Hi, I'm Aaron Welsh and this is this podcast will Kill You. Welcome back. You are listening to another bonus episode, our second in our mini series of bonus content, exploring in more depth the topics we covered the previous week. As we always say on the podcast, A we're not experts, and B we can't cover absolutely everything about a disease or a topic in our regular episodes, and those two
things probably aren't going to change. But we can talk to actual experts in the subject we covered the previous week and get to explore some aspects of that topic in more detail than we did in our regular season episode. In our first bonus episode, I followed up our hepatitis B episode with a conversation with doctor Sherry Cohen about the stigma and discrimination that people living with hepatitis B
often face and how it impacts their lives. This week, I'm very excited to chat with doctor Wilfried Matombolkoloji and doctor Natalie Stroborgaft from the Drugs for Neglected Diseases initiative about Human African tripanisamiasis. In particular, I wanted to learn more about the development of fecsinidzol, a new drug to treat this disease, one that is much safer and easier
to use than those that have been historically available. How is this drug discovered, what are some of the challenges in making sure people who need it have access to it? And what impact has it had on control efforts? These are just some of the questions I want to explore in this bonus episode. If you haven't listened to our Human African tripanasimiasis episode yet, you may want to do so before you listen to this bonus episode because there's just so much to that story and it'll probably help
give a bit of context for this interview. But either way, I'll give a quick overview before we begin. Human African tripanasimiasis, also known as hat hat or sleeping sickness, is a neglected tropical disease caused by two subspecies of tripanosome parasites, one of which Tripanosoma brucei gambience, is much more common
than the other, Tripanosoma brucei rdisience. These parasites, which are transmitted through the bite of a setzifly, have been infecting humans for thousands of years and cause a disease that is considered fatal without treatment. Over the past fifty years or so, there have been substantial global and national efforts to reduce the prevalence of human African tripanisimiasis, and we've
made a great deal of progress towards elimination. For instance, from two thousand and nine to twenty twenty, the number of recorded cases dropped from just under ten thousand to
six hundred and sixty three, which is absolutely amazing. But still these parasites persist in thirty six countries in Sub Saharan Africa, with some countries carrying a disproportionate burden of disease, such as the Democratic Republic of Congo, where seventy percent of cases reported over the past ten years have occurred. Control and elimination efforts for human African tripanisimiasis face many
different challenges. For instance, these vector borne parasites have a supercomplex eco pology, Diagnosis of the disease can be quite tricky, and there are many logistical difficulties in providing care to those who need it. Funding for research or drug discovery is always a challenge, and for decades the only available treatments were either arsenic based with toxic side effects. These drugs are called arsibol or malarsaprol or extremely complicated to administer.
These last points have changed in the past few years with the discovery and approval of fecsinitisol, which is an oral treatment effective for both the first and second stages of gambience human African tripanisimiasis. This drug was developed through a collaboration between the French healthcare company Santo FI and
the Drugs of Neglected Diseases Initiative. And I am super thrilled that I get to speak with not one, but two amazing scientists at DNDI about this exciting new development and what it means for the global elimination of human
eye African tapanis miasis. Doctor Motombo Colomgi and doctor Stuboorgaft have both been involved in many different aspects of human African tapanistas's control efforts, from regional fieldwork to clinical trials, and from drug research and development to forming industrial partnerships to bring these drugs from the lab to where they are most needed. And I will let them tell you a bit more about themselves and jump into the interview right after we take this short break.
I'm Wilfrid m I'm a medical doctor. I'm based in DRC in Democratic Republic of Hongo in Kinshasa, and I'm working for the NDI currently, I am coordinating our local R and D T and we're working up current you on three diseases, Scenario, disease and COVID, so I'm coordinating all our R and D projects.
My name is Natalie football Geft. I'm a medical doctor by training. I've been with d NDI since two thousand and nine and I've been leading the NTD, R and D activities and started the vaccini as our program in two thousand and nine until it came to access to patients in two thousand and eating.
Thank you so much for taking the time to chat about d NDI and vaccinate as all. So I wonder if you could start off by telling me how did you both get involved with DNDI. What brought you to this type of work.
My first term to hear from the NDA was in two thousand and six. I was working as a doctor in a remote village, so I heard that the NDA was preparing the project of clinical trial on art human Africans. So I was interested because I was treating those passions and so I was aware of issue we had with this disease, and then I applied and I was selected to be a local PI principal investigator for one of clinical side study, so it since two thousand and six.
