Dr. Allan Pamba is one of the winners of the Shared Value Storytellers competition. He presented his winning presentation at the 2015 Shared Value Leadership Summit, which you can watch at the bottom of this post.
Growing up in Kenya, I was one of the lucky ones. I survived malaria to see my fifth birthday. But hundreds of thousands of children each year are not so fortunate. This insidious disease still claims more than 500,000 lives each year – most of them children under five in sub-Saharan Africa.
When I became a doctor, I discovered this can be due to any number of reasons. Sometimes malaria is not diagnosed early enough, or people cannot get hold of the medicines they need. I tried to save a number of children suffering from malaria. But for many, it was simply too late.
Those years practicing medicine in Kenya were tough but hugely rewarding. Alongside malaria, I treated conditions that are all too common in children such as pneumonia and malnutrition. Despite resistance and some prejudice, I set up an HIV clinic in Kilifi, one of the Kenya’s poorest districts to help improve access to some kind of care. This was before anti-retrovirals were accessible to African populations. Some of my fellow physicians were skeptical, but the patients were happy – if only to get a listening ear in a clinic that did not have the medicines they needed.
I loved my years on the frontline, but they were also frustrating. For every person I helped, there were many more I couldn’t. I realized that to truly change the face of access to healthcare, I needed to do something different. Many causes of poor health were preventable – such as poor supply chains and a lack of rural clinics. To really address these, the system needed to change and it felt larger than what a simple doctor in a rural set-up could affect.
That might sound like a big “ask”. But my grandmother had always challenged me to “hitch my wagon to something bigger than I could imagine possible;” – Anything less was a poverty of ambition; the kind of poverty she taught me to run away from. So I took the difficult decision to leave my patients and do further study in the UK – where I saw an advert for a job at GSK.
For those who don’t know, GSK is a science-led global healthcare company that researches and develops innovative vaccines, medicines, and consumer healthcare products. It has a significant global commercial presence in more than 150 markets, a network of 84 manufacturing sites in 36 countries and large R&D centers in the UK, USA, Belgium and China.
I hoped moving into industry would provide me with a platform to advocate for the changes to the healthcare system that patients so desperately needed. I also hoped that I could bring a useful perspective from the frontline.
Nine years on, I’m heartened to say that much progress has been made. GSK has fundamentally changed its business from top to bottom to help more patients – wherever they are in the world – get the medicines and vaccines they need. And in doing so, we are showing that it is possible to create value for business and for society.
As you probably know, Africa bears 24% of the global health burden, yet has just 3% of the global healthcare workforce and 1% of the global health budget. In developing countries, people affected by certain diseases face stigma and discrimination, disability, and a vicious cycle of ill health and poverty. Diseases that can be prevented, managed, or cured cause significant suffering and mortality due to a lack of basic knowledge and inadequate health services. We do not accept this inequity, nor do we believe traditional business models will deliver the healthcare that many of the 1.2 billion people who live on less than $1.25 per day in these countries need.
GSK is addressing these unmet healthcare needs. First, we are advancing what we believe to be the industry’s most extensive portfolio of R&D projects for diseases of the developing world, and are the only company with programs targeting both treatment and prevention of all three of the WHO's priority diseases: HIV and AIDS, tuberculosis (TB), and malaria.
And we are making these medicines and vaccines accessible to as many people who need them as possible. Our products do not help anyone if they sit on shelves.
In 2014, we extended our tiered pricing approach to prescription medicines as well as vaccines, asking countries to pay based on their wealth and ability to pay. And we committed to freeze vaccine prices for Gavi graduating countries for ten years. The prices of our high quality medicines are capped at no more than 25% of prices charged in developed countries. This allows us to deliver our innovations to developing countries more quickly; for instance, one of our newest HIV medicines has been approved in Kenya and was recently launched.
At the same time, we re-invest 20% of the profit we make in each of these countries back into the country’s health systems, by training health care workers, raising awareness of health services and providing basic public health education.
The World Health Organization currently estimates a global health worker shortage of around 7.2 million – with the shortage keenly felt in the world’s poorest communities throughout Africa. If we are to help curb needless deaths from everyday illnesses from preventable diseases such as pneumonia and diarrhea, we need more feet on the ground.
Yes, government has a part to play in plugging that gap. But, business – with its scale, financial firepower, and intellectual capital – must step up to the plate too. Creating robust systems that enable people to access quality care without falling into hardship as a result, is a job for all of us.
