Robin van Puyenbroeck 0:07
Welcome back to Trade Wins. I’m Robin van Puyenbroeck, your host. This episode is a conversation in support of the SDG Inspiration Day, hosted by RELX Elsevier in partnership with the United Nations Association in New York. The topic of our conversation could not be more pertinent. It is health diplomacy and the role of business and the future of global health in a post-pandemic world.
Robin van Puyenbroeck 1:15
Now that we see this post-pandemic world emerging, clues of disruption that this new world of digital globalization will bring are visible — inflation is rising, public debt levels are stratospheric, supply chains are being disrupted leading to price increases and shortages from basic food staples, and medication to semiconductors. The global trade infrastructure is also yearning to make global trade more inclusive so it can work for everyone. In the midst, this greatest health crisis in a generation is far from over yet. There’s no more pertinent topic to discuss at this SDG Inspiration Day than the role of business in addressing global health. Relevant goals today are Goal 3, good health and well-being and Goal 17, partnerships for the goals. We will be discussing the relationship between business and global health, the role of business as a force for good but also the importance of good health for economic resilience. We could not have wished for a more expert panel and it is my pleasure to introduce our panelists today. I will briefly introduce each of the panelists to our guests and then give the floor to each for introductory remarks after which we will start our discussion. So first, welcome to Usama Malik, CEO of Fore which is a next-generation targeted oncology biopharma. He is also the former Chief Innovation Officer and Chief Strategy Officer at Pfizer where he had instrumental roles driving innovation including the development of new R&D models. He has tremendous expertise on the health subject for sure and coming from Pfizer, I’m sure that he also will bring a lot of insight on the COVID-19 vaccine development. Again, welcome Usama. We are very much looking forward to your thoughts.
Usama Malik 4:33
Robin van Puyenbroeck 4:34
Welcome also Dimitri de Vreeze, Co-Chief Executive, Chief Operating Officer and a member of the managing board of Royal DSM. DSM is a purpose-led, global, science-based company in nutrition, health and sustainable living. Dimitri, it’s also good to see you again. It has been a while since we last saw each other in the Netherlands. I will add that Dimitri, who is a great corporate leader, and DSM have been staunch supporters for many years of the work of the United Nations and the United Nations Association. DSM was recognized in 2010 with the UN Humanitarian Award for its work on global health and nutrition. Again, welcome, Dimitri. So good to have you with us as well for this important conversation.
Dimitri de Vreeze 5:18
My pleasure, Robin.
Robin van Puyenbroeck 5:20
Last but not least, a warm welcome to Gabriela Cuevas Barron, Co-Chair of the UHC2030 Committee, Honorary President of the Inter-Parliamentary Union and a member of Parliament of the Mexican Congress. UHC2030 — UHC stands for Universal Health Coverage — provides a multi-stakeholder platform to promote collaborative working at global and country levels on health system strengthening. They advocate for increased political commitment to universal health coverage and facilitate accountability and knowledge sharing. It is also important to mention that Gabriela is a member of the Lancet COVID-19 Commission. Needless to say, she is one of the most prominent health policymakers and advocates. Again, welcome Gabriela and thank you for being here with us today. I have already spoken too much so let’s get started. Usama, let me turn it over to you for your introductory remarks.
