Being Eclectic – A Pharma Leadership Quality In The New Normal

Posted on June 21, 2021 by Tapan Ray

It’s no-brainer that since the onset of Covid pandemic, digitalization initiative of many pharma companies in critical facets of business operations, has reached a new high. The process is now fast accelerating with the adoption of avant-garde ideas, and scalable digital tools and platforms. Some of these initiatives may be incremental in nature, but several others possess game changing potential in delivering business outcomes.

This period of transformation is also an opportune time for pharma leadership to be more eclectic, while working out strategies to gain business momentum – outpacing the competition. As is being revealed, strategic inputs from a diverse range of sources – often from totally different areas, to meet fast changing customer needs and expectations, would immensely help in the new normal.

In this article, I shall argue on the need of being eclectic for pharma leadership to gain competitive edge, especially in the trying times. I shall elaborate this point with the example of an eclectic idea – Gamification. If used where it ought to be, eclectic ideas may help organizations to successfully navigate through unprecedented disruptions, especially, caused by Covid pandemic, in various critical areas of pharma business.

Gamification – an eclectic strategic tool for pharma:

Gamification – an eclectic strategic tool, ‘incentivizes people’s engagement and activities to drive results with game-like mechanics.’ Various companies, across the industries, are leveraging this technique for greater effectiveness in different business domains. This includes, driving employee motivation for sustainable performance excellence.

I discussed ‘Gamification in Pharma’ in this blog – about a year before the onset of the pandemic. However, its potential is being increasingly realized with virtual engagement becoming more common during Covid pandemic. Several drug companies are now imbibing Gamification techniques to offer greater value in several areas of business. These include, among others, chronic disease management, adherence to the prescribed dosage regimen, and also for training and development.

The core purpose and value:

The core purpose of Gamification is to effectively engage with both internal and external customers of an organization, with clearly captured details of their changing needs and expectations in the new normal. Game mechanics are basically the rules and rewards that build the foundation of game play. Game dynamics involve a set of emotions, behaviors and desires found in game mechanics that help foster engagement and motivate participants.

The broad process of Gamification entails integration of game mechanics on various existing platforms. These include, a website, online community, learning tools - providing target audiences with proactive directives and feedback through game mechanics that lead to the accomplishments of business goals and objectives.

According to BI Worldwide - a global engagement agency, ‘Gamification is about driving engagement to influence business results.’ When people participate and engage with gamification initiatives, they learn the best way to interact with the business, its products, services and in thereby in the brand building process.

It further says, the business value of Gamification doesn’t end with the participant. Engagement with game mechanics provides insightful data that can help influence marketing campaigns, platform utilization and performance goals. Every employee or customer interaction gives a better sense of where a participant is spending their time and what activities drive interest.

Application of ‘Gamification’ in pharma is a decade old now:

Gamification isn’t totally a new concept in the pharma industry. It was successfully tried by some pharma majors, at least, about a decade ago. Let me give below just a couple of examples from that period to get a feel of it:

Way back in 2011, Pfizer created the Back in Play game for European patients, to boost knowledge of ankylosing spondylitis, a disease that causes inflammation in the spine and pelvis joints. Interestingly, the game delivered a simple healthcare message to a notoriously difficult to reach audience 38 million times.

In 2012, Boehringer Ingelheim launched its pharma game – ‘Syrum’ on Facebook platform. This particular initiative is considered as an evolution in the pharma industry’s use of the social media platform. It gave the Company a new tool to educate and expand the knowledge of the general public about the challenges of its business. It also helped to improve disease awareness, besides allowing the company to conduct its market research.

Besides these two, other interesting Gamification initiatives taken around that period include, Zec Attack (Novartis), Silence Your Rooster (Sanofi).

Its potential in pharma marketing – and what to avoid:

Applying game mechanics to healthcare marketing could also help ensure that patients are activated, educated, and engaged throughout the duration of their care, driving both – business performance and patient outcomes. This observation was made in an article on ‘Gamification’, published in the Pharmaceutical Executive on February 28, 2019. Another article titled, ‘Gamification is Serious Business’ also reiterates, ‘Research and case studies from both the academic and healthcare space bring forth ample evidence that games can improve patient compliance and healthcare outcomes.’

However, if any pharma marketer enters into the gamification arena with greater focus on the desired outcome than on patient goals, or the games themselves don’t excite, engage, and motivate the users, the efforts may not succeed.

Gamified e-learning helps during Covid pandemic:

An interesting study on ‘The Impact of COVID-19 on Learning,’ conducted by find courses, noted some interesting points. A few of which, are as follows:

Covid pandemic is fueling an unprecedented interest and opportunity for many people to acquire more job knowledge and skills, mainly to protect their future in uncertain times.

In tandem, people’s priorities when it comes to learning are also changing. Health-safety being at the forefront of many learners’ minds, they prefer mostly online courses, or heavily reduced classroom sizes - to maintain social distancing.

It has also been noted that many such learners often find virtual learning programs uninteresting and lackluster. Sensing this issue, many organizations, which include some pharma companies, are now using Gamification to augment learning effectiveness and build greater team harmony. Let me illustrate this point with an example from the pharma industry during the ongoing pandemic.

It’s more relevant in the new normal:

On June 04, 2021, Fierce Pharma featured an article on Pharma companies’ getting into gaming to boost retention, recall – and fun. There, it quoted a top official of the global pharma major AbbVie, who said: “Gamification has become more important and more impactful in the virtual environment.” The honcho further said: “The pandemic showed we need this now more than ever. – It’s given an extra push to what has always been core to what we do, which is retention and recall in a fun and engaging manner.”

The report elaborates, AbbVie Canada uses gamification to onboard new reps, district managers and brand managers as well as for national sales meetings. Instead of studying or reading up, AbbVie asks employees to do the advance work through gamification tasks and then follows with more tasks after the meetings to boost retention and recall.

The Global Healthcare Gamification Market Report 2021-2027, also vindicates this point. As it reported, utilization of new healthcare gamification applications based on mobile tablets and laptops, witnessed a good growth during Covid pandemic. It reported, ‘Healthcare Gamification Market’ is expected to reach US$35,982.7 million in 2027 from US$ 3,072.5 million in 2019 with an estimated CAGR of 36.2% from 2020-2027.

Gamification is now being used by pharma in India, as well:

Abbott India is using elements of gamification in its customer services through a: care program. As the company Press Release says: ‘This new healthcare service is designed with games, quizzes and recognition programs to support patients, doctors and pharmacists throughout the entire healthcare journey, from awareness and prevention to motivation to get and stay healthy.’

In India, since quite some time, many well-known non-pharma companies are successfully using gamification for employee engagement and hiring.

Conclusion:

Unprecedented disruptions caused by Covid pandemic have considerably impacted the business operations of virtually every industry in India – just as other nations, across the globe. Since the onset of the pandemic, non-covid related medical centers, fitness institutions or gyms remained shut. Getting F2F – in clinic or hospital care, especially for non-Covid patients were also challenging for several reasons, with virtual care being the only options for many.

Interestingly, with most interactions and engagements – including learning, training and development programs going virtual, ‘Gamification’ initiatives started gathering wind on the sail, in some of those areas. This happened mainly because, organizations, institutions and people were driven to look for digital and app-based solutions for all needs and necessities, for a sustainable progress in an uncertain future.

An article on gamification, published in the PharmaPhorum on March 21, 2021, reiterated the same. It said, “Gamification” – adding game-like elements into non-game or real-world settings – has become a popular concept in the pharmaceutical, healthcare, and event industries, especially as virtual engagement becomes more common during COVID-19.’

With diverse applications and approaches, Gamification is quickly becoming a promising tool in various areas of pharma service and operations. These include, patient adherence, chronic disease management, preventive medicine, rehabilitation, besides better customer engagement, medical education, training, hiring and more.

From this perspective, in my view, pharma leadership now needs to more eclectic, and try using methods and approaches, such as, ‘Gamification’ – drawn from various other disciplines, in pursuit of excellence in the new normal.

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

Unleashing Pharma’s New Potential In Changing Market Dynamics

Posted on June 7, 2021 by Tapan Ray

Several pharma majors have started pondering in this space. This is evident from several recent developments, both in India, and also in other places of the world. One such articulation can be heard from the very top of the domestic pharma industry, which could be a pacesetter for many others.

The founder and Managing Director’s Message of India’s top pharma company – Sun pharmaceuticals, was released to the media on June 02, 2021. This speech is a part of the company’s Annual Report 2019-20. It is indeed interesting from overall pharma business operations’ perspective in India amid Covid-19 pandemic. It is also in sync with what many of his global counterparts have also expressed in recent times. To give a sense of Sun Pharma Chief’s reading and understanding of the fast-changing business dynamics, I am quoting below a few critical points of his above message:

There is a gradual realization that the COVID-19 virus is here to stay and that all of us will have to learn to coexist with the virus till an effective treatment or vaccine becomes available.

