Merck Greece's Susan King-Barnardo outlines how she navigated the affiliate through the challenging waters of COVID-19, the unique market access challenges that innovative pharma is facing in Greece, Merck's burgeoning clinical trial footprint in the country, and her approach to fostering diversity, equity, and inclusion.
You took over at Merck Greece back in January 2020, a few months before the COVID-19 pandemic hit Europe. Can you describe your experience leading your team through this challenging period?
Back in early 2020, we had no idea of the massive direct and indirect impacts that COVID-19 would have. The Greek pharmaceutical market was greatly affected, as was the healthcare landscape more broadly, meaning that coming into a new organization at that moment would be a challenge.
I had only met my team in person for the first time a few weeks prior, before we were plunged into lockdown, meaning that I had to organise the teams virtually, putting the right structures in place, and building trust. Fortunately, I am blessed with a phenomenal team who had set up homeworking within a week and established a framework to make the best of what was to come.
Merck Greece’s previous General Manager, an amazing person and professional, passed away in 2019. As a result, I was presented with a full task list upon joining, covering everything from new distribution agreements to the lease of our office. The team was fantastic in terms of putting plans in place, working together to develop a virtual structure, and engaging remotely via new digital tools. We put together a new commercial excellence and digital strategy that later became part of our foundation and continues today very successfully.
What were your first impressions of Greece?
Fantastic people, food, and weather! Coming in, I was not sure what to expect as the first woman in this role for Merck Greece, with a largely male leadership team. However, the receptiveness, acceptance, and mutual respect that the team has for each other has allowed us to build and grow towards our common goal of making a difference for patients. Everything we do as an organisation is focused towards creating, improving and prolonging patients’ lives and our team all believe and work towards this ethos.
Globally, Merck is increasingly focused on the development of innovative neurology, immunology and immuno-oncology medicines, with a slew of new product launches in recent years and a full pipeline. How has this global shift played out in Greece?
While in my previous role as country manager for both Slovenia and Croatia I had the privilege of launching one of Merck’s latest innovative neurology treatments, unfortunately – due to the reforms that have happened in Greece – this product was not available for Greek patients when I arrived. Therefore, one of my first projects in this role was working to gain reimbursement for this treatment in Greece. While we were finally able to start supplying this product in Greece at the beginning of 2021, this was approximately three years later than other European countries.
How representative of the overall market access process was this negotiation experience? Are you still facing significant delays?
Greece remains a tough market – probably the toughest market I have ever worked in – and navigating the healthcare system is difficult. With the structural reforms that have taken place, the healthcare budget has remained the same for numerous years at approximately 2,6 billion euros, while the population has increased and more innovative treatments have come to market. Additionally, several reforms were put into effect retrospectively, creating issues of clarity and predictability.
Moreover, via the system of mandatory returns (clawbacks and rebates) pharmaceutical companies are paying for two out of every three drugs, creating a challenge in terms of being able to bring future products to market. The clawback system was envisioned to be a temporary measure however over the past years, mandatory returns have steadily increased.
Despite this significant challenge, there is a lot to be optimistic about in Greece. For example, the implementation of a digital app and vaccination certificate during COVID-19 worked very well. Moreover, Greece’s electronic drug approval system is fantastic. However, to ensure a sustainable healthcare system moving forward, these returns need to be remedied. The healthcare industry is the only industry where prices fall and costs rise.
How challenging is it to advocate for further investment for Greece from Merck headquarters given the situation around these clawbacks and rebates?
The pharma R&D models are continuously developing breakthrough innovations for unmet medical needs across disease areas, thereby contributing to a robust industry, and generating highly qualified employees which are drivers of economic growth.
Restructurings have had to take place and products have been delayed in coming to market. As we know science and innovation are drivers of economic and social prosperity. Globally, 22 percent of medical innovation comes from Europe, while 48 percent derives from the US; a ratio that is the opposite of what it was 20 years ago. The EU is declining in terms of competitiveness, meaning that the continent and its countries need to make significant decisions to boost and protect innovation to not miss out on economic opportunities and become dependent on other regions.
One thing is for sure, change will continue to be a constant in the healthcare system, hence the effective and efficient implementation of innovation and technologies is essential, and interaction between government, healthcare professionals, stakeholders, and society is paramount for the future.
While it is beholden on governmental authorities to change the overall structure of healthcare systems, the industry itself has a role to play in creating innovative pricing models that share the cost risk associated with new products more evenly. Do you see a greater stakeholder openness to these models in Greece?
Unfortunately, no. While funding from the EU’s Recovery & Resilience Facility (RRF) is aimed at reducing the level of clawbacks, this is going to put pressure on the government to achieve similar levels of returns. The government is also in a difficult position, attempting to find the right balance, however currently negotiations remain driven by price reduction only and do not take the therapeutic benefit and the value of innovation into account for the patient and country.
