Philippe de Pougnadoresse, country president & general manager pharma for Novartis Belgium & Luxembourg, outlines his affiliate’s fast and comprehensive response to the COVID-19 crisis, what can be learned from it, the importance of Belgium to the European group, and the challenges of launching gene therapy Zolgensma® in Belgium.
Here in Belgium, we have a perfect match between country and company, as both thrive on innovation
Can you begin by outlining your career trajectory?
I have about 20 years of experience in eight countries across Europe, the US, Asia, and Australia in three sectors: cosmetics, not-for-profit, and now pharma. My career path is somewhat unconventional, having started at L’Oreal, which gave me a lifelong passion for innovation, and then spending a year in Cambodia running a humanitarian project as a volunteer. I also gained an MBA from INSEAD.
My experience in remote Cambodia was the first time I realised the shocking truth about populations deprived of basic access to healthcare. This was a wake-up call and led me to join the pharma industry in 2002. Since then, my goal has been to have a positive impact on access to healthcare wherever I can. This passion for access is something I have in common with my Novartis colleagues; we are all here to make a difference for patients.
This is your second country manager role; your first having been in Vietnam. How has the experience of moving from an emerging to a developed high regulated market like Belgium been?
What struck me in Vietnam was people’s incredible appetite to learn and grow and their openness to taking risks to experiment! Competency levels are high in Belgium and it is a privilege to work here. In Europe, we have an opportunity to be curious about what is happening in these emerging markets and be inspired by their passion to try new things.
What is the scope of the Novartis franchise in Belgium in terms of team and infrastructure and what is the significance of Belgium to the European group?
Belgium is a very important market for Novartis. The company’s vision is to reimagine medicine using science-based innovation to address some of society’s most pressing healthcare issues. Here in Belgium, we have a perfect match between country and company, as both thrive on innovation.
Interestingly and rightly, back in 2017, the then prime minister Charles Michel named the country the ‘pharma valley of Europe’ and designated pharma as a strategic national sector. We have invested hundreds of millions of euros for years and now, beyond being recognised as a top employer in Belgium, we are a top pharma leader in this country in terms of innovation and ensuring our products access the patients.
We have more than 2,000 employees here across production, distribution, clinical trials, sales and marketing, and support functions. Novartis is the country leader in clinical trials, with 150 ongoing trials serving 2,500 patients and providing Belgian patients with first-line access to new and innovative treatments. Last year we were number one in market share for pharma, including revenues from our generics and biosimilars division, Sandoz, and we are growing faster than the overall market.
One thing that separates Novartis Belgium from other affiliates is our huge production facility in the Puurs-Sint-Amands municipality, Antwerp, which has been operational since 1977. This is our global flagship production site for visco-elastics and eyedrops. In 2017, we inaugurated a state-of-the-art analytical lab and a world-leading filling line for biologics. We are continuing to invest and modernise to prepare Belgium for the future and have invested over EUR 100 million over the last five years with plans to make further investments into some of our most radical technologies here in Belgium.
On that note, I would like to acknowledge the 1500 employees at our production site who have not stopped working during the COVID-19 crisis. They are serving millions of patients across 155 countries.
If any pharma player is well-equipped to shift to digitalisation and teleworking as a result of COVID-19 it is Novartis, which has been promoting digitalisation and an unbossed culture for a long time! How is Novartis Belgium living this current crisis?
Novartis is in the middle of a huge cultural transformation journey to one that is “curious, inspired and unbossed.” The COVID-19 crisis has shocked the world and taken its death toll on humanity, but I have truly been inspired by the caring behaviour I have observed and the many acts of solidarity at the heart of the crisis. As a sector, we offered a united front to a crisis that has revealed our true nature as a nation, as an industry, and as a company. It has been a great opportunity to demonstrate our culture and we take pride in having taken quick and bold decisions right away to protect our employees and support Belgium.
I have three examples of these quick and bold decisions that we made locally on top of Novartis’s global response. Our first decision was to donate our stock of 100,000 masks and gloves as well as 1,000 protective suits to the Belgian authorities to protect the healthcare professionals at the beginning of the crisis when they were badly lacking. We also donated EUR 350,000 to four Belgian organisations fighting the coronavirus in different ways: the Belgian Red Cross, the Samusocial taking care of the homeless people in the context of the virus, and two COVID-19 reference hospitals. The last example is the partnership we struck with Philips to reimagine medicine through data and digital, whereby we created an app that allows healthcare providers to screen and monitor their COVID-19 patients remotely. We are working with several hospitals to give them a free license for this state-of-the-art app.
In terms of partnerships, we are a strong believer that one company alone cannot do enough; we need to collaborate with others and break the silos to fight COVID-19.
What lessons from the COVID-19 crisis will Novartis Belgium carry on into the future?