Usama Malik 6:18
Robin, thank you for that great introduction and it is a pleasure to be part of this illustrious panel. I’m honored to be here today. Quickly on myself, thanks again for the introduction. I’ve been in the healthcare industry for a little over 20 years. I’ve been in management, consulting, investment and operational roles. I started as a management consultant in the industry and then took leadership roles at Pfizer. I’ve worked with multiple biotechs and executive roles in the public market. Prior to healthcare, I also spent a lot of time in technology and telecoms in the ’90s. The digitization of the world was an important part of that period that I was contributing to as well. It’s been an enormous journey over the last 30 years looking at the evolution of the world as digital and physical have started to come together and its specific implications on healthcare as well. Concerning today’s topic, it is a broad topic. It’s a complex topic. I have a lot of thoughts. I’ll try and synthesize some of the topics that hopefully we can discuss throughout this conversation. Business has evolved significantly since the Industrial Revolution — how we organize, how we produce and how we distribute innovation, products and services. On the bright side, if you look at the long stretch of history over the last 100-150 years, we’ve seen an enormous amount of progress for everyone. There’s always inequality and there’s always injustice but I think overall humankind has made progress and that’s stated in the numbers. Life expectancy has grown by 2 times over the last 100-150 years. The global population has quadrupled over the last 100-150 years. GDP has gone up by 30 times, 3,000% over the last 100 years or so. These are all seminal points to think about and this has happened due to the organization of governments, civil society and businesses and their contribution to innovation. Those are all positive characteristics of a growing society. There’s always a dark side or a cynical side to all of this. At the same time, I think the organization of business and this acute focus on Milton Friedman’s capitalism and how we measure productivity and the role of business has changed significantly. To give you an example, in the ’40s and ’50s, specifically in the US but I think globally as well, businesses were very local. They were part of their communities, they engaged with labor and they gave back to their local communities. You could go to a local bank and open a bank account because the bank manager knew your mother and you had a reputation in the neighborhood. There was this very local, physical interaction between businesses and communities. We’re getting more and more detached from that. We now have — starting in the ’80s with these massive corporate raiders coming in and creating large global institutions — these multinational companies that are bigger than countries. They produce more income than the GDP of lower-income countries combined. They wield an enormous amount of power without the governance and oversight that’s required at these kinds of institutions. The government has a role to play in terms of how these models for large, multinational companies operate moving forward and how they contribute and give back to society in addition to making profits for their shareholders. At the same time, there is self-policing as well. You can see a lot of companies now focused on what was previously known as corporate social responsibility, but this ethos of purpose and purpose-driven companies. I’m sure Dimitri will talk a little bit about this as well, but this whole notion of purpose and companies moving away from just focusing on profits and generation of income to doing something bigger and more meaningful for their communities and society at large and taking some of that income and profit and reinvesting it to continue the innovation and progress that’s required equally across human societies. You take the role of foundations that large companies have, for example, my ex-employer Pfizer has a very large foundation that invests in a lot of civil society initiatives, local initiatives, distribution of vaccinations, distribution of medicines in lower and poor income societies. There is always an ethos for purpose and to give back. I think the balance has skewed over the last 30-40 years with an acute focus on hyper-capitalism, laissez-faire capitalism and an acute focus on income, but I think that balance is starting to shift back. If you look at people like the CEO of BlackRock Larry Fink, he talks about purpose-driven companies all the time now. He’s acutely attuned to income inequality and the types of aberrations that can create in society moving forward. You talk about Ray Dalio, the CEO of Bridgewater, the largest hedge fund in the world. He’s acutely attuned to income and equality and the role and the purpose business has to play moving forward to ensure that justice, equality and purpose are also top of mind for these institutions. There is some self-policing that’s happening and because of the positive impact of these conversations, other organizations are learning but I don’t think we’re at the pace that we need to be at. The last thing I’ll say about healthcare specifically — I think the institutions and governance mechanisms that have been implemented over the last 40-50 years and some of the new institutions have catapulted the role of public health and disseminating quality and access across the globe. I think the Millennium Development Goals, setting global standards and having goals, even if it’s not at the pace that we would have liked, has impacted and shaped the view of what the role of society is. While we developed these goals decades ago, we’re still talking about them, we’re still working towards them and we’re aligning institutional incentives to make sure that we are making progress on these things. That’s incredibly important and I’m glad that we as a society concluded that we have to think ahead and we have to set goals that are common and allow societies to move forward. You take things like Gavi and the distribution of vaccines. These are public-private civil society initiatives. You think of what the Clinton Foundation did or what Bill and Melinda Gates have done. They are aligning incentives between governments, between businesses and between civil society to tackle some of the toughest issues that exist in public health. You take Operation Warp Speed, which was a fascinating journey last year. The breakneck pace and speed with which we aligned our purpose and our incentives to create vaccines in one year is innovation at its best. Going from a virus that was spreading at breakneck speed to organizing scientists around the world to confer and come up with the best ideas, create the medicine, put it in tens of thousands of people around the world, generate data and get enormous results — 90% plus efficacy is unheard of in vaccinations. We haven’t had that before. Influenza vaccines are 50-60% effective at best. Look at this. We’ve essentially solved at least the first set of strains for COVID. That could not have happened without the government setting frameworks and aligning incentives, the private sector innovating at a breakneck pace and civil society helping distribute these innovations so that all of us can benefit from them. As we progress the conversation here today, we can talk about all of these elements — how businesses have changed the role of business, how purpose drives business moving forward and what kind of frameworks governments can continue to create to align the incentives, not just with business, but also civil society, which is an important factor in all this.
