Dit is Leaders in Life Sciences, een podcast waarin we op zoek gaan naar het verhaal achter de mens. We praten met leiders van nu en later over wat hun drijft, hun carrière en privéleven. Want door naar elkaar te luisteren komen we als individu en als sector verder. We willen onze partners hartelijk bedanken voor hun steun, dat zijn Pivot Park, Pedersen & Partners en Johnson & Johnson Innovative Medicine. Te gast in deze aflevering, Jay Iyer. Uw host is Henk Jan Out.
Henk Jan Out
Welcome everybody. Today our guest is Jay Iyer, the CEO of the Access to Medicine Foundation for nearly 10 years now. And we will be discussing this foundation at length during this podcast. She was trained as a molecular microbiologist at the Johns Hopkins Bloomberg School of Health, had her PhD in Singapore and after a post-doctoral fellowship at the Netherlands Cancer Institute and the Anthony van Leeuwenhoek Ziekenhuis in Amsterdam, she joined the top institute Pharma in 2008 as a senior program manager. In this role she was very much involved in creating public-private partnerships between non-governmental organizations, academia and the industry for the development of medicines in priority diseases. She became head of research at the Access for Medicine Foundation and subsequently succeeded Wim Leerdeveld, the founder of the foundation, as its CEO. Welcome Jay, thanks for coming here to Oss.
Jay Iyer
Thanks for having me.
Henk Jan Out
Yeah, so impressive career. You’re now based in the Netherlands, but where were you originally raised?
Jay Iyer
So I was born and brought up in Singapore and before the whole country was developed into the sort of conglomerate-megapolis that it is right now.
Henk Jan Out
But you studied in the United States?
Jay Iyer
Yes, so after my undergrad degrees, I moved to the United States to study in infectious disease, vaccinology in Johns Hopkins. And there I also started a startup company, basically bringing healthcare services and diagnostics to different parts of the world. And that’s when I really understood that, you know, at the end, it’s all about, you know, where you live and where, you know, the kind of background you actually have that determines whether you have access or you don’t have access to medicine.
Henk Jan Out
All right. So already then you had an interest in access for medicines, right?
Jay Iyer
Exactly.
Henk Jan Out
Yeah. So, you, but you stayed in, you created the company, but you did a PhD afterwards in Singapore.
Jay Iyer
Correct. So, that was around the time when Singapore was developing a lot of interest in life sciences and biotechnology. So, a lot of different centers that were instrumental in developing research products, research innovations, were actually drawn into setting up shop in Singapore itself. So that’s when I moved back to Singapore and decided to complete my PhD in Singapore, and at the same time assist in developing the School of Biological Sciences in one of the technological universities that really was focused on biotech and innovation and in that regard. And then after that, I moved to the Netherlands.
Henk Jan Out
All right. But you kept your startup company?
Jay Iyer
No, no. I mean, once I left the US and once it was already a model that worked, I basically left the company and left it to the others to kind of continue the work. It’s still in function today, actually.
Henk Jan Out
Right. And so, yeah, back to Singapore where you were raised. So, that was nice to be there again, I suppose.
Jay Iyer
Yeah, correct. Correct. Especially at a time where Singapore was really opening up its borders, you know, really embracing innovation. There was a lot of funding available and other incentives available for companies and public sector organizations to work together on some of the health care issues. So it’s a very exciting time to be in Singapore.
Henk Jan Out
So what brought you to the Netherlands then?
Jay Iyer
Well, a number of things. Since I’ve worked in the United States, I’ve worked in Asia. Around the time when I was working in Singapore, I’ve also worked in Indonesia for quite a large number of months helping to set up a non-profit organization’s capacities in diagnostic measurements for Malaria. So, I really started on a real understanding that okay it would be nice to then move to Europe and see what life is like in Europe, especially when it comes to innovation, policy and eventual access. So I moved to the Netherlands.
Henk Jan Out
But you could have chosen the United Kingdom or France or Germany, but you went to the Netherlands.
Jay Iyer
Correct, correct. I had actually offers in different parts of the world. And at that point, I re-met my now husband, who was also a medical doctor in the Netherlands at that point. And we basically thought: okay, why not live about an hour away from each other and try a relationship and see what that’s like. At the same time, I can do my postdoctoral research and see where the world takes both our relationship and my professional career. So then the Netherlands was probably an easy place for multiple reasons. One is a lot of work is conducted in English. And the second is, there’s a very strong innovation culture here. And at that time, there was a pharmaceutical industry. There was also a lot of interest in global health and global development. And so all those things kind of basically made me say:
yeah, this is a place for me to work.
Henk Jan Out
Right, and so you joined the Netherlands Cancer Institute and you worked with Piet Borst, didn’t you?
Jay Iyer
Exactly, exactly. I worked with Piet Borst who was, and still is in a very interesting character where basically everyone who is anything in healthcare would come by, meet him, be in the hallway. So…
Henk Jan Out
He’s just recently appointed a fellow of the American Association for Cancer Research Academy, wasn’t he? And he’s 90 years of age.
