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ANNOUNCER: (In progress) Ö AID assistant administrator for the Bureau for Europe and
Eurasia, Paige Alexander.
PAIGE ALEXANDER: (Applause.) Thank you. Thank you. It is my pleasure to introduce our next
speaker, who has been hailed as one of the most influential people in biopharma today.
Sir Andrew Witty, along with Administrator Raj Shah, will embark on a conversation about
collaboration on innovative solutions in accessible health care. Working together with creativity
and innovation, we can overcome the development challenges of today.
In my region, in my area of the world, I have seen the impact of creative partnering with
the private sector to improved outcomes of health care. Just one example is a partnership
that we have with Johnson and Johnson, along with others, on prenatal care and new mothers'
access to information through a text-for-babies program. It takes the babies through the first
year ñ the parents through the first life of through texting, and it's been quite remarkable
and it has spread to other regions in the world.
So there's no better person to speak about private sector innovation than Sir Andrew
Witty. He has had an extensive and esteemed career at GlaxoSmithKline for over 30 years
and now is the CEO. He had initially worked in areas such as new product development and
the scope of ***/AIDS, as well as respiratory diseases. So, clearly not one to shy away
from challenges.
So please join me in welcoming Administrator Shah and Sir Andrew Witty. (Applause.)
ADMINISTRATOR RAJIV SHAH: Thank you, Paige. Good afternoon. And welcome, Sir Andrew Witty.
We are thrilled to have Andrew with us here today, in part because we have such an expanded
vision of how we can partner to help save children's lives around the world. And we
applaud the leadership you've provided to that end.
I wondered if we could start just by your sharing with us a little bit, as the CEO of
a major international pharmaceutical firm that produces a broad range of products, technologies,
research, and has real, immediate responsibilities to your own bottom line, why do you spend
so much of your time working with us and others to help get vaccines at very low cost into
the arms of children who are not part of your revenue stream in any meaningful way?
SIR ANDREW WITTY: It's a good question, and I do get asked that from time to time. And
I think that it's a ñ it's so easy to simply think about complicated problems in a simple
way and then become very narrow, so drug companies can only focus on innovation, can only focus
on delivering for the West, when in fact it is entirely possible to do both innovation
and support access by being thoughtful around different business models. So the idea that
it's a choice, it must be one or the other, I think is a wrong and false choice. I think
it's simply a question of thinking through alternative business models.
Why do we do it? Because we're the ones lucky enough to have the technologies which can
be leveraged. If we don't do it, who will do it? And I think as a ñ as a temporary
owner, or landlord, if you will, of some very rare and scarce resources and technologies,
I think it's incumbent among private companies as well as governments to be thoughtful around
a global audience, not just the audience who can pay today. And that's really what drives
the way we think.
And within our organization, I think as you go deep into the population of the company
you will find one of their biggest sources of interest and biggest motivators for being
at GSK is the agenda that we've developed for the global health agenda, not simply for
the rich countries. And as a result, you know, we have a huge amount of activity going into
these parts of the world. Two-thirds of our vaccine volume now goes to the least-developed
countries in the world through the various programs, which really, when you think about
how big that is as a proportion, just signals the seriousness with which we have this intent.
But when you go to the villages and the communities who, even in the last year or two, for the
very first time have had vaccination opportunities, and you can see and you just know what the
difference is going to be for their future versus their very immediate past, it's obviously
the right thing to do. And I think what I've been delighted about at GSK is that we've,
I think, never, never been challenged by shareholders on whether this is the appropriate thing to
do.
And so it really brings me back to the first comment. I think there is almost an artificial
argument for why this is difficult to do, because when you do it, everybody, including
the shareholders, applaud it.
ADMIN. SHAH: Well, we applaud it as well. And when I had the chance last year to visit
a refugee camp called the Dadaab refugee camp, and there were these refugees coming across
the Somali-Kenyan border, these children were so emaciated ñ it was during the famine in
September ñ and I was amazed to see, as they were being taken into the system, they were
getting pneumococcal conjugate vaccine, which happened because of some extraordinary actions
you took with the U.K. government, the U.S. ñ the Gates foundation and so many other
partners through the Global Alliance for Vaccines and Immunizations.
Could you tell us a little bit about pneumonia, diarrhea, the vaccines that are now available
and what your vision is for how our world, working together, can really get these new
vaccines to the kids who, frankly, if they donët get them, will die? Kids in rich countries
when they don't get them go to hospitals. And we still lose too many, but they don't
die at anywhere near the rates that children would have perished in that camp from this
disease.
