Read the Conversation
Conversation highlights:
- Introducing Bert Maddens as the new General Manager for AbbVie Southern Africa.
- Bert's dual mission: accelerate patient access to innovation in the private market where spending is EU-comparable but adoption lags, and expand basic access for 45–50 million with little to no coverage, extending impact beyond South Africa into sub-Saharan Africa.
- Highlighting access gap: South Africa's population size matches Italy's, yet advanced therapies in immunology, oncology, and neurology reach only about a million people and are not consistently reimbursed, unlike broad access in Italy's system.
- Three-market strategy: Focus on meeting the unique needs of patients across all segments; those with private insurance, those relying on public healthcare, and those paying out-of-pocket, as each has distinct needs and levers for expanding access
- Prioritize elevating standards of care, given TNF therapies are now first-line and a global standard of care. By expanding access to these advanced treatments, we can help all patients achieve better health outcomes, receive effective, world-class care, and improve their health outcomes.
EF: How do you see the portfolio adapting to the region, and where are the biggest opportunities?
BM: Let me give a general overview of how we see the market. First, there is the private market for insured individuals. Second, there is the public or state market. And third, there is the out-of-pocket market, which is what you mentioned earlier.
Given our portfolio, we want to operate in all three markets because each has different needs and priorities. The company grew a lot with Adalimumab, but now it is time to make our treatments accessible to as many patients as possible. TNFs have become the standard of care worldwide, even used as first-line treatment in many places. The question now is how we can make these therapies available to the largest number of patients.
EF: What opportunities do you see for improving access in the country?
BM: Now is the best time for a pharmaceutical company to work closely with the Department and the Ministry of Health, as well as payers. We not only bring products; we also get valuable international experience. I grew up in European healthcare systems in Belgium, the Netherlands, and Italy. Each system works differently, but the basic principles are similar. When you look at the goal of creating a national health insurance, I believe the most valuable partnership we can offer is in health technology assessment. This is the foundation of a sustainable system because it helps measure the value of treatments and ensures the cost of care is managed responsibly. It is where government and industry can work together while still allowing room for innovation through a shared framework.
EF: What strategies do you use to bring accessible innovative treatments to Africa, and how do you advocate for this with headquarters?
BM: South Africa and the rest of Sub-Saharan Africa are very different. The starting point is always to look at what each country actually needs. South Africa still has high rates of tuberculosis and HIV, and you can already see cancer cases increasing and more immune-related diseases appearing. So, the country has new areas that its health system needs to develop. In many parts of Sub-Saharan Africa, you see something in between. HIV and other infectious diseases are still a priority, and vaccines are still essential. But some countries have moved past the earlier stages, and now cancer and immune diseases are major issues for them too. Yet the available treatments are often limited, and even when they exist, supply is unreliable. This means governments are not yet fully addressing all the healthcare needs of their populations.
When it comes to our strategy and how we explain it to headquarters, they do understand that Africa is important and that the region is at a turning point.
What matters most is identifying the true priorities of each country, whether that is based on health ministry goals or disease prevalence and incidence, and then matching our portfolio to those needs. Our older portfolio in anesthesia, neonatology, and HIV still serves a purpose, but those areas are now genericized. We can support through supply, but we cannot add significant scientific or strategic value there. In South Africa, opportunities to partner are stronger in newer areas, such as oncology, neurology, and immunology, where patients often have very few options.
EF: How do you explain that investing a dollar in South Africa and the region gives better value than investing elsewhere?
BM: When you truly want to follow your own principles, resources will come to cover the unmet needs. That kind of value is more important than the financial value. This is where you connect with people, help them grow, and actually build a long-term legacy. We focus on serving patients' needs. At the same time, we have talented employees here who deserve opportunities to grow. And when you look beyond South Africa, there is still a population of around one billion people in the region. Many of them have high mobile penetration and want access to modern healthcare solutions. They are asking for innovation. AbbVie does not expect me to behave in a traditional way; rather, it expects me to manage risks and opportunities. The focus here must be on the patient and handled differently from other regions.
EF: How are you building and upskilling local talent in Africa, and are you partnering with any associations?