There will be far-reaching changes in the way in which organizations are likely to operate going forward.

Consumer behavior and consumption patterns are also likely to change due to the global pandemic.

Social distancing and maintaining individual hygiene (like using masks and hand sanitizers) have become imperative.

Work-from-home (WFH) option has been exercised by most organizations for certain functions and there is a likelihood that it will continue for some more time till the viral infection comes under control.

There is a possibility that WFH may become the new-normal for certain categories of corporate work force even after COVID-19 comes under control.

Also, there is a higher focus on automation, digitalization as well as an increased dependence on analytical tools for decision making.

Overall, in the global pharma and biotech arena, one can now witness a varied response to opening-up – some quite bold, others are flexible and cautious – as the scenario unfolds. In this article, I shall dwell on the importance of framing a well-thought-out plan, with clearly stated Plan B, C and D in this area, to prevent any business opportunities to slip by due to delayed action.

Key questions to answer – what to open and when to open:

It goes without saying that remote working or WFH for all pharma employees can’t remain in-force for any indefinite period. It will mostly depend on two critical drivers, mainly to avoid any reckless decision with grave consequences. One – how fast several – reasonably strong preventive measures, such as, vaccinations, can provide a reasonable herd immunity to most people around. And also, how most other similar businesses successfully start carrying out their commercial operations in the same environment.

Pharma players would then need to have a clarity on the business functions where selective personal presence of the qualified staff is necessary, as no extent of technological interventions can compensate it. Then follows the question, when to start opening – without being reckless and following all prescribed Covid related health norms. The answer to these questions should be addressed along with Plan B, C and D ready – just in case something doesn’t work out or because of competitive reasons.

To elaborate this point, let me first give an example of what an Indian tech behemoth is planning to get back some employees in the workplace, based on a sophisticated digital model. Thereafter, we will have a glimpse on how several pharma and biotech players are planning in this space. The basic assumption is – the grand show must go on – with collective scientific learnings on how to coexist with the virus, for an indefinite period, if inevitable.

Integrated digital plan to get back more employees at the workplace by TCS:

Lilly, Amgen, PfizerAs reported on June 02, Tata Consultancy Services (TCS) are working on a plan to get back more employees to the workplace. The tech giant is focusing more ‘on increasing talent fungibility as global clients increasingly require associates with niche skills to be deployed on projects at short notices.

Thus, to evaluate how it will get a certain percentage of people back, TCS has drawn up a risk assessment model, Intelligent Urban Exchange (IUX). To effectively address the new requirements for employees’ safety, regulatory compliance, and operational efficiency, the company has devised this system. It will help TCS to get real-time insights that will help restore operations and ensure safety, while becoming nimbler and more resilient in the new normal.

What some global companies are planning now:

One will witness a mixed approach of global pharma players to get back employees at the workplace, soon. This will be evident from a few examples, as below.

A Bloomberg report on April 27, 2021, highlighted: ‘As vaccine drives ramp up and open the possibility of a return to the office, a growing number of companies have pointed to a continued role for remote work — and less of a need for pricey office space.’ It quoted Novartis CEO saying: ‘“We’ve all learned from the pandemic that we can work from home and work from the office, and it will always be a combination going forward.”

Thus, in Novartis, “hybrid-based working environment” – at-home and in-office work, will persist for the long term – extending beyond the pandemic. The Company CEO also reiterated: “We think this is the future.” The flexibility should allow Novartis to “access talent pools we would not have been able to access in the past,” he believes.

Similar approach, but with specific dates for returning to the workplace:

By an open announcement on Linkedin, the Chairman and CEO of Eli Lilly declared the Company’s plan at the current stage of Covid pandemic. He said: “More than a year later, I’m pleased to say that we’re actively planning Lilly’s return to our workplace in downtown Indianapolis, and other facilities around the world.”

He further said, on June 1, 2021, Lilly will begin reopening their Indianapolis offices, inviting 25 percent of our workforce back – with masking and distancing indoors, and a requirement for vaccination. Barring a change in the steady downward case rate in the community, the Company will then open to all Indianapolis-based employees on July 12, 2021.

The company’s new work model will be based on the requirements for each job. Some employees will be on site all the time, others most of the time, and some will have even more flexibility. As ‘individual work’, and some ‘transactional work’, is easier done remotely, employees in those roles can choose that option in consultation with their supervisor. But collaboration, innovation and learning are best done in-person at the Company facilities, the Chairman and CEO said.

He reiterated, Lilly is not taking these steps casually, but based on a data-based approach, and will continue to do so. If external factors change, Lilly will adapt. In other countries, the Company offices will continue to follow local guidelines and open as they are allowed based on local circumstances, the Company clarified.

More remote working being planned by many other global majors:

According to another report of May 07, 2021, many other global pharma and biotech majors are now planning in favor of long-term remote working for several critical business than ever before. For example, on May 07, 2021 Amgen announced that the Company will make working from home a permanent policy for much of its international workforce, including locally.

It said, “Most of our employees who are currently working remotely will continue to do so for a majority of their time, even after the pandemic ends. Our intent is to create a more flexible environment that intentionally combines the benefits of remote and in-person working.” The statement further added. “We are not initiating any changes to our Thousand Oaks campus at the time. Though some staff may come to campus less frequently.”

As reported on April 27, 2021, Pfizer has put its large Philadelphia-area campus up for sale, as it considers the future of work. According to the company, as revealed by Fierce Pharma, “The decision to do so is primarily being driven by the company’s evolving – flexible working model, providing employees with greater flexibility to work remotely while still maintaining the ability to connect and collaborate regularly on-site.”

Conclusion:

It’s over a year of business disruptions within the pharmaceutical industry, at varying intensity and in different phases, though. For example, after more than a year since the pandemic hit India, Covid 2.0 has, reportedly, pushed up Indian pharmaceutical sales to a new high. It recorded an exponential growth of 59% year on year in April 2021, against 16 per cent – year on year in March 2021. This is obviously an outlier and is apparently unsustainable. Thus, for a sustainable good growth with greater certainty, Indian pharma players would require working out a well-researched digital blueprint of the future working framework of business operations with ‘what if’ options.

As has been revealed, remote working, wherever it makes robust business sense, will help getting hard-to-reach talent pools regardless of geography. This opportunity needs to be leveraged. However, it’s also a fact that for various reasons, everyone may not be too comfortable to work from home. Thus, the future work plan may call for a balanced and employee specific approaches.

Which is why, the process will require in-depth analysis of key functions where the personal presence of qualified staff is necessary, mainly because, no extent of technological interventions can compensate the human presence. Then follows the question – when to start opening in a responsible way – following all prescribed Covid related health norms. A representative pilot trial may help in this area.

Some of the key factors to consider will include speed of getting the staff vaccinated. Besides, arrangement for quick identification of breakthrough Covid infections among staff through quick tracing, testing, and provisions for appropriate hospitalization, if necessary, need to be put in place. Thus, I reckon, it’s time for the domestic pharma companies to diligently plan for unleashing the new potential of the respective organizations – amid the pandemic-triggered changes in market dynamics.

By: Tapan J. Ray

Augment Pharma Customers’ New Value Expectations With Content Marketing

Posted on May 31, 2021 by Tapan Ray

‘COVID-19 is driving lasting changes in what HCPs need and value,’ found the Accenture Healthcare Provider Survey May 2020, named – ‘Reinventing Relevance.’ Several physicians from the US, Europe and Asia were found to have experienced a significant change taking place in many pharma companies’ communication with them – going much beyond just product information.

The study observed, right from the early days of Covid-19 pandemic, daily operations of many health care providers (HCPs) shifted to more virtual interactions with both patients and pharma companies. The participating doctors also felt, the services that pharma companies are now offering deliver higher value than the pre-pandemic period.

Accenture’s follow-up study in August 2020 reiterated, ‘pharma companies have improved how they engage with healthcare providers during Covid-19.’ It, therefore, appears that the new value expectations of many physicians are being met with a newer value delivery model, significantly deviating from pre-Covid practices.

For example, in the above August 2020 survey, most HCPs said pharma players are increasingly providing education on how to better treat patients remotely and help them manage their conditions in light of COVID-19. Besides, some of these companies are also helping patients understand various contemporary health and care related issues.

Against this backdrop, as the study underscored: ‘Now is the time for pharma companies to redefine their relevance.’ Picking up from here – in this article, I shall focus on the relevance of ‘Content Marketing’ in pharma to effectively deliver the new value expectations of physicians with a new value delivery model.

Pharma marketing can’t be ‘an outdated and uncoordinated analogue’ any longer:

Since quite some time, technological innovation has started opening new vistas of opportunities with new tools, multi-channels, and platforms for personalized and more effective customer engagement in pharma. But, majority of tradition-bound pharma players, unlike their counterparts in other industries, preferred to stick to the single channel marketing model, that has been offering golden eggs, till Covid-19 struck.

