Debrief on the Healthcare Panel

This morning's health care panel was a huge success. It was a dynamic, engaging, and lively debate between moderator President Jim Kim and our four expert panelists - Dr. Derek Yach of PepsiCo (also the Conference's keynote speaker), Dr. Vas Narasimhan (Novartis Vaccines and Diagnostics), Dr. Jaime Bayona (Dartmouth Center for Health Care Delivery Science), and Dr. Paul Chew (Sanofi).

President Kim, known for his tremendous public speaking abilities, was especially impressive today as he arrived to host the panel after enduring a morning of last-minute oral surgery to repair a chipped tooth. He admitted right away that as a University President, he is used to delivering many speeches, but "giving a speech with a mouth full of novocaine is just about the most maacho thing we do."

Despite the dental work, President Kim was an active and highly engaged moderator, pressing the panelists on tough issues. How can big drug companies get interested in investing millions of dollars to develop new malaria and tuberculosis therapies for patient populations in developing countries when these markets are notoriously unprofitable? If companies choose to bring drugs into these markets, how can they ensure that local physicians and nurses are trained to help procure and deliver the drugs to patients? How do companies manage the complexities of these health care ecosystems, where infrastructure is poor and patients think mosquito nets that should be used to prevent transmission of malaria are better suited for fishing and clothing?

The panelists offered facsinating anecdotes from their highly diverse backgrounds. Derek Yach told the story of his recent meeting with the CEO of PepsiCo and the head of the World Health Organization (WHO), Margaret Chan. At the conclusion of the meeting, Dr. Yach showed his CEO a beloved statue that sits in front of the WHO building - a statue of a child leading a blind man. According to Dr. Yach, this statue epitomizes the mission of one of Merck's programs to eradicate river blindness around the world. Dr. Yach turned to his CEO and asked "What's our equivalent?" What strategies does PepsiCo have to tackle major public health challenges? Dr. Yach conveyed his passion for public-private partnerships and articulated the need for corporations to build new business models that allow companies to meet the health needs of customers and be profitable. "We have to focus on the 'and."

Vas Narasimham leads the vaccine division of Novartis, where "working with public health agencies is most of what we do." He described three distinct phases in the history of the vaccine industry. From the 1980s to 1990s, the industry relied upon donations, and poor nations had to wait because of severe technological deficiencies and a lack of infrastructure. The era of the 2000s was defined by new global frameworks and international organizations like UNICEF that began to enable counries to introduce vaccines at lower cost via novel "pull mechanisms." Today, in the most recent decade, economies have slowed, and markets of enormous potential such as Africa, India, and China represent the new frontier for many major companies. Access to vaccines and clinical therapies has improved enormously, but now the question is, how do we ensure equality in access?

Dr. Jaime Bayona told the fascinating story of his time in Haiti and Peru, where he worked tirelessly to build an infrastructure on the ground to deliver treatment for multi-drug-resistant tuberculosis (MDR-TB). Dr. Bayona's primary observation is that infrastructure and systems are the problem. Drugs can be developed, but how to procure and distribute the drugs, and how to ensure that patients have access continue to be major hurdles in underprivileged nations. The governments of Peru and Ecuador engaged with international aids organizations such as Partners in Health (PIH) to put MDR-TB treatments in the hands of local doctors. Dr. Bayona, as part of PIH, led national training sessions on procurement and quality control to lay the groundwork for a sustainable health care delivery system in these two countries. "It is about creating a large partnership together in a setting where everyone's input is value." Starting at the top with a cohesive training program was the most effective way of ensuring that comparable processes trickled down to the local level.

Finally, Paul Chew spoke of the R&D strategy at Sanofi of "no profit, no loss." Sanofi has developed a successful method for bringing new drugs to underprivileged markets without substantial financial loss. Manufacturing is done close to the intended source of distribution, providing a boost to the local jobs economy and giving the Sanofi team an opportunity to observe the health care market first-hand during the course of development. Creative and cost-effective solutions are devised when the company encounters resource-based hurdles. For instance, in Africa, many communities do not have scales, so Sanofi created a conversion table to distribute to local physicians to get around the inability to do weight-based dosing.

All the panelists agreed that the most significant pressure on the industry comes from financial analysts. Analysts stress the need for major profits and massive cost-cutting. Pharmaceutical companies - and in particular the R&D teams - want to fight for important projects but if these projects threaten the profitability of the company, they become difficult to justify to shareholders.

President Kim left the audience with the thought that "the plural of anecdotes is not evidence." Thus far, the pharmaceutical industry has made huge strides in improving access to clinical therapies, but we have so far to go before comprehensive systems for health care delivery are in place. Global health experts, physicians, and other researchers have many individual anecdotes, but these stories, when combined, do not yet tell a complete story of success. As business school students, we can bring to the industry a strategic mindfulness and an ability to communicate across stakeholders. Pharmaceutical companies as well as government organizations and foundations will need the fresh perspective of recent graduates, who can bridge the gaps and recognize opportunities to build new systems and business models.