Jay Iyer
Yeah. He’s 90 years and still very active in driving basically the healthcare and challenging healthcare, especially for young scientists.
Henk Jan Out
Yeah, must be very stimulating to work with a scientist like him.
Jay Iyer
Yeah, yeah.
But then, although you did a PhD, you worked as a postdoctoral fellow, but you didn’t decide to stay in science.
Jay Iyer
Correct, correct. I mean, I think there would have been a perfectly fine career remaining as a researcher, as a research scientist, and I knew that my path was going to take me towards vaccinology, vaccine development all around the world. I specifically worked in malaria vaccines for a large part of my research career, which meant I would have lived in any part of the world in that sense. But actually, I realized that at the end, it’s not about the actual innovation always, because there’s plenty of innovative ideas out there and plenty of science available that can really save lives. It was all about changing people’s behavior, challenging stereotypes to ensure that as access.
Henk Jan Out
Implementing innovation.
Jay Iyer
Implementing it. So that you have a difference between impact for a very few people in the world versus impact for global populations everywhere. So that’s when I said I want to do something where you’re basically challenging those stereotypes.
Henk Jan Out
Yeah, that’s one of the things nowadays, isn’t it? There’s a lot of startups, biotech companies, there’s a lot of innovation taking place, fantastic technological advancements are being made, but to implement them, that’s a completely different story.
Jay Iyer
Yeah, and to implement them you cannot do that without partnerships, which is why I joined Top Institute Pharma, which has now become Ligature, an organization in Amsterdam, in Utrecht actually, and they basically develop partnerships between the pharmaceutical industry, biotech companies, research institutes, to sort of solve problems in healthcare. And so that really drove me to understand that, okay, if you’re part of developing those partnerships, you can really make a big change in the results that they get.
Henk Jan Out
Because you need these types of partnerships to make it happen, to actually implement those innovations.
Jay Iyer
Correct. Because at the end, it’s not just about the product. It’s about the product in the hands of the right implementers and really developing, taking risks together, investing together and really driving success.
Henk Jan Out
And was it successful? Did you create many of those partnerships?
Jay Iyer
I was responsible for about half of the portfolio at one point in the Top Institute Pharma, which was about, I think, budget-wise, about 260 million euros worth of partnerships, at least at the start. Some of those partnerships are still running today under the guise of Ligature, and many of them have actually developed some very interesting and important results, such as the schistosomiasis medicines, which has made age appropriate for school-going children of a younger age. Previously, pills used to be really, really large and difficult for children to swallow. So things like that has actually been coming out of those type of partnerships. And it’s very nice to see that.
Henk Jan Out
And this is typically those developments that private companies don’t find interesting to do themselves because it’s probably not as profitable as other projects they have in their company. So therefore you need a public sector to actually work together. Is that correct?
Jay Iyer
Yeah, you need partners to drive it. You need at that point public investments also to de-risk these type of projects because it does involve an innovative step in developing child friendly formulations. And obviously that costs money and the regulatory filings that have to come into place also cost money. So at the end you really need to drive that through public private partnerships.
Henk Jan Out
Yeah. And how was that to work together with academia and industry and non-governmental organizations? All have their own interests, must be complex to bring them together.
Jay Iyer
Yeah, it was extremely exciting because at the end of it, the work we did was to be independent. And in that way, ensure that the public sector, the private sector were working together and you can represent different interests without necessarily having your own interests added into the mix. So you learn how to negotiate really well between scientists, lawyers, finance members, and really drive that. But what I realized at that point is the understanding of what successful partnerships look like is very different among different organizations. So you really have to bring people together.
Henk Jan Out
Yeah, can you develop on that a little bit longer?
Jay Iyer
Yeah. So for example, the drivers for an academic institution was, is, you know, it was and still is publications, sometimes patents, but often a lot of the science stops at the point of clinical development because usually they don’t necessarily have the capacity to drive it further. The drivers for pharmaceutical industry has been and still is profit based and growth in specific markets itself. So at the end, just putting the drivers together towards a project, often in a very early stage, really requires kind of realigning the incentives, realigning sort of the vision between parties to say, you know, what do you really want to achieve? If you want to achieve better dosing for children, do you want to achieve a product that is going to reach more patients globally? Do you want to achieve a comparative analysis between different types of products that are being brought together, but screened under a single platform so that you maximize results? That I think is a really important thing, understanding what you want to achieve.
Henk Jan Out
So how was it difficult? I mean, this podcast, I think the audience, many of them are working in the life sciences industry, in the pharmaceutical industry. Was it difficult to convince pharmaceutical companies to actually be part of those public-private partnerships?
Jay Iyer
It was a very, I must say it’s very, it took a very long time to convince different companies. And every company has their own, you know, depends on who you get also from the company available to do those negotiations with, right? So it was a lot easier for areas where there is already a market, right? So for oncology, for cardiovascular diseases, for pharmacokinetics, pharmacodynamic studies. It was a lot more difficult when you’re talking about neglected tropical diseases and infectious diseases that affect global populations. So that’s where the partnership work had to be done in a much more innovative and clever way. And I was responsible for kind of both types of relationships, right? But my specialization was in making sure that the impact would affect global populations. So we had a neglected tropical disease portfolio of projects that were hand curated in a particular way. And I think that’s really the point of success that you have to really drive innovation.