That was my first.
Contact, and then after I continue, I was investigator in another clinical trial that was called Nightfield, and then after from two thousand and twelve, I start working as coordinating and a skepter of affecting as all projects and seis two and sixteen full staff of the NDA.
As for me, it's a bit different. I've been working before in the pharmaceutical industry and in some biotechs, and in fact, in two thousand and three, when DNDI was launched, I was informed via friends and I kept watching the DNDI website for interest because I've always been interested in doing something that adds value to public health. And once I saw a position that was opened for clinical development director and I called them and I said, this is me, this is me, and they were at the end of
the process, so they accepted to receive my CV. I went through interviews and I got the position, and that's how I came with d NDI, and I'm still.
There wonderful so today will mostly be chatting about human African tripanasamiasis, but DNDI is involved in control efforts for many other neglected diseases. So can you talk briefly about the general missions of DNDI and what type of work the initiative does so you know, in.
Fact, yes, the NDI was founded in two thousand and three after MSF Doctors Without Borders received their peace Nobel price, and some people at MSF, in fact, doctors who were working in the field, were facing terrible dilemma where they couldn't treat patients who they were trying to take care of because they didn't have the proper tools, the proper treatments, and so they started looking a little bit more and it was very clear that there were a range of
patients or diseases that were totally neglected by the efforts of the industry because they were targeting diseases and all populations that had no economic power and for which there would never be what was expected to be needed, i e.
Return of investment. So they developed the model, and at that time there were a few others that started developing what was called product development partnerships, looking at ways of developing treatment options that would be responding to the needs of those that are neglected by this industry, and that's how the NDI decided to focus initially on developing a combination of foral treatment for malaria fixed those combinations that was aligned with what the WHO was asking for at
that time, but also focus on some specific diseases where there was both a need some partners and a hope for short, medium and long term response. And that's how a few diseases were selected from the list of neglected tropical diseases, which included mostly kinitoclastic related diseases so parasitic
diseases including sleeping sickness, jagas and lehmanniasis. And then we expended every three four years we had a revision of the strategic plan and based on needs and opportunities, we expanded to encore psarkiasis, to pediatric HIV, which might come as a surprise but very neglected in sub Saharan Africa, and also hepatitis C and then mycetoma also extremely neglected.
And then in twenty twenty we started, as wolf Kind mentioned, to engage in two COVID response, but COVID response for low and middle income countries.
The global efforts towards elimination of human African trim panicema, they've been amazingly successful over the past ten years. For instance, I saw that only six hundred and sixty three cases were reported in twenty twenty, which is a drop of over three hundred from the year before. That's an incredible drop in cases and it shows that real progress is being made. What do you think are the biggest factors contributing to this decline in human African tripeness and ISS cases.
It was the dagnostic that was very, very difficult, and the second and very big challenge was the treatment.
Because the treatment we used to lose was.
Archobal with arsenic and that treatment was toxic and less effective, was losing its effectiveness. And I think the great moment was when the NDA was involved with all his partner and when we change the treatment. The first wed step was to change to switch from the arsable to net the combination of thirty knox and this was the first.
Quick step we did.
But this changing of treatment, we had a very effective drug and less toxic and so we we have very very few relapse and even people was very comfortable to receive this treatment. This was I think for me, the very critical moment, and with our involvement of d n D and this partner, we are still working on the best way to ease the treatment and now we are on oral treatment.
So all this was very important and very critical step toward the elimination.
Yeah, so maybe I think we should also recognize the from the I mean, this is what Wilfred mentioned, but under the umbrella of national sleeping Sickness control programs and collaboration with many partners, which I think under you know, they're also the leadership of the who all of this, there was a momentum and a push to consolidate to
have joined efforts on diagnostic and treatment. A lot of training activities performed via the national programs, and since Wilfred was also part of the national programs, maybe that's why he's being modest, But I think we should recognize that the organization at the country level was was also absolutely crucial in making this reality.
So you have both been working in this field for a number of years and have had this opportunity to witness this drap in cases firsthand. So how do you feel that this field has changed since you first became involved.
