Healthy Skepticism Library item: 16238
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Publication type: news
Boseley S
Andrew Witty: drug firm boss out to change his industry
The Guardian 2009 Aug 12
http://www.guardian.co.uk/katine/2009/aug/12/katin-glaxosmithkline-andrew-witty-pharmaceuticals
Full text:
Many thousands of miles from the curving plate glass expanse of GlaxoSmithKline’s west London headquarters, a war widow with two adopted daughters, one of whom has a badly deformed leg, sits outside her brick hut in a parched village in northern Uganda with the boss of one of the world’s leading drug companies.
Nosiante Aduwe has no real idea who Andrew Witty is or why he has come but she answers his questions with smiling courtesy and shows him her broken Singer sewing machine. That machine, and her refusal to marry again after her husband was killed in an incursion by the Lord’s Resistance Army in 2003, are the main reasons why her two-room house behind the trading centre in Katine is not made of mud and straw and she is not bone thin with a ragged crowd of urchins at her skirts like so many of her neighbours.
But life in a time of drought with a poor first harvest and no promise yet of the rains that allow planting of the second crop is hard enough and many families are back to one meal a day. Nosiante shows me the scanty gatherings from her own field – circles of sorghum, cassava and millet thinly spread on the dry red earth. What does she want, asks Witty. Another sewing machine and for her daughter’s leg to be straightened, she replies quietly.
Witty has pledged to help Nosiante and her impoverished African brothers and sisters who bear a disproportionate share of the world’s disease burden. In February he initiated what he hopes will be the transformation of big pharma, so often excoriated for aiming its medicines at the rich sick and failing to help the far needier poor. He has cut the prices of GSK’s medicines in the least developed countries to no more than a quarter of their cost in the UK, promised to reinvest 20% of his profits from those drugs to help those countries, put 800 patents on potential drugs or parts of drugs into a “pool” so anyone can investigate them to find cures for neglected diseases such as malaria, and invited scientists to share GSK’s labs for such research in Tres Cantos, Spain.
Pirates
Now, at the Guardian’s invitation, he has come to Katine to reflect on what these promises from one of the wealthiest companies on the planet will really do for some of its poorest people.
It is a brave move. Katine’s main Tiriri health centre has only one GSK drug – Albendazole, which the company gives away, for the disfiguring disease lymphatic filariasis, or elephantiasis. The rest are cheap copies made by generics companies, whom Witty’s predecessor, Jean-Pierre Garnier, called pirates.
Uganda buys generics because they are the cheapest. GSK’s price cuts will make no difference to that. Witty knows GSK will never undercut the Indian companies. On the contrary, he says, in a U-turn from Garnier, he encourages them – as long as they are quality manufacturers and apply to GSK for a licence, which they can have royalty-free.
“I’m not telling my managers you need to have your boxes on the shelves. What I’m telling our managers is we need to make sure we’re doing nothing to get in the way of effective delivery.”
But it means the promises on low GSK prices and reinvesting profits in local infrastructure will barely trouble the company balance sheet. GSK’s Uganda market is tiny. Turnover is about £6m a year from government hospitals and clinics, mostly in vaccines, £1m a year from the private sector and £2m from consumer products such as Lucozade and Ribena. Those sort of sums are like the 1p coins people don’t trouble to pick up off the pavement for a company with revenue of £24bn and a stock market valuation of £60bn.
But, says Witty, he always said this wasn’t much in money terms. “We bent over backwards to make sure people knew, for example, that the amount of profits we make in the LDCs [least developed countries] was less than £5m. I knew immediately people would think that must be billions. It’s not. It’s tiny numbers. It’s the point of principle. Actually even £1m is a lot of money in these markets,” he says. And if GSK does it, he adds, “why can’t every foreign company that makes profits in Uganda do the same? I don’t just mean drug companies. Everybody.”
Witty is the new generation of drug company boss; aged 44, in the post for just over a year, he is a marathon runner, massively energetic, full of ideas. He hopes to change the culture of the industry – or certainly the public perception of it – for ever. In Katine he turned his phone off. “That means I can really think about this – think about how we can change this.” He talks constantly of the enthusiasm for the new approach within GSK, where he has started a volunteering programme that will have around 100 employees at any time lending their specific skills to aid organisations at home and abroad.
Culture
“Whether it’s an NGO in Katine, whether it’s providing support for the homeless in Atlanta, or whether it’s in the UK, when people spend six months working with an NGO they will come back with a broader view of the world, a more community view of the world, and I think that will change the culture of the company – for the good, actually.”
But improving the image of a greedy, uncaring pharma is harder and Witty, who earns £1m a year before bonuses, is alert to the risk of bad publicity. In the maternity ward at Tiriri health centre unusually only two beds are occupied. Witty has a word with a happy and healthy new mother, but then abruptly and nervously backs away. In the other bed is a clearly sick woman. Sarah Angwao, 17, has malaria and chronic abdominal pain with a threatened miscarriage. Perhaps the last thing GSK needs is a picture of its CEO beside her bed under a headline crying “Dying for Drugs”.