We have been using the expression, “no-one should waste a crisis” and have learned a lot over the last few months, both as a company and as a society. Novartis Belgium has accelerated its digitalisation journey in an unprecedented way and we absolutely need to capitalise on this.
A crisis like this is perhaps the best possible opportunity to show that we truly care for our employees. The last few months have been quite traumatic for everyone and we have decided to focus on our employees’ physical and psychological safety and wellbeing. This is already paying off, as the company conducts a survey on worker engagement every quarter and the most recent results from May are at an all-time high.
At the start of the crisis, Novartis was the first pharma company in Belgium to ask its employees to work from home, starting with medical representatives, to give healthcare professionals the courtesy to focus on their patients. We also kept constant and open communication channels to stay connected with our employees to steer our decisions – that is going to stay. We surprised our employees with a gift box for the Easter break to stay fit and energised at home, as well as a care box with all the materials needed to come back to work safely.
Our employees have full freedom to come back to their office activities at their own pace. The way we look at work-life integration and working from home is going to change. During this summer we are going to harness the collective intelligence of our employees to define together what the new normal will be, no doubt incorporating greater homeworking flexibility.
With our new CEO Vas Narasimhan taking us into a new era of data and digital integration, we were very fast in providing our employees and their families with a whole suite of digital training from week one of the crisis. As part of our push to encourage our culture of being curious, we also organised a series of weekly calls on agile leadership, leading in crisis, and the art of being in an unbossed team, among other topics. We will not waste this crisis, but rather capitalise on the good things we have done and collectively co-create the new normal.
Moving into operation and strategy, in an economy that is growing very slowly and with a relatively stable healthcare system, what mandate does Novartis give to a Belgium country manager?
European markets are growing more slowly than those in the Asia Pacific for sure; when I was in Vietnam, the market was growing by 20 percent every year, for example. However, Novartis Belgium, as a leader in innovation, grew twice as fast as our market of reference in 2019, despite no new product launches.
Growth is always possible when you have a world-leading pipeline and introduce new innovation. At Novartis, we have invested for years in an industry-leading R&D engine because we want this engine to serve our ambition to reimagine medicine. However, that alone is not enough. Under the leadership of our global CEO, we keep expanding our innovation gameboard. On top of our own R&D engine, we are making bolt-on acquisitions in radical innovation platforms such as AveXis and Advanced Accelerator Applications (AAA).
As country president of Novartis Belgium, I am expected to ensure that we collaborate well with the various stakeholders in the country to pave the way for our innovation to reach Belgian patients.
In what direction do you sense that the Belgian government is moving in terms of embracing innovation, given the country’s political instability and the ‘Industry Pact’ recently coming to an end?
First, aside from COVID-19, we have lived through an unprecedented time of political instability in Belgium. However, for the next five years, I see strong fundamentals for future growth. I believe that Belgium and its government deeply care for patients and are willing to bring the best innovation to them. It is a land of innovation. Belgium is a European leader in clinical trials for example, because of its high-quality research centres, dense medical infrastructure, real-life experience of investigators, and rapid start-up timelines. As Novartis is number one in clinical trials here, we are driving a lot of this innovation.
Belgium is at a turning point in terms of its collaboration with pharma. We need to open a constructive new chapter together. I personally believe that Belgium has everything it takes to maintain its ‘pharma valley of Europe’ label in the coming years. It needs to position itself at the forefront of innovation, as some other countries have started to do, and really establish incentives for companies to invest in transformational technologies like cell and gene, radioligand, and immuno-oncology therapies. This is where Belgium can, and should, make a difference. Additionally, Belgium needs to remain an attractive place from a business standpoint for pharma to continue to invest. It is critical that the country invests in effective, flexible, timely patient access to innovation.
How challenging is the market access situation in Belgium today?
Patient access is the biggest challenge and opportunity for the global industry. Most governments are facing budget challenges, so it is important to go back to our common objective – to serve society better. The only way we can do so is not to work in silos but to collaborate in an open, humble, and transparent dialogue with all stakeholders.
For example, in collaboration with other stakeholders, we recently created a thinktank on advanced therapy medicinal products (ATMP), the most radical and transformative innovations in healthcare today. Novartis is taking the lead in bringing stakeholders together to find access solutions for innovations that do not fit within current pathways. We need to find solutions together outside of the box.
One of these new solutions is Zolgensma®, the company’s proprietary gene therapy for the treatment of paediatric patients with spinal muscular atrophy (SMA). How does this therapy fit within your portfolio and why has it generated such strong debate?
One of the key tenets of our new culture is our curiosity. We are curious because to deliver on our mission of reimagining medicine, we have to explore the most advanced fields of healthcare innovation. We have our own R&D engine, but we also continue to invest in external acquisitions to expand our innovation gameboard. This includes very radical innovation like AveXis [the original developer of Zolgensma® – Ed.] and AAA because we want to have a presence in all healthcare innovation R&D platforms of the future.