Henk Jan Out
So what was eventually the convincing factor for companies to actually step into those partnerships? Why did they do it?
Jay Iyer
In that time, it was social responsibility, wanting to make an impact in people’s lives, and reassurance that at the end, the risk that they were walking into was not going to cause problems downstream, right? Liabilities and things. Today, a lot has changed in the pharmaceutical industry, which is what brought me to the Access to Medicine Foundation.
Henk Jan Out
Yeah, because this seems like a fantastic background indeed to join the Access to Medicine Foundation, where you joined as head of research initially, right? So it was very much building upon the experience you’ve already had at the Top Institute.
Jay Iyer
Correct, correct. Wim Leereveld and I, we knew each other because we would be invited to different platforms.
Henk Jan Out
Wim Leereveld was the founder of the foundation.
Jay Iyer
Correct. Wim Leereveld and I, we used to be kind of side by side in a lot of conversations and discussions about the role of industry in partnership versus, you know, sort of a system to ensure that the competitive nature of the industry was used towards making a social impact. So at some point we got together and I said, look, Wim, instead of outsourcing all the research and instead of just making a ranking which measures the result, what if we could drive that change ourselves with the skills of negotiations, the skills of impacting policy developments, impacting strategic investments by both government and institutional investors. And he said, sounds like a nice idea. Would you join me? So that’s when I joined him as head of research. We started the organization from that point onwards. So and now today, we’re just under 50 people. So that’s and basically the whole research team. And we have a group of people who engage on driving that research in discussions with policymakers in government, in discussions where investment firms who invest in the pharmaceutical industry need to invest sustainably and working with communities, working with companies.
Henk Jan Out
But just going back a little bit, so the Access to Medicine Foundation, when was it founded?
Jay Iyer
It was originally founded in 2003, but the first index was in 2008.
Henk Jan Out
But that was the purpose, right? It was making an index, ranking pharmaceutical companies, how much effort they put into access and other things.
Jay Iyer
In low- and middle-income countries.
Henk Jan Out
In low- and middle-income countries. And I can remember the first times already, it had quite an impact, hadn’t it? It was published, all the newspapers were writing about it, it was heavily broadcasted also in international media.
Jay Iyer
Yeah, yeah. At the end, what we, what I think the premise has always been, is: if you want to convince the pharmaceutical industry to do better on access, you need to clarify the expectations of what society expects from the industry. So what the foundation did, already from the start, is convert those expectations into metrics, use those metrics to measure the actions of the pharmaceutical industry, and show a result via the ranking.
Henk Jan Out
Right. So how did you do that? How do you rank them?
Jay Iyer
Yeah, via using metrics, using a combination of public data, inviting companies to submit information and data, often proprietary data, on their policies, their practices. And that was done across, and today still done across a number of different areas, such as governance of access. So how do they ensure that they’re following ethical methods in their policies? Do they have an access to medicine strategy that really is embedded in the business or is it corporate or social responsibility and in a corner of the company? We have a section which is on research and development where we look at research and development pipelines and whether they match the top priorities of the world set by the World Health Organization and global populations, and whether the innovations that are in research and development are actually eventually launched and delivered in low- and middle-income countries. And of course, the third area, which is often what most people think about when they think of the word access to medicine, is on drug pricing, on availability, on supply chains, on in-country capacity investments by the pharmaceutical industry.
Henk Jan Out
So how did the industry react when you start asking them questions about all of this? Were they cooperative?
Jay Iyer
Not initially. And every now and then we have companies that are hesitant to share information. But overall, we’ve seen a tremendous progress in sort of the engagement of the industry on this work itself. Today, I think all the industry recognize their social responsibility. They recognize that they need to be transparent about policies and practices, and they want to do well. They want to show that impact.
Henk Jan Out
Are they all participating or is it only a selection of them? How do you approach all of them? I mean, how do you actually approach?
Jay Iyer
Yeah, so we pick the largest research-based pharmaceutical companies and we pick 20, right? And the premise has been, if you’re a large company, you have products that you control in the world that are under patents, or basically because of your market share in the world. And based on that, we choose the top 20 companies to measure.
Henk Jan Out
Right, and now they’re quite eager to actually show the outside world how good they are.
Jay Iyer
They’re very eager to show how good they are. So you can imagine that they’re not always very pleased when we basically say this is not good enough, or you’re missing an opportunity here. Because one of the things that we try to do now beyond the ranking is, we’ve gone a long way since 2008 and the first ranking itself. We have customized opportunities per company where every company has said, Pfizer, here are the key things you need to do. GlaxoSmithKline, here are the key things you need to do based on your portfolio and your business and the gaps that are there in the world. Secondly, we also have the actual ranking, which tell companies on how they score among their peers. And we show best practices of what they can still do, because they don’t often get a chance to see what another company is doing. They’re competitors, so they don’t often see the entire spectrum.