Robin van Puyenbroeck 14:55
Yes, very well said. Where there’s a will there’s a way. The innovation that public and private partnerships have brought in this case is extraordinary. I take away your points about changing demographics in combination with redistribution of power and how that has led more companies than ever before to be purpose-driven which takes me to Dimitri. When we talk about the focus of purpose I think DSM has always been a pioneer in purpose-driven leadership. I believe, correct me if I’m wrong, Dimitri, but DSM also stands for “Doing Something Meaningful,” right? I’ll give the floor to you because I’m sure you have a lot of very interesting things to say about this notion of purpose-driven leadership.
Dimitri de Vreeze 15:38
Yes, thanks, Robin. Thanks for that introduction. Indeed, the interesting thing is that DSM, when we started 120 years ago, stood for Dutch State of Mind. Can you imagine talking about transformation going forward and you were saying, if you put your minds to it, it can happen? The “Doing Something Meaningful,” DSM part, was introduced by our younger DSM generation who said, “Hey, this is why we’d like to work for DSM, because we feel we are contributing to doing something meaningful.” That is changing the mindset of many of us, not only in the company but also outside and certainly the next generation. Talking about the next generation, that is certainly not me. Let me talk a little bit about myself. I’m a fossil at DSM, more than 30 years with DSM. I started with DSM to do a bit of a traineeship and then move forward to other interesting companies, but here you go. I stayed with DSM for more than 30 years. You see where it can end up. I have been Co-CEO of DSM for the last 1.5 to 2 years together with my Co-CEO Geraldine Matchett. It is a very interesting journey within DSM and it continues. As you said, we were one of the first companies to put very prominently out there that we are a purpose-led, performance-driven company. We were being asked, “Why would you do that? I mean, you are on earth to make money for your shareholders.” We said, “No, we have a broader responsibility.” We do see that at DSM. In coming to your point how does business play a role? We think that businesses have to play a huge role. I think Usama said it well that some of the companies have a larger GDP than some countries. The private business environment has to create an environment where they take responsibility for what they do. COVID has been a perfect test to see if the combination of public-private partnerships works. That has been under an emergency in a stressful situation. My call for action is that we keep that momentum to address other issues in the world. After COVID, we have other issues to combat like climate change and hunger. You mentioned it, SDG 2 is zero hunger. It’s still out there. We need to solve it. There’s no reason that we cannot solve it if we work together. It is ridiculous that we have as many people malnourished as people being obese. We can solve these issues if we bring things together. I’m fully echoing what Usama was saying — governments need to set the pace, the boundaries, the laws and the requirements, and businesses need to do their best within these restrictions to take everything it has to solve these problems and do that in cooperation. That is what DSM stands for. It’s one of the reasons why the younger generation said “Hey, we work for DSM to do something meaningful.” It is important to start with the notice of capabilities. Many of our companies see that there are huge capabilities — vaccine development, and in our space, nutrition and creating health for people and the planet. If you have that capability, you also have a responsibility not only to make money but also to create a brighter life. Between now and 5-10 years, companies will be viewed differently. Today, if we look at the annual reports of companies, which normally are 200 pages, the financial figures are being audited, fully audited and double audited. The planet and people figures, your greenhouse gas emissions, you’re scope one. How are you doing on child labor? What are the emissions on scope three? What is your engagement survey? Those are maximumly audited as being what they call “reasonably assured.” It is in the words, right? Reasonably assured. If you think about people, planet, profit — the profit numbers are maximum assured. Could you imagine that we go out there as DSM and say, “Hey, our numbers are reasonably assured, also for our profit and loss in our revenues.” I think nobody would accept it. What the world does accept is that the greenhouse gas emissions which we report are at