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EF: You have seen healthcare change substantially in the three years you have been GM for Sanofi. What is the state of the South African healthcare system? What are your hopes for the future?
TCL: One of the main challenges in South Africa is the way the healthcare system is structured. The private sector caters to 8 to 9 million people, while the public sector provides for the rest of the 47 million people. It is similar to the system in the United States, where the more one pays, the more one can access innovation and technology. On the other hand, the public sector focuses on the disease burden of the country where most of its resources are consumed by tackling HIV, TB, and mental health. However, while the public sector is tackling infectious diseases, non-communicable diseases, like cancer and diabetes, are growing fast. Three (3) years ago, diabetes was the 5th leading cause of death. Today, diabetes is the second.
The gap between private and public equity is enormous. 15% of the private sector population uses half of the resources while the remaining half is spent on the 85% in the public sector. Hopefully, the National Health Insurance (NHI) will improve this since addressing this inequality is a critical issue for the government. Although there are many questions when it comes to the NHI implementation, Sanofi’s position is very clear: we support the NHI because one of its objectives is to improve healthcare standards. We are hoping the system will enable access to innovative therapies that can significantly improve patients’ lives.
EF: How does Sanofi’s portfolio cater to the South African disease map?
TCL: We have a diverse product portfolio that seeks to address South Africa’s healthcare needs in key therapeutic areas, particularly Diabetes, Mental Health, Tuberculosis, Rare Diseases, and Vaccines. In the area of communicable diseases like TB, which is predominantly managed by the government, we are a vital partner in the supply of essential medicines treating these diseases. There’s an explosion of non-communicable diseases, and Sanofi is well-positioned to play a meaningful role in combating these emerging diseases.
EF: What is Sanofi’s focus in terms of public-private distribution?
TCL: Our operation is geared towards working with the public sector. For years, we have been focusing on affordability, a key factor when working with the public sector. However, for the new innovative therapies, affordability becomes a challenge; this will be a key consideration during the National Health Insurance (NHI) transition. We have a local manufacturing facility that addresses a major public health need, i.e., TB, so that we can respond quickly to the demands of the country.
EF: Are there any alternative reimbursement models or investments that you are considering? What do you envision as a possible alternative model?
TCL: Officially, alternative reimbursement models (ARMs) are not feasible as legislation doesn’t allow for them. We are currently working with payers, authorities, and the industry to come up with a proposal for the government to enable an ARM. Some key principles for a successful ARM are an improvement in patient access, confinement to specific diseases and products, and compliance with SEP regulations.
EF: What products in the pipeline are you currently excited about?
TCL: We have a sizeable innovative portfolio currently in the South African Health Products Regulatory Authority (SAHPRA) awaiting approval. These include new treatments for rare diseases, immunology, and oncology. As researchers, we are passionate about scientific excellence because what we do today may improve the lives of people tomorrow.
EF: What is your personal definition of access?
TCL: For me, there are three (3) pillars of access: equity, efficiency, and education. There is a need for equity, meaning patient access that is not constrained by the ability to pay. However, for new treatment solutions, we need to consider alternative models to create patient access. Secondly, an efficient healthcare system is one where access is not constrained due to resource limitations and one where an overly complex health system does not impede the quality of service. Lastly, education is key for both the healthcare professionals and patients because it empowers both to make informed decisions with the potential for better outcomes. Furthermore, for the ecosystem to work, we need to be innovative with how we approach reimbursement and funding for newer molecules, as this will enhance access to more patients.
EF: We are now in the technological era. How can technology enable efficiencies in the system?
TCL: The government is very open to using technology, and they rely greatly on the private sector to bring them new ideas. Their willingness to collaborate with Sanofi is very promising and it shows an openness to partner with the private sector in bringing innovation. In 2018, Sanofi introduced Vula Mobile to the National Department of Health (NDOH), and it was readily accepted and implemented in all provinces. Vula Mobile is a medical referral app that makes it easy for GPs & primary healthcare workers to refer patients and get advice from specialists and is the brainchild of Dr. William Mapham who conceived the idea for the app while working at the Vula Amehlo Eye Clinic in rural Swaziland. He experienced first-hand the difficulties faced by rural health workers when they needed specialist advice. This app aims to give health workers, particularly those in remote rural areas, a tool to provide patients with quick and efficient specialist care. Interestingly enough, the demand for specialist services has been reduced because HCPs at lower levels can manage patients without the need for upward referrals.
EF: What sort of impact would you like to achieve in your South African tenure?
TCL: Whatever I do must have an impact on healthcare and the patients not only through the supplying of medicines, but through supporting the healthcare system. I’m striving for a positive effect by empowering medical officers with education, by helping the government improve efficiencies for the benefit of the patient, and by investing in innovative ways to reach and service the patient irrespective of their geographies. In addition to this, following Sanofi’s legacy of forming partnerships, my ambition is to strengthen this partnership paradigm to have an even more significant impact on patients and their quality of life. The launch of a new treatment option for latent TB is a prime example of a partnership with the government and various other stakeholders. Patients will now have access to an innovative treatment solution, which shortens a 12-month treatment to 3 months. This medicine will be a game-changer for latent TB as it is a simplified regime that will make it easier for the HCPs and patients to manage their treatment.
EF: The pharmaceutical industry has always been very good at managing their triple bottom line (people, planet, profit). What would be your advice to other sectors of the economy on managing a triple bottom line?
TCL: It is a question of vision, values, and ethics. Those of us who work in the pharmaceutical industry serve patients. Our employees are all scientifically driven. Regardless of their function in the organization, they are all passionate about changing patients’ lives, and we make a significant impact on the lives of the patients. Their reality speaks and empowers patients to manage their disease and make a difference.
EF: What final message would you like to share?
TCL: We take pride in what we do, and we will continue to work in collaboration with payers and the government. The pharmaceutical industry has an important role to play in the healthcare equation, and we believe we must be part of it. We must be at the table of discussions to bring an impact so that we are where we are needed for healthcare, for the patient, and society.