Henk Jan Out
Whenever you publish the index, those who are actually in the top three are always quite keen in broadcasting it and the press releases, etc. that how well they’ve been doing, understandably.
Jay Iyer
Correct. And often that does lead to high level stakeholders such as ministers and the head of the World Health Organization, investors asking companies, all right, tell me more about how well you’re doing, what are your future plans on access? How are you actually addressing some of the geopolitical changes that are coming forward and still maintaining your commitment? how are you going to stay high on the ranking?
Henk Jan Out
So you get calls from CEOs of the really big pharma companies, don’t you?
Jay Iyer
Yes, and letters.
Henk Jan Out
Critical ones? What do they write to you?
Jay Iyer
Yeah, a kind of a mix. Sometimes the ones I enjoy the most are when they invite you to come and speak to them or the executive team, not just to inspire on the fact that here’s the big problem and you need to do something about it, but really to show examples of what they can do in a very concrete way. Those are the kind of discussions I enjoy the most. Of course, there are letters and calls where they would write and say, in a couple of areas, you’ve got us wrong, we’re very proud of it, and you could be a bit more generous in measuring us and judging the results of it. And often I do get a lot of companies articulating that they cannot do something because of the challenges in the countries or challenges where the investors do not agree with the vision that they have or vice versa. So I do get a long list of challenges that the industry faces in the conversations.
Henk Jan Out
But you develop a research methodology, you publish it upfront so everybody knows exactly how you’re doing it.
Jay Iyer
Yeah, correct. We try to be as transparent as possible. We also organize town hall meetings with the pharmaceutical industry where we bring in our experts and we try to explain to them, here are the ways that there were other companies are doing. Because at the end, the most convincing argument is when another company is doing something.
Henk Jan Out
So did you see over the years change at the company? Have they changed their behavior?
Jay Iyer
Yeah, over the years, I think we’ve seen some very promising changes for us. The main things that we’ve noticed is every single small step that is taken by the pharmaceutical industry has a huge impact downstream in patients’ lives, right? If you just launch your product in one more country, there’s like a million people who can get access to treatments in that sense, right? So those very small changes mean a lot for patients’ lives. But in terms of transformative changes, most of the industry, at least in the early 2000s, were seeing access to medicine as a part of their corporate social responsibility, a charitable cause. So very small focus, still making quite a bit of an impact on patients’ lives around the world.
Henk Jan Out
But corporate philanthropy.
Jay Iyer
But corporate philanthropy. So a lot of it was supported by money and expertise, volunteerships from staff. And today, we’re starting to see that all the pharmaceutical companies in the index actually set access to medicine targets, which is a major improvement from years ago. So every single one of the 20 companies actually have that access to medicine strategy in place.
Henk Jan Out
Right. That’s a fantastic result, isn’t it?
Jay Iyer
That’s a fantastic result.
Henk Jan Out
By just benchmarking companies and they stimulate each other actually to do better.
Jay Iyer
Yeah, correct. The big problem is the strategy needs to still be implemented across their portfolios, right? At the scale.
Henk Jan Out
Tensions are nice, but achievements is another thing.
Jay Iyer
And at the end, what we found in our research over the years is there has been steady progress in the industry in terms of actual expansion in different markets around the world and reaching more patients. But the scale and scope of that is still far, far, far from where the need is. And it doesn’t apply to entire portfolios. More recently, we’ve actually noticed a number of companies setting more innovative and inclusive business models, which affects the entire portfolio. One example is Pfizer, where they have something called the Accord, where they’ve ensured that all their patented products and all their generic products are going to be made available in a range of low- and middle-income countries. And that’s now being picked up by Sanofi. They’ve got 30 products that are covered under not-for-profit business in the rest of the world. So we have a number of those type of examples that we’ve articulated in our research of what is happening today. Of course, they struggle with the similar challenges in countries because they need to take a tailored approach in every scenario and every setting. And that’s hard.
Henk Jan Out
How would you generally describe the efforts of the pharmaceutical business, the pharmaceutical companies in actually making the drugs available in lower middle income countries? Are they doing well enough? Of course, they can always do better, but what’s the major problem?
Jay Iyer
I think the major problem is that these incentives are not aligned to sort of drive that at scale, right? So at the end, the pharmaceutical industry’s incentive is still profit margins. And you can make profit margins already if you work in a few geographies around the world and not necessarily in reaching patients globally. We’re hoping that the incentives will be pivoted towards burden of disease and really think of sort of where can I get the volumes of patients? Where are volumes of patients waiting for the treatments that I’m making as a pharmaceutical company? I think that’s the biggest gap that I see, which is why it applies only for, a lot of the progress that you see is actually applied for very sporadic areas within a company’s portfolio, but not across the entire business.
Henk Jan Out
But population-wise, in low- and middle-income countries, represent a huge potential market.