maximum, reasonably assured. I think the world will expect these companies to be just as transparent that people, planet and profit will be maximum assured for the future. You see already audit firms preparing for that. That is good news. For us, we call it holistic P&L, holistic profit and loss, which encompasses people, planet and profit contribution. You have a net contribution or you have a negative contribution. Could you imagine companies who have a fantastic score on people, a fantastic score on planet, but they had a loss. That is not a sustainable company; that will not exist. However, if you have a company that made huge profits and is very good for their people, but they’re destroying the planet, that’s not a sustainable company either. The other extreme example is very good for planet, making a huge profit, but it’s bad for their people. That is not sustainable either. The real champions in business are companies who think about people, planet and profit and score on all three and that is moving towards people, planet, holistic P&L. The beauty is that within DSM, we are trying new boundaries. We have, for instance, our remuneration as 50% finance-related, 50% non-financial. Our shareholders initially said, “Well, why is that the case?” It’s because in the long-term, you need to think of “Triple P” — people, planet, profit going forward. That is something which we need to keep in mind if we look at the responsibility of companies looking forward. Therefore, for us, the link to SDGs is almost as logical as you can see. What I’m strongly advocating for is that the strategy for the world which is covered by the SDGs is being pronounced and used a bit more prominently. In the Netherlands now we are teaming up with the Dutch multinationals — Oxo, Shell, Unilever, well Unilever is no longer a Dutch multinational, but we still try to influence them — to report in our annual report how we contribute to the SDGs. The beauty is that we’re all on board. Within DSM, we are also trying to do that. It is in the learning phase and we are progressing, but it makes huge sense. For us, it’s SDG 2 zero hunger, SDG 3 good health and SDG 13 climate action, because they fit in what we stand for as a strategy. To that point, how is responsible care, how is sustainability talked about? Usama was talking about it. It’s normally a corporate social responsibility. I dare to say that if there’s a company that has a corporate social responsibility care department, it means it has not been embedded into the company — it is a nice add-on or a requirement. These companies will be the dinosaurs of the future. We have no dinosaurs today, so we will certainly not have dinosaurs in the future. The companies that will not adapt will be the dinosaurs of the future. With DSM being there for 120 years, we try to avoid being a dinosaur of the future. I think we’re doing a nice job so far but we’re not there yet. We need to progress. Therefore, with all the complexity of the problems Usama said have come from COVID — with the technology and the science level in the world at companies, at universities, as governments, at startups and venturing if we bundle that together — there is no reason that we cannot improve rapidly on many of the SDGs being formulated. That’s my plea to everybody out there. Companies take responsibility. Governments set consistent frameworks so that the businesses can play in that sandbox. If we collaboratively do that well, magic can happen. COVID was a nice example that magic can happen.
Robin van Puyenbroeck 24:06
Dimitri, I couldn’t agree more that magic can happen. I think it’s also a notion you mentioned that as a company or as an organization, you will be disrupted or you become the disrupter. On the people, planet, profits that you were talking about, I had this conversation earlier with Professor Roberto Rigobon from MIT. He has a very interesting thesis about measurement and how we measure things and how we end up measuring all the wrong things in the world and that we make decisions based on bad information. He would say that we measure the stock market on a per second, millisecond basis but we don’t measure anything to do with happiness. Even GDP numbers are a year delayed but yet we make very important decisions on that information. This takes me to the public-private partnership notion and to you, Gabriela, when we talk about being purpose-driven and doing something meaningful. That of course also translates very much into the role of government. We’d love to hear from you with your role also as an elected official and the role of government as a policymaker in this conversation. I’ll hand it right over to you.
