5 bold predictions for a post-Covid pharma

A year ago, I wrote ‘5 bold predictions for pharma’.

Since then, the world has turned upside down. We are in a war, and like with all large wars, the aftermath looks very different.

It’s time for a fresh look.

I’ve interviewed almost 100 pharma executives in the past two weeks, at all levels and functions. The sense of opportunity is palpable – for the first time we are embracing a common enemy rather than fighting along national or company lines – yet the sad truth is, we are already squandering many chances to make the new normal a better normal.

First, let’s state the obvious:

• Telehealth has been reborn, embraced by HCPs and patients alike – 400% up in the US during the week of March 20 according to IQVIA, with a 50% decline in patient visits. Just as with homeschooling on an international scale, what was deemed impossible a few weeks ago is suddenly the only modus operandi. This is here to stay.
• A more collaborative atmosphere has emerged as we scramble to identify treatments and develop a vaccine, enabling the holy trinity of pharma, governments and providers to feel part of the same team for the first time in history. Financial considerations are on the backburner.
• Digital medicines and therapeutics will be more prevalent, for obvious reasons.
• Mental health will be the second pandemic, especially amongst those struggling at the bottom of the economic pyramid. There will however be less stigma and more acceptance, with a greater focus on social connectedness.
• Public interest in pharma will remain high. There is a newfound, respectful understanding of the drug development process and safety testing. We'll have more (remote) clinical trial volunteers, and they will be applauded. The passion of scientists to see this through will be very visible.

But wait. I said ‘bold’ predictions, and none of the above qualify. So here goes. Just remember, I make predictions not to be right, but to encourage the right debate.

1. We will all become a little more Chinese 

2. Pharma will fail to turn attention into acceptance

3. A major privacy backlash is imminent

4. Pharma will rebuild Africa’s health infrastructure

5. Pharma will quit pretending, and turn provider

Let's look at the rationale for each.

1. We will all become a little more Chinese

The NYU professor Scott Galloway often informs his students of why 3D printing never became as popular as we anticipated. “The world already has a very capable, inexpensive 3D printer,” he explains. “It’s called China.”

China is clearly now synonymous with skill in manufacturing, as it was for Japan in the 80s and 90s. But China is also now being praised for bringing its processing power to a 60-million-person, 76-day public lockdown that initially appeared draconian to us western wallflowers – but now in global context appears sensible and pro-active, lauded by the WHO, as we, the great unprepared, each overtake Wuhan in confirmed deaths.

Yet this bold response is not the reason why we’ll be inspired by China in the coming months. More impressive is the country’s co-ordinated post-virus response and the rapid rollout of “health codes” to all citizens via smartphone apps. Those who we once pitied as the infected will recover spectacularly, going from victim to free agent (I think I’ll call them ‘coroamers’) while the rest of us live in fearful retreat. These coroamers will demand a badge that ensure their immune status doubles as a passport to all the best bars in town. But they won’t simply become party animals while the rest of us self-isolate – they’ll gain new responsibilities as plasma donors while we wait for effective treatments, and deputizing as frontline key workers where possible. They’ll need to assist with alleviating our second pandemic – the wave of imminent mental health issues stemming from our long-term social and economic malaise.

There are plenty of jobs for the immune. Your entry to this privileged world? A mere two weeks of painful isolation. The risk of hospitalization or death is a price worth paying for many of us, especially the young, who need the economic gains and will strive to avoid long-term suppression. Ideologically the West has always looked down China’s roughshod treatment of civil liberties, but greed overpowers ideology for the majority and we'll readily give up a few civil liberties to become a little more Chinese.

And you know what? The pharmaceutical industry is perfectly placed to help make this transition work (although it’s unlikely to: see below).

2. Pharma will fail to turn attention into acceptance

Healthcare and vaccine development will become a social cause, spending the next few years at a heightened public consciousness previously reserved for climate change (although anti-vaxxers, as with climate deniers, won’t stay quiet). Bill Gates will become a modern God.

Despite the potential, it’s bad news from pharma’s front lines. Most of our current pharma managers are not, regrettably, imaginative or empowered enough to quickly build new business models for a post-Covid world, and as such will miss out on major opportunities to create a new dialogue or new playing field with our stakeholders. Outside of those people working specifically on Covid-19 treatments or vaccines, companies are primarily trying to maintain a sense of status quo rather than designing business models based on a new set of rules.

Even the basics are a challenge: despite many years of talking about ‘going digital’, very few companies or people have a credible vision for what this actually looks like. We’re accelerating short-term plans but that’s it. I fear that if Steve Jobs was any of our bosses, we’d have already been fired.

We need to act immediately yet thoughtfully if we are to find the silver lining under these dark clouds. I’d like to see our companies step up to the plate in some key areas:

-      Establishing new operating models with government and payers that share data at the front-end to speed development, and at the back-end to make value-based reimbursement far easier.