I did my medical training in the side province, so this was one of anemic areas of sleeping sickness. So even during my training, I was seeing how those passions was treat with melasoprol. And when I became a medical doctor, I was in charge of managing those persions in my small village where I was working, and you know, I was receiving those passions and the only drug we had at that time was melasoprol. This was terrible drug. I even lose lost two of my patients. It was a sad,
very bad experience. You know, when we were treating passion with a SOB, it was stressful not only for health worker, but you.
Know even for passion family. So but since we have those new drug.
Things change, you know, we have even health worker are more comfortable, more confident.
This is a which change and I think the key point is also that people are less less afraid of going for treatment. But maybe also with time they will also be less stigmatized because you know, less mystery is surrounding this disease. They can with with vacciny asert patients
can be treated in the village. There's nothing magic about you know, the treatment patients come and some of our colleagues used to say the success will be one day when you consider sleeping sickness as any other infection, it has been, you know, impacted by a lot of stigma. That this stigma I think may decrease with getting a
treatment that looks like any other treatments. It's tablets, there's nothing, no specific requirements regarding you know, its use, protection of activities you shouldn't be doing when you take the dragon, a lot of things which make it really more normal, and that's really important because what we need is patients
to be treated. What we have observed is that patients have come, sometimes come very late for treatment because treatment before meant going to hospital, which meant not being able to work, which meant maybe having an economic impact on the family, which meant also that the family had to accompany patients at the hospital pay for fees. I mean a lot of things which are impacting the quality of life and the acceptability of treatment. So it's a huge change.
One of the things that I wanted to ask about was the COVID nineteen pandemic. How has this had an impact on control efforts? Do you think that we'll see another decline and reported cases of human African tripanismiasis from twenty twenty one or has the pandemic impacted control efforts?
So sure, yes, the pandemic is an impact on control efforts. You know, most of the National program works with what we call mobile team, and those mobile teams walk twelve months. Every twelve month, they spend more than twenty days or more than fifteen days going from a village to another doing the screening of population. So it's not easy for them to go from a village to another village due to COVID restuction, and since we have this COVID problem, you know, they are not able to have a twelve
months of work. This is another problem. And you know we work with many partner, many founding partner with COVID. Their impact to SAW the National program you know, receive not the entire money for their activities. So this is a second impact and another impact. You know, if we go, for instance, in the field of another elective disease like filarial disease, they do what we call mass rog administration.
They can do it.
You know, last week I was leiting some remote areas and then the mass rog adminisation was not done.
Due to this COVID issue, due to this restriction of movement and due to.
The decrease of finance. So this COVID will have a good impact and we must be aware of this.
I was wondering if you could talk a little bit more about the stigma surrounding human African tripanosamiasis.
Yes, as you know this it's a chronic disease. The first step is what we call a molempathic step. The second stage, it's neurological stage. And at that stage, you know, can become like a foolish you know, mostly pe and so on, with a trouble of theev and so on. And for those who suffer from sleeping sickness, this was a very with sigma. That was one of the factors that could avoid some people to come to receive the treatment.
But now sleeping sickness are more and more accept and are being humanized, you know, now things are changing.
In our episode on human African tripanos semiasis, we touched briefly on vacting it as All, which is this oral medication recently developed to treat this disease. Can you tell us a bit more about the drug, starting with how exactly it works.
We haven't fully elucidated the mechanism of action of vacciny desert, but we know it interacts with the enzi material of the parasite that is responsible for the disease, so it is innocence, it kills it.
How effective is it for gambiensa?
So it's really effective. So we did a study, a very robust study in comparison with the NEXT, which is the standard of care mentioned earlier by we FEED, and we showed that it was non inferior to it, which was the statistical hypothesis, within a limit of thirteen percent, which means that in essence, it is almost as equivalent as NEXT, with slightly lower efficacy, but within a range that is considered as really what the physicians wanted and
what the regulators accept. So it's very important because it means that with an aal treatment you can replace an injectible treatment and something else, a combination of an injectible
and oral treatment. But I think something we haven't yet mentioned is that to administer the standard of care, which is NEXT, you need to have patients being hospitalized, but before that they need to go through a lumber puncture to verify if they are eligible to this complex but very effective treatment combining an infusion and a normal treatment, or if they can stay with an intramuscular treatment, which is simpler to use, but still to get this standard
of care, they need this lumber puncture. The lumber punctures are painful. Some of us who have had lumber punctures in the past, we have access to anastasia, but that's not the case when you do lumber puncture to test patients for treatment allocation. You have headaches first lumber puncture, and that's also one of the factors that made sometimes patients want to avoid being tested just for the sake
of not having to go through this lumber puncture. Now, with vaccin need as a you don't systematically need a lumber puncture. You may need it if patients are experiencing severe neurological symptoms, where maybe they would benefit more from this standard of care treatment, but otherwise, once a patient has been tested with the parasite, that patient, provided he doesn't have very severe symptoms, can get oral treatment immediately.
