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EF: 2020 was the year of diagnostics, 2021 the year of vaccines, what do you think 2022 will be the year of?

ZB: What we have seen over the past couple of years, especially in relation to COVID-19, is that things change and move very quickly. 2022 will be a year where the need for broad-scale vaccinations will continue to resonate within the public discourse. We have seen historically that vaccinations are sustainable and impactful healthcare interventions in situations such as this.  

Going forward, approved COVID-19 treatments are going to be part of the discourse as COVID is here to stay. Testing and treating are going to become part of our way of life.

EF: Could you elaborate on returning the importance to NCDs within the context of misdiagnosis?

ZB: This is of critical importance as it is a well-known fact that many other healthcare areas such as cancer programs, and HIV treatment rollout programs, were put on the backseat due to the importance of COVID-19 and the impact that it has had. From our perspective, it is important that we get back to that. We have seen that our healthcare systems can be resilient, and we are now bouncing back on HIV programs whilst hoping to see the same impact on cancer prevention and treatment programs. We are continuing to have those conversations with regulators, and the ministry of health, because we do not want to avoid one problem whilst creating a much bigger problem on the other end.

If you think about the impact that things such as cancer screening and awareness have years down the line you may be dealing with a bigger issue that one wants to avert, and we are not just talking about cancer treatment, but cancer prevention. It is similar for vaccinations. We saw in the early stages of COVID-19 that childhood and adolescent vaccination programs were impacted. The focus now is on ensuring that those critical health programs get back on their feet, and that the institutions that deliver those healthcare services are supported as much as possible.

EF: Is South Africa ready for the new wave that is approaching?  

ZB: We do not know what the impact of the wave will be. We have had different waves all of which have had different impacts on our communities, people and families, but also on our healthcare system. Generally speaking, our healthcare system has grown to be quite resilient, in the previous wave we did not see a large-scale disruption of healthcare services as we saw in the first two.  

There is still room to improve regarding the robustness of the system, and that is why it is important that our strategy around dealing with COVID-19 is diversified by continuing to emphasize the importance of vaccinations and diversifying while availing one of the two treatment options that are available to people. This provides a sense of comfort and certainty that we are able to overcome future waves. We do have a wave that has been forecasted for May and we need to be vigilant around what we do between now and then, and be prepared to move with speed should urgent interventions be required.

EF: Going into the future, how can we leverage the experiences of the past couple of years?

ZB: Flexibility is key. As a leader, the past two years have shown me that as organizations and as human beings, we can be much more flexible than we previously thought with the expectations of our employees regarding face-to-face meetings and flexible with how we engage with our customers.

We have been able to broaden our reach during this period of COVID-19 whilst having people working from home for protracted periods of time. And this is important for us because a lot of what we do is disseminate critical healthcare information, and provide a lot of healthcare worker education and training. The more people we engage, the better it is for patients.  

We have also learnt that partnerships are critically important. We partnered with AMREF around the creation of a pandemic response program which was put together to share experiences and learnings around healthcare workers, as well as displaying how healthcare systems can be more resilient and robust when dealing with pandemics.

The other big thing for us is leading with empathy. When dealing with patients and healthcare workers, our employees' empathy has probably been the one thing that has kept it all together. It could have gone bad but for these organizations to still be standing and still servicing their missions, we really had to dial up the empathy across the board.

EF: What do you think are the biggest contributing factors to the company's growth in South Africa?  

ZB: MSD’s guiding principle is that we innovate for lives by creating sciences that deal with healthcare challenges in spaces that not many organizations invest in. Many of these are therapeutic areas that resonate with challenges that exist on this continent. We have spoken about our investment in vaccines and in oncology, but we also have HIV programs that we participate in as well as our antiviral portfolio, which is underpinned by our COVID-19 therapeutic.  

When you look at all these therapeutic areas, you can see the huge impact we can have on the continent; it becomes incredibly important that these innovations that we create find themselves with the patients that need them. We spend quite a lot of time working on access and access driving solutions.

We also continue to work with both patient organizations, industry associations, and governments to create conducive legislative environments for alternative access programs or alternative reimbursement mechanisms which South Africa currently does not have. We have gone past the process now where we view each other as competitors and have realized that we actually all want greater access to healthcare products and innovative products.