Hopefully she won’t die, but in fact Sarah is at the heart of the drugs problem in Katine – the absence of them. None of the health centres have any anti-malarial drugs for the biggest killer of pregnant women and small children in the region.
GSK does not make anti-malarials, although it is trialling a promising vaccine, but the issue is a growing and troubling one. Until recently, Katine also had no drugs to prevent babies getting HIV from their mothers at birth, such as Zidovudine, which GSK does make. When Nosiante went into hospital recently she needed blood pressure pills which many companies, including GSK, make, but there were none.
It deeply troubles the people of Katine. At a smaller clinic in Ojom, where Witty is greeted by singing women before he watches a baby being immunised and tours a new lab, the chairman of the health unit committee, retired prison officer John Eotu Enangu, has a quiet word.
“I told him that we receive very little drugs here,” he said later. “For the last four times we had a delivery there were no anti-malarial drugs and malaria is a great killer here. We haven’t had any since last year. We order them and they don’t come.”
The reasons for the shortages are complex and include shrinking government budgets, inefficiency and corruption. GSK, inventor and manufacturer of medicines, could say its responsibility stops at Entebbe airport. But there are those, such as Paul Hunt, until recently UN special envoy for health as a human right, who disagree. In a recent report with which GSK co-operated, although it did not totally agree, he said that “having developed a life-saving medicine the company has a human rights responsibility to take all reasonable steps to make the medicine as accessible as possible, to all those in need”.
Witty is not ducking the issue. He thinks there are things GSK might be able to do. “The tragedy is you’ve got people like us and the generic companies shipping products into airports and ports and, as you’ve seen, it doesn’t go anywhere.”
It cannot be GSK alone. Government and NGOs such as Amref, which runs the Guardian’s Katine project, have to be involved. But, says Witty, he is prepared to dedicate staff to looking for solutions, including people on the GSK volunteer programme.
“We can’t just sit back and say we developed a drug and for some reason which we’re not going to spend the time to try and understand, nobody in Africa can get it. I don’t think that’s an acceptable position to take. It’s equally obvious we can’t solve the problem, because the problem is so big, it’s so complicated, but we absolutely can challenge ourselves to do more every day.”
One man, leading one company into change – whether for idealistic reasons or to stem the bad publicity – can have only a limited effect and certainly will not alone redeem a tarnished industry. Witty says he believes other companies are thinking about their stance. When he announced his plans for the patent pool and publicly challenged his competitors to join in, he says, it was a bit of a shock.
“It has caught them a bit by surprise because we didn’t go around talking to people at the time, and they’ve had to come up this curve from zero,” he says.
Eventually, last month, one US biotech put 1,500 patents into the neglected diseases pool and Witty says negotiations continue with other big pharma companies. But none of Witty’s initiatives will cost the company more than goodwill and small change. GSK’s patent pool excludes their money-spinning HIV drugs. Witty says there is no need to put them in, because the pool is to stimulate research in an area where the lack of money to buy drugs gives no incentive. HIV is a big market in the west.
The UK government disagrees. It recently backed a call for drug companies to put their HIV patents into a pool being planned by Unitaid, a drug financing mechanism set up in Europe. By 2030, a report by the all-party committee on Aids estimated, there will be 50 million people in need of drugs. As intellectual property rules tighten on India and China, after hard pharma lobbying, the pirates will be stopped from making cheap copies of new medicines.
Witty says all he knows about Unitaid is what he has read in the papers. “The first point is I’m not saying no to anything because nobody’s actually put in front of me a really concrete proposition.” Secondly, he says, GSK knows how to get things done in the HIV arena. He cites the £50m he has just pledged to help children with HIV and prevent babies getting it, together with £10m for research into better children’s drugs, and his total willingness to let generics companies make cheap copies of any of GSK’s Aids drugs under licence.
But many crucial HIV drugs are made by other companies. GSK’s reforms will mean little if none of them follow suit.
Transparency
Health in the developing world, together with transparency in the west, are key issues for GSK, Witty insists. “People who work for the company really feel good about it because it is changing the way the place operates and the way we behave and hopefully more and more will align it with what communities and society expects of us.”
What will it mean to Nosiante? Possibly a new sewing machine, donated by GSK. As the convoy of Toyota pick-up trucks left in a cloud of dust, carrying a man who earns more money than she can imagine, Witty told an aide to sort it out. That sort of instant problem-solving for individuals is easy. But far better for her and for Africa would be a real change of tack from the drug companies, to put a fraction of their considerable skills and some money into efforts to lessen disease and improve healthcare for those in real need.
If GSK can initiate that, it may not help Nosiante’s daughter with the crippled leg, but it may mean in the future there will be fewer like her.
