MEDICAL AFFAIRS IN SUB-SAHARA AFRICA – 10 LESSONS FROM MY 10 YEARS SO FAR - PART TWO

Lesson 4: Think Big, Think Global!

I began 2015 the same way I did 2014 with even more enthusiasm. I was able to hire an MSL for the Oncology department and began not only a new role but my first experience in having direct oversight of a team member in this industry. By this time some of my colleagues who had expressed scepticism were now keen on understanding this unique career path for medical doctors in Kenya and indeed sub-Sharan Africa. Moreover, many expressed interest to join and I did spend several coffee meetings sharing insights and experience – I always tried my best to share a balanced view of the role highlighting both the successes as well as the challenges. I was also happy to have developed a great working relationship within my department across all functions as well as with regional and global teams. I was beginning to better understand the nuts and bolts of the corporate world. One of the most important projects I undertook at Novartis was to work with internal cross-functional teams and key external stakeholders in Kenya to execute a Memorandum of Understanding (MoU) between the Kenya Ministry of Health and Novartis Oncology to provide second line treatment access for Chronic Myeloid Leukaemia (CML) patients in Kenya. The company had until that point provided first line treatment for free through a global access programme run jointly with the Max Foundation. However, second line treatment was not covered in the programme so we had set about trying to find a solution to ensure patients who required second line treatment were not left behind. This project involved many hours at the Ministry of Health engaging key stakeholders and drafting several proposals over several months. This was a project that truly spoke to the value of public private partnerships (PPPs) to support better patient management and I was happy to play a significant role as scientific lead for Novartis Oncology. We had to think big – it was not easy to get the government to engage with the pharmaceutical industry as we were (and still are) always perceived to be purely motivated by commercial gain. We worked hard and finally in October 2015, over two years since initial conceptualization of the project, the MoU was signed! I was ecstatic! What an achievement as a team and as a country! I was yet again nominated for another accolade – this time a regional one! I received the Novartis Region AMAC (Africa, Middle East & Asia Pacific Countries) Medical Award Honorable Mention in November 2015. Receiving a multi-continental award made me realize the amazing potential for success in multinational companies. You may be doing your work quietly in Kenya but someone in another continent is able to see it or hear about it and recognize your success. It was truly incredible!

Lesson 5: Leadership amidst adversity

By 2016, I felt like I was becoming a truly proficient medical affairs professional because in three short years, a lot, mostly good, had happened…including one promotion! I had many people to thank for their constant support and mentorship both professionally and personally. I again found myself being promoted, this time, to Head of Medical Affairs for East Africa and Head of Medical Operations for sub-Saharan Africa. The title alone took me to cloud nine…this medical affairs path had really worked out. In an instant I grew from managing one person to now nine people across Kenya, Ethiopia and Sudan. However, with this leadership came great responsibility and challenges in equal measure. At this point because of the rapid growth of the team, more questions were being asked from other departments within the company. Some felt that the medical team was too large. Some even questioned why medical doctors had to be hired to perform the role. Some probed further on what Key Performance Indicators (KPIs) should be used to “measure medical affairs” achievement. These questions were not unique to Novartis but across the industry, and yes I did recognize the need for continuous accountability not just for my team but across all departments in the company. Now it’s important to start by pointing out that some of the internal stakeholders had immense appreciation and respect for the work medical affairs teams were doing. They had seen the fruits of tireless scientific engagement and partnership with healthcare practitioners, medical societies and patients. However, the growing interrogation made many of my medical affairs colleagues including my team begin to have serious misgivings about their work and certainly their career choice. In my view, when things were not going well especially in terms of commercial performance, harder questions were asked about the value of medical affairs…as was asked about various other departments too but to a lesser degree. Indeed, when the going gets tough the tough get going! It was important to remain calm under pressure and remain steadfast in having full confidence in the abilities of my team as strategic and operational pillars of the company. We had seen a steady rise in innovative projects and partnerships with the scientific and patient community that had had an impact on the company and the healthcare system. Matter of fact, many of us had received awards for exemplary achievements so I was not going to let the naysayers have their way. I spent many leadership meetings articulating and defending the work of medical affairs. Additionally, I always tried to be as collaborative as possible in seeking approval for some projects to ensure cross-departmental buy in. I was growing my leadership skills through this process and I’m glad I went through it. My inspiration came (and continues to come) from Dr. Martin Luther King Jr who said, “The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.” To date the question of the value of medical affairs continues to be asked globally. I began to realize that in any job, you must defend your position not purely by saying what you’ve done but how what you’ve done has generated internal and external impact.

Lesson 6: Medical Affairs evolution locally and globally

I’d like to reflect deeper on the question of “the value of medical affairs” and for that I’d to go back in time to the origins of medical affairs. According to an article by the Medical Affairs Professional Society (MAPS), medical affairs in the life sciences industry is believed to have begun in the 1960s. Upjohn, a division of Pfizer, had introduced the concept of MSL where “experienced and scientifically oriented sales representatives were designated as MSLs to answer more in-depth scientific questions about the appropriate use of drugs and devices”. It then continued to grow and develop over decades into the various sub-functions that we have today including external education, medical information & communication, medical operations, evidence generation, field medical excellence and so on depending on the structure and focus of a pharmaceutical and more recently medical technology organisation.

