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EF: What role do you want Pfizer to have in the MERA region, and how do you balance your priorities in these countries?
PV: We have classified the region into five primary clusters: Gulf Cluster, Egypt-Levant & Iraq (ELI), Russia/Belarus & CauCAR, North Africa and Sub-Saharan Africa (SSA). Within the Sub-Saharan Africa cluster, Kevin Francis serves as both the Cluster Lead and South Africa Country Manager. He oversees operations in South Africa as well as certain export countries from our office located there.
We have designated a West Africa Cluster Lead and an East Africa Cluster Lead who report to Kevin. We divided the regions based on comparable patient coverage to the best extent possible.
Across the entire region, we have approximately 2200 colleagues who are distributed among our commercial enterprise. Additionally, we have manufacturing facilities located in several countries within the region. Through our manufacturing partnerships, we conduct clinical research on the continent, encompassing a wide range of activities from manufacturing and a substantial distribution centre in the Gulf to commercial operations.
EF: How has the receptiveness of governments developed long-term partnerships, and how can we increase the value and foster these types of collaborations?
PV: Pfizer has been in business for 174 years. Our extensive experience and proven track record have been instrumental, especially during the pandemic, in swiftly developing and scaling up the manufacturing of the first mRNA vaccine. This accomplishment not only increased our visibility but also strengthened our relationships with important stakeholders such as healthcare practitioners, policymakers, patients, patient groups, and civil society members.
Throughout the pandemic, we actively collaborated with and supported various African countries. We recognize the continent's aspiration to enhance self-sufficiency in healthcare, particularly in the manufacturing of critical products.
It is noteworthy that before the pandemic, only one percent of Africa's total vaccine consumption was produced within the continent. However, our collective aim is to establish a framework wherein 60 percent of vaccines will be manufactured in Africa by 2040.
It is a significant ambition, but simply constructing brick-and-mortar facilities will not be sufficient to achieve it. There are several essential factors to consider. First and foremost, a reliable regulatory framework is necessary. SAHPRA has made commendable progress in South Africa in enhancing its capabilities, and they are striving to reach a WHO standard that would enable South Africa to export its products within the next two to three years. This achievement will be crucial for South African factories to effectively distribute their products across the rest of the continent.
Moreover, I believe that SAHPRA, along with other key regulatory authorities such as those in Egypt and Morocco, can play a pivotal role in establishing a unified framework for regulatory approvals through the African Medicines Agency. This framework would facilitate a mutual recognition process, eliminating the need for individual approval procedures in each of the 54 countries. Implementing a central approval mechanism would greatly simplify the process for multinational and local companies alike to introduce their products to the continent. Additionally, it would foster manufacturing activities within these countries.
Access to healthcare involves two essential components: a robust regulatory framework and affordable medicines. The regulatory aspect is crucial, but it is complemented by the presence of appropriate support mechanisms, which can take various forms. As a company, we strongly support the Unjani clinics and have directly funded eight of them. Additionally, we have provided equipment to 62 other clinics, and just last month, we pledged funding for nine more clinics to be established in the next year or so. Our commitment extends to primary healthcare and the training of physicians and clinicians through PHEF in South Africa. Furthermore, we actively engage in clinical research and have access to research facilities across the continent.
South Africa holds significant importance as one of our key markets for conducting clinical trials on the continent. For instance, during the development of the COVID vaccine, Pfizer conducted rapid clinical research in South Africa, alongside five other countries worldwide. This reflects the high calibre of hospitals, the robust healthcare framework, and the diverse population that makes South Africa an attractive location for such research. Presently, we have approximately twelve clinical trials running in South Africa at any given time.
Affordability is another crucial aspect that takes on various forms. In countries where products are reimbursed and private healthcare systems exist, we have implemented support programs to assist individuals who require them. Additionally, last year we introduced an initiative called "An Accord for a Healthier World," which was announced at Davos. In summary, it means that Pfizer is offering all its innovative and non-innovative products to low- and low-middle-income countries that graduated within the past ten years, as classified by World Bank status. These products are made available on a not-for-profit basis.
Access to the public healthcare system extends beyond the mere availability of a product. While it's possible to introduce a high-end oncology treatment to a country, its effectiveness would be compromised if the country lacks the necessary support mechanisms. For instance, if there are no provisions for breast cancer screening or if there is a shortage of advanced diagnostic capabilities, the product's value diminishes. In order to address these challenges, we are not only partnering with diagnostics firms, payers, and global funding providers but also working towards ensuring the smooth implementation of these programs in the respective countries.
Out of the approximately 50 countries eligible for our initiatives worldwide, around 30 are located in Africa. Our programs encompass both commercial and non-commercial aspects. While countries do bear the cost of the product, they do so at significantly reduced rates.
