You have just arrived as general manager in January 2011. Coming to a new market obviously means a new context, different challenges and so on. Can you first elaborate on your key priorities as you took over?
There are at least two levels of priorities when you arrive in a new country. The first one is to understand the country itself, meaning the social system. This relates to how people live, how they interact, how their relationship with work and government is, and so on. With other words, it goes beyond understanding healthcare alone.
At a second and interlinked level, it is essential to identify what the key points of discussion are between the people, the industry and the institutions. I arrived here after spending 5 years in the USA, which was in the midst of its healthcare reform. It has been very interesting to see how in the US there is a capacity and ability to move people. Apart from the discussions in the House of Representatives for example, there are numerous groups of interest that play a vibrant role, such as patients associations.
I first tried to identify how the Romanian system worked, and tried to relate my findings to my previous experience. The Romanian environment, where you have one payer, is much closer to the Italian system. There is one main stakeholder that takes care of the bills. An utmost fascinating aspect I faced upon joining this industry, was to see that – at best – there are 3 relational elements. The ones who use the product, the patient, is not the one buying. The one that gives the prescription, the decision-maker, in turn will neither use nor pay for the medicine. Lastly, the party that pays for the product is neither the decision-maker nor the final consumer. These types of interactions are a very interesting aspect of the industry, and were a key point to understand upon my arrival in Romania.
In a second instance, I spent my time on understanding the organization internally. Like many other affiliates in this market, the Romanian subsidiary has been an organization that has been fairly successful for many years. How can we further leverage our core areas where we do very well? Which areas do we need to rethink or bring to a next level? These were my priorities during this initial “exploration phase”.
Overall, the GM position at Lilly Romania seems to have been quite popular lately. After Marius Savu left in 2007, the company saw 2 more general managers until you took over this year. Has this been an issue for the continuity of the business?
Every time you change a position that has a direct influence on the organization at large, such as the one of general manager, you will get a certain disruption. However, internal decisions are always balanced, meaning that every disruption is weighed off to its respective benefits. One part I particularly like about Eli Lilly is the aspirations of the people here. A lot of leaders in the industry have either passed through this office or another branch of Eli Lilly worldwide. This is something I am very proud of. It shows that Lilly has been able to give them a certain set of skills and knowledge that were very interesting to be tapped into by other companies.
Coming back to the success of Lilly’s Romanian subsidiary, can you expand on the importance of the Romanian operations for Eli Lilly worldwide?
We are part of the Southeastern European cluster, which includes all the former Yugoslavian countries, Bulgaria, Malta and Cyprus. Romania represents roughly half of these entire operations. However, while size matters, it does not tell the entire story.
A particular aspect I am very proud of is the fact that Lilly holds approximately 20% of the clinical studies that are being run in Romania. Clinical trials and innovation at large, is such a key point of our business model. Pipeline is already the most frequently used word in our industry, and provides the cornerstone to identify where our strengths and weaknesses lie.
The exact targeting of patients that require the type of help we can offer, is exactly what drives us overall. We are now talking about more than 70 molecules in Lilly’s pipeline, of which 33 are in phase II and III. The mere fact that we account for 20% of the clinical trials in Romania, symbolizes how important the country is in terms of investment for Eli Lilly.
In 2009, out of the 288 requests for clinical trials, the national agency approved 233 studies. This also means that Romania recognizes the importance of clinical trials in the country. Through our investments we also bring a culture of very high standards. I then not only talk about the scientific and statistical standards of a trial, but particularly about the ethical standards. It defines how good we are in keeping the potential benefits for local patients very high, and demonstrates how good we are at protecting their safety. By bringing this knowledge, we increase the visibility, the expertise, etc. of the researchers in the country. It is a virtuous cycle. It is a platform for them to have more contact with other medical centers in Europe. It increases their knowledge and makes them better researchers, which in turn has a positive effect on the patients’ safety. At the end of the day, these researchers are also the people that treat the patients in Romania.
How do you explain that Lilly reached this 20% level in the first place, and that other companies may not have tapped into this potential? Do you feel it is a priority for the government?
Other companies may probably have some of their centers of excellence in other locations. First of all, in terms of government commitment, I do not feel that clinical trials are not being supported. Looking at the numbers again, the great majority of the requests for clinical trials have been granted lately. However, getting an approval mainly depends on what exactly the company is planning to do, the way it wants to do it and what it is able and capable of putting on the table. As long as we are able and successful at keeping our level of standards high, there are generally no barriers to engage in clinical research. At the end of the day, clinical trials are a sign of stability for a country. In our case, the investments in Romania imply that we are here, and planning to stay here. Maybe the government does not provide clear incentives to do clinical trials in Romania, I firmly believe that approvals can be obtained if you do things the way they should be done. Again, Lilly is committed to making sure that its partners, i.e. the researchers, hospital staff, and CROs, deliver work that corresponds to our company standards. By engaging in such knowledge exchange, you end up with a well developed network that will facilitate the next clinical studies.
What does Lilly’s current portfolio in Romania look like? What are the biggest therapeutic areas for you here?
The first three main therapeutic areas in Romania are cardiovascular, psychiatrist and metabolic. First of all, it is worth mentioning that it is often the diagnosis that can makes the difference. I personally come from a very rural area in Italy where depression, for example, carried a social stigma for a long time. Depression has been considered as a luxury that people were not “allowed” to have.