It has also shown us that it has really high efficacy in stage one, meaning that those patients were not severe, and it's also as efficicious in children, which is very important as well, because otherwise those small kids would require the lumber puncture if they are in the advanced stage, and would require the infusion, the combination of infusions and oral treatment. So overall it is almost the same as the standard of care, but it's oral and doesn't need the lumber puncture.
That's wonderful. Yeah, And I'd love to hear more about the story of the drugs discovery. How is it selected as a potential candidate for a sleeping sickness medication and then what happened after that?
So that came from the well, the way we worked at the NDI, and it was our predecessor, so elsto Rele and bernardet Bourdain who evaluated drugs of the class nitro medesol class because they were known to have a potential for this disease, and looked at a library or I think of almost seven hundred drugs and started looking at the potential for those drugs. Vaccini Desol came out. It had been developed earlier on by predecessor of Sanufi and put on shelves before it came to clinical stage,
just for probably you know, strategic reasons. Nothing else so it was identified back from the shelves and then as the value chain of clinical development evolved, meaning looking at individro testing on parasite labs, going to animals to test the efficacy of the drug in animals infected by the parasites.
We selected the end vacciny as a clinical candidate, at which point we also signed contract agreement with Sanofi and then started engaging in the standard phase one healthy volunteer study, followed by the very large study in Africa that was called by Wildfree and doctor comt in the DRS.
The historical lack of funding for human African tripanasamiasis and all other neglected tropical diseases it has meant that drugs are slow to be developed and once available, there are many logistical challenges that prevent access by people who need them. So can you talk about how important it is to form industrial partnerships to connect drug development with setting up infrastructure for actually administering those drugs.
Having a disease that has priority for public health that is on the wtual list of diseases that need to have you solution is one way of attracting funders together with an organization that can bring elements to show it can deliver, which was something we did with the development of Azak, which in fact we had done also with SENUFI. On the other hand, SENUFI, as part of their global Corporate Responsibility activity or access to Drug engagement for a
long time, had been supporting the WHOW financially. Therefore, it was kind of a natural partner for us to go with SENUFI to engage into this partnership where we would be doing the development and looking for funds to do that, which we got from public funding as well as private funding them doing the manufacturing and distribution together with the writ show via a donation of Vaccini as a two
countries via w O Shoe. So it's a bit complex, and I think for each disease it's different, and it's clear that we have to continue to promote the need to fund research for neglected tropical diseases. But there is you know, a kind of move to public health firm interest in doing that, although still not as much as we have seen for tibing, malaria and HIV.
So I want to take a quick pause here and then when we get back, I want to dive deeper into the story of vaccing it as all specifically with the clinical trials process. Welcome back everyone. So I was wondering if you could talk about what went into the clinical trials to test the safety and efficacy of this drug and what were some of the biggest challenges in conducting these trials.
This is a good question.
You know, to conduct technical tyers, you need to go where pasions are and those persons are.
Living in remote areas.
As you may know, our health facilities in remote areas are in very bad states. So the first challenge we have many challenges. First, we need to improve those health facilities, passion towards laboratory sanitation, all those things, and even to put clean waters and electricity by a generator and to provide internet connection because this is very important in clinical toil. We need to train people because health workers working in those remote areas was not very used to clinical trial.
So we need to train them on a GCP good clinical practice, on protocol on how to manage the clinical trial, how to manage the adverse events, serious adverss events. So we need to trend people on this and we need to set up a good way to reach those sites because we have local teams, we have National International Team. So we need to set up a very safe way to reach those remote areas by using safe board, safe
cards and so on. Eving to set up to all those accommodations because when people go there to work, they need after the working day to have an acceptable accommodation. So we need to set up all this and again working on those populations, you know, most of them would not be able to read or to be involved or to you know, to go in the clinical trial. We need to give your UNI to sign an informed consonant form.
So how to make this at that level for those people who could not read, So we set up image boxes to explain them clear what is the clinical trial?
