Q&A: Steps to making this the decade of delivery

NEW YORK — 2020 marks the start of a 10-year timer until the deadline for achieving the Sustainable Development Goals. With the pressure on to end hunger, achieve gender equality, and ensure health care access for all, Caroline Roan, vice president of global health and patient access at Pfizer and president of The Pfizer Foundation, says private sector companies can help take successful models to scale, putting ample resources behind them.

“We have an ability to drive measurement and impact, and all of that is going to be necessary for us in the next decade,” she said. “We've got to really put the gas in the tank and get going.”

Speaking with Raj Kumar, Devex president and editor-in-chief, in New York, Roan explained how to accelerate progress toward the SDGs by 2030, the role of pharmaceutical companies in achieving universal health coverage, and how a global surveillance system is helping to tackle antimicrobial resistance.

This conversation has been edited for length and clarity.

There's still a lot of people who think about the foundation side and certainly, you wear two hats here — you run the foundation but you also lead all the corporate stakeholder engagement around corporate responsibility — and nowadays you talk to people like António Guterres, the head of the U.N., and how he thinks public private partnerships as essential to achieving the SDGs. The big question, I think, is how do you actually get there?

I think sometimes we use PPP a little too lightly. And I think, as you said, there are great models. We are proud partners with Gavi, the Vaccine Alliance. And the Global Fund had a very successful outing recently with a lot of private sector organizations coming up and taking active engagement in that.

I think for health, one of the impactful areas is the work that the pharmaceutical industry has done around neglected tropical diseases. The reason I think this is such a fantastic model is that it existed well before the Millennium Development Goals, before the SDGs, and it truly took those elements of partnership and brought them together.

For us at Pfizer, we're focused on eliminating an NTD called trachoma, the leading cause of infectious blindness globally. Since 2006, we've reduced by half the people who are affected by this disease, which is quite extraordinary. We're doing that with our antibiotic that treats this disease, but more importantly, the model was built on a true broad public health intervention.

So it's not just about the medicine, it's about education, it's about sanitation and water, and it involves more than 100 actors globally. Just this past year Iran was declared the eighth country to be trachoma free by the World Health Organization, so I think if we can look at those types of models — while they might not be the newest and the shiniest — they demonstrate real lessons for us about how we can put the fuel in the gas tank and get going on PPPs to address the SDGs.

There's a clear path on NTDs, but it may be less clear around UHC. We were just here in New York a few months ago where there was the high-level panel and there was a global declaration, which is a really big step. But it's a question of “then what”? From your seat, what do you see happening on the UHC front?

The path to UHC is going to look quite different by country. Countries have to take into consideration the political environment, the historical environment of how health care is delivered — and I think it is not necessarily going to be easy to identify actual actions that countries can take to get there.

I think the way that we’re thinking about it as each country takes this on is to try to contribute in a meaningful way — and the way we’re doing that first and foremost is to focus on our mission, which is breakthroughs that change patients’ lives. We've got to deliver the next wave of innovation: medicines and vaccines that will make a meaningful difference for patients. Then, I think we have to take on the affordability challenge, straight on, because that is an issue that is being talked about by all governments: how can we affordably provide UHC? And that includes pharmaceuticals.

At Pfizer we’re looking at different pricing models, everything from the kind of partnership you see with Gavi, all the way through to looking at reimbursing based on the performance of our medicines and our vaccines, to a tiered payment process for some of these innovative products for rare diseases that have typically been more expensive for governments.

Another issue that comes to the front nowadays is antimicrobial resistance. Pfizer is a company that is a world leader in terms of anti-infective medicine, so what are your thoughts about where we are in the AMR discussion? And what is Pfizer doing to try and play a positive role in this?

What I think has been interesting about the conversation around the SDGs and Goal 3 [good health and well-being] has been a real focus on noncommunicable diseases — including cardiovascular disease and diabetes. We know that that burden is growing, but we also know that the burden of infectious diseases is also there, so it really is truly a dual burden.

For example, we're going to continue to do our research and continue to support activities around good stewardship with AMR and education and then we're also supporting a global surveillance system called ATLAS, which we're very, very proud of. We're expanding the pathogens that are in that database — anybody can use it and what that tells us are patterns of resistance, which are going to be critically important as we take on AMR in the future.

And then from our global health work directly, we’re leaning into the concept of preparing primary health care providers for the appropriate diagnosis and treatment of infections and making sure that the system is better able to deal with both epidemics and pandemics, but also just the day-to-day of how a patient presents and ensuring the right protocol in is in place.

700,000 people who are dying every year because of AMR. It's an example of these systemic challenges in global health that are frustrating sometimes because no one institution, no one company — no matter how big — can actually tackle this alone. We need global stakeholders, the global community, to get together. It's why the SDGs are exciting. So, 10 years out what's your feeling … what do we do to inject a sense of energy and urgency behind this agenda?

I think you hit the nail on the head when you said urgency. It's great to talk about a decade of action but without action, it's not a decade of action. And I think one of the areas that we've really been focused on at Pfizer is identifying individuals who can drive great action. We've seen that most recently with a teenager who drew global attention to climate change. We see it every day in the work that we do with these providers who are so deeply committed … They move with a sense of urgency. They see a problem, they're immediately thinking of a solution; they are relentless in their pursuit of providing health care for those patients.

As we talk about multi-sector partnerships and private sector partnerships, we can't forget that individual and we need to figure out how to empower them to give them the strength to drive that action that we're going to depend on.

The second thing we have to do is to really break down those barriers of what PPPs mean. You still see resistance within multilateral organizations within the private sector itself as we try to understand the language that we each use to achieve the goals that we have. And I think we've got to continue to press forward and increase that dialogue and that exchange where we can learn from what's worked in the past. Be honest about the challenges, but commit to that forward momentum.

Editor’s note: The Pfizer Foundation is a charitable organization established by Pfizer Inc. It is a separate legal entity from Pfizer Inc. with distinct legal restrictions.