-      Explore more comprehensive partnerships with digital-only, agile service providers and startups rather than the large incumbents.

-      Combining clinical and real world data into evidence packages that resonate not just with larger payers but also local HCPs and providers.

-      Finding more ways to gain partial or staged approval for new medicines using real world evidence.

-      As Christian Marcoux advocated last week, having more visible, down-to-earth and human communication with the public as industry leaders operate from their home offices. Ideally this would extend to producing healthcare’s equivalent of ‘concept cars’ as I suggested recently.

3. A major privacy backlash is imminent

Covid-19 has turned privacy on its head. A month ago we were worrying about what Google, Facebook and surveillance governments might be doing with patients’ sensitive health information; now we are wondering if they are doing enough. Governments in the US, UK and elsewhere have relaxed their enforcement of HIPAA and similar laws as the rush to find and test new vaccines becomes our singular goal. Indeed, governments themselves have taken new liberties with data to identify the most vulnerable and assist them – and the fears of data abuse are already front-page news. Mass surveillance is being recommended by ex-FDA Chief Scott Gottlieb, ex-Novartis CEO Joe Jimenez and many others. By tapping into phones and medical records, public health authorities are hoping to more swiftly identify and isolate potentially infected patients for future outbreaks. This is vital especially in the developing world where smartphones are ubiquitous but hospital capacity and economic bail-outs are not.

But someone, somewhere, before the end of 2020, will overstep the mark – perhaps in an area entirely unrelated to Covid-19. And with those health records now at stake, it will create a scandal of Cambridge Analytica-esque proportions that take us into a world where privacy becomes more prized than ever before, and we see the US finally introduce GDPR-style controls as a 100-day pledge from whichever President is elected, red or blue.

Despite this, it’s still worth it. Privacy is a luxury that barely exists today, and to be over-protective of it in an emergency is against the public interest.

4. Pharma will rebuild Africa’s health infrastructure

As I write this on April 10th, the virus has yet to take hold in Africa and other developing economies. These are the places where total collapse is possible, where uncountable numbers of lives will be tragically lost. Few citizens can practice effective social distancing and there is no economic safety net. We’re starting to see this disaster played out on our news websites and TV screens, with huge expectations raised about what western companies and economies will do to alleviate the problems. The reality is that there is very little that can be achieved now; there simply isn’t enough time.

Pharma has largely ignored the developing world to date, unable to find returns on sales and with little commercial benefit to distributing them freely.

This will change. Covid-19 cannot be swept under the carpet; when one country is affected then the rest of the world still is. Better infrastructure and vaccine distribution will become vital to eliminating the virus in these locations, and pharma companies will be reminded of the social mission that is written on all the walls of all their offices: to give health, health being a global construct. The rebuilding of Africa will become as prescient as climate change and a new Greta Thunberg will emerge to hold industry accountable.

5. Pharma will quit pretending, and turn provider

Pharmaceutical companies increasingly depend on achieving patient outcomes. This is a total detachment from our past, where companies were rewarded for simply making and selling medicines. Suddenly it’s in our interests to ensure that outcome is delivered, no matter what. In any other industry that would predicate a vertical integration: just as Netflix now makes its own content (backwards integration, to ensure control of costs and quality), pharma should practice forwards integration to ensure frontline care is as good as it could be. This is particularly pertinent in the latest range of more sophisticated medicines (immunotherapies, cell & gene therapies, stem cells) which feature high prices, complex delivery procedures and value-based contracts.

Except that we don’t, because pharma companies aren’t there to provide healthcare, nor do we have the legal structure to cope with the liabilities, nor do we have the capabilities or structure to operationalize it.

Except that we do, because every day we invest in beyond-the-pill services, patient-support programmes, using data to improve the patient journey. It’s time to stop pretending and embrace our new future as service delivery partners – in partnership with those who are the interface with patients. The Covid-19 pandemic, with our dependence on remote monitoring and decisions made through data, will only accelerate our journey towards this inevitability and we must embrace it fully.

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Covid-19 is an international disaster. Many pharmaceutical companies have torn up the rule book, doing whatever’s possible to find treatments and a vaccine. In the words of George Yancapoulos, President of Regeneron, New York resident and one of my recent interviewees, “we have not had one single conversation about the financial implications of what we’re doing. We are working tirelessly out of a profound sense of duty to save our loved ones who are dying right now in this crisis.”

The rest of our industry is, however, not yet acting with the same level of urgency, imagination and radical action. Leaders need to keep one eye on (digitized) business-as-usual of course, but they should absolutely be using the other to redefine the company for a world that will never be the same again.

Archived:

-      Only Novartis dares to dream - Feb 2020

-      More weirdos please – Jan 2020

-      Into pharma’s roaring twenties – Jan 2020

-      A taste of your own medicine – April 2019

-      5 bold predictions – March 2019

-      Pharma: Dumb & Dumber? - May 2018