BM: What I tell my team is that in the toughest markets, you often meet the strongest people. This market is not easy. There are many access challenges, and even when you do have access, it can be unpredictable, so you need to adjust quickly. Because of that, the quality of people you meet here is usually very high. I believe strongly in developing people, but mainly through real on-the-job experience. About seventy percent of learning comes from doing. I can send someone to a training course, but three weeks later, they will have forgotten most of it. When you work on something every day, you become skilled at it.
South Africa gives people a unique learning environment. Here, you can work in traditional pharma, meeting doctors, educating them, and building programs. You also have exposure to consumer marketing, which is something not all pharma markets offer. You deal with private insurers and the public sector, explaining the value of your products, discussing reimbursement decisions, and pricing. From a market access and health economics perspective, this is a great training ground.
Finance and supply operations are also challenging because the country is large and logistics can be complex. Supplying Cape Town is different from providing Johannesburg or handling shipments into neighboring countries, so you learn a lot. And then there is the cultural side, which influences performance. You need to set clear expectations for leadership, execution, and teamwork, while giving people the tools to stay connected and deliver results in the field.
EF: How can South Africa become a regional hub, and what long-term investments or infrastructure are needed to achieve this?
BM: There is a lot of potential, e.g., South Africa has its own regulatory authority, and I can say they review dossiers very thoroughly. They do an excellent job, recognizing that they must approve all medicines entering the country. This leads to long approval timelines. There needs to be commitment from the industry and from the regulatory system. I also believe that once the national health insurance system is fully in place, the whole discussion will change. You will move from small niche volumes, mixed with some out-of-pocket demand and some government tenders, to much larger volumes that can support better pricing aligned with value. That shift could attract significant investment.
EF: How do you build and balance organizational culture in South Africa, and what opportunities exist?
BM: I have worked in many countries around the world, and in every place, you can see the local culture show up. No matter where you go, you meet teams with strong backgrounds who are committed to their work every day. They stay humble at every level, and they are open and easy to approach. They share what went well and what did not. I see the same level of people here in South Africa. What feels different here is that people have a very strong appreciation for authenticity. On one side, you have diversity; on the other, authenticity. Together, they create a very strong collaboration. People here clearly want to work together and achieve things as a group. For me, that is an amazing base to start from. Imagine if people worked in silos, did not know each other, or did not want to collaborate. You would be starting at a disadvantage. Here, you start with a strong foundation.
What I want to bring culturally is the feeling that they can have an impact and see the results of their actions. I want people to end their day feeling satisfied. The market is not easy. When they meet doctors, those doctors struggle with reimbursement systems. When they meet patients, those patients struggle with access to products. When they work with public systems, there can be limits on treatments or gaps in patient education. It is a tough environment with many moving parts. So, the question becomes: which part is the most important right now, and how can you contribute and feel your own impact?
EF: At the end of your first year in the country, what achievements will you be celebrating?
BM: Having the chance to live in a country like South Africa feels like a blessing. But honestly, every country has something unique, and you do not learn that as a tourist. You only understand it by living there. I feel a lot of gratitude for being here and learning from the people around me. There is genuine interest in caring for one another. You can really feel it, and it is very strong here. That is probably what we will remember most as a family.
On the professional side, I am enjoying every day in my new role. What makes it special is the team's mindset and the shared understanding of what we can achieve together. That is a real gift. I have worked in places where it was not always easy to find that level of alignment. Here, the people are warm, committed, and highly skilled. Being able to work with them every day is something to be truly grateful for.
EF: Is there any key message or challenge you would like to share?
BM: Beyond just the usual investments, if you really want to make a difference, there are two ways to approach it. One is to take what you already have and just push it harder, try to get more out of it. The other is to open it up, see what's inside, make some changes, and then use it regularly. I think we are at the point of doing the second. Simply doing more of the same probably will not benefit anyone. Right now, the country is starting to "open the machine," looking at all the parts to understand what really needs to change. Openness and collaboration across industries are key because each industry sees only one piece of the puzzle. To improve the whole system, everyone needs to come together. The potential is there, but no one yet has the full picture.
