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EF: How can we keep health at the top of the agenda in the different African countries, especially this year, when there are several African elections?
DA: Centricity towards patient care does not change regardless of whether it is a year of elections or not. This is an important element in the health agenda, and we remain focused irrespective of what is happening in the political arena. It is key to bring the discussion of NCDs with the respective Ministry of Health (MoH) and National Department of Health (NDoH) and the importance of Private Public Partnerships to raise the prevention agenda.
We are pushing the boundaries of science to help solve some of the world’s biggest public health challenges, including the rising burden of disease and health inequities in the context of the climate crisis. Africa is key in this accelerated transition to a more sustainable and equitable future. What keeps us focused and motivated is one of our core values of “Putting Patient First” developing an ecosystem to accelerate patient centricity and bring innovation in terms of access to information, digital reach, AI-based platforms for early diagnosis, and also innovative medicines as well as broadening access to our portfolio. Moving from treatment to prevention as an agenda, with a push on early screening at public health centers and capacity and capability building of the primary care physicians, will help prevent complications and hospitalization.
EF: Could you elaborate on your priorities for 2024?
DA: Our focus revolves around initiatives to improve climate, health, and society. This includes everything that we do for our employees. At the beginning of 2024, we learned that we maintained our Top Employer status in Kenya and South Africa for the fourth consecutive year. We were also awarded the Top Employer certification in Nigeria with our first submission. Finally, I am happy to share that French-speaking African countries, Ivory Coast, Cameroon, and Senegal, also certified AstraZeneca as one of the Best Places to Work in 2024.
Our significant focus revolves around people and sustainability, as they form the cornerstone of our operations. This year, we have streamlined our strategic priorities into 3 pillars, the first being people and sustainability—fundamental to our foundation. Secondly, we emphasize accelerating innovation and fostering partnerships, recognizing that collaboration and innovation are essential for progress. While our efforts can only take us so far, partnerships and innovative approaches are key to expanding our horizons. Lastly, regardless of our endeavors across all functions, bringing collaboration and Execution Excellence is a key priority. We are committed to scrutinizing our performance and have set an ambitious target of double-digit growth for the year 2024, which is still very much attainable as the fastest-growing pharmaceutical company in prioritized markets. Everything we do is covered in the strategic pillars of Execution Excellence, accelerating innovation and partnerships, and, most importantly, people and sustainability.
Amidst the evolving landscape in Africa, we are expanding strategically, prioritizing sustainability and equal returns on investment. Our expansion efforts are targeted towards regions where sustainability is achievable. Excellence in execution in every aspect of our operation is non-negotiable. Adherence to ethical standards and compliance with AstraZeneca’s code of conduct are paramount to ensuring our performance remains exemplary.
EF: AstraZeneca is always leading by example and fostering collaborations. What initiatives can raise awareness of the importance of Non-communicable diseases in a region that is mostly focused on communicable diseases?
DA: Since our last conversation, we have taken proactive steps towards sustainability by initiating a Sustainability Summit, held in November in partnership with the Swedish Embassy and collaboration with the National Department of Health. This summit was a landmark event for us. We brought together key stakeholders, including the Ministry of Health representatives, innovative partners like Medsol, and forward-thinking organizations. We engaged with future-oriented entities in South Africa to bolster our efforts. Partners and organizations like UNICEF, with whom we collaborate closely on youth health programs, were also pivotal. The primary objective of the summit was to raise awareness and advocacy for non-communicable diseases (NCDs). We recognize that our African continent has a high burden of communicable diseases such as HIV, tuberculosis, and malaria and we need to focus on prevention. However, we are also sitting on a volcano of NCDs as increasing incidences of cancer, diabetes, Chronic Kidney Disease (CKD) & asthma are unfortunately growing at a high pace. We must broaden our scope to encompass NCDs to address critical health challenges and work toward sustainable solutions.
I am happy to share that one of the steps taken toward that goal was to strengthen the Healthy Heart Africa (HHA) initiative; AstraZeneca, the Ministry of Health, Ghana Health Services, and the Programme for Appropriate Technology in Health (PATH) have strategically collaborated in an agreement announcing the expansion of the HHA program aiming to address the growing burden of Chronic Kidney Disease (CKD). Chronic kidney disease, or CKD, has emerged as a significant public health concern in Africa, affecting individuals of all ages and socioeconomic backgrounds. According to the BMC Health Services Journal, the prevalence of CKD in Africa and sub-Saharan Africa is 15.8% and 13.9%, respectively.
The background to the extension of HHA to HHA2.0 with CKD screening comes from the rising incidence of CKD. From a capacity perspective, we have very few dialysis centers, and the procedure is very expensive. CKD also has a high mortality rate. As CKD is usually silent until the advanced stages, more than 70% of people with this disease are unaware of its presence, and it is identified in its later stages when opportunities to prevent adverse outcomes are limited. This creates a huge burden of disease and a lot of costs in managing these patients where we do not have good dialysis centers. And when we do have dialysis centers, we cannot cope with the number of patients who require regular dialysis sessions. The dialysis centers across Africa are currently working 24/7. There is a high burden of disease and investment is needed for these centers.
CKD is just one example of an NCD. We can see similar patterns in cancer and all its variations. Breast cancer is a major concern as the numbers are doubling. We are also witnessing cancers that are not common in Africa. For example, there has been a 100% increase in lung cancer rates. We are detecting this cancer quite late in stages, which is alarming. The issues around late screening, late diagnosis, late treatment, and high morbidity are pushing our sustainability agenda to enable us to tackle them.