It’s not that no one in pharma knew at that time about the usefulness of content marketing. This is vindicated even in the article on the future of pharma marketing, published in the Pharmaphorum, on May 23, 2017. It wrote: ‘Where others have taken marketing innovation in their stride, pharma retains an outdated and uncoordinated analogue perspective of how to communicate its business.’

Citing examples of some pharma marketers, such as, Boehringer Ingelheim and Eli Lilly, it wrote, ‘while moves have been made to embrace new marketing methods, such as the integration of digital technologies for multichannel marketing (MCM) strategies, the way forward for pharma marketing is far from clear.’ It was – then.

It is different now;

Covid-19 pandemic has encouraged many pharma marketers to expand marketing focus much beyond just product information to meet their customers new value expectations. These encompass some critical areas, as the May and August 2020 surveys of Accenture have brought out.

For many companies, content marketing strategy with an omnichannel presence will help build long-term relationships with customers. That said, for all to be on the same page, let me recap – what exactly is content marketing, and its difference from the traditional single channel marketing in the pharma industry.

Content marketing in pharma:

According to the Content Marketing Institute: ‘Content marketing is a strategic marketing approach focused on creating and distributing valuable, relevant, and consistent content to attract and retain a clearly defined audience – and, ultimately, to drive profitable customer action.’

Instead of pitching the products or services, content marketing provides contemporary, relevant, and useful content to customers to help them solve their contemporary issues in the given space. Since quite some time, content marketing is being practiced in many industries, including -by a selected few in pharma, as indicated above.

The key difference from traditional marketing:

The value of content marketing lies in the quality of personalized engagement between the customer and the company with personalized content through different channels. From this perspective, while traditional marketing is akin to ‘shouts’ at the customers – generally, for a brand prescription, whereas content marketing is akin to ‘talking’ with them for a solution. Content marketing in pharma is, therefore, about a grand strategy for effective participation in meaningful conversations for development stronger stakeholder relationships.

Content marketing usually includes educational articles – on the company website or in the form of e-books, videos, infographics, white papers, magazines, podcasts, or webinars. The content for all these need to be tailor made to credibly answer specific questions that customers have and provide them with something they can’t get elsewhere. This process of creating a deeper and a sustainable bond with stakeholders, often pays a rich commercial dividend, even in trying times.

Increasing use of content marketing, especially, in a fast-changing scenario, as we witness today, can help a pharma company to change and enhance its customer’s behavior toward the company, in a win-win manner.

Some recent examples of content marketing in pharma:

For more clarity, let me give below a few examples of good content marketing in the pharma industry, as available in the cyberspace – some of them capturing Covid related issues too:

Speak Your Migraine, developed by Novartis, was created to support people living with migraine. The website carries an impact assessment tool for the visitors to feel how migraine affects people’s lives, enabling them to openly share their experiences with doctors and family.

Lilly Pad is Eli Lilly’s official blog, consisting of articles on the company, its research to cure diseases and improve the quality of lives. The blog also provides details of the health and public policy, along with corporate social responsibility of the organization in various areas of the society.

Takeda Pharmaceutical launched its campaign IBD Unmasked to support and create increased awareness of inflammatory bowel disease (IBD). The campaign aims to help IBD sufferers find their inner super-strength and become superheroes like the characters featured in the graphic novels within the campaign.

Bayer’s content marketing initiatives span across print and digital media with a large following. The organization publishes two well-appreciated publications as a carrier of its content: The Bayer Scientific Magazine and the Bayer Magazine.

Conclusion:

Overall, pharma and biotech industries don’t seem to be doing as well in this area. According to ‘The State of Content Survey for Life Sciences’ by Accenture, only very few of them think that they are doing well. For example:

Just 13% of pharma and biotech marketers and 17% of med tech marketers think they leverage content well.

Only 4% in med tech and 11% in pharma/biotech report they have a clearly documented content strategy that meets their current and future needs (compared to 42% across all industries).

Only 6% of med tech marketers and 9% of pharma/biotech marketers feel objectives are clearly laid out (versus 19% across all industries).

It is quite possible that more than a year since Covid disruptions, this situation has somewhat improved for some companies. Nevertheless, amid this complex environment, most of the pharma and biotech players still require defining a robust ‘content marketing strategy’ for them. Establishing clear objectives of the content strategy based on well-researched data, along with its measurement criteria, will demand a quality thought process. Depending on the strategic requirements, the leadership will need to put in place an organizational structure for content marketing, including people, processes, technology, and tools that can deliver the stated content marketing goals – both during, as well as after the pandemic period.

Thus, I reckon, to effectively augment pharma customers’ new value expectations, content marketing needs to occupy an important place in today’s pharma marketing playbook.

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

Rebalance KOL-Mix As Covid-19 Redefines Pharma Marketing

Posted on May 24, 2021 by Tapan Ray

‘It’s safe to say that 2020 was a year like no other and that 2021 will certainly not revert back to the old normal,’ reiterated the Harvard Business Review Article - ‘10 Truths About Marketing After the Pandemic,’ of March 10, 2021. Amid Covid 2.0, several astute pharma marketers, I reckon, have also realized the same by now. The recent Government announcement on the impending third wave of Covid-19, coupled with slow vaccination pace in the country, further strengthens this possibility.

That said, making all internalize that pharma marketing, and specifically the brand building process will no longer remain – as it traditionally was, may still be a tough task. Mere digitalization of the traditional marketing processes won’t be a magic wand, either, to excel in the rapidly transforming market situation. The task ahead is fundamentally cerebral – ahead of any Artificial Intelligence (AI) tools and applications.

With the market dynamics going through a metamorphosis, pharma marketing needs to be redefined. Capturing the nuances of this redefinition is essential also to ensure the right focus on the right Key Opinion Leaders (KOLs) – for successful branding with long-term image building. Today’s article will focus on this less charted area during the pandemic. Let me begin with a few examples of the redefined areas of marketing triggered by disruptive changes in the current pharma business environment.

Traditional pharma marketing axioms need to be redefined:

To give a flavor of this redefinition, I shall pick up the following two examples from the above Harvard Business Review Article and then zero-in on just one, to explore the recasting and rebalancing need of the KOLs, for business excellence in the new normal:

A. Technology and human enablement:

Pre-pandemic belief: The right tech stack to drive modern marketing success.

Post-pandemic need: The right balance of factors (including tech stack) to drive modern marketing success.

In pre-pandemic days, focus on “tech stack” was emerging as an end-all game changer for marketing. But in the pandemic days there emerges a need to take a step back. The right approach to human enablement is becoming the key to properly understand the changes and their implications in the pharma business environment. Human enablement includes, making sure that people have the right skills to select and employ the most appropriate environment specific technology tools, effectively. The system should also ensure that the right measurement approaches are in place to motivate innovation and rewarding success.

B. Relationship building to drive marketing success

Pre-pandemic belief: Relationships matter to drive marketing success

Post-pandemic need: Relationship building is everything to drive modern marketing success

Building relationship with customers rests on the bedrock of trust. Covid-19 has placed a new emphasis on relationships, faced with a near virtual sales environment. New findings indicate, the teams with existing relationships have been able to maintain revenue momentum, capitalizing on the strength of their prior bonds. In contrast, prospecting for new customers has required an evolved set of skills focused on selling solutions, not products, as the Harvard Business Review Article emphasized.

Trust, credibility, and integrity are fundamental to driving market momentum. These are foundational to the value exchange between a company and a consumer. As the Harvard paper writes, this has necessitated ‘a serious recasting of talent to identify people best suited to driving relationships in this new world of online interactions — a world that relies less on charm (and even an expense account) and more on insights and solutions. Trust will be built by and rewarded to those that listen to customer needs and then craft solutions to meet those needs.’

Thus, I believe, in the redefined pharma market, the marketers need to have a fresh look with fresh a pair of eyes to expand and select their KOLs to achieve their business goals – consistently, in the years ahead.

Pandemic impacted pharma’s KOL outreach:

Pharma marketers are well-aware how much they rely on their KOLs in several areas of a brand building strategy, including the creation of widely acknowledged brand reputation, winning key stakeholder trust on brands. Thus, a robust strategy for engaging with stakeholders – based on KOL inputs, continue to remain an area of paramount importance for drug companies.

From this perspective, as I wrote before, during the early days of national lockdown triggered by Covid-19 pandemic, many marketers felt that in-person KOL outreach activities in physical events have only got disrupted temporarily. As the disruption prolonged, some companies hurriedly shifted online. Others hopefully kept waiting for some more time, and then tried to figure out how to catch up quickly by switching over to a more effective, interactive – and situation-specific contemporary communication channels and platforms, for them.

Marketers require recasting their KOL outreach strategy:

No doubt, KOL engagement remains a high priority area for pharma marketers - for guidance with fresh inputs while charting a new marketing pathway, mainly based on their:

Therapy area expertise where the company represents, and the sphere of influence
The span of influence to further business progress, gaining stakeholder trust and building brand reputation.