At GSK, it makes sense for us to help strengthen health systems. We can bring our knowledge for discovering and developing medicines, along with an understanding of supply chains. But people might ask why we reinvest 20% of our developing country profits in this endeavor. How is that sustainable in the long-term?
It’s sustainable because we’ve fully integrated this work into our Africa Developing Countries Unit, which is focused on improving access to GSK medicines and vaccines for patients regardless of where they live. We take a long-term view on widening access; and innovative steps, such as the 25% cap on prices which I mentioned previously, has more than doubled the volume of medicines we supply in less than three years. And GSK medicine sales in LDCs have increased by up to 80% per country. This means we have put our business on a robust footing and have more to reinvest in health worker training.
Investing in healthcare systems should – over time – improve access to quality care that helps people keep well. In turn, that helps strengthen these countries’ economic development – after all, countries can only thrive if their populations are healthy – and that creates a better environment for business too.
But we can’t strengthen health systems alone. We don’t always have the on-the-ground knowledge that is necessary to provide truly effective interventions at a community level. So we joined forces with three NGOs – Amref Health Africa, CARE International and Save the Children – providing them with funds to support health worker training. Together we currently run programs in 34 countries, including 26 across sub-Saharan Africa; the three charities have so far helped train 25,000 frontline health workers, reaching 6.5 million people.
This is making a real difference to the health and prospects of some of our most marginalized communities – and it’s made us look differently at partnership, too. Inspired by the health worker training program, we’ve taken our collaboration with Save the Children further. We are now combining our scale and expertise with their knowledge and reach to help save the lives of one million children. Through this ambitious global partnership, we will reformulate and develop new child-friendly products, train health workers, widen vaccine coverage, research new nutritional products, and match employee donations.
Like any partnership, these kinds of collaborations are not always straightforward. But we are greater than the sum of our parts. Bringing together different organizations unleashes the ideas and resources we need to strengthen health systems, and improve health and wellbeing. For instance, without the different perspective of Save the Children, we might not have considered turning the antiseptic present in our mouthwash product into a gel that could be used to prevent infection in newborns. Yet thanks to our partnership, we’re now developing this innovation.
We’re now developing our business model in Africa so that it has a strong domestic manufacturing and research and development base. As well as expanding our existing factories, we will build five more and are also creating an ‘open lab’ to research non-communicable diseases – like cancer – in Africa. These investments are intended to help address pressing health needs across the region, build capacity, and create sustainable growth and jobs.
As well as improving access to healthcare through changing our business practices, it is exciting to see the difference scientific innovation can make. Our scientists are at the frontline of developing new HIV treatments. We have opened our laboratory doors and compound library to visiting scientists in an effort to find new interventions against neglected tropical diseases. Together with partners, we’ve accelerated the development of our candidate vaccine for Ebola at an unprecedented rate, with trials now underway in Liberia. We are in the final stages of developing what could be the world’s first malaria vaccine. And we have committed to make the vaccine available at a not for profit price for those who need it.
In Africa, we have more work to do. Our vision is to make GSK products available to 80% of the population in sub-Saharan Africa and least developed countries (LDCs) by 2020. We have committed to invest £130 million in Africa over the next five years, aiming to provide a portfolio of relevant products, develop innovative pricing strategies, support African R&D expertise and increase local manufacturing capacity and capability.
All the while, it is heartening that, for the fourth consecutive time, we have been ranked number 1 in the Access to Medicines Index, which rates the efforts of the top 20 pharmaceutical companies to improve access to medicines in the developing world. At GSK, we are proud of this recognition for doing good business for better public health.
When at medical school in Kenya, I never imagined I would work in the healthcare industry –they were the ‘enemy’. But I realized that rather than fighting companies, I could do more from the inside – by first changing my attitude, then helping to change ways of working and forging innovative win–win partnerships with other organizations.
Our initiatives show that when business does what it does best – in GSK’s case developing innovative medicines and delivering them where needed – and at the same time working creatively with others, we can advance shared value and make a real and meaningful difference.
As you can see, this isn’t philanthropy. This is a new way of doing business: we enable people to do more, feel better and live longer… we strengthen health systems… we are growing our markets… together, this means we are building our business while building healthier societies over the long term. We believe these are firmly compatible aims.
I am honored to share this progress with you, and grateful to be a part of something so good for my homeland.
"Our long-term goal is to equip Africa to discover, develop and produce the medicines required for Africa." (Andrew Witty, CEO, GSK 2014)
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