It's important to note that our efforts do not involve simply donating products. Instead, we are striving to facilitate patient access through various means. For instance, we collaborate with Doctor Tumi and SAHPRA on digital initiatives aimed at capturing the standards set by the World Health Organization (WHO) and exploring alternative mechanisms for improved accessibility.
EF: Which country in Africa do you think has the best potential to be the chairman of AMA?
PV: The African Medicines Agency (AMA) has chosen Rwanda as its base, a decision that holds great promise. In reality, one of the larger countries involved will likely provide the chairperson. Unfortunately, South Africa has not yet signed or ratified the AMA, and countries must ratify the AMA in order to attract greater investment from pharmaceutical companies in the region. One of the larger anchor countries that signed on will likely provide the chair for the AMA.
Rwanda has made impressive advancements, boasting a WHO Level 4 qualification despite being a relatively small country. With Rwanda already securing its location, one of the larger countries on the continent will probably step forward to provide the chairperson. We must secure the commitment of all countries involved; the benefits should not be limited to a small country alone. Large countries need to contribute in order to encourage participation from other major nations. This is a matter of politics and requires engagement throughout the entire value chain. Presently, many Chinese and Indian companies are showing interest in establishing a presence in Africa. However, there is a duplication of efforts as numerous countries strive to manufacture the same set of four or five vaccines. These countries aim to become the primary suppliers for the continent.
To address this, fostering partnerships becomes vital, as no single entity can accomplish everything independently. It is imperative to reach a clear agreement across the continent and establish a comprehensive framework. This is precisely what the Partnership for Africa Vaccine Manufacturing (PAVM), an initiative led by Africa CDC, aims to achieve. It brings together the European Medicines Agency, Asian authorities, manufacturers, and other stakeholders to create a framework that considers not only immediate manufacturing needs but also the long-term supply of raw materials and other essential components during future pandemics.
A broader and more holistic approach is necessary. This realization has become increasingly apparent to me during my time here in the past few years. Africa's challenges cannot be resolved through isolated solutions; a comprehensive strategy is required to ensure its success.
EF: Do you think that Africa sees the value of bringing innovation into their countries? Do they see this as a priority?
PV: These countries have a rightful need for access to the same level of innovation as the rest of the world. Take sickle cell disease, for example, which is a rare condition. Pfizer has made a significant investment in this area, and the first product resulting from that collaboration is now entering the market. Interestingly, ninety percent of sickle cell disease patients worldwide reside in just three countries, and two of those, Nigeria, and the DRC, are in sub-Saharan Africa. Nigeria, in particular, has the largest population of sickle cell disease patients globally. The innovation that can be achieved there would directly benefit sub-Saharan Africa. Innovation should not solely focus on high-priced products; it should encompass the development of suitable solutions that benefit broader populations.
When discussing products in the field of oncology and our commitment to a healthier world, it is worth noting that Rwanda was the first country to sign a contract and receive these products. Rwanda is known for its remarkable innovation and proactive approach to healthcare for its population. Interestingly, they also desire access to these products in the areas of inflammation and oncology. However, it is crucial to establish the right access plan to ensure affordability for these countries. Basic anti-infectives still pose a challenge for many of them when it comes to supplying their population with necessary medications.
To enable these countries to access innovation, the implementation of appropriate access programs and funding mechanisms is essential. Many countries still require foundational support to establish the necessary infrastructure.
EF: From a Pfizer perspective, how is the healthcare sector making the continent more productive, and what is the role of healthcare in developing the economy?
PV: Without proper healthcare, there is no healthy economy. You need the fundamentals of healthcare: good hospitals, good physicians, good pharmacists, and clean and proper infrastructure. It is crucial to ensure that the country is not plagued by diverted or counterfeit medical products, as this remains a significant challenge across the African continent.
Access to good and affordable healthcare for the entire population is of utmost importance, and governments acknowledge this fact. However, implementing such healthcare systems can be challenging when a large portion of the population lives on extremely low incomes. In countries with low GDP, expensive treatments like cancer medications might not be prioritized when the nation is grappling with hunger and poverty. Therefore, it becomes the responsibility of various stakeholders to offer assistance in making these essential healthcare services accessible. This may involve alternative arrangements and agreements beyond the traditional commercial model. Moreover, as the market size expands to encompass 1.5 billion people, the allure of manufacturing and conducting clinical trials becomes increasingly attractive from a commercial perspective, particularly in relation to export opportunities.
Presently, we have established proprietary factories in North Africa and Saudi Arabia. Additionally, we have entered into a substantial agreement with the Biovac Institute in South Africa for vaccine manufacturing and. have invested over R855 million in Biovac in the form of infrastructure and skills development. However, it is imperative that each country establishes a comprehensive framework.