As the market environment and stakeholder expectations have altered significantly, in several marketing related areas, pharma marketers require quickly recasting their KOL outreach strategy, including virtual communication models and platforms. Many may consider, for valid reasons, though, that virtual events may not be as effective as effective as F2F physical events.

Notably, some well-researched digital outreach strategy for the KOLs – tailor-made according to their new expectations in the changing market dynamics, are trying to fetch the best out of them. The new initiative is also improving the effectiveness of virtual interactions manifold, steadily – with the ongoing honing of the processes. However, this would involve fresh mapping, and identification of a contemporary set of KOLs, soon, with in-depth understanding of their needs and interests.

Pharma KOL-mix need to include ‘influencers’ also:

Just to recap, KOLs are experts in their respective fields. Each one of them is also a well-regarded and influential voice, whose expert advice is respected and followed by many others – related to that field. These may include authorities in the same industry, whose opinion or decisions may have significant influence or impact on the business. In that sense, KOLs play the role of influencers, too.

Traditionally, in the drug industry KOLs are selected from accomplished and well-decorated medical experts who are often early adopters of new brands, playing a significant role in the prescription decision of other doctors.

Leveraging two other key roles of KOLs in the changing environment:

The other two roles that need to be leveraged by pharma companies in the in the changing environment may include:

Making more people aware of the critical roles of pharma brands, e.g., what people have witnessed recently with Covid-19 drugs and vaccines.

Improving brand credibility and corporate reputation by gaining stakeholder trust. This is usually triggered a favorable word-of-mouth awareness of the role that the company is playing to save and improve the quality of human lives – and, in that process, the livelihoods.

This gets reflected in the most recent annual Axious Harris 100 survey, where two widely publicized Covid-19 vaccine makers – ‘Moderna and Pfizer leaped into the top 10 best-regarded companies in the U.S,’ among all other industries. This clearly highlights ‘Americans love their vaccine makers’. As reported, Moderna ranked third, while Pfizer featured at No. 7 on the strength of its product and innovation scores, nabbing high marks for vision and culture along the way.

‘They’re the first biopharma companies to crack the top 10 in the ranking’s 20-year history.’ Interestingly, Johnson & Johnson, which featured in the top 10 before; this year, it ranks 72 on the list with a reputation score roughly the same as 2020’s,’ the report adds.

KOL outreach needs to be more focused and well-targeted on even niches:

This is an important need and has been vindicated by Deloitte focus group studies in the U.S., India, South Africa and the U.K and published on May 06, 2021. The studies found that the pandemic did improve overall pharma reputation score with a ‘reason to hope for more.’

However, still many respondents used phrases like, “profit-making” and “harmful”, as reasons of why they don’t trust pharma. Curiously, in the U.S., 29% of people cited “questionable moral integrity of biopharma executives” as a problem. Only about one-fourth (26%) of participants agreed that their trust in drug makers increased during the pandemic, even when Deloitte mentioned vaccine development.

Conclusion:

To mitigate such reputation, trust, and credibility related issues, besides transparency in drug pricing, besides efficacy and safety related research-data, pharma needs to work closely with a wider span of KOLs, who may help in explaining complex science in simpler words.

As the above Deloitte studies bring to the fore, the pandemic could be yet another fresh starting point for pharma to gain long-term trust of customers, and other stakeholders. In that endeavor, a fresh set of KOLs need to be identified through well-structured mapping. This initiative should ideally include, besides top medical and regulatory experts of high repute, globally acknowledged academics, top domain experts, and key members of the government.

Thus, in my view, as the pandemic redefines pharma marketing, there is an important need of rebalancing the KOL-mix of each company, based on their specific needs, especially in the virtual space, as the situation will unfold.

By: Tapan J. Ray

To Allay Customers’ New Apprehensions Pharma Needs A New Conversation

Posted on May 17, 2021 by Tapan Ray

Since the beginning of 2020, witnessing the rapid spread of Covid pandemic with very high global fatality rate – virtually the entire global populations – directly or indirectly, have been looking up to the health care industry for help. This, of course, includes the drug industry – with high expectations of people on deliverables, blended with palpable apprehensions on what’s happening around.

Amid the wave after wave attack of Covid-19, many have realized that there will neither be any quick-fix or immediate solution to tame the virus. As India goes through the Covid 2.0 catastrophe, while waiting for Covid 3.0, a similar situation prevails in the country – with a sense of lurking fear for future uncertainties, slowly but steadily creeping in.

Thus, an unprecedented public expectation for speedy disentanglement of Covid-19 disruptions, confer a huge responsibility to all health care providers and entities, such as, the drug industry, which will be my key focus in this article. Just as any extraordinary situation calls for extraordinary initiatives, this national tragedy also demands from pharma professionals to start a new and proactive conversation, driven by ‘out of-box’ thinking.

I shall explore in this article, in which areas pharma needs to roll out a new conversation to meet with new expectations of its stakeholders, formed during the Covid Pandemic. This engagement needs to go beyond drugs and vaccines, spanning across key contemporary developments that are bothering pharma customers. The aim should be to help customers visualize a brighter horizon based on scientific reasons, in not-too-distant future, such as:

How several pharma companies are taking novel initiatives, as a part of their corporate objectives to save lives and livelihoods, faster.
How pharma players are thinking ‘out of the box’ to allay Covid related public apprehensions and neutralizing gross misinformation on Covid cure – based on scientific reasons, often selectively deploying their staff members.

In this regard, let me start with a recent advice of a top pharma veteran of global repute, especially on political and public expectations of ‘the endpoint’ for successful prevention and effective treatment of Covid-19 infections.

When focus is on ‘the end point – the price point’, it needs pharma’s attention:

Former CEO of Novartis Joe Jimenez – Ex-Novartis CEO and CEO & Cofounder of Aditum Bio, advised the same in an interview with Reuters Events, published on April 06, 2021. Although this was against the backdrop of the United States, the same is applicable to India, as well.

There, Jimenez said: “And I think the political focus in the United States is too often on the end point, the price point, which definitely needs attention, but not enough on the whole pipeline. And that absolutely needs attention and can bring down the price point at the end of the day.”

“It’s the pharmaceutical industry’s responsibility to show how their drug can lower total costs through the system, whether it’s reducing hospitalization or whether it is reducing other health care costs and comorbidities that lead to ever increasing budgets. If the industry focuses on that, I think I think that’s going to result in better launch success in the next few years,” he added.

However, there is another endpoint – of equal importance, especially in the Covid-19 prevention and the treatment process.

The other end point is equally important, as there may be an extended need for Covid vaccines:

Wider access to Covid drugs and vaccines is another political and general public’s ‘end point’ of expectations, besides price. As I wrote in my previous article, on October 02, 2021, India and South Africa had proposed at the WTO about an IP waiver for Covid-19 drugs and vaccines to resolve the issues of access and affordability for these products.

Thereafter, on May 05, 2021, the United States also issued a statement supporting the IP waiver for Covid-19 vaccines at the WTO, in its ‘service of ending this pandemic.’ As reported on May 13, 2021, even China now backs the drugs and vaccine IP waiver at the WTO.

Patent waiver for Covid drugs and vaccines make sense for the coming years, especially, in view of the reports that ‘Pfizer, Regeneron CEOs see extended need for COVID-19 vaccines, treatments as pandemic enters the next phase.’ Adding that the data stressed a “need” for re-vaccinations, the Pfizer CEO said, while protection remains high for those six months, it does “go down by time.” Thus, the need for Covid vaccine may continue to remain as important as of date, to prevent the pandemic over, at least, a couple of years, if not beyond.

That apart, some interesting developments followed soon – coincidentally or otherwise.

Meanwhile, some pharma companies responded with laudable initiatives:

Presumably, for wider availability and affordability of Covid drugs and vaccines, several pharma players alone or in association with governments, took some laudable initiatives. A few examples are, as follows:

On May 10, 2021, BioNTech, which has partnered with Pfizer to produce its COVID-19 vaccine, said it plans to set up a new manufacturing site in Singapore, with a capacity to produce several hundred million doses of mRNA-based vaccine.

As reported on the same day, as above, Eli Lilly promised to supply India with thousands of tablets of baricitinib for hospitalized COVID-19 patients. It also pledged to sign a royalty-free, non-exclusive voluntary licensing agreements with Cipla, Lupin and Sun Pharma—to expand baricitinib’s availability in the country. Notably, in this month itself, the DCGI has authorized baricitinib plus remdesivir combo for emergency use of ‘hospitalized patients requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).’ Baricitinib has also faced a shortage of during the Covid 2.0 surge.

As per reports of May 12, 2021: ‘The US is looking at joint production of Johnson and Johnson’s Covid vaccine in India and ways to help manufacturers like Serum Institute of India (SII) to boost production,’

Pharma’s new role to allay public apprehensions in many Covid related areas:

In this complex scenario, various public apprehensions on Covid vaccines and drugs, need to be explained with scientific evidence – in a common man’s language. These include frequent changes in the dosage interval between two doses of some vaccines, whereas for other vaccines there isn’t any change in this area. Or why in India even within a group of fully vaccinated individuals, wearing masks or maintaining social distancing norms are necessary, when these requirements have been relaxed for fully vaccinated people in the United States. Or, when reports like: ‘Covid Cases Double In World’s Most-Vaccinated Nation, Raising Concerns,’ add fuel to the fire of public apprehensions in this regard.