We spend quite a lot of time focusing on policy and shaping the legislative landscape with the hope that as we move into NHI and universal healthcare, we will move into that with a framework that would result in broadening healthcare access. For us, it is a market that we simply cannot fail in because our innovations are for the people on this continent and if they do not gain access to them, then we wouldn't have done our job.  

EF: Could you elaborate on MSD's commitment to the fight against cancer and NCDs?

ZB: There are two themes that we tend to talk about regarding cancer care, cancer prevention and treatment. Cancer prevention is primarily through our HPV vaccine. Over a third of all cancer deaths or cervical cancer deaths globally occur in Sub-Saharan Africa, although the region hosts 14% of the world's female population, which really shows you the importance of cancer prevention, and we've got a real solution in our HPV vaccination. We have a solid partnership where we support countries across the continent with HPV vaccination programs. The impact we foresee is that obviously later on in life, we would like to see cervical cancer statistics drastically reduced. For me, it gives me great hope that many governments across the continent are wanting to roll out these cancer prevention programs by availing large-scale vaccinations in schools.

The second pillar is around the treatment. We have spoken about our treatment, and we continue to work at availing and broadening access. Our previous CEO said there were two things we must ask ourselves as employees at MSD. 1) how many people are you helping. 2) how much help are you giving those people. Once you maximize on those two things, the commercial aspect of the business will take care of itself. And for us, that is exactly what we are doing. It would not give us any joy to innovate and create all this cutting-edge science for it would not help or be used by people. It is about maximizing the amount of help that we are giving people and with those two things, our contribution to the cancer space will certainly make a lasting impact on the globe.

EF: Could you elaborate more on your education initiative programs?

ZB: We have a partnership with AMREF, which is a continental, pandemic preparedness response program based on engaging healthcare practitioners and providing skills and learnings for multiple countries on how to ready themselves as well as the health system to deal with pandemics.

The other one is what innovative pharmaceutical companies do on a daily basis. The largest share of our promotional budgets on educating and building awareness among healthcare practitioners is actually brand agnostic, where you teach people particular therapeutic areas and interventions that stretch far beyond just your product.

Historically our blinder was that everything had to be face to face, but the COVID-19 pandemic pivoted digital engagement and allowed us to stretch much further in terms of our reach. Now it is very common for us to be hosting upward of a thousand healthcare practitioners on a weekday on a 2-hour-long webinar sharing valuable information around a particular therapeutic area. That is the real benefit organizations such as ourselves bring to the healthcare landscape, not only bringing these therapeutics to the market but partnering these therapeutics with upscaling and bringing knowledge to the users of these products.

The next area that we are going into from an education and awareness perspective is around the patients. COVID-19 has shown us that virtual engagements are highly beneficial, but there are potential consequences such as misinformation. We are leveraging these platforms to circulate trustworthy information that allows patients and people to make requisite decisions based on their healthcare and know who to inquire about healthcare. That is a growing aspect which is going to be important as we move forward.

EF: How do you keep your employees engaged with remote work?

ZB: The first thing is trust. We need to lead with empathy and trust that our employees have grown and learned how to manage their lives within the new working environment. I have engaged with many employees over the past couple of months and we are cognizant of the fact that people's lives have changed in the two years, and as a result, how we do business and interact with them as an organization also has to change. We have given them a large amount of trust when offering this hybrid working environment. We believe that if you allow people who are committed to the overall task and purpose of the organization to manage their time, they will perform.  

The other important thing that we have done is to stay in touch. Although we work virtually, I found that I was engaging a lot more with individual employees, much more than I did on a face-to-face basis, and our engagement scores actually increased during this period. We have gotten away from talking about work-life balance to work-life integration and just trying to make sure we emphasize that it is okay to be offline and be with your family. You do not have to send an email at 10 p.m., just integrate your life in a way that works for you and in a way that is conducive to the team members that you work with.  

EF: When you are hiring new employees, what are the new skill sets you look for?

