Medtech industry veteran Sanjay Prabhakaran outlines the footprint and strategy of women’s health specialist Hologic in the dynamic Asia-Pacific region, how it leveraged its molecular diagnostics expertise to pivot towards COVID-19 diagnostics tests in 2020, and the leadership lessons he has learned from a 30-year corporate career with US multinationals.
Governments are now gearing up to the reality that without routine cancer screening of the population, the COVID problem may be addressed, but a bigger challenge with cancer is potentially looming in the years ahead
Sanjay, you have had quite an illustrious career in big medical device companies across Asia-Pacific prior to joining Hologic in 2016. Could you begin by introducing yourself and your career trajectory?
My childhood was quite nomadic as my father worked in the Indian Armed Forces, because of which we moved around a lot. I was born in London, grew up in India and 20 years ago moved to Singapore and became a naturalised Singaporean. During my career, I have lived in China for five years and worked for most of my 30-year corporate career with US multinationals.
I am an electronics engineer and joined the healthcare industry as a service engineer for Boehringer Mannheim GmBH, which later became Roche Diagnostics. I very quickly moved from service into a sales role on the advice of a mentor and later worked for the medtech industry with companies like Boston Scientific as one of the first 20 employees when the company was establishing their presence in India and Southeast Asia. After that, I joined Baxter with responsibilities for ASEAN, China, and later the entire Asia-Pacific region. I joined Hologic as President for the Asia-Pacific region five years ago, breaking my run of coincidentally working for companies beginning with the letter ‘B’! I have lived in Singapore for over two decades and both my daughters and wife see it as our permanent home.
As this is PharmaBoardroom’s first time speaking with Hologic, could you introduce the company, especially for our non-US audience?
Hologic is one of the few companies globally that is focused on women’s health. Men may feel a little out of place with our portfolio, because everything we do predominantly is for women’s health. We work in the areas of breast and cervical cancer detection and women’s reproductive health and well-being. I do not think any other company can claim to do more for women than what Hologic does for women across the globe. Most of our focus is on prevention as early detection of breast and cervical cancer leads to much better treatment outcomes; therefore, it has always been our goal to advocate for preventive screening.
Hologic Global Women’s Health Index in partnership with Gallup is being launched at the World Economic Forum (WEF) later in the year and is the first global measure being used to track the progress of women’s health and our promise to bring better care and treatment to 3.9 billion women globally.
Even though I had been in the healthcare industry for over 25 years before I was headhunted to join Hologic, I had never heard of the company’s name. The brand was little known in Asia and had a limited international presence because of its historical focus on the US and, to a lesser extent, Europe. This is also a great opportunity for me and my colleagues in the region to launch innovative products and technologies and build the Hologic brand awareness with our customers and patients.
In the last several months, we have received significant attention for our COVID-19 tests that have been rolled out globally at very short notice. Hologic has very strong expertise in molecular diagnostics, with a high throughput automated system called Panther on which we have been performing tests for cervical cancer, virology, sexually transmitted diseases, and flu.
During the COVID crisis, we were able to quickly pivot and use our existing technology and platform to develop and scale up the COVID assay to turn adversity into opportunity and become a larger contributor to COVID testing across the globe which has allowed us to help countries and economies get back to normal sooner.
2020 has seen a drop in routine testing and treatments for non-COVID related indications, which has impacted diagnostics firms’ bottom-line revenues. However, as you have mentioned, there is also an opportunity to step in with COVID-related tools. How was 2020 for Hologic in APAC?
2020 was indeed a challenging year for us and no different for preventive healthcare in Asia which was the first to witness the Covid outbreak and its business impact. We also learnt to operate virtually with our employees, customers and continue to support the patient needs remotely. With the lockdowns and containment measures that were put in place across many countries, there was clearly going to be an impact across those businesses because not many women felt comfortable going into a hospital environment when the perceived Covid risks were high.
However, we saw that very quickly things started to change once countries put safety measures in place. Cancer does not stop for COVID, which has been our primary message throughout the pandemic. Governments are now gearing up to the reality that without routine cancer screening of the population, the COVID problem may be addressed, but a bigger challenge with cancer is potentially looming in the years ahead.
COVID-19 has also pushed diagnostics more to the forefront of healthcare conversations. Do you foresee a re-evaluation of the importance of diagnostics moving forward?