Data in Romania show that the work of psychiatrists has been very well developed. They have a high interest in what is going on in other countries, and overall try to enrich their area of expertise. Lilly’s global reputation in CNS, with no exception for Romania, is very strong. Unfortunately, apart from depression, other psychological problems such as schizophrenia are quite prevalent in this market. This is also why Zyprexa is still one of our biggest drugs here.
When I joined Lilly in the first place, I knew Prozac better than Lilly. This is because Prozac, at the end of the day, dramatically changed the interaction between the doctors and the patients, as well as the outcome and the life of depressed patients. Zyprexa too, made a huge difference on the social functioning of patients, and directly improved their lives as well as the lives of the people around them. This was, and has been for many years, Lilly’s main focus in Romania.
Today, products such as Cymbalta exemplify Lilly’s new generation drugs of anti-depressants, representing a switch from SSRI’s to SNRI’s. Again, we have strongly focused on what difference a new drug can bring to the patient.
There are of course also some other areas that we focus on. For erectile dysfunction, our molecule Cialis has been proven to be a gamechanger in the lives of patients. Again, this is another area where the social stigma is significant. The medicine represents another way for Lilly to drastically improve the quality of life of its patients.
We do see quite some competition in certain areas such as diabetes care for example, where there is strong leadership of Novo Nordisk …
In my view, competition is healthy and avoids an organization to become complacent. In terms of the problems the Romanian people face, diabetes is obviously another key area. As I briefly mentioned before, I have just returned from the US, a country where diabetes hits the news headlines daily. Eli Lilly has historically been the company that introduced commercial insulin. For many years, we have had a strong presence, acting as a strong partner towards patients and the medical community in this area. While this presence reduced slightly a few years ago, Lilly has again massively increased its efforts in this area more recently.
Of course, Lilly’s re-emergence in diabetes has been successful, for the very reason that it is an area that is deeply rooted in the company’s DNA. Following the 2009 reorganization within Eli Lilly worldwide, diabetes has once again become a key area, next to oncology and biomass. This was a clear message that showed how Lilly is adjusting its pipeline to what is needed in the market. This message was further complemented with our actions in terms of alliances. Our cooperation with Boehringer Ingelheim lately, has been a pragmatic alliance that really said “we are going to be here, and we are going to stay here”.
Such partnerships are indeed clearly the way forward for the industry. How do you manage and nurture such cooperation on a daily basis?
I am not afraid of “contaminations”, with which I refer to any kind of interaction at the level of the industry and the institutions. When you start a partnership you look at two things. First of all, you look at what resources you can share, what synergies you can build to enhance efficacy and efficiency, etc. Secondly, we really try to stand behind the values and the way we work. It is a challenge for me to keep the highest ethical standards on a daily basis, ensure compliance, and so on, while meeting my goals at the same time.
In my daily life, I dedicate a lot of time to partnerships like the one with the Ministries of Health and Education on awareness programs for ADHD. You need to be clear on what you want to achieve, which in this case was the better access to medicine. Essentially, it all comes down to allowing the aforementioned “contamination”. From day to day, you may have converging interests with many different parties, including distributors, technology suppliers, and so on. If this contamination leads to an increase in the standard of care or the usability of the products you make available in the market, this should be welcomed.
Of course, it remains crucial to be able to communicate in a clear and meaningful way. Without clearly communicating to our own marketing people what value means for our partners and stakeholders, we cannot have a meaningful conversation with the nation’s medical community.
Today, Lilly is the 12th largest company in the Romanian market with a 2.4% market share. Looking forward, where do you want to take the operations in the coming 3 to 5 years?
Rather than focusing on exact numbers, there are other factors that would make me happy. I would be very satisfied to see that healthcare providers, patients and government officials know what differentiates Eli Lilly from other companies in the industry. We really try to put a lot of effort into our corporate behavior, in the way we work, and how professional we are. This of course does not need to come via words alone, as actions can often say enough.
On a more personal note, we see that you have obviously had quite significant professional experience abroad. How has this affected your personal management style?
No matter where you go, organizations are groups of people. It is of utmost importance to understand these people in the first place. Organizations can only be successful as long as its people are successful. What I try to do, is to enter into their reality. Instead of reading a descriptive book on a country for example, I find it far more useful to read the local literature. This tells you much more about a nation.
Talking about people and in order for them to be successful, you need to keep motivation levels high. Therefore, it is important to have the right people and the right talent in house, and additionally really try to understand them, in order to know what is important for them in their lives. In my opinion it is not possible to differentiate how a person is satisfied or happy in their personal life and their work life. Aligning both objectives and lives requires a thorough understanding of the people at a personal level.
What is your final message on the commitment of Eli Lilly to Romania?
We are active in an industry that undergoes change. If we look at the progression we have experienced from a scientific and organizational point of view, the situation has been very different between from decade to decade. However, change is in fact the constant. We have to learn how to read the world outside us. The world moves much faster than the industry, and it is our commitment to catch up with this speed. This is a sine qua non to be able to deliver innovation and value in the way the overall society defines it, and henceforth match its expectations.