ZB: There are the technical skills, depending on what position we are hiring for, and there are also skills such as the ability and the willingness to collaborate and utilize digital solutions, and these are critically important. A collaborative nature is a skill we look for as we are constantly working in a resource-constrained environment and we have found that setting up cross-functional teams that may not have previously worked together within the organization has been immensely important for us.  

We also have the generational mix. For the first time, we have three different generations in the workforce which help create a diversity of ideas and ways of doing things.

EF: As the newly appointed president of IPASA, what was the mission you set for yourself?

ZB: My mission is the same one that has kept me in pharmaceuticals for many years and focuses on ensuring increased access to innovation on this continent. It has always been a bone of contention that those who need these innovations often struggle to access them. There are many challenges related to innovation; logistical challenges, manufacturing capacity, distribution channels, and legislative gaps across the continent. There are challenges associated with the fragmented nature of our government's procurement and engagement process. As an African citizen, these issues are close to my heart, and I am motivated by finding solutions. IPASA is an important tool for achieving change.

EF: What are your expectations, and how do you see the situation evolving?

ZB: My primary expectation is to bring the innovative pharmaceutical industry in South Africa closer to its stakeholders. The overarching stakeholder is the patient, and we are doing a lot of work with patient advocacy organizations to broaden and improve access to innovation, particularly in oncology. We are working to bring the association closer to government stakeholders. The importance of the government is that they create an enabling legislative framework for business because, in constructive engagement, we are close together. I recently spoke with the minister on a very challenging subject, and we had a highly progressive discussion. IPASA must not be quiet on industry-impacting matters and, with its voice, shake the landscape within which we operate. Fortunately, all the IPASA members have the patients' well-being at heart. We owe it to the patient to ensure that South Africa is an environment where innovation is welcomed and has an enabling healthcare landscape. The second important aspect is that South Africa impacts the rest of the continent. I have lived in Nairobi, Kenya, and Dar ee-Salaam, Tanzania, and I have seen firsthand the impact of limited access to healthcare. Part of my responsibility is ensuring South Africa works well, allowing the rest of the continent to advance.

EF: Next year, it will be IPASAs 10th anniversary; how do you plan to celebrate that milestone?

ZB: We must have some big wins this year, which would set us up for success next year. We are zoned in on the strategic aspects of bringing health systems improvements, especially through our partnership with SAHPRA, to ensure South Africa has a legislative landscape favourable for innovative manufacturers. We must ensure patients have access to innovative medication, particularly in oncology. These are the focal areas; hopefully, by the fourth quarter, we aim for there to be cause for celebration.

EF: Most companies appear open to collaboration, both in the private sector and between the public and private sectors. Is this something you are encouraging among your members?

ZB: Collaborations and partnerships are critical. I was in Washington D.C. and had several engagements with critical stakeholders in the US. I had those meetings under the banner of deputy chair of the US & South Africa Business Council. I met with the Trade and Development Agency specifically to get insights and feedback around the developing partnership they have with SAHPRA, contributing positively to health system strengthening. SAHPRA would improve the efficiency and knowledge levels of its reviewers and leadership and strengthen our ability to implement the reliance model, speeding up the ability for innovation to access the market and improve digitization. SAHPRA will be modelled on the best healthcare regulators that exist in the world. It was crucial to meet with the Trade and Development Agency to discuss and learn about the contributions they can make toward health system strengthening, particularly in the oncology space. They have identified opportunities where they can contribute and directly benefit the patient. We must continue to work hard to build an active business case. Partnerships are critically important, and we will continue to drive them.

EF: Is there any final message you would like to share?

ZB: IPASA is focused on ensuring that all our work as an industry association ultimately benefits the patient. South Africa continues to become a core focal market of many member associations. There are challenges, but it is important to note the contribution of some of our members in broadening and availing access to innovations long before the waiver discussions came into place. Decisions still need to be made in certain areas, but J&J has already localized some form of partnership with Aspen and Pfizer has an alliance with Biovac. mRNA is manufactured in Cape Town through investment from the business community, and therapeutics are available on voluntary license to multiple manufacturers across the globe. All of these speak to where the innovative healthcare industry is in broadening access. The industry has shown through its actions that we are willing and able to collaborate, and I hope it allows for a stronger engagement and collaboration with the government.

April 2022
South Africa