Absolutely, one positive outcome of this pandemic is that healthcare awareness about quality testing has risen. This has been true on an individual level where consumers today talk about Covid PCR and Antigen tests with some level of awareness, but also more importantly governments are now realising the importance of investing in high-quality diagnostic testing capacity and capabilities. COVID shone a light on those countries that had been well-prepared post SARS in 2003 but in reality, no one was adequately prepared for the magnitude of the Covid pandemic.
We believe that governments need to start thinking proactively about advance purchase agreements for better pandemic preparedness, to build the capabilities and infrastructure to do testing on a massive scale. If a country does not have some level of capacity and capability built for routine testing, then during a pandemic it is very difficult to scale up as engineers cannot travel, trainings cannot be done at short notice, and staff must start from the basics on a product, technology, or platform for which they have limited or no experience. Time is of critical essence during a pandemic as Covid has taught us the hard way. Risk management is like a seatbelt in a car; most of the time you do not need it, but in a crash, it is the difference between life and death.
During COVID, we got our engineers on the front line to install the machines and conduct remote training where possible. Hologic has installed a significant amount of Panther machines globally, which has helped us to perform millions of COVID tests across the globe.
Asia-Pacific is a region with a great variety in terms of levels of healthcare spending, GDP per capita, and population numbers, which must lead to discrepancies in ability and willingness to invest in these kinds of tools. How do you manage such a diverse region?
This region has countries with significant disparity on many different economic and health indicators. The heterogeneity of these countries within Asia-Pacific is what makes it exciting for business leaders to embrace the challenges and shape the healthcare landscape to make a meaningful impact on human lives.
Managing this diverse region needs leaders to be agile, willing to take risks and deal with a significant amount of ambiguity as we do not have well laid out healthcare road maps in several of the ASEAN countries which are looking to healthcare leaders from the business community to help them build the right capabilities. This is the biggest contribution healthcare leaders in Asia can make by working closely with the governments in engaging and addressing the three key barriers of Awareness, Access, and Affordability.
I take tremendous satisfaction in my 30-year career journey with several leading healthcare companies, I have been fortunate to shape the healthcare practices and bring in new technology that is making a meaningful difference to the patient, physician, and the payer. During my Boston Scientific days, we shaped the treatment for coronary artery disease from bypass to Angioplasty and todays this is the first line of treatment. Similarly, in my Baxter days we worked closely with several governments to introduce home-based Peritoneal Dialysis (PD) as the main treatment for End Stage Renal Disease (ESRD) and allow a patient to be treated in the comfort of their home and be an active contributor to the community.
In recent times at Hologic, we have been working closely with governments on establishing breast cancer screening guidelines using 3D as the screening modality for improved cancer detection. Similarly, we are actively recommending Liquid Based Cytology (LBC) as the means for Cervical cancer screening versus the conventional pap smear which has significant drawbacks.
What opportunities are there for greater harmonisation and collaboration between countries in APAC, perhaps led by the likes of Singapore?
Harmonisation is linked to the question of establishing what “good” looks like. What good looks like in one country may not be replicable in another where the circumstances are different. Attempting to replicate something one-for-one in a developing country that works in a developed country with higher GDP spend will probably not be a good solution. However, there is a stakeholder willingness to establish what a good outcome looks like and how it can work in a developing country context. There is a greater opportunity to simplify the regulations in several of the ASEAN countries which will allow for faster access to the latest technology benefiting the patients.
The toughest job in healthcare belongs to the Ministry of Health. It is truly a challenging task and therefore industry stakeholders need to put themselves in the MOHs shoes. We need to understand that they are trying to keep costs down so that a larger part of the country’s GDP can be spent on more revenue-generating growth drivers while at the same time ensuring that the population is healthy and has access to good healthcare. Bringing these two diametrically opposed views together takes a considerable effort, so by working in partnership with the payers and providers we can come up with solutions that can be beneficial for all.
Hologic seems to be in growth and acquisition mode currently, with three acquisitions already this year, in addition to the massive shift into COVID-19 diagnostics. How do these global moves filter into your operations in APAC?
Five years ago, Hologic had a much smaller presence in this region as a predominantly US-centric company with a large proportion of revenues in the US. However, a significant shift has happened in the last five years, which will only increase over the next five years as access to healthcare expands in Asia.