Jay Iyer
Correct. 80% of the world’s population live in low- and middle-income countries. And if a company is performing where they are not even reaching that 80% of the world’s population, then are they really performing well financially in patient-reach as a society in having a societal impact? I think now a lot of times that is being driven by internal stakeholders and external stakeholders, activists, advocates, and the World Health Organization countries, communities are speaking out, are fully aware of innovations that are emerging, but they don’t have access to it. But at the same time, it is internal change-makers within companies who are demanding that they want to work for a company that makes a social impact.
Henk Jan Out
These are the shareholders or the employees?
Jay Iyer
Well, the employees play an important role. If you work in an access team, if you work in R&D, you want, your vision is to ensure that more patients have access to treatment. So we’re basically incentivizing sort of company staff from thinking outside of that golden cage to say, what are you doing to ensure that you’re addressing some of these major gaps in the world.
Henk Jan Out
And increasingly companies are responsive for those appeals.
Jay Iyer
Increasingly companies are responsive to that, especially because we also have a very large group of investors. So currently we host the largest investor signatory based in the world for healthcare, which means more than 140 investors use our findings and our insights to drive sustainable investments in the pharmaceutical industry itself. And they account to 22 trillion US dollars worth of assets under management. So once you have the shareholders on board, you can make a huge change in the pharmaceutical industry. That’s the premise of our work.
Henk Jan Out
Yeah. And you see that movement among shareholders that they indeed look at the efforts, for example, in your access to medicine index, and they value that by investing more in particular companies who are ranking high in the index.
Jay Iyer
Ranking high in the index or moving in the index, you know, suddenly high because they made a strong change in that sense. At the end of course, we’re all dependent on all the companies, because we might need a product which is being produced by number one and number 20. So as a society, we are dependent on all the companies, so we need all of them to move at the same time.
Henk Jan Out
So how’s the foundation financed?
Jay Iyer
So we’re supported by a number of governments and a number of charitable organizations.
Henk Jan Out
But not by companies?
Jay Iyer
Not by the pharmaceutical industry.
Henk Jan Out
Deliberately I assume?
Jay Iyer
Yes, we try to maintain our independence. A few investment firms have put grants towards specific parts of our work. So at the end of it, we maintain that independence. We have a diverse group of funders who all believe that the industry can work stronger with their partners to deliver on access.
Henk Jan Out
Right. The last decade or so, you’ve been expanding also your activities beyond the index, right? You’re doing more things now. Can you tell us a little bit about that?
Jay Iyer
Yeah. So, we have actually realized that the model of changing the industry has been working quite well in driving progress. Slow and steady progress, still not reaching the full potential, but we are driving a certain level of progress, which matters to people and patients all around the world. So, we basically launched a new strategy a number of years ago, where we said, what if we tried this across a number of different industries in the healthcare space? So currently we have programs with the generic and biosimilar medicines industry. We have programs with medical oxygen companies, which I think was very important during the COVID pandemic. And we now have programs in vaccines and very specialized programs in a few therapeutic areas where you want to see some major change after years and years of lack of access, right? So we have a diabetes care program, we have a program on antimicrobial resistance. So we’re spreading this work across the continuum of care so that more industries are doing their part on access.
Henk Jan Out
Right, and how successful has that been? I mean, are companies equally interested in participating in the original index?
Jay Iyer
No one is interested in participating unless you basically convince them why this matters, right? So, for a lot of industries who are not used to sort of the scrutiny in sort of the Northern Hemisphere countries in terms of reporting, we do need to basically convince them on how to report, how to articulate, how to measure progress, what does the access to medicine strategy even mean for their company? And often we have to do a lot to prepare the companies so that they are able to share data and driving progress in that way.
Henk Jan Out
Because, for example, generic companies, I don’t think they have much of corporate social responsibility programs in place. Or are they very interested in access in low- and middle-income countries?
Jay Iyer
I mean, with the generic industry, they often are interested in growth markets that they’ve already been active in, right? So, often the Indian generics would be active in India. There’s historically a number of Indian generic manufacturers that are also active in Africa. So, at the end, the approach that we take is to ensure that they do that business in a responsible way. So we have indicators that drive responsible business practices, and we have indicators that drive how to expand access to underserved populations where we measure their activities and we suggest areas that they can do better. But often they don’t always have an R&D department, so then we don’t measure them on research and development. Often if they do have an R&D department, it’s for adaptations to serve specific populations. So, the nuances on what they are measured on in order to sort of bridge that gap are different. And the mechanism of influence is also different because traditionally the investment firms need to be aware of what’s happening with the generic industry. So most of the investment firms know medical gases, for example, but they don’t necessarily realize that there is an engagement strategy that can be created with medical oxygen companies.
Henk Jan Out
Yeah, because I assume that the impact generic companies can make on the availability of drugs is huge. Because what is it, 80, 90% of all drugs that are being prescribed are generic. So if you can make those available easily in low- and middle-income countries, that’d be a huge step forward.
Jay Iyer
Correct. And at the end of it…
Henk Jan Out
But it’s not happening yet.
Jay Iyer
It’s not happening yet. And you often see the gaps in registration. So, pump products are just not even registered. The gaps in quality, there are a lot of, well, fake drugs that are out in the market. So, you do need to make sure that quality medicines are in the forefront of access. And there are gaps in supply chains. And today, we actually are facing severe shortages all around the world for basic medicines that are just no longer produced or are produced in one country but need to be delivered in another country and you’ve got problems in the supply chains itself.
