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EF: What was your given mission when recently appointed Managing Director for South Africa?
BM: I was the Commercial Director for Middle East Africa when Covid first hit. The transition from pre-Covid to Covid happened while I was in a similar role and it was a different experience stepping into a new position when travel was restricted. After being appointed to South Africa, I was based in Dubai for the first five months, managing remotely. I have worked across the Middle East and African region, routinely communicating and collaborating virtually with people in Algeria, Morocco, Lebanon, etc. But to take on a local affiliate role from a distance when all our stakeholders are in one country -except me- was a new experience. The screen has a very limited view, I can see the individual or groups I am talking to, but I don't get a 100% sense of what is going on in the organization. The screen works as a filter and I have to fill in the gaps with mental models from cues picked up from the individuals or groups I talk to. I felt I was missing out on concerns and functions and the challenges they are facing. It was a relief to come to South Africa; since I have been here, I have a better sense of how the organization is performing, how individuals are and if the organization's culture is supportive enough of people during this time and of real-life challenges.
EF: What were the lessons learnt managing a company remotely and in a complex environment?
BM: Regardless of where we are, Covid has had a huge impact on the way people work, so managing a transformative change is new learning for leaders. Agility and adaptability are required from all leaders, as is an open mind to experimentation. Nobody has the right answer, so the communication between individual stakeholders within the organization and between internal and external stakeholders is critical. A positive signal from Covid was how well industry, governments, and payers could work together in a crisis. The communication between the industry members allowed us to learn from each other's mistakes and successes -historically, the pharma industry has regarded each other as competition- but there has been a lot more collaboration during this period. Communication has been incredibly important.
EF: If you had to create a Master in Pandemic Administration which two courses would you consider mandatory?
BM: Change management is one course that every business leader should do. The rule that 70% of all transformations fail is still valid. This is why the process of change management is essential learning for leaders.
Having a forward-looking view, scenario planning, understanding what signals are out there, that could precipitate a huge change. You see these black swan events like COVID and they can be predicted. There are signals to suggest that these types of things will happen. And some experts talk about that and quite often we ignore those signals as leaders because we're so focused on the day to day work. That ability to prepare for a range of different scenarios so that when something like that happens, you're able to react and adapt to that situation more readily. This made the difference between companies that have survived and thrived through COVID versus the ones that have really struggled.
EF: What advice would you give on balancing tactic decisions for the short term versus strategic long term vision?
BM: I think we have got a bit complacent about the significant macro trends taking place globally, digital transformation, hyper-competition, demographic changes, which are all big changes but they take place over a long period, so we become complacent about them. Covid was quite a "nice" shock to the system for many leaders, taking us out of our comfort zone. Ultimately, Covid will not change our corporate strategy. We are not reacting to Covid, but it acted as an accelerator to do new things faster than previously, flipping our minds to consider the external environment and has been an essential part of this experience.
EF: How can we restore focus to non-communicable or chronic diseases in an infectious disease scenario?
BM: Astellas focuses on very specific disease areas with very specific technologies. Our vision is to be at the forefront of healthcare change and focus on bringing in innovation to add patient value. Our portfolio is shifting significantly to focus on cell and gene therapy, immuno-oncology, mitochondrial biology, and all the new research and science have nothing to do with Covid. Through the pandemic, specific chronic life-threatening disease areas were focused on; good cancer care continued despite the challenges of entering care facilities. In products that make a difference to a person's life quality –not products in disease areas that threaten lives- we saw a significant decline quite early on in the pandemic that was restored over time. The focus remains on Covid, managing and vaccinating the population, and until we get to a point where there is equity of vaccine access across the globe, the challenge will remain. The investment going into managing the pandemic and vaccination is enormous and will potentially have a knock-on effect for governments and healthcare budgets moving forwards. In our space, there is a dichotomy of declining healthcare budgets because of the investment in Covid; significant healthcare reforms have been planned and delayed. Our renovative products coming into the market for the treatment of a relatively small number of people with high clinical unmet needs are products that come with a cost. As we go out of the backend of the pandemic, there is a real challenge to rethink and reengineer the way we work collectively (individual companies, industry and government) to bring innovative products to market. Even without Covid, the challenge exists. All countries are moving towards the UN sustainable developments goals; Saudi Arabia had their transformation plans which included massive healthcare reforms to be implemented by 2030, and Egypt is transforming its national health insurance to a universal healthcare coverage also planned for 2030. South Africa wanted to do the same by 2026, but that date has been pushed back. The macro trends toward achieving sustainable development goals have been there with or without Covid, and the improvement of access to healthcare will come at an additional cost. Innovative companies looking at high-cost, low-volume products will be challenged and will have to work with the government, payers and patients to provide value treatments.
EF: Are governments more aware of the value of innovation, and could they allocate healthcare budgets to innovative technologies shortly?
BM: I am not necessarily sure governments value innovation per se; they value a solution to a massive problem. The decision-making process around Covid and Covid vaccinations differ from chronic disease innovation or oncology innovation. There was a pressing acute need to find a solution to a pandemic, very different from planning for a person with pancreatic cancer, a relatively small group of patients with very high mortality. A new product for such treatment comes with a very big price tag attached, significantly changing decision-making dynamics. The innovation of vaccines, the new amazing technology and the speed at which it was done demonstrated what can be achieved when a variety of different stakeholders come together. But the real challenge will be coming together when the acute need isn't there.
EF: What is your personal definition of access?