Gabriela Cuevas Barron 25:10
Thank you, thank you very much. Indeed, the 2030 Agenda is bringing out some ambitious and challenging sets of commitments that we need to deliver. We also need to put all of the different pieces together. From one side, we have the United Nations and the different governments agreeing on this agenda. On the other hand, we need a lot of different constituencies, a lot of different stakeholders to translate these global commitments into national proposals that last. It has to go even to the local solutions, to the community level. That’s why politicians should also be part of this conversation. Yes, at the government level or I should say the state level, because there’s the side of the government who is developing a lot of policies, executing the budget, a lot of things. On the other hand, we have, for example, the parliamentarians. I have been a parliamentarian almost all my life so I must bring parliamentarians to the table. In the end, our nature is to be people’s representatives and that includes businesses, local communities and national policies. As parliamentarians we have different responsibilities and one of them is national legislation. Dimitri was talking about that. We need to set the rules. Those rules are made for certainty, for understanding how we can coincide in the public space with each other. Those are the rules and we have to commit to those rules. That’s why rule of law is important for business, peace, development and everything. There is another important task which I think could be probably the most important one even though sometimes as parliamentarians we are not aware of that and that is budget. We are responsible for the most important public policy instrument at the national level. When the government is usually proposing the first draft for the budget to parliament, that reflects the government’s priorities. But that instrument, the budget, goes to the parliament because it has to be a plural and inclusive decision. That means to have the different parts of the territory, but also the different political expressions — gender, age, ethnic groups, etc. If something is not reflected in the budget, that’s not a priority, that’s a political narrative. Then we have accountability, which I believe is also a very important mandate. We need to understand that it is not a trade-off between collaboration and fighting against the government. Yes, we can be an amazing opposition or we can be the best supporters of the government but accountability is about transparency. It’s about delivering results and having accurate information. Of course, there are a lot of different things that parliamentarians must be doing, but we need to understand the nature of that representative body and that includes bringing businesses to the table. We cannot continue with the same model that politicians are on one side of the table and the private sector is on a different one. What I like about UHC2030’s structure is that we are bringing different stakeholders to the table. We have the governments, we have the businesses, we have civil society and we are creating that dialogue. That dialogue has to be reflected at the national level. Again, it is not about the private or public side; it’s about bringing and building a different way of partnerships. The other part that I would like to address is how this influences health and concretely as each three. Someone was saying that we are just getting out of the pandemic. I’m not sure — perhaps because I’m from Latin America and we are receiving everything later — but we still have the pandemic and are struggling with that. We need to learn the lessons from it. We have a health crisis, economic crisis, climate crisis and I would say also a gender crisis. Gender-based violence is growing everywhere. We have a lot of different issues that we need to attend to. If we go to the numbers, we are not improving. We are going backward because the pandemic moved us backward. We need to make an extra effort and bring all the different stakeholders to the table and understand that first, there’s no economic recovery if there’s no health. We need healthy societies. We need to also understand that the majority of people who died during this pandemic died because they didn’t have proper access to health, good hospitals, medicines or even community-level healthcare. That has been unfair because what is deciding between life or death is mostly money or family income. That cannot continue. We need to change that reality. That’s why we are also advocating for universal health coverage — not because of now. We have been doing that for a long time. It’s part of SDG 3. We need to understand that healthy societies are the only ones that are going to be able to have economic recovery and to have, for example, real changes in energy policies. In general, I do believe in partnerships. I have been a politician all my life. I understand that you cannot make an economic change without a political or parliamentary decree. We need to work together on the implementation processes. We need to work together to translate international commitments into national and local reality. Thank you very much for the invitation and for having this very interesting dialogue.