So while they were giving the agreement, there was a work of what is it?
So we need to follow all this and we set up all this and again, you know, because we were in a clinical trials, we need to provide food to those passions. But we were giving food to all hard passions, not only for those who was involved in clinical trial. So we set up all this and then after we start with a clinical trial and with the MANY supervision, many follow up. So we work with the national program and with the NDI and all our partners with TPH that was doing the monitoring.
So when I joined and I was coming from the very well equiped the clinical research networks in Europe US and I came to the NDI and here we were, you know, with a new chemical entity. We had the basic standard package for phase one very good, and then we had to start this phase to study where for the first time you start treating patients very far away
and with little access. I would say, to information of what was going to happen to patients at the site level, And as Wilfrid said, we had to do it where patients are and with the only people who know how to treat those patients and who are also physicians that
work in very remote areas. So we had to do things that I had not thought before I would need to do, which is set up internet connections, come with more, you know, bring some equipment that was not there, find ways of doing lab tests in a way that would not bring something artificial and then living that was not
the argat. So we had to think with many people and it was a collective effort of how can we bring the best science in the conditions where we were And in addition to everything that Wilfrid said, we had to think about this and bring what we thought were
the best sustainable solutions. We had to do electro undrograms, so we took those devices that allow us to have direct connection in France with what was happening in the middle of the DRC in one patient, etc. So it was quite a bit of a stretched effort, but I have to say, with so much enthusiasm from everyone everywhere,
we were all so excited to make it happen. So I think we did something really nice that could serve as a model for future, you know, research, and that also brought a lot of experience to all of us.
Something else we did a side of this because when we said, okay, we need to have this study, as any study in the world approved by an ethics committee, Well, who's the best position to verify that you're not taking risks for patients, that you're responding to your scientific hypothesis, that what you're doing is well done, makes sense, you're
not exposing patients to a risk. And when I joined, the routine way was to have a double ethics committee, one in the north and one in the south, and it was exactly that and we said, well, maybe we can do differently, Maybe we can have committees from the South and one committee in the North discussing this together and finding ways of you know, consolidating different experience from different areas of the world in a way that would
help to have the best review. This is what we did and we published and it was a learning experience for all of us from those maybe from less experience ethics committees in DRC or elsewhere that we're taking a huge responsibility in accepting, you know, for the study to be conducted in their patients, but also from the committee in the North, who were you know, faced with questions they had never thought about that you know, made them
think a bit differently, like you know, funding issues. Are colleagues from Africa, we're asking are you sure that you will have the funding to continue, or they were asking questions about how we explained the study to patients or community issues, things like that which they had not ever,
you know, really experienced. So a very rich experience. And then once everything was in, the study was conducted as it would be anywhere else, except that we found again something which when you have experience in clinical trials you wouldn't think is real. We had a follow up of patients involved in the study of eighteen months. And you know, it is not unusual that one patients are receiving a
treatment that here was for ten days. Well they come after okay, they will come for their follow up visit at three months, maybe at six months. A few will not come at twelve months, and why the heck would they come at eighteen months if they're feeling well. Well, we had three I think three patients lost to follow up out of over three hundred and ninety patients. This is outstanding, outstanding, and everybody has been so impressed by this.
Why did this happen? Because there was such an effort locally, not every in one patients first diagnosed and entered the study was followed, and I think again we can explain how this was done because it was not simple.
Yes, you know, clinical trial on hat we need to keep those passions. Because the last follow up was eighteen months after receiving the treatment. This was not easy, you know, because when they feel good, they don't come because they are okay, they.
Receive the treatment.
The very important moment when we were doing the informed content form so that for the award that they need to come to all the follow up visits, because if you don't come, it's it's considered failure. But we had the address, even the name of the leader of their village, the name of the head of the news of the village. So we have a motorbike to follow them, then cell phone number of one of relatives if they have it.
All these rules, all these to to to reach the Greek majority of passions and as we were all motivated local team, they are at the national level and at our age que. So we we did. We did this secess Storian and this acceed but it was not easy that we did it.
Yeah, that's incredible and I can imagine that you know, this enormous effort at the national and the local and international scales, it's probably led to a lot of lessons in terms of, you know, not just how to set up clinical trials and how to reach patients and keep
in contact with them. But I wanted to ask, you know, what are the biggest lessons do you think we can take from this story affects in it as all, and how can we use them to help control efforts for other neglected tropical diseases or just general healthcare infrastructure.