BM: From a pharmaceutical company perspective, access is the ability to provide the right treatment to the right patient at the right time and the right price. Value is determined by the patient's healthcare outcome versus the cost to the patient or the healthcare system. We give access to a valuable resource, and it is vital we prescribe for them to understand the value of the products we bring to market. As the science becomes more and more complex, and as the treatments for the patients become more personalized, the business model moving forward will have to change to reflect that. Equally, we need to work with payers to move from a discussion around the cost to a debate on value for the healthcare system. Countries in Europe have very sophisticated ways of looking at value and calculating the value of products, whereas cost is a major factor in decision-making in emerging markets. We have to move away from the cost discussion to focus on value, something Saudi Arabia is trying to do at the moment and is furthest ahead in that discussion in the Middle East African region. South Africa is taking a significant step forward to discuss what value means to the patient and the healthcare system. All companies that want to introduce an innovative portfolio to South Africa face the same challenge of the unresolved issue of price and value. As we transition to a new strategy and focus on a new portfolio, we leave behind the old products for a different set of new technologies, but if we can't engage on health technology appraisals and agreements on value with governments or funders, we won't be able to launch that innovation.
EF: Based on the new focus, what is the relative importance of South Africa to the group and what opportunities do you see for South Africa?
BM: Astellas has shifted its corporate strategy; we have created new business divisions and now are working with Canada and Latam -we used to be in Europe, Africa and the Middle East region. That was split up and converted into established markets: Canada, Europe and Australia. We became part of a newly formed division of international markets, something many multinationals are already doing. We are now part of the Latam team with Middle East Africa and South East South Asia as part of the division of international markets. To achieve the corporate vision and strategy, international markets focuses on three things, i) the new pipeline of products, ii) focus on the geographies that will sustain those types of products, and iii) capabilities. I see a lot of opportunities for South Africa but also many challenges. The international markets division identified a handful of priority markets in terms of pharmaceutical size or top twenty globally; Brazil, Mexico, Turkey, Saudi Arabia, and South Korea have very large markets. We plan to invest significantly in those evolved markets to expand our footprint with a good opportunity to launch our new pipeline products successfully. Below that group, there is a range of countries with opportunities to launch some or all of the products, and South Africa falls in this category. We need to analyze product options carefully; we may have to pick and choose to launch commercially and look for other routes for patients to access other products. There are threats to us being able to do everything.
EF: Are there therapeutic areas with better possibilities for launching products?
BM: The South African government has identified oncology as an area of interest within their healthcare plans, but it competes with many other healthcare needs. The fact that oncology is in their healthcare transformation plan is a good thing as it means it is on the priority list, but it doesn't mean overnight resolution. Several challenges must be addressed before we can move forward; the mindset around innovation, and the economic challenges the country faces, make the agenda we would like to discuss not entirely coincide with the government's healthcare needs. The structural and process challenges within the South African market need to be addressed. The long regulatory timelines associated with registering a product is a challenge and lead multinationals to believe innovation is not well accepted in the country –something I don't believe to be true. But three to five years to register and approve a product is not appealing for companies with finite resources and is not good for competition at an industry level or for the company allocation of resources. The SEP pricing mechanism in South Africa is becoming an issue; the policy was created for a specific reason, for which it was very successful, but times change and the processes also need to change. Science and technology have moved on, the disease pattern has changed, demographics have changed, what was fit for purpose in previous years isn't today, and SEP makes it difficult for us to find creative solutions that work for all the stakeholders.
EF: How do you attract resources from headquarters to invest in the South African footprint?
BM: Ultimately, we are a business. We have obligations toward our shareholders who expect our managers to make the best decisions regarding the return of investments and value. The challenge for all affiliates of multinational companies is that managers must fight for those resources demonstrating they can create more value than another affiliate in the market.
EF: Astellas has a strong Japanese culture; what do you look for when building your team? Are there differences in operation and value between South Africa and the Middle East?
BM: I have worked for Astellas for fourteen years in a variety of countries and the culture has remained consistent wherever I have worked, whether it is in the UK, Europe, the Middle East or South Africa. The culture really attracted me to work in the organization and is one of the strong suits with its embedded value-driven ideals. I think we need to take more calculated risks. Our corporate strategic plan has now recognized this shift to include some organizational health goals geared toward engineering a slight change in the culture. We have included intelligent risk-taking because, in the past, we have been too conservative in our decisions for fear of failure, disregarding certain opportunities. Within South Africa, there is a very positive feel, there is a very close-knit group of very passionate people, and it's a great place to be in with the right mindset as they are enthusiastic, which is half the battle. I see room for improvement in the realm of how individuals look at the country. Since I arrived in South Africa two months ago, I have repeatedly heard the phrase "yes, but our country is different". I feel South Africa has been quite isolated; far from headquarters, originally from the UK and now from Dubai, the physical distance has created a mental distance. We need to open our eyes to what else is going on and what parallels we may find in markets that may not be identical but have similarities that we can learn from. It would be great for our people to get experience outside of South Africa and bring people into the country with different experiences. Sending people out is relatively easy but not bringing people in, mainly due to the South African employment laws. These restrictions limit our capacity to do business at the speed we would like.
EF: When you look back on this period in your professional career, how would you like your tenure to be remembered, considering you navigated a pandemic?
BM: Those of us who work in the pharmaceutical industry aim at making a difference. I would like to be remembered for making a difference in patients' lives and to the communities we serve, as somebody who helped the team navigate Covid, and as a leader who helped guide significant strategic change. Ultimately I want to be remembered for creating more value for patients and the healthcare system and more value for the community. I want to have made the Middle East and Africa markets a part of the newly formed International Markets division alongside LATAM and South East Asia. Understanding the value of innovation and addressing the economic challenges that new innovations create.