SIR ANDREW: Well, I think that a huge number of agencies and individuals have worked tirelessly
from a very theoretical perspective initially through to something now which is extraordinarily
large in scale, to try and bring together things like the advanced market commitment
mechanism; obviously the GAVI, the whole GAVI concept; the role of the Gates foundation
critical in all of this; clearly U.S government has been crucial, alongside U.K. and others.
That coalition has really brought energy, which has resulted in something which I think
even 10 years ago you'd have said was impossible, that within two years of a new vaccine being
first registered in the West, that it would be available en masse into the least-developed
countries in the world, in the developing world.
This year alone we will ñ GSK will ship about 40 million doses of vaccine for pneumococcal
vaccination under the program. That is 40 million. I mean, that's a huge number. It's
remarkable. We always talk about millions of this, millions of that. If you think about
40 million doses really from a standing start, it's remarkable.
Now, we know that the demand is even higher than that, and which is also very encouraging.
So what we're focused on for pneumococcal disease, for diarrheal prevention ñ and by
the way, we'll ship about 11 million doses of rota this year ñ but we're already installing
the next two production lines for pneumo, the next two for rota, and we're absolutely
committed to do everything we can to keep up with the demand that's there, because,
you know, we know this is going to be transformational for families, for the livelihoods of those
families, for the emotional stability of those families.
And then if we're fortunate enough at the end of the year to have the world's first
malaria vaccine, then you can see that by bringing this innovative technology to the
places that need it ñ bluntly ñ the most first is the right thing to do. And to be
able to do this so rapidly after first introduction, compared to previous eras, where Africa's
had to wait maybe 10 or 15 years before they could access technologies that had been available
in the West I think really tells the way we have to go forward. It's all doable. And,
you know, our challenge is to keep up with demand. We're committed to doing that. But
we believe this is going to make a huge difference to these populations.
ADMIN. SHAW: Well, I'm glad you articulate it that way. From our end as a funder and
investor in children's health around the world, these vaccines are actually a way to save
money. And we know that it's far less expensive to help prevent the cases than it is to treat
them after the fact, especially in very resource-poor settings. But despite that fact, when we all
looked at this maybe a decade ago, people would say, look, it takes 20, 25 years for
a new vaccine that's introduced in OECD countries to reach very resource-poor communities. And
the companies themselves would say, well, we don't have the capacity, it costs hundreds
of millions of dollars to build these plants.
You just said you're putting on line so much new capacity. How did you get to a place where
you had the confidence to make the decision and your company could invest the kind of
resources ñ these are complex, difficult facilities to pull together to produce complex
products. You're doing this additional capacity essentially for the bulk of the world's kids
who are in resource-poor settings. How did you get to a place where you kind of overcame
the skepticism of an industry that wasn't putting that kind of capacity online, so that
today you can confidently say you are?
SIR ANDREW: OK. So I think there are two dimensions of that. The first, and probably the most
important, trigger was really the GAVI fund and the AMC. So the AMC absolutely gave a
sense of underpinning to the sustainability argument. So that was clearly ñ clearly one,
and it's very, very important. It's important to understand some of the numbers involved.
So the Singapore pneumo facility, which is coming on stream right now, will essentially
be ultimately the prime resupplier of pneumococcal vaccine for the program. It was a $600 million,
12-year investment. So, you know, that is not a trivial proposition. And if any of you
ever have a chance to look around that facility, it is the world's most advanced vaccine manufacturing
facility, and it's dedicated to this vaccine. And so you have to have a sense of confidence
that at least the initial opportunity is there. And I think we got to a place where we were
confident there was a political will and the funding will and a conceptual design which
would happen, and then we bit the bullet and we went forward. So that was absolutely critical.
I think the second part is again, though ñ back to ultimately companies ñ it's like
governments. Governments can make choices. You have hundreds of choices every year you
get to make. We get to make choices as well. And I think a lot of it speaks to what you
want your company to be. Do you want your company to be just the innovator in the West
at the high-priced marketplaces, or do you want your company to be a contributor to global
health care and an organization which seeks to leverage its technology wherever it can
add human health value? And I think once you've made that choice, then a lot of other issues
which were previously very difficult become very obvious very quickly, and it simply becomes
how do you solve for the challenge, rather than a kind of almost philosophical divide.
And I do ñ I think all companies need to go through that, because the AMC's available
to lots of people. There are lots of mechanisms which are around to encourage lots of companies
to do lots of things, but they don't do it. Why? Because they haven't made that choice.