We are making big bets. Zolgensma® is the most striking example of a real gamechanger. The therapy received EMA approval in May 2020, the first such approval for an SMA gene therapy, which gives new hope to parents of children with SMA. This is a one-time intervention, moving away from chronic maintenance treatments to a disruptive therapeutic breakthrough. This therapy addresses the genetic root cause of SMA in a one-time infusion. To me, a non-scientist, it is akin to science fiction becoming reality.
We understand that reactions in Belgium regarding access to Zolgensma® pre-reimbursement have been strong and emotional, which is normal as it concerns the lives of children and the impact it has on their families. I am father to an 18-month old child, so I completely empathise with the distress it can generate for parents. The longer a child with SMA waits for treatment, the more damage will be caused. Finding an early access solution is, therefore, our number one priority.
Reflecting on this one year on, the development of our managed access program (MAP) for Zolgensma® has been an excruciating ethical dilemma. We had significant production capacity limitations, yet our goal was to help patients across all markets, including where there is no access. We wanted to give an equal chance to any child in the world to have access to our revolutionary treatment. We did not want to be a company that dictates which children do or do not get treated. We sought guidance from an external panel of independent international bioethical experts to design this “first of its class” Zolgensma® managed access program (MAP) because we did not know how to do that; there were no reference points or precedents.
They advised that the medical criteria alone was not enough as there were still too many potential children in the pool of patients, so the best thing we came up with based on their guidance was to apply the same randomisation methodology that they use in clinical trials. We realise that this solution may not be perfect; we have always kept an open mind and invited our stakeholders to a constructive dialogue.
With Zolgensma® we are entering unchartered territories. This therapy has generated profound societal questions for which we did not have all the answers immediately. It has been a time of trial and error and we have learned a lot, at times, the hard way. That is the price to pay for being a pioneer, but again we have constantly kept an open mind and challenged ourselves in the first place. We have been able, from Belgium, to elevate this topic and talk about it with our global CEO, who was genuinely open to the challenge and helped us try to find better solutions.
Moving forward, I trust that together with stakeholders we can find sustainable access solutions. This will demand more work as these revolutionary one-time treatments do not fit in the current boxes.
What has been the impact of the introduction of Zolgensma® on the wider stakeholder community?
It has been disruptive for all of us. If I could do it again, to avoid this tsunami of emotions that did a lot of damage, I would engage with the government, patient associations, healthcare providers, hospitals, and the media much earlier to explain and start co-creating solutions as a company and as an industry.
That would have hopefully spared a significant emotional impact on the impacted families, like the one from baby Pia, in the first place, in the general public and finally, on our employees who were appalled by how Novartis was portrayed in the media. There was such a gap between what we live every day together as a community of co-workers, serving a better life for patients, and what was being said in the media. During the crisis, we stayed very close and well connected with our employees to explain what was happening via regular candid dialogue sessions.
2020 has been a very unusual year so far, but what are your expectations for this year and next?
Our business performance was negatively impacted by COVID-19 in Q2, especially our hospital drugs. However, the impact on us in the pharma sector is not as severe as that in other sectors. Novartis Belgium had a very strong start to the year, but because of this negative impact we will grow in the low single digits for the full year, assuming the Belgian government does not trigger a second lockdown. It is difficult to predict what will happen next year with the new pharma saving measures and the consequences of the COVID-19 crisis. It will also depend on what we can put in place with the hopefully soon-to-be-formed Belgian government.
Looking at the short- to mid-term in 2021, we have a firework of innovation coming up. Novartis has 25 potential innovations in the global pipeline. In the next 18 months, we hope to gain reimbursement for transformative treatments in different therapeutic areas like neuroscience with a new migraine treatment and new treatments in Multiple Sclerosis, in ophthalmology with a gene therapy in retina and wet AMD, in respiratory with new asthma treatments, and in addition, we also hope to be able to bring two new oncology & haematology innovations to patients with advanced breast cancer and for sickle cell disease.
Several Novartis executives with global roles were country president in Belgium at some point. What sort of skills do you develop when managing a small but complex market like Belgium?
It has been a learning ground for leaders who inspire me. Belgium is a mid-sized but complex and multifaceted market. My current role covers a wide range of activities, from manufacturing to drug development and clinical trials, commercialisation and public affairs with the European Union. It makes Belgium a very comprehensive experience.
There are a couple of attributes that uniquely set Belgium apart, best embodied by two Belgian artists. The first is the surrealist painter René Magritte, most famous for his 1929 work The Treachery of Images, alternatively known as This is Not a Pipe. Belgium is at times positively surreal and more complex than it first looks. The second is the cartoonist Hergé, the creator of The Adventures of Tintin. Hergé’s work really says a lot about Belgium’s ability to innovate and show resilience throughout its history. To navigate the complexity of the Belgian market, leaders here need to navigate complexity and be innovative and resilient.