Drug companies, especially those who are engaged in the global battle against Covid-19 – in their research lab, product development process, including clinical trials, can play an additional stellar role in this area, too. With ‘out of the box ideas’ for Covid related public engagement, they can scientifically respond to all public apprehensions with scientific reasons, in a simple language, on what is happening around most people, nowadays. Selective deployment of their own staff members can also make the initiative more meaningful.

This conversation may also include, science-based response to some bizarre claims of ‘Covid cure’ – from religious leaders having significant followers, and even by Union Ministers, without hurting their feelings or sentiments. These ‘advices’ were widely circulated by the mainstream global and local media, including the Wall Street Journal.

For example, one such report said: The president of a century-old religious organization declared that “consuming cow urine and cow dung will stop the effect of infectious coronavirus.” The swami added that a “person who chants ‘om namah shivay’ and applies cow dung” on his body “will be saved.” However, it was also reported that ‘Indian doctors warn against cow dung as Covid cure.’ Similar advice in different forms, even by elected politicians, keeps misguiding many unsuspected members of the public.

Conclusion:

A series of Covid related contemporary needs and apprehensions, besides the traditional ones are surfacing. These are to be mitigated, on an ongoing basis. Pharma players – individually and collectively, instead of being always reactive, may wish to volunteer to proactively address these issues to help people move in the right direction.

As Covid appears to be a medium to long-haul battle – unlike most other pandemics, pharma companies need to think ‘out of the box’ to create innovative – new – and proactive conversation models in this space. In turn, the initiatives will help them win long-term trust and loyalty of customers – that will always remain as invaluable assets, fueling sustainable growth in business.

By: Tapan J. Ray

Impact of Covid Vaccines’ Possible IP Waiver In India

Posted on May 10, 2021 by Tapan Ray

Just when Covid 2.0 rages in India with almost 4,000 people died in just 24 hours, scientists warn that Covid 3.0, and further waves are now ‘inevitable, reported Reuters on May 06, 2021. With hospitals running short of beds and oxygen during the onslaught of Covid 2.0, the World Health Organization (WHO) highlighted, ‘India accounted for nearly half the coronavirus cases reported worldwide last week, and a quarter of the deaths.’

The report revealed some more heartrending details: ‘Many people have died in ambulances and car parks waiting for a bed or oxygen, while morgues and crematoriums struggle to deal with a seemingly unstoppable flow of bodies.’

No visible overall improvements with ‘here and now decisions’ or maybe the lack of it, of the National Covid Management Team, is perceptible, just yet. It’s also a matter of further concern that unlike what happened during Covid 1.0, the second wave of the virus, reportedly, ‘started hitting even young adults hard – leaving countless children to fend for themselves.’

Ironically, alongside a rapid surge in infections, India witnesses a sharp decline in Covid vaccination numbers though more people are eligible. The key reasons being supply chain related problems, despite India being one of the largest vaccine producers, globally. In my last article published in this blog, I broached on finding a possible exit to this covid 2.0 maze in India. However, this article will explore some unprecedented developments of the last week in this area. To give a perspective, let me start by exploring whether the people responsible for Covid Governance in India, grossly misjudged the situation, claiming the ‘endgame’ of Covid-19, too soon.

‘India announced its triumph over Covid-19 early’:

A third Covid-19 wave is inevitable, but the timing could not be predicted, said India’s principal scientific advisor on May 05, 2021. Intriguingly, less than two months back, the national Government announced its triumph over Covid-19. On March 08, 2021, as Covid vaccination process for senior citizens and people above 45 years with comorbidities had just commenced, the Union Health Minister claimed, ‘India is in the endgame of the novel coronavirus pandemic.’ Just about a couple of months later, it sounded akin to a note of hubris for many, which prevailed, by and large, across the nation.

Acknowledging the same, on May 04, 2021, even Uday Kotak, MD&CEO Kotak Mahindra Bank and President CII commented, ‘India announced triumph over Covid-19 early’. He further urged: “We have to do whatever it takes to save lives first, even as we battle for livelihoods. And if our healthcare capacity is currently going through its challenges, we must be ready to curtail non-essential economic activities.” The latest editorial from ‘The Lancet’ also highlighted the same.

India’s Covid 2.0 – “A self-inflicted national catastrophe” – The Lancet

Yes. The editorial of the latest – May 08, 2021 issue of The Lancet, also reiterated so. It emphasized, ignoring warnings about the risks of super spreader events, the government allowed congregations of millions of people from across India in religious festivals, along with huge political rallies with utter disregard to Covid appropriate behavior. ‘The message that COVID-19 was essentially over also slowed the start of India’s COVID-19 vaccination campaign, which has vaccinated less than 2% of the population.’ India’s national vaccination plan soon fell apart with the government abruptly expanded vaccination to all 18 years, draining supplies, ‘and creating mass confusion and a market for vaccine doses in which states and hospital systems competed.’

The IHME estimates a staggering 1 million deaths from COVID-19 in India by Aug 01, 2021. ‘If that outcome were to happen, Modi’s Government would be responsible for presiding over a self-inflicted national catastrophe. India squandered its early successes in controlling COVID-19. Until April, the government’s COVID-19 task force had not met in months,’ The Lancet editorial revealed.

Besides, India also misjudged the complexities involved in procurement, distribution and for speedy inoculation of affordable Covid vaccines, at least, to its entire adult population. But, before delving into that area, let me highlight an interesting mismatch.

India’s vaccine shortage when Pfizer logs a record vaccine turnover during pandemic:

Two contrasting scenario surfaces – as the world is reeling under unprecedented disruptions caused by successive waves of Covid-19. Witnessing India’s unparalleled healthcare tragedy in Covid 2.0, the W.H.O director general said: “The situation in India is beyond heartbreaking.” Outlining the reason for the same a separate report commented: A ‘complete collapse’ of preventive health: How India’s 2nd COVID wave exploded.

Concomitantly, one reads news items, which bring out, ‘Pfizer eyes $26B in COVID-19 vaccine sales for the year, with $3.5B already in the bag.’ Notably, most vaccine companies received huge public funding much before Covid vaccines were rolled out. For example, ‘The New York Times’ article of July 22, 2020 came with a headline: ‘Pfizer Gets $1.95 Billion to Produce Coronavirus Vaccine by Year’s End.’

The Scientific American also reported on November 18, 2020, ‘For Billion-Dollar COVID Vaccines, Basic Government-Funded Science Laid the Groundwork.’ It added: ‘Much of the pioneering work on mRNA vaccines was done with government money, though drugmakers could walk away with big profits.’ That’s exactly, I reckon, is the reality today.

Similarly, Moderna’s COVID-19 vaccine generated $1.73 billion in revenue during the first quarter, as compared to $3.5 billion of Pfizer’s Covid vaccine in the same quarter. Moderna now predicts its vaccine will generate $19.2 billion by year’s end. Interestingly, through its COVID-19 vaccine partnership with the U.S. government, Moderna also received nearly $1 billion in research aid. The Company is now joining a list of other vaccine players to take a supply order from the federal government.

By the same token, Serum Institute of India (SII) – the contract manufacturer of Covishield, developed and owned by Oxford University and AstraZeneca has also received initial advance funding from the governments, prior to its manufacturing.

Was India’s ‘Vaccine Maitri’ a pragmatic step?

Today, India is one such country facing the brunt of Covid vaccine shortage alongside arriving at an affordable price per dose of the same – a part of which is due to ‘unrealistic’ planning, as many experts believe.

For example, on January 20, the Indian government launched Vaccine Maitri – an ambitious program to export the two Indian-made shots – Covishield and Covaxin – to the world. On that exact date, India counted 14,112 fresh cases of Covid-19. Going by a report of May 01, 2021: ‘According to the government’s own submission before the Parliament, more shots were sent out of the country than administered to Indians as of mid-March.’ Many, therefore, wonder, whether this was a pragmatic decision that helped save lives of Indians during Covid pandemic.

An unprecedented development on vaccine IP waiver:

This is regarding IP waivers for Covid vaccines. In my last article, I wrote about it, stating, on October 02, 2021, India and South Africa had proposed at the WTO about an IP waiver for Covid-19 drugs and vaccines to resolve the issues of access and affordability for these products. It was also widely reported: ‘Richer members of the World Trade Organization (WTO) blocked a push by over 80 developing countries to waive patent rights in an effort to boost production of COVID-19 vaccines for poor nations.’

