The sky’s the limit
in public health

“I don't get fazed by things anymore,” says Marc Destito, Vice President and Head of Global Health at QIAGEN. “Like if I show up in a country and I haven't heard from the people I’m supposed to be meeting, or I have no idea where people are taking us. Once we were in Moldova and the guy in the lab pulled out a bottle and said, ‘Try my homemade wine before we talk business!’ These things just happen, and you’ve just got to roll with it.”

He sees his role as an essential part of building on QIAGEN’s commitment to increasing access to quality healthcare, and took up the position in July 2021, having worked in global health for around a decade before that. While travel restrictions were still in place at the time, since they’ve lifted he’s been travelling almost every week. “Not always to some far-off place, there’s been a lot of regional travel as well,” he says. On long-haul trips, however, he can easily be away for a couple of weeks at a time. “If it’s Asia or Africa, I try to build in as much as I can because of the cost and the planning involved. I usually try to get to at least two or three countries and visit as many people as I can, visit our local offices, our local team. I really try to pack a lot in.” 

It's helped immensely that his previous experience has taught him what to expect, he says. “When I travel with people who don't have a global health background, I see the stress on their face immediately – ‘What time’s the meeting? Who's setting up the meeting?’ And I say, ‘We'll see what happens – it'll all fall into place.’ The global health space is so different from everything else in business – it’s its own universe. Things change on a dime, appointments get canceled and sometimes you can't get an appointment at all.”

Baptisms of fire

One particular baptism of fire in a previous job saw him have to organize a trip to India at 48 hours’ notice to present to a panel of leading clinicians. “We had a letter from the equivalent of the FDA requiring us to appear in person to appeal for the approval of our product. It was basically myself and the lead of the clinical trial, who was going to present this data. As I'm on my way to the airport I get a message that he was denied boarding because his passport didn't match the number on his visa application, so it’s ‘You need to go by yourself or the product's not going to be approved’.”

After a four-hour wait and a “brutal” meeting where the panel of doctors were firing heavily scientific questions at him, the local consultant told him, ‘That was great!’. “I said, ‘What are you talking about – were you at the same meeting?’ He said, ‘You don't understand, the guys before you were kicked out after five minutes’.” What’s more, the drug was approved. “It was one of the craziest experiences from a professional point of view,” he says.

Another hair-raising experience, for different reasons, was being frantically hustled into a vehicle in the Gugulethu township in Cape Town, where he was visiting TB patients. “We had security with us because they said it's not safe to go on your own. At some point we got separated from the vehicle, and the crowd started to get bigger and bigger until it was around 50 people. The security guy got really uncomfortable because he realized if something happened there was nothing he could do. He was saying, ‘We have to go’ and I was saying ‘I don’t want to offend these people.’ He just grabbed me, like one of those scenes in the movies where they're rushing the president into the car, and then the door to the van flies open and everybody gets pushed in. The atmosphere was definitely getting charged.” But that is part of the experience.

What’s the worst that can happen?

However, it does pay to be structured about some things, he stresses. “My colleague who helps me with my travel booking knows I'm a stickler about airport pickups, because you don’t want to be fussing around unregistered taxis. I'm super picky about things like that, and getting to the airport on time. But then I also just live by the rule of what's the worst that can happen? If my flight gets canceled, there'll be another flight. If I can't leave today, I'll leave tomorrow.”

Always using the same backpack also helps, he says. “I keep things in the same pouches in the backpack, and they never go out of the pouch. So my passport I don't put in the drawer at home, it always stays in the same pouch so I know where it is.” The same applies to chargers, cables, adapters, as well as printed COVID forms as, “You never know when you're going to show up somewhere and they don't accept the QR.”

Planning for the worst, “I also have a full-blown medical kit with thermometer, painkillers, antibiotics, bandages, you name it.” He's never had any lost-luggage disasters because he only ever travels with carry-on baggage, no matter the duration of the trip. “I'd rather pay for laundry than risk it getting lost, especially when you've got seven flights.”

What’s missed most

All of this, however, has perhaps inevitably played havoc with his sleep. “When I was younger, I could sleep anywhere, but as you get older it gets much harder, and I do need sleep to function.” It’s the thing he misses most on the road, he says. “I'm not one of these people who says, ‘I’ve got to exercise every day, I've got such a rigid routine.’ The thing I miss is just as basic as it sounds, being in my own bed.”

There are also challenges when it comes to food. “I put this under the same category as sleep in that as your body ages, certain things change. I used to have an iron-clad stomach which people would laugh about. Before I could eat street food, anything. In the Philippines I tried balut, which is literally a fermented duck embryo, in rural China I ate a fried scorpion. I still try to eat local food, but I won’t eat raw or undercooked foods overseas now, because it's not worth the risk.”

So has all of this travel taken its toll on him? “I’ve been doing a lot since I was in my twenties and there’s no question that you notice it starts to wear you down. It does require more mental stamina than before, and sometimes you really need to psyche yourself up for it – on the last trip to Africa I probably spent as much time on a plane as I did on the ground, just because of the logistics of getting to some of these places.” COVID has also made travel far more complicated and frustrating, even on short-haul trips. “I waited four hours to get through security in Dusseldorf airport recently – that can be as brutal as an eight-hour flight.”

Personal connections

So why keep doing this? All of this is worth it in terms of the benefits that the travel brings, he says, by far the biggest of which is the ability to make personal connections in a way that wouldn’t be possible over email or Zoom. “People remember you. When you develop that personal connection with somebody, then you know you have someone you can rely on. If I have a problem I know who to go to – it just creates a whole other sense of openness.” 

One recent example was when he’d been trying for a long time to email contacts in the Philippines to start a conversation about TB infection testing. “I found that emails would just get lost in the ether, so thankfully when we got to the Philippines we were able to get a meeting. They said, ‘We know we need to do more TB infection testing, WHO’s telling us to do it, Stop TB’s telling us to do it, we’ve got money from Global Fund. The problem is that we've been focused on active TB and treatment and we don't know how to do it, we don't have the tools. And I thought, ‘Wow, we're having a really frank discussion with this person who wants to create this collaboration.’ How do you do that over email?”

On the subject of TB, a major surveillance project is now underway in Malawi that’s set to focus on 10,000 children. “It's a large number and a segment that's so vulnerable and so often forgotten. For years many people in the TB community didn’t want to focus on children, particularly under-fives, because children are less likely to spread TB bacteria to others so they're just completely overlooked. But for me it goes to the very heart of this health equity argument and access to healthcare – everybody has the right to quality healthcare, whether you're one year old or 100 years old. So how can we just completely ignore this group?”