Skhumbuzo Ngozwana – President and Chief Executive Officer, Kiara Health, South Africa

EF: Kiara Health is an example of attracting health investment to Africa. What is your advice to other companies looking to do the same?  

SN: A solid vision and business case are necessary to attract investment, strategies must be solid and reliable, and the team must execute the plan to carry it out. There must also be a need for the product we want to sell and ways to reach the market identified. Finally, all the necessary governance must be in place; compliance, regulatory obligations, and financial documentation all build a credible base for investment. Vision and strategy are the most important elements in executing our desired plan.  

EF: Healthcare has a unique kind of investors; how do you identify the investors interested in investing in pharma specifically?  

SN: South Africa and much of Africa are unlike the rest of the world. We do not have an established venture capital sector in Africa; we have many equity companies, but they do not understand the timeframes of the healthcare sector and usually look for short-term results. The design, commissioning, and construction of a plant takes years, and a partner must be prepared to provide capital, as paying the interest and capital back becomes almost impossible unless the company has an extremely established business generating cash from elsewhere. By default, most African companies resort to Development Financial Institutions (DFIs) because they tend to have longer-term financing instruments and appreciate that the new company will not start making money for the first three years. To attract funding, I believe DFIs are probably the best option. The African Development Bank has a new instrument with a three-billion-dollar fund, and the IFC, with a two-billion-dollar fund, are also a great alternative. 

EF: Healthcare seems to be distilling lessons from the pandemic in 2023; What is your view on multinationals focusing on boutique products and overlooking the mature markets and more generic molecules? 

SN: Some multinationals are downscaling operations, spinning out their portfolios, and exiting the small molecules market in Africa, creating opportunities for local companies. Unfortunately, many multinational companies only want to partner with big, established companies. I would rather have a million people access simple out-of-patent medicine than 20 patients access an expensive monoclonal antibody or gene therapy. It is a tradeoff, and the Western markets are more lucrative. Since COVID-19, everybody has rushed to produce vaccines. Still, in Africa, people are dying from lack of access to s products like insulin, so it is a question of priorities. It is a question of priorities and company strategies; if I were at the helm of a multinational, I would not completely be divested of small molecules, as they remain the bedrock of treatment systems in many African countries and worldwide. People still need simple antidiabetics and such drugs.  

We are always looking for opportunities to partner and assist when big companies want to diversify and scale down their operations; we look specifically at three areas we consider important:  

1. We are already doing work for Sandoz and, until recently, for the Novartis subsidiary, for Servier, a French multinational, for CIPLA, the Indian generic multinational, and a few others that we offer post-importation testing services, and we are looking for more partnerships. 
2. Many companies import products from India, North America, or Europe and then import them to South Africa. They send back products for post-importation testing to their main plants overseas, and in the process, they lose three or four months of shelf life or cannot release the product to the market till the results have come in. Depending on the process or methods, we can help close that gap by testing and releasing the products in a week or two. We do contract manufacturing and packaging and provide stability services and post-importation testing, so the multinationals do not have to return the product to the US or Europe for retesting.  
3. Multinationals have products they are not actively marketing –called tail brands- and sometimes dossiers they have pulled off the market because they have better and more exciting products. We are very keen to partner on those products as they are truly relevant for Africa, and we can throw resources at them and try to push sales up.  

EF: Could you elaborate on what is on your portfolio today?   

SN: The Cervical Health (Cancer screening) portfolio has been approved, and we are working on pre-launch activities, which is very exciting. In a single setting, it is possible to do a cervical digital colonoscopy in thirty minutes and get a diagnosis, versus the current system where women do PAP smears and have to return a few weeks later for results. Our neo-natal monitoring system is gaining significant traction, with big hospital groups buying it. They are getting real-world evidence, saving neo-nates as it identifies babies at risk and intervenes before anybody suspects anything is wrong. We have a Pebble device for diagnosing COVID-19 and are developing a glucose test, a breathalyzer or a nano-sniffer. We are waiting for several other interesting tests to be run on the same platform for malaria to differentiate between different viruses and bacterial infections. On the pharma side, we have a couple of exciting things happening that I am not yet at liberty to discuss. A lot is going on, and it is all hugely exciting.  

EF: What will your next steps be regarding Kiara's geographic expansion and presence beyond South Africa?   

SN: We are already operating in neighbouring countries, Botswana, Namibia, Lesotho, Swaziland, etc., and we are now aggressively partnering in four other countries. We are proceeding very well and gaining traction. East Africa will be next; hopefully, by the end of the year, we will have a partner in Nigeria.  

We are still small outside South Africa because we must undergo regulatory processes that take time. However, we acquired a portfolio from Sandoz, which required a certain transfer of application, moving the product ownership and changing trade names from Sandoz to Kiara before we could commercialize them. Sales have reached a halt across the countries where we have registrations, which, once done, we recommended selling, so it is probably 10%, but it is growing very nicely. Our interest is to cover as many patients as possible in the different territories.   

EF: From your position as chairman of Biovac and on the board of many important organizations, how do you see collaboration between the public and private sectors to enable the implementation of universal healthcare coverage?  

SN: Collaboration is crucial; no player has the full competencies to address the pressing issues we face. Conducive environmental policies and legislative frameworks are needed for the private sector to enter the fray, and joint investments are required. The COVID-19 vaccine, for example, is about building the capabilities to respond to future pandemics, and for companies that invest in that capability or in a platform that would be rapidly scalable to address future pandemics, government investment, assistance, and commitment are vital. The German government has contracted six companies to reserve capacity for vaccine doses for five years. They are investing ahead, preparing for future pandemics, and investing in capabilities that can be redirected to address future crises. These plans can only be done with the public and private sectors working together for the common good and a healthy future.  

EF: How do you see Kiara Health celebrating its 10th anniversary in three years? How would you like to be positioned in Africa?  

SN: We would like, at that point, to be fully entrenched in several key markets in East and West Africa, have partnerships with other companies on the African continent, and have a bidirectional flow of products, not just supplying but taking products from Nigeria or Kenya. We would also like to see tech transfers with Western companies and have significantly enhanced capabilities to produce other priority products for diseases that plague the continent. And, of course, be a successful, well-established, well-respected firm, profitable, in the top 20 in the Sub-Saharan region, a significant supplier to both the government and private sectors and a substantial supplier to the globally funded public health markets. Finally, we aim to be an employer of choice and a company embedded in the local ecosystem, collaborating with academia and researchers to build skills.  

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

SN: Kiara is open to business and willing to talk to companies to impact health outcomes on the African continent. We have a very specific purpose of partnering with healthcare professionals to address the continent's pressing needs regarding priority health and diseases that plague our people. We are keen to enter into licensing agreements, technology transfer, and partnerships with international companies to make their products available to the African continent. Our area of focus, and something I am personally driving, is to open up these partnerships with multinationals to absorb technology and if they are willing to potentially invest in building new capabilities in the continent and make their products available to people desperately in need.