Norman Nashed: Can you explain what Novartis Social Business is and why the work it does is so important?
Harald Nusser: Novartis Social Business (NSB) combines five important access-to-medicine initiatives: Firstly, Novartis Access was launched two years ago to address the rise of non-communicable diseases in lower-income countries; secondly, there is the Novartis Malaria Initiative, which has been ongoing for 15 years and is one of the biggest access-to-medicine programmes in the industry. This particular programme has delivered more than 800 million anti-malarial treatments to the public sector without profit since 2001; then there is Arogya Parivar (meaning healthy family in Hindi), launched 10 years ago in India. It provides healthcare education to the poorest people in rural India. This programme also exists in Vietnam and Kenya, and we are looking to expand it further. Sandoz NGO Supply [Sandoz is the generic medicines division of Novartis] has a very broad range of products that are offered to international NGOs like WHO, UNICEF, Global Fund and so on. And finally, SMS for Life, an innovative public-private partnership led by Novartis that uses mobile and digital technology to improve stock management of essential medicines and increases the quality of care in sub-Saharan Africa.
NN: What specific issues has NSB encountered when carrying out this work in some of the world’s poorest communities?
HN: First, as a responsible company, it goes without saying that it is important for us to look beyond the usual business approaches – hence why we’re called Novartis Social Business. We need to look into the social externalities that our programmes generate, beyond the traditional financial KPIs. That is a disruptive approach in the sense that the traditional business model as understood by Wall Street is being expanded.
Through Novartis Social Business, and in particular Novartis Access, we have learned to accept that even though we don’t have all the answers, we should still try things out. For instance, we don’t know when Novartis Access will break even or exactly how we’ll get there. Being transparent and vulnerable means that we’re not expected – and indeed cannot – know all the answers from the get-go.
Non-communicable diseases are chronic illnesses that usually require lifelong treatment. So when we say we want to reach 20 million patients over the next five years, it means we will need to produce roughly seven billion pills per year: the biggest European pharmaceutical production plant has about that capacity. It tells you a lot about the scale Novartis Access may eventually have.
Internally, aligning a programme such as Novartis Access to the standard commercial operations of our company is challenging and requires substantial cross-divisional collaboration. This ranges from allocating manufacturing capacity to dedicating sufficient resources to run activities such as regulatory submissions. Intense discussions took place on how we could operate Novartis Access without running the risk of negatively impacting our core business in developing countries. In some countries, we are trying to build a new commercial business as well as a social business using the same products. So there’s a healthy tension in the system that needs to be managed, and you do that through optimising a diverse set of KPIs collaboratively.
NN: Internal collaboration, then, is key to reaching a compromise. But how do you collaborate externally with the WHO, NGOs, the Gates Foundation on one hand, and other, possibly a competitor, pharmaceutical companies on the other?
HN: First of all, you need to have all the internal conflict points resolved in order to be a good partner to any external group. Collaboration for me encompasses more than the usual or traditional partnership model. It means leaving one’s own comfort zone and co-creating something with the risk of failure – and learning from that failure. This also means that we may need to move away from the traditional public-private partnership model. This is why we are looking beyond our industry sector and exploring collaborations with competitors in the access-to-medicine arena. In areas such as diabetes care or oncology, beyond the critically important public health actors like the WHO and the Gates Foundation and many more, we also need industry-wide efforts to make a scalable impact.
What is key is to demonstrate tangible benefits for everybody. The usual notion of “we are good, they aren’t” is simplistic and shouldn’t be used anymore in the era of sustainable development goals. I would argue that it’s always for profit also for NGOs. Not necessarily financial profit, but for the profit of having done good and really moved things in a positive way – and eventually getting the recognition for that.
A key benefit, for example, for us is employee engagement. Attracting and retaining talent today is inevitably linked to a sound social agenda.
NN: Can you provide an example of really effective public-private collaboration?
HN: We have just signed a Memorandum of Understanding with the Government of Pakistan to roll out Novartis Access. Novartis Access medicines will be made available to the poorest population through hospitals under the Prime Minister’s National Health Insurance Program. We expect first treatment deliveries by early 2018. For me this is a success story in two ways: on one hand, internally, the local Novartis commercial organisation was determined to make this programme a reality, and, on the other hand, the Pakistani Government was overwhelmingly positive about the programme and made things happen quickly. We had a press conference with the Pakistani Minister for National Health Services Regulations and Coordination in May during the WHO Health Assembly in Geneva, which exemplified the keen interest of the government to help its people. This is critical collaboration in practice.
NN: Do you have any final thoughts?
HN: We have started a journey which is far from being straightforward. This is a huge change programme with lots of ambiguity and diversity of thought and perspective. Putting this in place and looking to impact public health policies around the world, being perceived as a constructive disruptor and being part of the solution, for me, is incredibly exciting.
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