Frameworks for local manufacturing and regional manufacturing need to match the purchasing plans of governments and private players. If not, who is going to invest if there is no market for the product? Let's take Morocco as an example. In El Jadida, we have a factory that manufactures 70 percent of the volume we sell locally, and it also exports to other French and West African countries. I envision Biovac, a factory we’ve had since 1985, achieving the same level of success in other countries. To make this possible, it is crucial to strike a balance between the Ministries of Trade and Investment, which encourage investments, and the Ministry of Health, which needs to procure the product. The existence of this connection is paramount.
This is our objective, and it aligns with the intentions of government stakeholders. The separate ministries in the South African government share the desire to achieve this goal. However, the current legislation does not facilitate the desired outcome. These countries need to work on improving this aspect as they implement the AMA and as the Africa Centers for Disease Control and Prevention (Africa CDC) gains more influence. With the potential expansion of the Africa Medicine Supply Platform (AMSP), it is crucial to establish a well-connected ecosystem that can effectively attract investments from our company and others. The potential for this exists.
South Africa demonstrates leadership in certain areas of the ecosystem. For instance, when it comes to private healthcare, companies like the Discovery Group have played a significant role. Their data was even utilized by the White House, providing valuable insights into COVID-19. Africa has talent, expertise, and a skill set within its boundaries. However, government frameworks must be aligned with the existing capabilities and resources.
EF: We believe including the young generation in the healthcare industry and upscaling them to be able to contribute to their country's development is very important. In addition to the YES program, what other initiatives has Pfizer been working on to upscale the younger generation?
PV: We pride ourselves on maintaining a highly diverse workforce. Currently, we have 200 employees in South Africa and 50 in sub-Saharan Africa. Over 70 percent of our workforce consists of black employees, with over 60 percent being women. In Pfizer South Africa, 145 employees are female while only 50 are male. This diversity extends to our leadership team as well, where out of the 16 executive leaders, 12 are female. It is evident that our workforce is both diverse and inclusive.
Moreover, our commitment to diversity takes on another dimension. We were the pioneers in establishing a disability program for young interns, aimed at providing disabled African youth with opportunities to develop their careers. This program specifically caters to blind and audibly impaired individuals. Through active recruitment, we have sought out young, exceptional talent for the country.
We invested a substantial amount of 850 million Rand in BIOVAC, with a significant portion allocated to workforce training, supplier training, and ecosystem development in the Southern Cape region. Apart from infrastructure construction, a major focus of our investment was on education. We have made significant contributions to the education of numerous young individuals in the province. These talented individuals, fresh out of university, play a vital role in our industry.
In South Africa alone, we currently have over 12 ongoing clinical trials at any given time. By collaborating with university hospitals, we can work alongside young talent in the field of research and development, contributing to their education. Considering Africa's population growth, it is poised to become a global hub for youth expansion. Consequently, our major education investments are directed towards the youth in Africa, ensuring our continued involvement in shaping the region's future. While we may be the only players in this arena, we acknowledge that other companies are also pursuing similar initiatives.
EF: How would you want to be remembered as a leader?
PV: When I think about a legacy that I want to leave behind in the region, the first thing that comes to mind is the sustainability of the business. Historically, this industry has been characterized by volatile ups and downs, with little middle ground. Over the past few years, our focus has been on establishing a sustainable growth model, and I'm pleased to say that we have achieved this objective. The trend that you now see for Pfizer is a very sustainable growth model.
Secondly, from an external engagement perspective, we have the strongest voice when it comes to pharmaceutical healthcare in the region. We gauge our success by the percentage of the market share we acquire, and we actively educate our staff to ensure they engage effectively with key stakeholders in the government, media, and various other sectors. Rather than shying away from challenging topics, we encourage our employees to address them head-on. I've had numerous discussions with governments regarding intellectual property, including productive dialogues with President Ramaphosa, who played a pivotal role in the TRIPS waiver in South Africa. Our people must be there, be visible, and drive the discussion.
Thirdly, I want to be remembered as a developer of talent in the region. Take Egypt, for instance, where there has been a remarkable shift in demographics. The workforce, once predominantly made up of individuals from Generation X and older, now consists of 90 percent of Generation Z and millennials. We have successfully transformed it into a more youthful model. Similar progress has been made in South Africa. Upon assuming leadership, the female representation stood at 42 percent, whereas today, across the entire region, including Russia, we proudly boast a 61 percent female workforce. Excluding Russia, the figure stands at 53 percent. However, it's worth noting that the overall numbers are influenced by the substantial size of the Russian workforce. This signifies a sizable increase in female talent from the low 40s to the low 50s within our organization.
Now, our focus lies in developing programs that enable these individuals to enhance their skills and advance rapidly, ensuring that our leadership is truly representative of this diverse population. That is what we are working on. Those are the three things: sustainability of the business, best external relationships, and development of talent.