Henk Jan Out
One of the things which would interest me as well very much is next to looking at the private sector, how they’re doing, how’s the public sector doing in making sure that access to medicines is taken care of. So is the next step perhaps that you’re going to benchmark countries next to companies?
Jay Iyer
We’ve actually thought about that for a long time. If you want to benchmark countries, you do need to come up with a mechanism of influence that convinces countries to do better. A benchmark alone, a ranking alone is not going to be enough, right? And that’s what we’ve learned over the years, that you need to come up with investor engagement, policy, you know, government engagement towards driving the industry itself. So something similar needs to happen for the, for countries itself, right, without causing a war in that regard. And what we do do now is we do getting involved in sort of policy recommendations for countries. And we do get involved, for example, in the Lancet Commission on Medical Oxygen, we, you know, assisted in helping them create a medical oxygen scorecard that countries can use to develop medical oxygen systems and invest in medical oxygen systems over time. So that’s the kind of ways that we are getting involved in.
Henk Jan Out
Yeah, because I can imagine very well that companies can do their best to make drugs available in countries. But if the government, local governments are not cooperating, I think, and that happens a lot, I think, then you still have an issue.
Jay Iyer
Correct, correct. And there’s a lot of investment in that at this moment. There’s a lot of investment in regulatory capacity, in supply chain capacity, in country infrastructure. There are new guidelines that are being developed for more innovative medicines in a lot of countries, especially in Sub-Saharan Africa. But to be honest, a lot of progress has been driven by international aid to help de-risk access, to really drive procurement when financing is missing. And that, I think, is where we’re sitting at today, where you’re sitting at a position where, you know, can we keep the level of progress high in order for us to achieve some of the goals?
Henk Jan Out
Yeah. So, how do you value the, you know, what’s happening right now with the USAID and other US-based organizations, financed organizations by the US government? That’s quite disastrous, isn’t it?
Jay Iyer
Correct. At the moment, it is quite a problem right now in terms of existing mechanisms that have been tried and tested to work in medicines delivery, in infrastructure, in procurement that are all now being disinvested in or completely crumbling. We’re starting to see, and I get calls from communities basically saying we anticipated a shipment and the shipment’s actually there, but we don’t have the ones that can sign off on it and drive it over because people have lost their jobs. So it’s not only livelihoods and lives that are lost, it’s actual systems that are now crumbling. Systems that actually have been very important for the industry to also deliver on their products because they can’t sell their cancer drugs if health systems are not safe. So the entire industry is now being faced with some of these major problems. And on top of that, you also have the threat of tariffs when we have a fragmented supply chain where active pharmaceutical ingredients are coming from one country and products are filled and finished in another country and then delivered to a third country. So you do need the geopolitics to settle down so that we have safety for healthcare.
Henk Jan Out
Yeah, that just doesn’t look good. If you listen to what’s happening right now, then as you said, the whole procurement systems, they’re gone as well. It’s not, and I, for the limited time I worked with Organon also in corporate social responsibility, those procurement systems and those organizations like USAID and others are essential to actually get your drugs there. You know, it all falls apart.
Jay Iyer
It all falls apart and it creates back again a risk when you think of infectious diseases and future pandemics, it creates back a risk to high income country populations at the end, right? Because if you don’t invest in international development, you don’t invest in vaccines, if you don’t invest in contraceptive care and systems of contraceptive care, you’re actually creating a problem that comes back and affects every population in the world.
Henk Jan Out
Yeah, let’s go a little bit in that direction and the women’s health side. I think the foundation is also active there, isn’t it? So specifically focusing on what companies are doing for women’s health.
Jay Iyer
Correct. So in women’s health, we’ve done a number of things already from the beginning. In the analysis that we do on whether it’s the big pharmaceutical industry or generics or medical oxygen, we do look at women neonatal care, sexual reproductive health and rights.
Henk Jan Out
Why specifically that therapeutic area?
Jay Iyer
At the end of it, it’s because when most, you know, when you think about the most vulnerable populations who are left out of care, it’s often women and women, girls and children. You know, they often are last in line when it comes to care. And at the same time, the level of death and disabilities is actually very, very large. At the moment, a woman dies every two minutes due to preventable causes of pregnancy and childbirth. That’s shocking, today. And that’s only going to be exacerbated by the fact that access to contraceptives is now no longer going to be available due to aid cuts. At the end of it, Sub-Saharan Africa, for example, accounted for 70% of global maternal deaths and has the highest neonatal mortality rate in the world. And at the same time, women and girls, if you do invest in women’s and girls’ health, it has a huge societal impact, huge economic impact for every country in the world. So for us, it was really important to make sure that products that are being made by the pharmaceutical industry are reaching women. Specific products that are meant for women are reaching women in low-income countries and low-middle-income countries equally. And what we’ve seen is a couple of developments where for some key products, there’s been huge investments, but overall, the pharmaceutical industry is still far, far, far from the goal of really addressing these preventable deaths.