However, on May 05, 2021, a statement of the U.S. Trade Representative said, ‘as the extraordinary circumstances of the pandemic call for extraordinary measures, in its service of ending this pandemic the US also supports the IP waiver for Covid-19 vaccines, although the US administration supports IP protections generally. As expected, Big Pharma lobby groups, including PhRMA, reportedly, have strongly criticized the move.

Let me hasten to add, there is, at least, one exception in this area. Months ago, on October 8, 2020, Moderna said, ‘it won’t enforce its vaccine patents against other companies during the pandemic.’ Without specifying any names, the Company revealed, ‘other Covid-19 vaccines in development might already be using Moderna-patented technology.

The WTO process is expected to begin now, but how long will it take?

As the Reuters report dated May 06, 2021 indicated – with the U.S. backing a proposed waiver of Covid-19 vaccine IP rights, the next stop is for the World Trade Organization to hammer out a deal – a process that could take months. “At a minimum, it’s going to be a month or two,” said a former Trump White House trade official who previously worked at the U.S. trade mission to the WTO in Geneva. The waiver, if happens, could also be significantly narrower in scope and shorter in duration than the one initially proposed by India and South Africa.

The relevance of IP waiver:

Currently, only drug companies which own patents or their authorized manufacturers like SII can produce Covid vaccines. A global decision on patent waiver may encourage the patentees to share the formula and manufacturing technology, instead of reverse engineering, as is done for off-patent small molecules and some biotech drugs. All companies with requisite resources may legally manufacture Covid vaccines, in that situation, leading to cheaper, and significantly more quantity of generic versions of Covid vaccines. This may help overcoming vaccine shortages, making the vaccines affordable, as well.

Some counter arguments and response:

As I wrote in my last article, the following three critical questions may arise in that scenario:

Will IP waiver help solve the immediate issues of vaccine shortages?
Can Covid vaccines be reverse engineered by domestic pharma industry without inventors sharing ‘Know-How’?
If yes, how long can it take?

The answer to the first question is – it may not help resolve the immediate crisis. But, for a medium to long term solution, there will be an emphatic yes, as Covid-19 fight is expected to be a long-haul one, as experts caution about subsequent waves of rapidly mutating new Coronavirus.

Moreover, Pfizer – BioNTech vaccine took less than a year from ‘mind to market,’ with support from all concerned. This is evident from Pfizer’s Press Release for the launch of Covid vaccine in the United States last year, on December 11, 2020. Thus, an efficient reverse engineering may also take that much time to respond to medium and long-term issues with Covid vaccines, especially in India.

Subsequent Covid-19 waves could be triggered by unpredictable compliance to Covid appropriate behavior of people. W.H.O has also warned: “When personal protective measures are being relaxed, when there are mass gatherings, when there are more contagious variants and the vaccination coverage is still low this can create a perfect storm in any country,”

Conclusion:

‘The pandemic is not a competition between companies and will not end without more-equal distribution of coronavirus vaccines,’ wrote Nature on March 30, 2021. It suggested: ‘It’s time to consider a patent reprieve for COVID vaccines.’

The world needs around 11 billion doses of Coronavirus vaccines to immunize 70% of the global population – assuming two doses per person. Interestingly, around 6 billion doses are meant for high- and upper-middle-income countries, against advance orders. Poorer nations, accounting for 80% of the global population, so far, have access to less than one-third of the available vaccines. ‘Unless manufacturing and supply can be distributed more evenly, researchers forecast that it will be at least another two years before a significant proportion of people in the lowest-income countries are vaccinated’, the paper concluded.

In this situation, I reckon, a temporary IP waiver would help in accelerating the end of the pandemic. It may not help immediately, but certainly in the foreseeable future, as discussed above. It may also call for an efficient and well thought out ‘Hub and Spoke’ distribution model. Simultaneously, of course, similar systems for raw and ancillary materials for vaccine production need to put in place to avoid intermittent shortages.

As reported on May 08, 2021, India registered a record 4,187 Covid death with 4.01 Lakh new cases, in 24 hours. Capturing the depth of the Indian crisis, ‘India Today’ is coming out with a cover page article in its May 17 issue, with the headline – ‘Covid 2.0 – The Failed State.’ Another article terms India as the ‘Flailing state in Covid storm.’

As I reasoned above, if this unprecedented step of IP waiver for Covid vaccines is finally taken by the WTO, it will significantly help India – along with the world – may not be immediately, but certainly in the foreseeable future. Only adverse impact that the decision could possibly make, is curbing Big Pharma’s unprecedented profit on Covid vaccines, and that too, during a deadly global pandemic.

By: Tapan J. Ray

Exploring An Exit To India’s Covid Management Maze

Posted on May 3, 2021 by Tapan Ray

‘India’s Covid-19 Crisis is Spiraling Out of Control. It Didn’t Have to Be This Way,’ was the headline of the lead article, published in The Time with the cover page ‘India in Crisis.’ All Indians also believe the same, as the current reality is shown virtually live in TV news channels daily, with experts commenting on the same.

Ironically, many in the country’s leadership still remain in a ‘denial mode’, even when the country records globally highest number, ever – over 402,110 daily new Covid-19 cases with 3,688 daily deaths, on April 30, 2021. One can also gauge how grim the situation is from the example of the US alert to its citizens in India. It says, ‘access to medical care is becoming severely limited because of a surge in Covid-19 infections and those wishing to leave the country should take advantage of available commercial transportation options.’

Notably, when most Indians, including the President of India, were taking pride in the country’s ‘Aatma-Nirbhar Bharat Abhiyan,’ especially in the Covid-19 vaccine area, during the pandemic, the stark reality appeared to be quite different. Pandemic demonstrated that each country is, in fact, interdependent. One may not acknowledge it in the days of hubris. However, when a crisis, like Covid 2.0 strikes the nation hard and interestingly – not unannounced, as many experts write, the reality dawns. This is also a reality that India as a nation could not adequately prepare itself for Covid 2.0 onslaught, even over a yearlong Covid 1.0 pandemic.

Nonetheless, India now needs global help, almost for everything – in the prevailing calamity – Oxygen, drugs like, Remdesivir – and vaccines, besides many others. Quite expectedly, witnessing the Covid 2.0 tragedy in India ‘Aid (also) pours in from the world to counter India’s Covid-19 second wave.’ Alongside, along with Indian media, even foreign media reports, ‘Bodies piling up at crematoriums: Record death toll may hide extent of India’s COVID-19 crisis.’

Amid Covid crisis, most countries in the world, including the United Kingdom, the United States,Israel and even India’s neighboring country - Bhutan focused on the mass Covid vaccination drive – at a blistering pace, to create a herd immunity. In this article, I shall explore the drivers and barriers for India to achieve a similar goal, soon.

Current developments with vaccine in India:

The latest development is – after a protracted hesitation, the Government of India opened ‘Covid-19 vaccination for all above 18 years of age,’ effective May 01, 2021. However, not so good news is, this happened at a time when the country is experiencing a Covid-19 vaccine shortage even for all adults above 45 years of age. Believing that government has taken this decision without enough advance preparation, experts warn, India is likely to face extreme Covid vaccine shortage from May 1.

They express concern: ‘India is running out of vaccines just as the new wave of Covid-19 infections batters the country, complicating Prime Minister Narendra Modi’s plan to inoculate the nation’s workforce while threatening to drag out the world’s worst healthcare crisis.’

India rejected ‘emergency use’ of imported Pfizer and other vaccines, unlike other countries:

Some decisions by Indian vaccine expert panel also delayed more vaccine availability in the country for ‘emergency use,’ sooner. For example, Reuters reported on February 05, 2021, ‘Pfizer drops India vaccine application after regulator seeks local trial.’ The Company had applied to the DCGI for a waiver of a local trial for importing its mRNA vaccine in India.

Similarly, as reported on February 25, 2021, ‘Expert panel seeks safety data for Russia’s Sputnik V Covid-19 vaccine before emergency use nod,’ in India. Ironically, it was again rejected on April 01, 2021. However, facing the fierce Covid.2.0 wave Sputnik V vaccine is now being imported from Russia. Similarly, as reported on April 30, 2021, ‘Pfizer begins exporting U.S.-made COVID-19 vaccine to Mexico.’ Pfizer has already exported 10 million doses to Mexico.

In the quagmire of indecision, late decision and other non-life saving priorities are omnipresent:

Many Indian and overseas experts opined that valuable time was lost to have more vaccines in India, by now. This is because, amid a wrenching surge in infections and deaths, on April 14, 2021 – ultimately, India agreed to fast-track vaccine approvals for ‘emergency use,’ without local trial. These are now applicable to all those Covid vaccines that have already been authorized by ‘drug regulators in the US, UK, European Union and Japan or cleared by the WHO, without having to conduct a local bridging trial.

The above developments, I reckon, gave rise to two core issues in vaccinating the Indian population of above 18 years of age – at a ‘blistering pace,’ as happened or is happening in countries, like the UK or the US.