And I think that is a key part of how private sector needs to modernize the ways that it
thinks in a world which is truly global.
ADMIN. SHAH: Well, and the public sector also needs to modernize the way it thinks to be
a more efficient partner with you and with others. One of the things we're trying to
do on this stage in two days' time is to launch a call to action, to really help people see
that it's possible to end preventable child death. As you know, 7 Ω million children
under the age of 5 will die this year, and many, many ñ the great majority of those
kids could be saved with simple interventions.
Could you give us a sense, from your experience at GSK, but also the global leadership role
you've taken on in creating a vision of what's possible in global health, is it possible
to end preventable child death? What do you think needs to happen differently in order
to dramatically accelerate the current rate at which child death is coming down in the
world?
SIR ANDREW: Well, so I certainly think it's possible. And I think the technologies are
available, I think insights ñ we understand what causes many of these premature deaths.
I think it's clear we also understand how to get in front of them. Just for a second
let me just focus on NTDs as an example. So I think NTDs should give us a lot of confidence
that we can do something. If you look at the shift in the last five years around the ambition
for eradication or elimination of 17 of the NTDs, you look at the way we've been able
to build a coalition of technology owners, drug owners, funders, distributors, to actually
start to really put within sight within a decade a realistic ambition to eradicate many
of those diseases, I think that tells you that when we get those coalitions properly
bound together and we somehow find that magic ingredient of energy, we can make a lot happen.
And the idea that these are fundamentally intractable problems is not the right belief.
I think we have to say these are solvable problems, but we need to bring together these
coalitions, which is ñ I certainly applaud what you're doing here this week. And it feels
to me as if we have, you know, some of the components, that timing ñ you know, sometimes
things have to have their moment, and it feels like timing might be right around the child
survival, child mortality issue.
Why? You've got a lot more vaccine than you've had for a very long time. It's very clear
that we have got a variety of different organizations who have begun to really deliver and build
appropriate health care infrastructure, health care workers. We've got a clearer understanding
of where the key focus points are. Some of the work that's going on around essential
commodity requirements is a really good example of really prioritizing what's important. So
it feels to me as if a lot of that information and knowledge is getting from the massively
theoretical to the very practical. Once you get to that level, a bit like NTDs, if we
can then harness a coalition around practical impact, I think we can make a lot happen very
rapidly.
So, you know, I'd be optimistic about this, actually.
ADMIN. SHAH: We're optimistic. (Chuckles.) We're going to keep working at it.
I do think ñ when you were mentioning the possibility that someday a malaria vaccine
would offer the world another point of intervention to reach vulnerable kids, and I was struck
in your comment because you weren't just talking about malaria, you were talking about something
broader. We look at the world and see that even within child health there are different
communities that appropriately believe strongly in and advocate for different diseases, different
solutions. Maybe you could just use the malaria example as an example for how would you advise
us to bring these things together so that every time we're reaching a child with some
kind of point of touch, we're getting enough technology, solutions and connection to that
child so that they have the ability to fully survive and thrive.
SIR ANDREW: Well, you know, I absolutely do think that the ñ so one of the great ñ it's
interesting how this debate moves on. So, initially we didn't have any drugs, we didn't
have any vaccines, then we didn't have any money, and then we don't have any distribution
network, and then we don't have any treaters. Right? I mean, there's always another thing
we didn't have. But gradually, slowly but surely, we knock these things off and we start
to work our way through. But we are very much now, I think, in a place where it's about
ñ I think a phrase you use often, that last mile, that last piece, how do we get that
final piece of distribution and touch with the patient to make sure this works properly.
And that's where I think we've got so many opportunities for ñ we have so much going
on. We have to just become a lot more thoughtful and efficient about how we leverage these
different chances. So NCDs a classical example. We've got lots of different eradication programs
going on. One of the goals of the London declaration was to try and coordinate and consolidate
a lot of that so we can get a lot more *** for our buck, essentially, in what we're doing.
Malaria's going to be, I hope ñ we'll see in November whether the data is sufficient,
but if we have a malaria vaccine, then we know that there is going to be another moment
where you're going to have young moms bringing their babies in for vaccination. Now, we can
either just do the malaria vaccination or that can be a chance where I think you would
be doing cervical cancer checks on the mom, because one of the biggest drivers of childhood
survival is going to be parent survival, right? So keeping that mother healthy is a key part
of the dynamic. And then obviously there's a great chance to interact with the baby again.
It's another chance to just make sure everything's got up to a good start, making sure they're
up to date with all their other vaccinations. Those sorts of things.