Many of the recent acquisitions of Hologic are outside the US, which represents a great opportunity as a lot of the products we are acquiring will be launched in our region faster. Everything we acquire helps to solve a healthcare problem; we are bringing in technologies in the adjacencies to where we currently work and aim to add value to our customers in solving their patients’ problems.
As an example, in our breast health business, we are focused on detection, but we realised that we needed to make the mammogram experience better for women. With our in-house SmartCurve technology, we have been able to significantly reduce the pain that women suffer during a mammogram, which had been a barrier in getting more women to undergo the mammogram in the past.
To what extent is Hologic APAC merely the recipient of innovation? What opportunities are there for APAC to be the source?
In my role as Head of Asia Pacific, I am a member of Hologic’s global leadership team and have a common goal to drive innovation that is beneficial for the region as much as being a recipient of the innovative products that our global R&D teams develop. We have regular interactions of physicians from our region with the global R&D teams to provide the voice of the customer that helps in identifying specific regional needs for Asian patients. It is important to note that although we are in the Asian geographic space, there are many Asians in the US and other parts of the world too. Sometimes a need arises with an Asian subset in the US which is applicable for a larger Asian population and vice versa.
We are always exploring collaboration opportunities and partnerships with the start-up community in the region. There are several countries wherein the start-up community is very vibrant, and we have innovative companies working on areas of interest and we continue to build relationships to guide and mentor these start-ups that will eventually be able to move from concept to a commercial product.
Following a challenging 2020 for us all, what are your goals for Hologic APAC over the next couple of years?
In my career, I have worked for companies across many different modalities but joining Hologic was my first opportunity to do something for women. As someone who lost my mother to ovarian cancer at a relatively young age and having a wife and two daughters, this is my personal motivation and inspires me to make a meaningful contribution to them.
Breast cancer and Cervical cancer are among the top two cancers with more than 450,000 women dying in the Asia Pacific region from these two cancers. We know from clinical studies that breast cancer and cervical cancer if detected early and treated in a timely fashion, can save many lives, and impact the mortality rates. Therefore, our goal in this region and across the globe is to detect cancer earlier. We continue to engage governments to establish routine breast and cervical cancer screening, I believe with this goal, we will achieve a significant milestone for women’s health and make a meaningful difference to women’s lives.
On a personal note, what are some of the lessons you have learned in your leadership roles over the years?
When you look beyond having a vision for the business and the right strategic drivers then it is all about having the right people in your team. Every day I ask myself if I have the best leadership team because you cannot achieve much without a great team. Working across multiple cultures in Asia Pacific means you learn to adapt yourself as a leader to the cultural nuances without compromising your core values and principles but being sensitive to the people emotions to connect effectively and be a better leader and human being.
Dealing with ambiguity and being aware that in Asian countries there are different ways to solve a problem, and often requires a nonlinear approach. A good example is how China skipped landlines and went straight into a mobile phone network. That is the similar thought process needed in healthcare given the infrastructure limitations in following the western model.
One of the biggest challenges in my career was in 2010 being asked to lead Baxter’s business in China with over 5000 employees under a very challenging business situation. I had to take up this role with no prior China experience or Mandarin language skills. I had to lean into my prior experience of working in India and ASEAN countries to learn the business situation and quickly gain the trust of the China leadership team and the employees. I relied on some of the core team and refreshed several leadership roles and the result was a great outcome both professionally for Baxter in China and for my career to be promoted to run the Asia Pacific region. During this journey, I was able to develop and appoint an internal successor Shirley Xu as the first woman GM for Baxter in China.
My success over the past 30 years, spanning multiple companies and countries, has been achieved by working together with some outstanding individuals starting with my mentors who took me under their wings in the early part of my career in shaping me. Today, I am thrilled to see several of my colleagues whom I had the opportunity to coach and mentor in leadership roles across the region with various leading companies and start-ups and this gives me a great sense of pride and achievement. I will continue to play an active role in mentoring and building the next generation of healthcare leaders in APAC. Together with a couple of like-minded healthcare leaders in the region, we are working on launching a more formalised mentorship program, that will allow Asian healthcare leaders to be developed from within the region who can make an even bigger impact to the growing healthcare needs of this vibrant region.