Yes, the great lesson to my side is you know, this collaboration because the NDS succeed to put together the National Control Program, and that was very important to have the National Control Program because they had to give the product profile they need, what was the exact need? That was the first And to have farmers of course, and to have WHO and to have you know, all those stakeholders to put them together working on this project.
That is a great great lesson to my side. So it's something we can you know, reproduce, use it.
When you want to tackle health problem, you need to involve the health worker, the control program, the researcher, university WHO, and all those takeholders and together.
We are strong.
So fixing it as all is currently approved to treat the Gambisa form of human African tass which is by far the most common form of the disease. But can you talk about how far along we are in the research to determine whether this drug is also effective against Tripanosoma brucei rhodesiense, the other form of human African tanas iass.
Yes, so we have good news because it took some time, but we managed to get funding from EDYCTP, and I think I should mention the other founders for the year for the HAT program, you know, the Gates Foundation, MSF, the Uki government, the French government. I just want to mention them because we wouldn't be here without their support.
But thanks to DYCTP, we were able to start and finish recruitment in a small study of vaccinidso tibio DIZNC because based on the same studies that showed the potential for vaccini desol to work on TIBIGOMNC, we had the same information of tibio diziency. So we've just finished a moment and I hope that we'll be able to report on this quite soon. But it's it's fantastic because because the year the reference treatment is melasopol, it's still melaxopol,
which is this arsenic based treatment. So if we can show that vaccini as at can be an alternative to a DUG that is yes, very efficicious but also extremely toxic, that would be incredibly useful.
Yes, absolutely, are there other potential applications for vaccine resolve, like, for instance, other parasitic diseases besides these tripenosamus.
So we looked at the swoosh maniasis, and we conducted a small study in Sudan which didn't show any efficacy. So here we stopped. And then we looked at tragas and the signal for guess is not quite clear, so I think we have to wait until we have final results because that could also be one area of interest. Other than that, we've not looked at anything concrete, but it's an antiparasity disease, so you know it could have other potential potential use.
So I just have one last question for you, and that is what do you hope this next year brings in terms of human African trepanees and MIASS research or control efforts.
I think the great step we made is too easy the treatment.
So we moved from melasoport to next, which is the kind of god standard.
But net with Next we.
Had many challenge, losistical challenge, But now what we have we're fixing it as all that can treat both stages, and that is tablet is you know, easy to send it anywhere in those remote area and it's very easy to trend people to use this.
And this is one of a very important contributions to our work toward elimination. I think maybe Nathay can completely No.
I think first we'd like to see Vaccini as our rollout, and we'd like to see, as I said, the results of vaccine hudevience. That's one, and see that numbers, you know, continue to go down, not as an artifact of patients not being fated. But I think what I'd like to see is still attention because we know that what people call the last mile or to elimination and sustained elimination
or elimination of transmission takes time. There's another compound in our pipeline which is hugely promising as well, a single dose treatment, and I think it's just making sure that there is still interest. Job is not done, it's not finished. There are still patients who need treatment. We need to continue the efforts, including to have you know, the commitments of countries to continue to be engaged in this, in
this fight. And in fact this comes really nicely because in three days this will be the third MTD, the second NTD day, but the third human African tripanusmisis day
in DRC. So you know, I think it's it's hugely important that we do not think that we have finished but we are encouraged by our successes and the fact that in a way, you know, if, if, if our success in HAT can be a kind of reference and enthusiastic hope for others to continue to engage in that area of enttds will all be really we will have double one and fulfilled a bit of our mission.
Thank you so much to doctor Motombo Cologi and doctor Stroborgaft for such a fantastic interview. It is so incredible to hear what a game changer effects in it asol has been for human African tapanisemiasis and also what this drugs development can teach us about the importance of collaborations among national control programs, healthcare companies, and global nonprofits for
the elimination of other neglected tropical diseases. If you want to explore more about fecsin it isol or other projects that DNDI is involved in, check out their website DNDI dot org and I'll also post some links on the
page for this episode on our website. Also on our website you can find all kinds of good stuff, like the sources for all of our episodes, transcripts, quarantining and plas Brita recipes, our bookshop dot Org affiliate account, links to music by Bloodmobile, links to merch our Patreon, alcohol free episodes, and so much more. A big thanks as always to Bloodmobile, who provides the music for this and
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