Whereas, for speedy mass vaccination wealthy governments took a quick decision to stock up on COVID-19 shots from Pfizer and Moderna Inc, because of their extremely high efficacy. More so, when safety concerns and production problems temporarily sidelined vaccines from AstraZeneca Plc and Johnson & Johnson.

Two core issues for a speedy vaccination process in India:

No domain experts in the world doubt that mass vaccination is India’s Covid-19 escape route from the prevailing health care massacre. However, arising out of the above developments, successful implementation of Covid vaccination process on the ground, making it available and affordable to all, poses a giant challenge. Thus, to effectively address the two core issues, with the quality of speed that it deserves, finding answers to the following questions are critical:

How to add speed to the vaccination process?
How to avoid different pricing for the same vaccine for the Central Government, the State Governments and the Private Hospitals? This will give a choice to the population for speedy vaccination, removing many personal apprehensions involving the entire process.

Let me give an example, each of the most recent quagmire related to each one of the above issues.

All vaccination centers in Mumbai were shut for three days for shortages:

Reuters reported on April 30, 2021 carrying a headline, ‘Indian states run out of COVID-19 vaccines; nationwide inoculation delayed.’ It added, several Indian states have run out of COVID-19 vaccines a day before a planned widening of a nationwide inoculation drive. Interestingly, quoting Indian authorities it elaborated: ‘All vaccination centers in India’s financial capital Mumbai were shut for three days starting Friday due to a shortage of vaccines, as the country posted another record daily rise in coronavirus cases.’ The same saga can be witnessed in the national capital of India. ‘Don’t queue up outside Covid-19 vaccination centers tomorrow, the stock will arrive in 1-2 days,’ urged the Chief Minister of Delhi.

The Government allowed Covishield and Covaxin price increase amid pandemic:

Covishield and Covaxin were being purchased by the central government at a price of Rs. 150 per/dose. While announcing Covid vaccination eligibility to all Indians above 18 years of age – despite vaccine shortages, the government allowed the two Indian vaccine manufacturers to increase the same vaccine prices – for direct supply to the state governments and private hospitals.

The manufacturers lapped up this decision and increased the vaccine prices by several times, amid catastrophic Covid 2.0 pandemic. For example, for state governments the Covishield price was raised to Rs.400/per dose and Rs.600/per dose – for Covaxin. However, facing severe criticism from all quarters the prices were revised to Rs 300 (Covishield) and Rs.400 (Covaxin). Interestingly, still the price increases were double or even more from the initial prices of Rs.150/per dose. Interestingly, one manufacturer even boasted this so called ‘price reduction’ from their initial humongous price increases, as a ‘philanthropic gesture’. Interesting indeed!

A hidden solution within Supreme Court questions to the Center:

While hearing a Suo Moto case in connection with the ongoing Covid 2.0 calamity in the country, the Supreme Court of India also took note of the difference in Covid vaccine prices for the Centre and the state governments. It observed Covid vaccine manufacturing is publicly funded, hence are public goods – these are ultimately meant for the people of India. At the same time, the apex court asked some of the following profound questions to the central government on Covid 2.0 management in the country:

Why is the center not following the national immunization program policy in its Covid-19 vaccination drive where the Centre will buy all vaccines from the manufacturers?
How much investment has the Centre made into the vaccine companies and given advances in the last year?
What has been the financial contribution by the Union govt in research etc. in the development of vaccines?
How will the Centre ensure registration for vaccines for illiterate people and those without internet access as registration through Co-Win is mandatory in the third phase of vaccination?
Will one state get priority access over another in getting the vaccines?
How will the Centre ensure equity by private vaccine manufacturers when it is buying only 50 percent of the doses?
Has the center considered invoking Section 92 of the patents act and issue compulsory licenses so that drugs can be manufactured while the royalty is sorted?
Why are we paying so much for this vaccine for which AstraZeneca has set at a far lower price to the US citizens?

One may possibly find a hidden solution to the question of invoking Section 92 of the Indian Patent Act (IPA 2005) to address some critical Covid vaccine related issues in India.

Is invoking section of IPA 2005 a near-term solution?

As many would know, Section 92 of the Indian Patents Act is a special provision enabling the Central Government to issue Compulsory Licenses for the manufacture of patented drugs in a public health emergency. Section 100 of the IPA enables the Central Government to use patented inventions for government purposes. Curiously, the Supreme Court of India has, reportedly, also observed: “This is an exact case where we should go for compulsory licensing. This is a situation of Public Health Emergency.”

Just to recap, on October 02, 2021, India and South Africa had proposed at the WTO about an IP waiver for Covid-19 drugs and vaccines that could help resolve the urgent issues of access and affordability to these products. It has also been reported: ‘Richer members of the World Trade Organization (WTO) blocked a push by over 80 developing countries on Wednesday to waive patent rights in an effort to boost production of COVID-19 vaccines for poor nations.’

Although, U.S. Trade Representative has recently met with Pfizer and AstraZeneca to discuss this proposed IP waiver for Covid vaccines and drugs, what stops India to invoke Section 92 and 100 of its own Patent Act even during this seemingly uncontrollable Covid 2.0 pandemic?

The April 06, 2021 article of the Observer Research Foundation aptly epitomized the need of the hour. It articulated: ‘As the pandemic continues to rage, countries collectively have to find innovative ways to not just increase the production of vaccines, but also ensure their timely distribution at affordable prices.” Such an initiative may encourage more manufacturers in India to manufacture enough Covid vaccine, facilitating speedy inoculation to Indians and at the same time the government can make its price affordable for all concerned.

Conclusion:

The question, therefore, arises: Is India’s exit to the Covid 2.0 maze now visible? But, before arriving at any possible conclusion in this regard, one may try to address, at least, the following two critical questions:

Can Covid vaccines be reverse-engineered by domestic pharma industry without inventors sharing ‘Know-How’?

Can the IP waiver by the WTO or invocation of section 92 and 100 of IPA 2005 by India, legally mandate vaccine developers, like AstraZeneca, Pfizer-BioNTech or Johnson & Johnson, to share know-how with others, if they do not want to do so?

The resolution of the above issues won’t happen in a jiffy – at this stage. It may take more time. So, I reckon, will be the search for a permanent exit to India’s Covid 2.0 management maze, to avoid a similar strike by Covid 3.0, if or as and when it will come. Thus, till all adult Indians get vaccinated, each one of us must comply with Covid appropriate behavior responsibly, to save ourselves, our families, neighborhood, and above all our own nation.

By: Tapan J. Ray

Covid 2.0 Rampages India As Top Echelon Policy Makers Ignore Science

Posted on April 26, 2021 by Tapan Ray

‘India is in the endgame of COVID,’ announced the union health minister of India, just in the last month – March 08, 2021. Although, it was then clearly known to medical fraternity that today’s Covid vaccines won’t be magic bullets against rapidly mutating new Coronavirus. Interestingly, a scientific-data based MIT study, published last year – on July 01, 2020 predicted that India might record the highest ever in the world – 287,000 new Coronavirus cases per day, by February 2021. At that juncture also Covid vaccines were expected to be available in India before that predicted time frame. The MIT study warning received a wide coverage even in India - by almost all news dailies, on that very month of the last year. The national Covid management team did not seem to have taken it seriously, along with others. These include, besides the top echelon of governance – a vast majority of Indians – across the social, political, religious and economic strata.

The fallout of such callousness – both at the individual Covid-appropriate behavior level, as well as Covid governance level, have been more disastrous than what was forecasted even in the above MIT study. The ferocity and scale of the second Covid-19 wave in India did not just overwhelm the nation, but raised grave concern across the world too. On April 22, 2021, India recorded the world’s biggest ever single-day rise with 314,835 new cases of Covid-19, causing death to 2,104 people. The very next day, this number increased to 332,730 new cases with 2263 deaths.

But, the peak of the Covid second wave hasn’t come, just yet. According to a mathematical model developed by a team of scientists from the IIT Kanpur and reported by news media on April 22, 2021, the number of active covid-19 cases in India during the second wave is expected to peak in May. The daily infection count is expected to exceed 350,000 cases. In this article, I shall dwell on three specific areas – acknowledging that the current scenario is the outcome of national misjudgment, if not a humongous misgovernance to prepare India for Covid 2.0:

Current struggle of India’s fragile and long-ignored health care infrastructure.
Need to neutralize some general misgivings on Covid vaccines and associated dilemmas.
Who is equipped to save people, if no external remedial measures remain unavailable for some more time?

India’s fragile and long-ignored health infrastructure can’t take anymore:

Amid this calamity, India has run short of oxygen, hospital beds, important Covid medicines, including Remdesivir. Curiously, reports keep coming incessantly confirm and reconfirm: ‘Ever since the second wave of the pandemic started, the healthcare systems in India have been teetering on the brink, with many hospitals unable to handle the relentless inflow of patients whilst also running short of beds, oxygen cylinders and other essentials.’

Doctors and many health care workers are overwhelmed by the massive scale of the human tragedy and in tears, as they articulate: ‘Many lives could have been saved had there been enough beds, oxygen supplies, ventilators and other resources – if the healthcare system had been better prepared for the second wave.’