And I think these should be seen as great opportunities to be leveraged, not to the
ultimate, you know, crazy extreme, but think through what are the two or three things that
it would be great to know or do when you see that baby or you see that young mom when they
come in for that vaccination. And I think more and more the challenge and the opportunity
to make big strides forward will be in leveraging those moments, because we know that it's that
final complexity of touch which is still tough, right? We all know that's still a very difficult
part of the equation. These are going to be opportunities for us to make some inroads
on that.
ADMIN. SHAH: I'm so glad to hear you say that. It's a great point of guidance for how we
should approach this child survival call to action and movement. And it helps bring reality
to the fact that sometimes politically we want to describe the outcomes of the investments
we make in very linear terms, that we spent this much on malaria, we save this many lives,
spend this much on pneumococcal conjugate vaccines, save this many lives, and that guidance
to bring it together for efficiency and outcome is very, very useful.
Let's talk about a different end of the spectrum of your business. This is a question from
ñ I guess it's from our crowd-sourced software. Last year the Department of Health and Human
Services here in the United States launched a health care innovation challenge, and we
launched a challenge called Saving Lives at Birth to spur innovation in the health care
industry but also universities and entrepreneurs around this country. Do you believe you're
seeing an explosion of innovation that is producing solutions for resource-poor settings
in health, or do you think that most of the energy and activity there is taking place
in a few uniquely committed companies that, you know, have the resources and the will
to do it?
SIR ANDREW: Well, I think we're seeing a bit of both. So I think what's fascinating in
the developing countries is some of the most exciting health care delivery ideas are coming
forward. So if you look at things like the YAM (ph) ñ (inaudible) ñ health initiative,
you look at some of the work that's going on around the associated field of leveraging
technology, a bit back to, you know, why don't you see any telegraph poles in China? It's
because they went straight to mobile telephones. And actually, in hindsight, wouldn't we all
rather have no telegraph poles?
So ñ now we can't fix that, but it's an interesting question whether or not in hindsight, the
U.S. and the U.K. are happy that they have so many massive hospitals, when in fact health
care is becoming much less of an inpatient hospital-dominated concept. So the opportunity
in the developing world to jump generations of thinking about delivery, I think there's
a tremendous amount of exciting innovation there we're also seeing.
So one of the things we did two or three years ago was we opened up one of our research centers
for outside, non-GSK collaborators to come and work on developing-world agendas. So our
Spanish facilities, essentially ñ we call it a research hotel ñ any researcher is allowed
to come in and work there. We provide a funding, granting mechanism to essentially allow that,
so we have African researchers coming in, as an example, to come and work alongside
our scientists on their projects, not our projects, their projects. And what that ñ
you can see there is a tremendous energy among the scientific group in Africa, who have got
great passion around what they're trying to resolve.
Now, you know, drug development takes a long time, whoever's doing it, but I'm pretty excited
about the energy which we're seeing in the developing countries to really contribute
and to be part of the technological solution. So I actually think we'll see tremendous newness
in lots of dimensions, both delivery, logistics, merging of different technologies, and hopefully,
in terms of basic drug development opportunity, as well as, of course, the tremendous work
that's gone on in things like clinical trial development. So, for example, malaria could
never have happened without the skills of African physicians and scientists in Africa
doing amazing work for the last 10 years.
So I think this is, again, a reason to be optimistic. Yes, you need big companies to
be there as well, but it's not just big companies. This is about lots of people all contributing
in the way we're seeing more and more of, I think.
ADMIN. SHAH: That's a very inspiring vision forward. You know, you've laid out a vision
that's really big, the idea that the future of a health care system could be based on
prevention and be so effective that actually when we close our eyes and imagine what a
successful system looks like, it's very different from what we have in place in industrialized
economies. And we know that vision would be correlated with saving literally millions
of lives a year for women, children and at all ages. So that's very uplifting.
And then maybe as we conclude, I'd ask something more specific about, in your role as CEO,
trying to think hard about how you build a great company, a great culture and a place
with a lot of diversity of thought, you have a program where you send fellows from GSK
ñ we're hoping to get one at USAID ñ into other institutions. Could you say a word about
that, why is that important to you, what have you learned from that, and do you have any
advice to us in our roles running federal bureaucracies, whether we should learn from
that at all?
SIR ANDREW: Well, you know, we have what we call the PULSE Program, what you describe
as a fellow program. You know, why do we do this? There are lots of good reasons why we
do this, and essentially what the program is, is we give any employee ñ I think the
criteria is they have to have worked with us for five years. Two criteria, actually.