Cancer Care Africa (CCA) represents our commitment to co-creating a stronger cancer care ecosystem in Africa, together with external partners, to enhance access to diagnostics and innovative cancer treatments. Launched in November 2022 at COP27 in Egypt, CCA aids countries in their fight against cancer by focusing on four pillars of impact: building capacity and capabilities, enhancing screening and diagnostics, focusing on patient empowerment, and enabling access to medicines.
EF: Could you elaborate on recent initiatives that you are pursuing in Africa, and what are their objectives?
DA: Healthy Heart Africa 2.0 is an initiative that raises awareness of the importance and benefits of early screening. We will close the loop for the patient who has been screened and provide them with a treatment regime. Since launching in Kenya in 2014, and subsequently expanding to Ethiopia, Tanzania, Zanzibar, Ghana, Uganda, Côte d’Ivoire, Senegal, Rwanda, and Nigeria, HHA has conducted over 47.9 million blood pressure screenings in the community and healthcare facilities. Also, it has trained more than 11,300 healthcare workers, including doctors, nurses, community health volunteers, and pharmacists, to provide education and awareness, screening, and treatment services for hypertension; and activated more than 1,500 healthcare facilities in Africa to provide hypertension services and facilitate access to low-cost, high-quality branded antihypertensive medicines, where applicable.
Localization of diagnostics is an important lever to promote equitable access to diagnostics. To this effort, AstraZeneca supported the installation of an EGFR testing machine at Aga Khan University Hospital in Kenya, a real-time test for the qualitative detection of defined mutations of the epidermal growth factor receptor (EGFR) gene in non-small cell lung cancer (NSCLC) patients. Identifying these genetic alterations promptly empowers healthcare providers to make well-informed treatment decisions, tailored to the individual needs of each patient. Prior to this installation, patients in need of EGFR testing had to rely on laboratories in South Africa, India, and Egypt, leading to potential delays in receiving critical information for their treatment plans. The local availability of this advanced testing capability at Aga Khan University Hospital significantly reduces turnaround times, giving patients a better chance at successful outcomes.
Expansion with frugal innovation like Amoy Dx introduction in Nigeria, or working with innovative startup companies like Revna Diagnostics, will also support capacity building and early diagnosis under the CCA principles. Cross-border collaboration can help change how we detect and treat cancer. Learning from each other's experiences is better for patients and healthcare budgets. Cancer Care Africa is creating an educational bridge between healthcare professionals in Egypt and Kenya who work on lung and other cancers, with thousands of health workers benefitting from in-person and virtual peer-to-peer learning, which it is hoped can eventually be replicated across the continent.
EF: What strategies can be implemented to increase access to innovative medicines in Africa?
DA: The Cancer Care Africa program seeks to improve care across the continent for breast, prostate, and lung cancer. Its four pillars are Healthcare Capacity and Capability Building, Screening and Diagnostics, Patient Empowerment, and Access to Medicines. We strive to enhance the availability of critical cancer medicines by introducing flexible models that can provide access to our innovative treatments with our partners.
We are trying to build scalability and capacity to look into how to treat these patients early by getting screening done first, increasing awareness, and making sure they adhere to the treatment. All these efforts create awareness in those countries. We just launched a campaign called “Oncology for non-oncologists.” This was based on the fact that we have patients who are seen by family physicians and have the risk of cancer because of their genetic predisposition, heredity, lifestyle, and urbanization. The signs and symptoms are there, but they are not detected early because the physicians who are seeing them are not aware of the signs and symptoms. Our program gives physicians a basic module and training through oncologists who talk about breast cancer, lung cancer, prostate cancer, and any of the silent diseases in tumors that they are not able to catch. This initiative will also help create awareness, early screening, and reference to the oncology centers.
We performed our first hybrid meeting with 800 physicians across Ghana dialing in to access our initiative. Through their affiliation with the tertiary institutes, we managed to get them to start referring patients. Oncology for non-oncologies saw more than 80 new patients in seven days being referred to tertiary centers and this is just the beginning. This initiative is cost-effective and is helping us find ways to be more sustainable and build capacity and capability. Between the last time that we talked and now we have seen accelerated growth in our initiative and we have been moving around all the countries looking for partners to see how we can enroll them and scale them up to increase the screening, diagnosis, and treatment numbers into the millions.
EF: As a year goes by into your role, what are you most proud of?
DA: I am proud of our people's perspective. When we look at our different levels, we have started discussing diversity and inclusion. Whenever we seek to hire new talent, we focus on being diverse. We have been consistent on that and I am confident that we will continue on that path.
Secondly, by moving people internally, we have been building up some of the development centers and development opportunities like the “iCan” project, and giving them a stretch assignment so that they pick it up in their areas of interest. This will get them ready for any opportunity that can appear in the future. I am extremely proud of our good succession planning in middle management. This is what makes us one of the Best Places to Work and a Top Employer. Our internal employees are given equal opportunities.
Also, employees have a direct connection with the country president and can raise any questions, concerns, or ideas. We are fostering a speak-up culture, and there is still some work to do, but we are moving in the right direction.
Lastly, I am also proud of all the sustainable initiatives that we are exploring to bring those levels up to 100%. Our global leaders have their eyes on us and we want to be the example they point to when they discuss our Healthy Heart Africa project and Cancer Care Africa in terms of localizing diagnostics. Our talk at the Boao Forum in Shanghai, China, was the first t time that Africa was represented and showcased ideas and work well done in the continent on international collaboration to improve cancer care. Key opinion leaders at the meeting included MoH, NCI, and key oncologists from Kenya, Nigeria & Ghana. Also, it kicked off a collaboration with a scientific exchange in lung cancer between the Guangdong Provincial People's Hospital and 3 CoEs in Nigeria.