The Supreme Court intervened, noting the ‘grim situation’ in the country:

Meanwhile, the Supreme Court of India, reportedly, ‘Suo motu’ (on its own) took note of the grim situation in the country and the havoc caused due to shortage of Oxygen cylinders in hospitals. Consequently, on April 22, 2021, the top court said, ‘it expected the Centre to come out with a “national plan” on the supply of oxygen and essential drugs for treatment of infected patients and method and manner of vaccination against the disease.’ The Delhi High Court also observed, “We all know that this country is being run by God,” coming down heavily on the Centre over the Covid-19 management.

Some Covid vaccine related misgivings and dilemmas:

Many people are raising questions of the efficacy of two currently available Covid vaccines in India – Covishield and Covaxin, especially against our probably ‘desi’ double mutant variety of Covid-19. The trepidation increased manifold when India’s former Prime Minister – Dr. Manmohan Singh got Covid infected after taking two doses of Covaxin. Or, reports, such as: ‘Sri Lanka reports six cases of blood clots in AstraZeneca vaccine recipients, 3 dead.’ Incidentally, these vaccines were made in India. Some may not possibly know that both the issues have been deliberated by the Indian scientists, who haven’t expressed any concern, as yet. This has to be shared with all by all concerned, soon. Let me explore some of these related issues, as follows:

Re-infection after taking Covid vaccines:

Regarding re-infection rate after taking two doses of Covid vaccines, the scientists have now released data establishing that only a very small fraction of those vaccinated with either Covaxin or Covishield, have tested positive. In any case, instances of a few “breakthrough” infections do not undermine the efficacy of the vaccines, they added.

The ICMR has also clarified, “These vaccines definitely protect against disease. However, the immune response begins to develop usually two weeks after every dose and there are variations within individuals, too. Even after the first dose, if exposure to the virus happens, one can test positive.”

Efficacy of Covishield and Covaxin against double mutant strains:

Notably, both – the Indian Council of Medical Research (ICMR) and the Centre for Cellular and Molecular Biology (CCMB) have announced last week that Covishield and Covaxin protect patients even from the ‘double mutant’, B.1.617, variety of Covid-19. Scientists believe that the “double mutant” is responsible for the sudden spike in the number of cases in Maharashtra and other parts of the country. They had earlier feared that this “double mutant” or B.1.617, may escape the immune system and thus vaccines may not offer protection from this strain of the novel coronavirus.

Reported risk of blood clotting with Oxford-AstraZeneca’s Covid-19 vaccine:

No cases of blood clotting have come to light in India. However, a government panel of experts is,reportedly, investigating for any domestic cases of blood clotting, even mild ones, as a side effect of the two COVID-19 vaccines being administered in India. According to India’s leading virologist Gagandeep Kang, “blood clots reportedly caused as a result of Oxford-AstraZeneca’s Covid-19 vaccine amount to a very small risk.”

As reported on April 24, 2021, the United States has also decided to immediately resume the use of Johnson & Johnson’s Covid-19 vaccine, ending a 10-day pause to investigate its link to extremely rare but potentially deadly blood clots. These details, I reckon, need also to be shared with all people, soon, in order to neutralize any doubt on administering Covid vaccines.

Covid vaccine availability and pricing:

Recent media reports highlight, at least six states of India – Andhra Pradesh, Chhattisgarh, Haryana, Maharashtra, Odisha and Telangana – are facing Covid vaccine shortage, as Covid 2.0 overwhelms India. Most of these states have already apprised the Centre of the situation, as the Supreme Court of India also seeks the details from the center about its current status.

As on April 22, 2021, India has administered over 135 million vaccine doses, where each individual will require two doses. Whereas, as published in Bloomberg on April 23, 2021, ‘1 billion Covid-19 vaccines have been administered around the world.’ The good news is, effective May 01, 2021, everyone above the age of 18 years will be eligible to get vaccinated. The Central Government will also lift its singular control on supply and delivery of Covid-19 vaccines in a bid to tackle the massive rise of cases that have crippled the country’s health infrastructure.

That said, the key question that follows – would Covid vaccine manufacturers be able to meet this increasing demand in India, when there already exists more demand than its supply? According to Niti Aayog Covid-19: Vaccine availability will improve by July 2021. The two major vaccine manufacturers in India are also indicating broadly similar time frame.

Meanwhile, amid a deadly second wave of Covid infections, a third Coronavirus vaccine - Russia’s Sputnik V, has been approved for emergency use in India. Incidentally, Sputnik V’s approval came not before India overtook Brazil to become the country with the second-highest number of cases globally. According to its local distributor – Dr. Reddy’s Laboratories, India will start receiving Russia’s Sputnik V vaccine by end May.

Be that as it may, it is still unclear whether enough Covid vaccine doses will be available right from May 1, 2021, to start inoculating all Indians above 18 years of age, across the length and breadth of the country. Besides, SSI’s decision to fix the rate of Covishield vaccine for private hospitals and state governments, has attracted sharp criticism from the Opposition, who argued that there was no logic in charging the state governments a higher price, when the Centre is getting the same vaccine at Rs 150 per dose.

This question surfaces, especially when SII Chief himself acknowledged that they are making profit even with Rs.150/per dose price as the pandemic ravages the nation. A news item of April 24, 2021 also underscores ‘Serum Institute’s Rs.600/dose for Covishield in private hospitals is its highest rate in the world.’ Nonetheless, price sensitivity to Covid vaccines during the pandemic is not specific to India.

Shareholders of Pfizer, J&J, reportedly, are also pushing for detailed COVID-19 pricing strategies of the respective companies, at their annual meetings. Curiously, at the same, yet another report highlights: ‘With the competition struggling, Pfizer’s COVID vaccine sales could hit $24B this year.’ Amazing!

India utterly overwhelmed, angry outbursts of concern beyond its shores:

Witnessing the nature of rampage caused by Covid 2.0 in India, global press blames the Indian top policy makers for utter failure to anticipate and tackle the devastating second wave. For example, The Guardian of the UK flashed a headline on April 21, 2021 – ‘The system has collapsed’: India’s descent into Covid hell.’ It further elaborated: ‘Many falsely believed that the country had defeated Covid. Now hospitals are running out of oxygen and bodies are stacking up in morgues.’ The Times, UK was harsher. It reported, ‘Modi flounders in India’s gigantic second wave.’ It further added: ‘Record levels of infection have put huge strain on the health service and highlighted the perils of complacency in the nationalist government.’

The New York Times reported on April 23, 2021: ‘India’s Health System Cracks Under the Strain as Coronavirus Cases Surge.’ The report also cited examples of ‘recent political rallies held by Mr. Modi that have drawn thousands, as well as the government’s decision to allow an enormous Hindu festival to continue despite signs that it has become a super spreader event.’

Conclusion:

Keeping aside the responsibility, or rather lack of it, of the National Covid governance team, individual Indians – like you and me – can’t in any way shy away from our own responsibility of compliance to Covid appropriate behavior, religiously. We are equally responsible, at least, for our own lives and fate. Even today, many of those who are wearing a face mask, are wearing in the chin – keeping the nose exposed – forget about double masking! Moreover, how many of us were or are eligible for Covid vaccination till date, but did not or could not take?

Curiously, Covid 2.0 is no longer striking mostly the poor urban population, living in slums or hutments, or the migrant laborer. Nor it is attacking mainly the senior citizens or people with co-morbidities. More young people, including children are getting infected in Covid 2.0. In Covid 2.0 – over 90 per cent of Covid new cases concentrate in in high rise and other buildings in major cities, like Mumbai. While urban slums account for just 10 per cent. On April 24, 2021, Bloomberg also reported, ‘India’s Urban Affluent Hit By New Virus Wave After Dodging First.’

Terming Covid 2.0 as concerning and scaring‘, Tata Sons Chairman also said, ‘India needs to get as many different Covid-19 vaccine licenses as possible. And replicate multiple factories on a war footing to ramp up production in order to meet the requirements as the country reels under the devastating second wave of the pandemic.’ It’s incredible, how a small country in the Indian subcontinent – Bhutan with limited resources, got its vaccination plan right and carried out, reportedly, the world’s fastest immunization drive.

Coming back to the last year’s above MIT study forecast for 2021 Covid situation in India. It goes without saying that this one, among several others, was based on credible data. It also brought to the fore the scientific reasons of consequences for not following the norms of Covid appropriate behavior. Looking back and coming back to real life scenario of date, one thing becomes crystal clear. When science is ignored, both at the highest echelon of national governance where the buck stops – or at the individual, social, religious or political level – it is virtually inevitable that a disaster would strike. And in most cases, it will strike hard – very hard. Much beyond what a human can withstand to survive. We have choice for survival – even in today’s frightening scenario. Let’s individually and collectively behave, as the science demands. Life and livelihood are important – for all of us.

By: Tapan J. Ray

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A Tapan Ray Website

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