based in Niger and we asked them to do some research, you know, some social science research to understand this. Of course, some of the reasons were very critical and were cultural because women didn't want to inform their families and their villages that they were infected by hiv aids. They were worried that they will be exposed. They will not be able to stay in their families, in their communities. Very difficult to address that. And it's not an international NGO that can fix this, but the other reason that was given is that the patient flow, the organization in the hospital was too complex and, uh, woman had to stay sometimes two days in order to get the treatment, et cetera, et cetera. And this is something we were able to fix with our national partners. And after six months, we improved almost by 40%, the loss to follow up patients we were treating. So this is absolutely key. To stay connected with the reality, to be humble, to listen to people and to bring expertise with us. I talked about social science, but it could be economists working with us, people from the legal aspects, cetera, cetera.

[00:31:17] Dr. Rob Murphy: So we've touched on this whole factor about shifting more research leadership and input to the global south. Where do you see this going in the next 10 years?

[00:31:28] Dr. Luis Pizarro: if we do this work. We need to find opportunities and constructive positive elements everywhere to move forward because the one who are suffering are not you and I. We live in countries that are secure. You know, we have our salary at the end of the month. So let's be very honest, we are not the ones suffering here. The ones who are suffering are the patients who are not receiving anymore vaccine drugs. Or communities like the LGBT communities that today are completely isolated with the new program. So, let's be very, very clear on this. We will be in, I think in a very fragile balance between the positive things in terms of empowerment. We are hearing from regions, Latin America, Africa, Asia, some countries saying it's time now to take our needs in care by ourself, and we need to invest more domestic resources. We need to take care of our population, and I'm very happy to hear that more and more governments, more and more politicians are understanding that health it's absolutely key for the countries and it's not something they can let you know, international organizations managing outside. So I'm very happy about that. Nevertheless, as I said before, we need to be very careful also that the people we're serving are the neglected one, and of course they are neglected by a, a pharma system that it's driven by profit, so the poor people are not interesting. That's true, but they're also neglected sometime, but their own government. And we'll stay very close to those patients because we know that neglected people will be more and more in the years to come. So let's try to navigate, you know, around that. The second optimism I have is that it's not only about countries, it's about region. Look at Africa cDC, Africa Medicine Agency, Africa Development Bank. Do you remember five, 10 years ago we were not in the situation we're now. There is a new generation of African scientists that are taking the lead that came very motivated with lot of expertise. They gain in some other countries, et cetera. And they are now really trying to move lines in the African continent, and I'm very happy of that. I see the same in my continent in Latin America. More and more young researchers, young doctors want to, you know, shake a little bit the status quo where they were. And you see that in Asia with a lot of new things coming. Countries like Indonesia. Indonesia is a very strong leader in the Asian region. They are now taking part in, for instance, the dengue effort. We are working a lot on that. We have a south, south Alliance with people from Asia and Latin America. And we know that countries like Singapore, Malaysia, Thailand, Sri Lanka, Indonesia, are not waiting for Europe or us to come and fix their problem. They're now saying it's our issue and we need to do something for that. So I would say. Those are positive trends. We need to really push for what is probably scaring me a little bit more and we'll need to follow, is what's gonna happen with the research and the pharma sector. The big pharma is not interested anymore in infectious disease. We're very conscious of that. And what is gonna happen, with all the outsourcing they are doing, they're not doing so much r and d, but buying biotechs they are outsourcing manufacturing. So, I don't know how those changes we're seeing in this ecosystem will impact the capacity, you know, to continue doing the work we're trying to support.

[00:35:44] Dr. Rob Murphy: A final question that I ask all my guests on this podcast, and that is. What advice do you have for young people who are just now embarking or considering embarking on a career in global health?

I will make the difference first between, you know, the, the health students that would like to work outside of their countries. So they have more, you know, the sort of traveling approach that honestly it's something you, you learn a lot and uh, it can be very inspiring of course. But it's something to be managed with intention with humility, I. Going somewhere else. Do the job of doctor you can do in your country. And that's it. A completely different aspect is students that are, you know, engaging in the real global health sector. When we talk about global health issues, those that are not managed at the national level and that are very multi-disciplined, right? So you can have your own health background, but you need to understand economies. You need to understand politicians, you need to understand legal, et cetera. And you need to be able to embrace complexity this multidiscipline and think outside of your let's say small box we have as doctor or economist, et cetera. My first recommendation is really to make this difference. And if you go into global health, open you know, to different disciplines. The second one is to be very clear also, what do you wanna do? Do you want to be an expert in something? So you go for a PhD and you become very, very you know, focused on the sexual and reproductive health economy. These, these, so that doesn't matter, but you are an expert and you're putting your expertise at the service of a country, of an international organization or whatever. This is different. From being a project manager, a team manager, and then doing the job I do, for instance, as the CEO of an international organization here, you need to not only be good, for instance, on health on this, it's important, but it's not enough. You need to be able to develop management skills, leadership skills and you know, a political understanding of what is going on. A third part that it's also very important and our students are forgetting is all the support functions we need in our sector. My colleagues are doing finance, human resources, communication, and fundraising. Those are very, very important functions. We need it everywhere in the global health sector. And you can think about that too. And for instance, my colleagues doing fundraising, external relations. They do a great job. They engage with very different organizations. They need to think about how to design a project. Then you know how to convince donors to come here. So those can be also very exciting, you know, jobs you can do in global health. So think about that. What do you wanna be an expert? Manager and leader, or you want to support the organizations in different aspects. And when you think about that, let's try. Let's explore, and again, humility in everything you do.

[00:39:24] Dr. Rob Murphy: Luis Piazaro, executive Director of DNDI thank you so much for joining us today. We really appreciate your comments and your insight and uh, wish you luck in the future.

[00:39:26] Dr. Luis Pizarro: Follow us on Apple Podcasts or wherever you listen to podcasts, to hear the latest episodes and join our community that is dedicated to making a lasting positive impact on global health.