Henk Jan Out
Yeah. What should they do?
Jay Iyer
I think a number of things. One is they can be more involved in addressing some of the gaps for research and development. There are still today research and development gaps affecting women and neonates and children. There’s something even called the specific list of priorities that have been published by the World Health Organization that innovators can look at, whether biotech companies or big companies. They can look at to see, okay, what technologies do we have that can help this particular product need that is out there? Secondly, they can ensure that when they do have a product, that they are early thinking
about how can they launch these products in countries that have the high burden of disease, rather than just prioritizing a few markets or only the US and Europe. So that what we call early access planning has made a huge difference in people’s lives. And today we’re starting to see that more and more companies are starting to embed early access planning frameworks in their research and development, where the commercial teams actually speak with the R&D teams to develop access programs downstream.
Henk Jan Out
But the other dilemma is, I think, also that there is not much going on in terms of research and development in women’s health. Ofcourse we had many, many companies in the past that invested a lot in contraception, hormone replacement treatment, infertility and so on. But increasingly companies are abandoning this field and they had to call for investing
more in R&D. You see it nearly on a daily basis in the forum like LinkedIn, et cetera. But the reality is that it doesn’t happen. And so don’t you think we should, as companies, perhaps we should even perhaps more focus on making those products which are already there, make them available. And that’s probably much more successful than starting your own R&D, which will be difficult to finance and which will be highly difficult to get registered because of all the risks associated. It’s better to go to access problems.
Jay Iyer
Yeah, I think there’s two parts to it. Companies that today have research and development capabilities and have a product that is in research and development need to keep on board, right? And not abandon it. Because we cannot have a society where we have fewer and fewer companies to a point where no one’s developing the next generation contraceptive care. No one’s developing specialized antibiotics for drug-resistant urinary tract diseases, which affects predominantly women. So we do need to have that level of R&D maintained, kept and continuously invested in. Secondly, I think companies that have products on the market that can benefit women globally, need to look quite carefully about whether women are included in their access programs. And that can be done by understanding where your products are actually reaching, right? So there’s a lot of interest now in patient reach and building patient reach indicators as part of your corporate strategy to say we want to make sure that this is inclusive in the world, right? So, for example, cardiovascular care, do you think that all the products that’s available for cardiovascular care are also reaching women equally?
Henk Jan Out
And then it’s also a matter of definition, isn’t it? Because we traditionally define women’s health as the endocrinological disorders, hormone dependent disorders, whereas you can also look at it as you know all diseases that affect women more than men and then it, of course, goes across all the other therapeutic areas and that’s a bit of a different discussion.
Jay Iyer
Correct, but that is I think important for a company to realize right. And today there are also threats to inclusion and diversity in a pharmaceutical industry’s business due to the geopolitics that are out there. And we are at a point where we’re risking more and more companies disassociating themselves from women’s health. And you’ve already articulated it very clearly that so many companies have already left the basic contraceptive care, reproductive health care and rights.
Henk Jan Out
Yeah, and there are also many, even in the endocrinological field, there are still areas which deserve a lot more attention. For example, infertility. I’ve worked most of my life in infertility drugs. But we never concentrate on infertility as a problem in lower middle income countries, where it is a huge problem as well from a societal perspective. And so companies could also perhaps put a little bit more effort into making those drugs available in those countries.
Jay Iyer
Correct. So we’ve started a recent campaign called the HerLens campaign where we’re trying to get women, global women leaders who have actually been instrumental in driving some of those access solutions, working with the industry and public partners together to basically say: these are the things that we need, these are the things that work. And we’re trying to span across reproductive health and rights to breast cancers, ovarian cancers, all the way down to cardiovascular disease, fertility. So you can actually cover a range of areas where the industry can find a place to invest in and do better on. At the same time, I’m also excited about the fact that recently there have been a few key product access innovations that have made a difference, again, driven by partnerships. To give an example, Bayer is a German company, Bayer. They have a partnership with the UN Population Fund. And what they do is they’ve actually got their contraceptive care covered by access strategies across all country groups. So across upper middle income countries, low middle income countries and low income countries. So to give an example, in Egypt, they have an agreement with the local government of a price that allows more women to have access via the UNFPA procurement system itself. And in Uganda, there’s a UNFPA procurement and a donor program that actually drive access to their contraceptives. And historically, we’ve actually seen companies like Pfizer that actually had a particular product which allows women to self-administer a contraceptive, which I think has really drastically improved women actually reaching for contraceptive care. And today, via their accord, they have offered contraceptives in a not-for-profit basis available in countries that they’re active in. And just recently, just a few days ago, there was even an announcement where GSK’s drug, Gepotidacin, has been approved by the US FDA for urinary tract infections. And this is the new class of oral antibiotics for UTIs in nearly 30 years. So innovations are there. It’s up to a company and their partners to really drive that access so that no one sits behind and no one’s left behind.
Henk Jan Out
Yeah. And contraceptives is still a major one, isn’t it? I mean, there’s still enormous need for easily accessible contraceptives in low- and middle-income countries.
