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EF: Why did you decide to join MSD South africa and Sub-saharan Africa and what was the mission you were given when appointed?
PA: As a physician with over 12 years of global health experience focusing on social upliftment and global women’s health, this was a perfect opportunity. I believe that health is an investment and a vehicle for value creation for a nation. Healthy girls and boys go to school, healthy women and men contribute to society, live longer and more productive lives and healthy people save financially. Investment in healthcare translates into unlocking economic growth. MSD is in the business of improving health so the role was an obvious choice for someone who is committed to the bright future of Africa.
MSD is Celebrating 60 years in South Africa and our footprint in South Africa is extremely strong: we have a manufacturing plant, our own dedicated regulatory department and our investment in local clinical trials has doubled in the last five years. We have life-saving and life-improving products for all ages and across the spectrum of diseases. We do the hardest form of innovation – its called invention. We have inventions that are important for the prevention of disease in the form of childhood vaccines protecting people from infectious diseases as well as specific cancers. We have products that address the double burden of disease on this continent – anti-infectives and antiretrovirals for the infectious diseases as well as drugs for chronic diseases like diabetes, hypertension, respiratory problems. We address maternal mortality through our MSD for Mothers initiative and contraceptives to help ensure that every child born is a wanted one. We have both human and animal health offerings. This amazingly diverse portfolio, combined with the possibility to make an impact, is what attracted me to the job.
Our mission is simple: Invent, Impact, Inspire – we are invested today for a healthy Africa tomorrow. We measure our success very simply using two metrics: How many people did we help? How much did we help them?
EF: What does access mean to you?
PA: I will use a company quote to share what access means to MSD “to bring the best of our medicine to each and every person: we cannot rest until we have figured out how to bring our finest achievements to everyone.” I would define access by how to get our products to people who most benefit from them. We like to think about patient access rather than market access. Patient access is a common goal and a shared mission with others in the healthcare ecosystem. We know we cannot do it alone. We need to sit around a table with others to enable patient access and talk about partnerships.
Internally, patient access leads to different conversations. If market access is the goal, the focus is on registration and reimbursement, but then what about ensuring the patient actually gets the product? If patient access is the goal, we need to think and act differently. In Africa that means we may need to partner to strengthen infrastructure, increase health literacy, with an increased focus on ensuring patients actually get the product they need and not just having the ‘potential’ to get it. For something like cancer where we are heavily invested, this means we cannot stop just when our lifesaving product gets reimbursed, we have to also ensure earlier diagnosis, reducing the time from diagnosis to treatment, supporting the healthcare system to provide holistic care for the patient and their family. We need to become a partner and not just a supplier. It’s a change in mindset and not an easy one for those that have been working in the industry for a long time.
An example of how we have partnered is in Senegal. In Senegal, the Ministry of Health noted that though they had plenty of contraceptives for the country, they were struggling to get these to the women and their partners that needed them. It was a weak supply chain problem. We brought in our internal experts, we worked in partnership with the government, the Gates Foundation, the local private sector and NGOs on a supply chain solution. The results were amazing. Not only did the stock outs of contraceptives reduce to less than 2% ensuring no woman left empty-handed, but the solution enabled female entrepreneurs to work as distributors so in turn supporting more families. This is just an example of how the golden triangle of Industry, government and civil society can work together to improve patient access.
EF: What do you want to achieve in the short term, in the next 4 years?
PA: It is all about investing today for a healthy Africa tomorrow. What does that mean? Firstly, we need to work with partners to get our inventions to more people in South Africa and in Africa more broadly. These are life-saving and life-improving products but they have no impact unless people use them. I am often caught saying ‘vaccines don’t work, vaccination does’. If you don’t get a vaccine, you are not protected. It is not good enough to just make the product available, we have to ensure it gets to those who need it.
Secondly, we want to support the acceleration of ‘One African market’. Right now patients don’t get access to lifesaving products due to some simple things like regulatory delays. The vision of having one African Medicines Agency, like the European Medicines Agency in Europe, is a great one. The question is how can industry support the realization of this vision. If we all focus on patient access being the goal, we should all partner to make this vision a reality so that patients don’t have to suffer.
Thirdly, (and really this comes first) its about people (again). We are committed to investing in the people and talent on the continent. South Africa is where the world’s first human heart transplant happened (where the patient regained consciousness). There is amazing talent here. We have some of the world’s best clinical researchers. This is why we are increasing our clinical trial footprint here. We are also invested in supporting the next generation of scientific and business leaders in the community. We are doing well as a business and that is because of our people. We have many employees that started off as learners or came in through graduate programs, They bring new ideas, they bring a diversity of experience. We want to do more to enable fresh ideas so that we can do more to invent, impact and inspire.
EF: There is a project management called the Iron Triangle with three variables: cheap fast and good, (time quality and price) but you can only choose two, cheap and fast sacrificing quality, fast and good but it will be expensive or cheap and good but it will take a long time. Which two variables would you choose for the health transformation in South Africa?
PA: Successful health transformation here requires a health policy environment that ensures none of these three are compromised. If you focus on the patient, you will see all three are critical. Quality can never be compromised because then you lose the trust of the people. For us at MSD, quality is non-negotiable. Then if your product is not affordable and does not get to the patient in time – then there is no impact. There are plenty of examples of where the right policy environment enables all three to exist. A simple example is the longer-term contract that allows for a high quality product to be available to patients in a country at an affordable price and earlier than usual, due to the contract affording the industry predictability, reliability and transparency – all three things of value to a company. That is a win-win. The same can be said of policies that ensure value-based pricing. These mechanisms allow for quality to be valued. These are just examples of how we can ensure no compromise on behalf of the patient.
EF: What are the trends that you see will have the biggest impact in our sector?
PA: I think the most obvious one is the impact of big data and digital. They are interlinked and have the potential to really transform health in a fundamental way. There has been a lot of focus on the power of digital transformation in the developed countries, but it is in this continent and countries like ours where digital can help us really leapfrog. Already in many African countries, a whole generation jumped from no internet to accessing internet on their phones – completely leapfrogging dial up on their desktops! This is where data and digital can enable a fundamental shift in how we seek and provide healthcare. Here is where digital and data could help a shift to prevention before treatment. Digital could really enable a huge leap in health literacy. Better use of big data could enable evidence-based policy and decision making. It’s a huge opportunity. There is a lot of digital innovation in South Africa and also on the continent, a lot of which is not being recognized or integrated at scale. In South Africa there is an opportunity with NHI to enable scale of many of these innovations for improved health. Its a very exciting time to be in this sector. I (and MSD) are invested in a healthier Africa and look forward to partnering with others towards the goal of helping Africans live longer and healthier lives.
