Meet the board: Esther Krofah

Following her appointment to our Board of Directors this May, find out what drew Esther Krofah, Executive Vice President of Milken Institute Health, to Protas.

Tell us a bit about yourself.

I have a broad background in health policy. I’ve worked across different sectors including public, private and non-profit to address the most challenging and systemic issues in health – always from the perspective of how to improve the lives of patients, including those from underserved populations.

I started my career in management consulting, working with a large firm with a variety of clients in life sciences, medical devices and state governments working to address challenges in the implementation of new federal and state regulations.

I moved on to further engage at the state level through the National Governors Association, which represents the voice of the leaders of 55 states, territories and commonwealths in the United States on a broad variety of issues.

There, I worked on critical issues for states including Medicaid, implementation of the Affordable Care Act (ACA), maternal and child health, healthcare workforce and the opioid crisis.

I then went to work for the Obama administration in the Office of Health Reform as part of the Office of the Secretary in the US Department of Health and Human Services (HHS), with responsibilities to implement the ACA, a significant federal legislation aimed to expand access to healthcare in the US.

My next job was within the private sector at GlaxoSmithKline, where I led engagement with US federal agencies, such as HHS and the White House, to expand access to preventive services and medicines, including vaccines and respiratory and HIV medicines.  

Whether my work focused on expanding access to health insurance, changing state policies or advancing access to medicines biopharma, my focus has always been to speed medicines, treatments and services to those who need them, as quickly and safely as possible.

Today, I lead Milken Institute Health, which represents the health pillar of work at the Milken Institute, a non-profit, non-partisan think tank. My role is to bring together and engage diverse stakeholders around the most critical issues in health. I am energised and motivated to explore solutions for an improved and more equitable future of health for all.

What does your work at the Milken Institute involve?

I have been at the Milken Institute for five years this July. It has been a wonderful journey so far and my responsibilities have grown significantly over that time.

My work at Milken Institute Health bridges from biomedical research and development to public health, advancing whole-person health throughout the life span as populations age, and nutrition and equitable food systems.

We conduct research and analysis, develop research and publications, advance policy, and convene top experts, innovators and influencers from multi-stakeholders to develop new solutions and recommendations to address complex health challenges.

We leverage our expertise and insight to construct practical, scalable programs and policy initiatives that lead to a greater understanding and investment in solutions that meet our mission, which is for everyone to live meaningful lives.​

What interested you about Protas?

I have been following Martin’s [Protas Chief Executive Prof Sir Martin Landray] work around clinical trials innovation for quite some time. This really came to the fore for me during the COVID-19 pandemic.

Through the tremendous reach of the RECOVERY Trial – scientists and researchers, regulators, policymakers and the media – we understood the power of the evidence-generating engine in the UK.

Clearly, certain systems allow evidence generation from across populations much quicker and more efficiently than we have in the US, which allowed good-quality, swift decision-making that affected patient care.

Protas was set up to build on the lessons of RECOVERY and the policy work through the Good Clinical Trials Collaborative, and I’m very interested in how we can roll out that approach in the US and worldwide.

In addition to what we learned through COVID-19, I’m interested in what clinical trial ecosystems can do in the future.

For example, with FasterCures, we’re looking at two areas in particular: how we bring clinical trials closer to the communities, and how we ensure more diverse clinical trial participants that better reflect those with the disease being studied.

Protas was created at the right time to bring us together around these big questions of evidence generation that is fit for purpose and can answer the most relevant questions.

What are you most looking forward to bringing to the Protas Board?

First of all, for Protas to be as successful as possible, we need to demonstrate how clinical trials can be done differently through real, practical case examples. This includes working with partners to execute successful trials that answer critical questions for the disease conditions being studied.

Second, we need to look across the various policy levers and regulatory bodies to explore what we need to create or update to ensure that clinical trials and, importantly, our clinical trials ecosystem is fit for purpose, responds to the needs of patients and communities, and provides relevant information appropriate for efficient regulatory decision-making.

Third, we need to think deeply about the stakeholders we need to bring together to champion and deliver on what we are trying to achieve – building the clinical trials ecosystem of 2030 as has been envisioned by US bodies such as the Clinical Trials Transformation Initiative and the National Academies.

In addition, we need to identify underlying incentive structures that may prevent us from moving closer to that vision.

Undoubtedly, one of our biggest challenges is that the incentives have not changed in how we fund and conduct clinical trials. There hasn’t been a compelling reason to change the status quo and perhaps the lessons from COVID-19 offer us that opportunity.

Protas is leading the charge in showing how we need to move together, globally, and I hope that my experience will help to inform that movement.

Why is diversity so important in clinical trials?

Diversity leads to better science. We must adopt that as a mantra.

Far from being a “nice to have”, diversity allows us to better understand diseases, leading to better medicines and better patient outcomes.

By ensuring that clinical trials reflect the populations they serve, we are working towards what we need – evidence that reflects the epidemiology.

In the US, we are seeing significant gaps in life expectancy of 10, 20, 30 years, just because of where people live. Whole communities are being left behind. It is vital we close the health gaps, in part through clinical research.

What motivates or inspires you in your health policy work?

I was born and raised in rural Nigeria and saw first-hand the experiences of many in my family who lacked access to high-quality healthcare in that setting.

The opportunities afforded me upon coming to the US, particularly through my undergraduate studies working with HIV/AIDS patients in the US South, demonstrated that the disparity can be just as much present in the US as in many low and middle income countries, despite the enormous resources available. 

More recently, my father was diagnosed far too late with stage 4 cancer. Helping him get access to treatments and clinical trials and seeing the significant gaps between evidence and clinical practice, showed what a very real and relevant issue this is.

Discover more from Esther here.