Jay Iyer
Yeah. Women are going to keep, you know, there are going to be more girls still being born and still reaching a mature age. And, you know, they’re faced with, you know, travel, work, and they’re faced with situations where they need access to contraceptive care.
Henk Jan Out
And it’s a way to prevent abortions and to prevent unsafe abortions.
Jay Iyer
Unsafe abortions also, yeah.
Henk Jan Out
And yeah, in the past, I was developed a bit in a project to make cheap IVF available. And IVF, in vitro fertilization, looks like a very, you know, like a treatment for rich people, and to a certain extent it is, and certainly in countries where it’s not being reimbursed. But you can, it’s such a sort of a generic technology in the meantime, it must be possible to do that in a relatively cheap way in countries where people can’t afford it. But that still doesn’t fly, unfortunately, but that could help also many people for their infertility problems.
Jay Iyer
Correct. I think the more we advocate for women’s needs and rights, the more we advocate for the fact that something is available, cheap, can be set up, the more we can show examples of activities that actually work, solutions that actually work. I think more people can be convinced that this can be done. And I do think that it’s not only a space for the large companies, it’s also a space for life science companies to really get involved in. Because there’s a niche and there’s a market. There’s huge demands for access.
Henk Jan Out
So, yeah, there is still a lot to be done. Also for the foundation. So, what’s next for the foundation? What’s coming up?
Jay Iyer
I mean, for us, we will always stay on course when it comes to bridging that gap. Especially now when we see that threat that all the progress that has been made is being dismantled. So for us, it’s really important to find the best practices and communicate about it, use our research insights to inform investments so that investments are actually increased. Investments from other players, as in some of the traditional players are not investing anymore. Investments from other players are actually brought on board. We want to make sure that the pharmaceutical industry, the healthcare industry across the different sectors remain invested in access to medicine for global populations, because again, reminding the fact that 80% of the world’s population are now fully aware and need access to treatment. So for that, I think that is still important for us, but we will keep looking for areas where there are severe gaps in access. And we’ll keep looking for organizations within the pharmaceutical industry that can actually bridge that gap. And there’s more and more. I think we noticed that now with climate change, there has been threats with just basic things like stoma bags or IV units being made only in one part of the world. So you do need to think about what are the areas which are, we have a fragile supply chain or we have a monopoly or oligopoly of very few companies making it today, either because of patents or because some products are just, you know, at the moment so too cheap to even produce for the pharmaceutical or healthcare companies. So they’re just not being made anymore, but we need them as a society. So we’re looking out for those areas and using our research to influence change.
Henk Jan Out
Right. And so what’s your ambition? How do you like to see the foundation in five years time from now? How does it look like?
Jay Iyer
I’m hoping that in five years time, we can show more good practices from the industry. And we would have had to, you know, we would see the kind of success we talked about how, you know, if 20 companies in the index all have an access to medicine strategy, I’d like to see drastic, you know, big change where all 20 companies can demonstrate the level of access. It’s a hard ask. It’s a lot. It’s a tough ask for five years, especially considering the fact that we’re sitting at a point where a lot of progress is being threatened. But I do expect that the pharmaceutical industry with its new generations and upcoming generations of leaders, upcoming generations of employees, investors, governments, communities are really saying enough is enough. We’re going to step up and do more. And we’re ready with our research and our insights to make that happen.
Henk Jan Out
Right. Well, that sounds fantastic. And one of the things I’ve always liked about the Access to Medicine Foundation is that you’re not judgmental, aren’t you? I mean, you’re just, you have your research methodology, you publish, you benchmark, and everybody sees we’re not doing well and we have to do better. And if you became very activistic, then probably many of those companies wouldn’t be willing to cooperate.
Jay Iyer
Correct. At the end of it, the industry often thinks that we’re too close to activists and activists believe that we’re too close to the industry. But you know, being independent comes with basically that label. And at the end, you know, there’s no point in judging if you cannot offer a solution. And a solution cannot be theoretical or just idealistic. It has to be a practical solution, ideally something that’s already happening. So I think for us, we are starting to see that that’s really important to us that, you know, we do judge the pharmaceutical industry’s actions, but it is against society’s expectations. We’re not judging them against our own expectations in that sense. So having that neutral position is really important.
Henk Jan Out
All right. Well, thank you very much, Jay, for coming to us and for telling us about the foundation. I wish you good luck in the future. I hope all your wishes will become true as you just described them. And you, wherever you are, thank you for listening to our podcast. And I hope you’re listening in next time again. Bye bye.
Dit was Leaders in Life Sciences, dankjewel voor het luisteren. Vond je iets van deze aflevering? Wij ontvangen graag jouw feedback. Wat houdt bijvoorbeeld jou bezig en over wie wil je meer horen? Laat het weten via een Apple of een Google review of stuur een berichtje via social media of natuurlijk gewoon per mail. Onze waardering is groot. Tot slot, nog dank aan onze partners. Dat zijn Pivot Park, Pedersen & Partners en Johnson & Johnson Innovative Medicine.
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