Have to work with us for five years and they have to be somebody we want to keep, right?
It's not ñ (laughter) ñ you know, it's always easy to second out the person you don't want,
so they have to be people we want to keep. But once you've got that, it's entirely voluntary,
so people put their hands up, they volunteer, and we'll basically pay their full cost to
be seconded to an NGO, typically an NGO, although it may extend to some government organization,
health-care associated, anywhere in the world. So far in the last two years we're now up
to about 200 ñ I think 200 GSK'ers have gone out and done this. Everything from needle
exchange programs in the streets of Philadelphia through to on-the-ground clinical trial logistics
in Africa. You name it. Everything you could imagine, people have done.
So why do we do it? First of all, as a corporation, because I'm determined ñ you know, we all
know the drug industry hasn't always made the right decisions over the last 50 years.
It's done a lot of great things. It's done some things which it probably shouldn't have
done. I'm determined that at GSK, we create a cadre of people who have a broad view of
the world, who have a multidimensional view of the world, who understand civil society,
who've worked with NGOs, who've worked with government and who have a view about global
health, because I think over time, those 200 ñ it will be 500 in two or three years ñ
they will be the absolute leadership cadre of the company long after I've gone, and I
want them to be truly thoughtful about the role of a company in society not just to make
money, but to contribute to the mission, which is to help people do more, feel better and
live longer literally everywhere in the world. And if we've got the means, it's our job to
find a way to make it available to people, wherever they live and however much money
they've got.
So for me it's about culture change of our organization. For them ñ and I honestly have
more mail on this issue from my employees than any other issue in the company, and every
single one I get is, it's a life-changing experience. I mean, it absolutely transforms
them. They come back very different sorts of people. It's interesting; they come back
eyes open: I've seen things, I've changed my life forever. Not always good things, because
they've been some tough places, but in a way that ñ you know, we have to see those things
to really change. They come back and say, my goodness, it's amazing what you can get
done without any money; how come we spend all this money and it takes us ñ (laughter);
my goodness, it's amazing, you can get things done without PowerPoint presentations. (Laughter.)
You know, and it's great. They come back and ñ (laughter) ñ
ADMIN. SHAH: (Laughs.) We have to stop you here. Otherwise, our folks are going to stop
doing the PowerPoint.
SIR ANDREW: I'm not sure what they're going to bring back from the U.S. government. We'll
see. (Laughter.)
ADMIN. SHAH: (Laughs.)
SIR ANDREW: It's a ñ it really is great for the individual. And actually the feedback
we've had from the NGOs ñ and we now, I think, are ñ we have one NGO who had taken 20 ñ
every six months. So it becomes ñ you know, and that tells me that they're doing a great
job for the NGO. So I think this is a great win-win-win. And if we, again, just step back
and just temporarily take off our profit-making, our government, our NGO hats, just be people,
doesn't it make sense for us to try and build bridges rather than throw bricks at each other?
And the more ñ every time we make a big step forward, it's when we found a way to work
together. And the more we can try and get our people to see that ñ so it just becomes
natural and it's no longer about the artificial choice of it's either innovation or it's access,
but actually you can do both and we can deliver a perfectly adequate return for our shareholders
and we can transform life for people who have no resources in Africa. That's where we want
to be.
And I think that to maintain that, that's the purpose of this program, is to really
embed in the company a mindset of thoughtfulness which isn't dependent on a few people; it's
truly the way the company thinks. And it's a chance for us to be a new type of company,
and that's what we want to be.
ADMIN. SHAH: Well, I just want to thank you so much for those inspiring comments. We're
trying to be a new type of aid agency and, in doing so, trying to build similar bridges,
with you and elsewhere.
And I remember when I had the chance to visit that refugee camp and see these kids, and
some of them had been on treks for weeks. Many didn't survive the journey, and it was
just so hopeless. And then you walk through and you see that they're receiving a vaccine
that just two, three years ago people said, oh, this is too expensive for kids in poor
countries because it costs too much and there isn't enough capacity and you'll never make
it work. And you made it work, with the bridge you built through GAVI, with the commitments
you've made and with crafting a new model of public-private partnership that allows
us to stretch American tax dollars that are invested and get more results, and ultimately
those results create a safer and more prosperous world.
So we want to thank you sincerely for joining us today, for your commitment to the call
to action, for your leadership overall. And we sure do hope to get a couple of those fellows
if we can. (Laughs.) (Laughter.) Thank you very much. (Applause.)
SIR ANDREW: (Inaudible.) Thank you very much.