Another part of the access piece is clinical trials. What is Merck’s current clinical trial footprint in Greece, and how do you see it evolving moving forward?
Globally, Merck spends more than 2 billion euros every year on research and development (R&D) every year, and since 2018 has led more than 230 clinical and observational studies.
Merck is a science-driven organization cracking the code of human biology and harnessing the power of technology and data to match the right treatment to the right patient at the right time. We focus on our established platforms in immuno-oncology, oncology and immunology through a biomarker-driven strategy and a clear best-in-class, first-in-class ambition.
Over the past few years, Merck Greece has grown as a valued partner globally and has also contributed significantly to the recruitment of multinational and preapproval trials and post-approval real-world evidence. We currently participate in 11 studies across our therapeutic areas. A positive initiative by the Greek government was the offsetting of mandatory returns for those companies engaged in clinical trials, however, the eligibility criteria for allowable expenses need to be broadened before this initiative can materially support international R&D investments.
Greece is set to receive EUR 30.5 billion from the EU RRF as part of its economic recovery from the COVID-19 pandemic, a significant portion of which is going towards healthcare. What are your hopes on how this funding will be spent? Which areas are most in need of reform to make the system more sustainable?
1.5 billion EUR is earmarked for Greek healthcare, with approximately 280 million EUR earmarked for digital upgrades, which will be important. Another project which will add value is the EKAPY bringing all the hospitals in Greece together. However, we still face challenges around the mandatory returns and still have not received the mandatory return invoices from 2022, having closed our books based on accruals and the assumption of what the returns will be. Greater transparency on this point would improve overall expenditure, specifically in hospitals, with centralisation of all ordering and invoicing.
Another point is the digitalisation of patient records which will highlight waste, and expenditure, where optimization can happen and where further efficiencies can be implemented. The funds generated can then be used for further real-world evidence.
Amid a transformation, having a strong company culture is vitally important to retaining and bringing in new talent. What strategy has been put in place to keep all your employees working towards the same goal?
The strategy for building high-performing organizations and a top place to work status requires the following:
- Fair remuneration for all employees for the role/ position that they hold.
- The potential for development – Development that is personalized, flexible and tailored to individual goals for example from purely skills development to international assignments and projects as a learning path for the next career step. At Merck, one of our key priorities is ‘Investing in People’ and in doing so provides a work environment which allows for us to grow, develop, learn, live a culture aligned to our values and competencies and in doing so develop inspiring leaders now and in the future. And, as our environment undergoes increasingly fast-paced changes, our ability to adapt, as individuals and as a business, is crucial hence development is paramount.
- Psychological safety – Provide an environment that allows employees to speak up or provide input even in difficult situations.
- Believe in the purpose – our purpose is to improve the lives of patients, as well as to have a positive impact for both our customers and society as a whole.
As Merck moves into new fields and expands its digital capabilities, are you confident that sufficient talent profiles are available within Greece?
I am an example of a skilled person that left South Africa in search of opportunities elsewhere. In tough times, war, or high unemployment, highly skilled individuals leave countries. In Greece today we are seeing an influx of people returning to the country, including doctors. Greece now has a tax incentive for Greek nationals to return and unemployment has also decreased.
There is a very high level of skill here in what is a highly competitive market with many companies focusing on AI and digital. We are spoilt for choice in terms of the talent pool. There is also a culture of learning, with people keen to continue furthering themselves, learning additional languages and skills.
Greece ranks relatively poorly on a European scale in terms of women in leadership. As a female general manager, what is your take on this, and what is Merck doing on this front?
Diversity is not a standalone but goes hand in hand with equity and inclusion and cannot be viewed independently. They are not add-ons but cornerstones of organisational success that contribute to our competitive advantage as well as the development and enrichment of our purpose. Being diverse is key to success and allows us to generate new ideas. This links back to my previous comments on psychological safety and having different opinions.
Merck has really focused on this as a diverse culture-loving company. We have more than 43 different nationalities in our company across 32 European countries, as well as an amazing female CEO, but we also believe that gender equality and female leadership form a framework. Almost 44 percent of Merck’s European employees are women, 8 of our 12 manufacturing plants are led by a woman, and 45 percent of our general managers in Europe are women.
Merck has really put a strategy in place with regards to not only diversity but also equity and inclusion. It’s also about having the right person for the right job. A lot of work is going on globally to make Merck more balanced.
What advice would you give to the next generation of women in leadership?
This goes not only for women: remember to be your authentic self, lead with the heart and love what you do.