Firstly, it is clear that the medical affairs function is a scientific one and does not necessarily need to be done by medical doctors but indeed anyone with a scientific background. However, from the experience myself and many of my colleagues have had across at least sub-Saharan Africa, medical doctors have continuously demonstrated the most optimum interaction with healthcare practitioners, particularly clinicians, because of their comprehensive understanding of the entire patient journey as well as their ability to generate peer to peer conversations on key scientific topics. This, nevertheless, does not mean that all medical doctors are suited to this function or that other medical or scientific colleagues are not. In addition, medical affairs roles differ from company, country and therapeutic area and one needs to have great adaptation to fit into the role according to their individual circumstances. In my experience, some of us have easily adapted across diverse roles whilst others have specialized and narrowed their focus to a specific sub-function of medical affairs. Obviously, one size does not fit all.

Secondly, medical affairs and commercial roles must be separated from a compliance and in many cases, regulatory perspective. This means, among many things, that the former cannot have sales targets as a KPI. Therefore, this brings out the famous question that every medical affairs professional across the globe is constantly asked, especially by commercial colleagues “how are you helping the commercial objectives of the company?” In many cases we showcase our value through understanding the business and leveraging our skills and experience to support pre, peri and post launch activities of pharmaceutical products and medical technologies. We also engage internal stakeholders to build trust and understanding that medical affairs is a critical pillar that drives scientific engagement as part of the overall product strategy. Finally, we constantly aim to communicate internally and externally on the value of building strong relationships with the scientific community and patient groups that impact the overall company objectives. This, nonetheless, is easier said than done because, again, various factors impact how one is effectively able to orchestrate this symphony especially amid the usual day to day work pressures.

Just like any other function in the life sciences industry or any other industry for that matter, medical affairs cannot remain static in execution of this role but must continue to evolve in both scope and maturity to better deliver value both internally and externally to positively impact healthcare. By late 2016 and early 2017, it was becoming increasingly clearer that medical affairs especially in sub-Saharan Africa could not just be a role exclusively for scientific engagement but one of engaging scientific and patient communities to shape the healthcare ecosystem. Many of us had already found ourselves stretching beyond the strict remit of medical affairs to support government and public affairs. Some had even decided to join other functions such as market access, key account and commercial management. If you look at my AMAC award mentioned earlier, most of the engagement came from a public and government affairs perspective rather than from a purely medical or scientific affairs perspective. In fact, many functions across many companies are shedding the traditional constraints of “pure” roles and adapting roles to fit the needs of the healthcare landscape or specific strategy requirements, a concept known as “function-agnostic roles”. Emerging trends in healthcare such as remote healthcare, personalized medicine and artificial intelligence will demand more adaptation to ensure fit for purpose medical affairs professionals now and in the future. Despite the resource limitations that plague African healthcare systems, the digital space has grown immensely and in fact many digital tools are supporting healthcare delivery to far reaching areas of the continent. The medical affairs professional of the future may require focusing beyond the “traditional” evidence generation to in-market real-time data generation with focus on health economic and patient experience benefits beyond the usual clinical benefits.

Lesson 7: Growing my internal and external social capital

By early 2018, my leadership experience took me on a journey of less operational and more strategic and people management tasks. I spent more time trying to build and mentor the team to adapt to both internal and external climate. I had experienced my first team exit which had shown me the downside of team retention but also the upside of how team members who stand out, can be recognised beyond the company. I’ve always believed that if people have excelled and they feel that they need a new experience outside their current role or even company, they should be given the chance to try and learn from that experience too! It therefore was (and still is) easy for me to have candid conversations with my team members about this. I believe in building medical affairs champions who excel both within and outside any organisation. In fact I believe in building healthcare champions that excel across diverse areas within the healthcare ecosystem and hence my passion for networking within and outside my organisation and in fact the healthcare field. I ardently follow Tim Sanders advice “Networking is your net worth”.

Back in 2016, I had undertaken a course on career excellence organised by Centonomy, a Kenyan-based financial and career guidance company. One of the crucial lessons I recalled was the power of social capital and how to take networking as a critical step in growing one’s career. Networking is its own job and requires attention and effort because no one is an island.?Porter Gale, once said “I?believe that your social capital, or your ability to build a network of authentic personal and professional relationships, not your financial capital, is the most important asset in your portfolio."?2017 ended with yet another achievement when I was successfully nominated as one of the Business Daily Top 40 Under 40 Men in Kenya! I had truly reached a pinnacle in my career…and I wanted more! I had also just completed my Masters in Public Health at The London School of Hygiene & Tropical Medicine and I felt I was ripe for a new challenge. I had been exploring opportunities within and outside the company and in fact the pharmaceutical industry. Fond memories from my time at KEMRI-Wellcome Trust, which at that time felt like ages ago, meant that I was keen to look for a role that had more evidence generation activities compared to evidence dissemination tasks. I had even considered a role in a different part of the world. However, as I would soon appreciate, sometimes change comes from the most unlikely of quarters.