Robin van Puyenbroeck 31:42
Thank you, Gabriela. I have to say, you started off talking about the budget and I think the key is a budget because budget is all about making choices and then allocating resources accordingly. That is a matter for private companies as much as for the government. Of course, what the government has, what you have as a representative of people, is that convening power. As governments can convene, they can also set, as Dimitri was alluding to, the sandbox to set out the regulations for everybody to play with. You also mentioned accountability and transparency. With that, I want to take it to you Dimitri. The relationship between business and public health, what is that relationship, especially in thinking about the accountability factor there? Do businesses have to be accountable for global health, for public health? Do they have a role to play there?
Dimitri de Vreeze 32:31
Absolutely. This is a key question. Thank you for asking. I think that companies do have the responsibility. They cannot back off on that responsibility. They cannot just take responsibility where it suits them. You cannot be selective on public health. You cannot say, “I’m only feeling responsible for that part and not feeling responsible for the other part.” You have a joint responsibility to play. The only thing is, where can you contribute? I’m coming back to my earlier statement — where you have a capability you also have a responsibility. For instance, if I come back to what we see at DSM on the health trends, we see three interesting trends happening today, maybe accelerated today. One is that the consumer is more concerned about their health than ever before, not only during COVID, but also post-COVID. We see, for instance, in Asia people remain worried about their immune systems. Health is on top of the mind — 65% of the people we have interviewed of a big sample say that one of the major concerns is their health. Therefore, businesses together with governments have a role to play. Secondly, we see that society at large, and I think Gabriela was looking at it from a budget perspective, we have an issue with healthcare costs. If it continues as-is, it cannot be financed. We need to change from solutions of people being ill to prevention. There is a bit of a dilemma because prevention itself remains a change of behavior. The costs which you put into prevention are multiple times lower than if you go into solutions. If you’re in the hospital, the costs are multiplied by 10. If you have a healthy lifestyle and you can prevent becoming ill, that is something we should work on. Gabriela was talking about how the sandbox requirements need to be put in place. Society is also playing a role. The third one is the environmental bit. Sometimes on the health piece we forget that. With global population growth, food security is a key issue and today food supply is growing at the cost of the planet. It needs to be within the planet boundaries, otherwise, we will erode the planet. Consumer, society and environmental issues do play a role. Companies do have a role to play together with the government, but also with the consumers. We sometimes forget the consumers, such as you and me buying products. We should demand transparency on how healthy things are — healthy for the people and healthy for the planet. Consumer, society and environmental things need to come together. Therefore, we feel that we have an important role to play. Consumers for immunity, society for healthcare costs and environment because of sustainable farming — healthful people and healthful planet. Let me give you a small example where it’s important where we all play a role. We at DSM have developed a fantastic additive to reduce methane from cows, etc. It’s not a public advertisement campaign, but it will show you a little bit of the dynamics. If you add that to the premix of feed for cows, you reduce the methane emission of the cows by 30%. That’s a huge breakthrough and is scientifically backed up. The only thing is that someone needs to pay for it. We went to the farmer and we said to the farmer, “You have a problem because your cows are emitting methane. If you add our additive to it, you reduce it by 30%.” The farmer said, “Well, thank you very much DSM but I don’t have a problem because the emission of methane is costing me nothing. I’m pretty sure that the additive you want to sell me has a price.” We said, “Yes, that is true.” We said okay and we went to the government. We said to the government, “You have an emission of methane problem and we have a solution.” The government said, “Fantastic that you have this solution, but you need to agree with the farmer and they need to pay for it.” We say, “Yes, but we’ve just been there.” And they said, “Oh, that’s a problem.” Today, we are in a situation where governments together with farmers and private businesses must say, “If methane emissions are bad for the planet, it needs to have a price. It needs to have a cost. If it has a cost, you can accelerate innovation and adoption in the chain.” We’ve done that with CO2 pricing. In Europe, the carbon price today is 50 euros at home. That creates a huge innovation. Therefore we do see innovation coming. Coming back to the point, do we have a role to play? Absolutely. We also need the government to set the boundaries. Society today is almost like a free-cost waste interaction. You can throw away your carpets for zero. If it is eroding the planet, it should have a huge price. If it has a price, innovation will start where we as private businesses have to play. I was a bit pessimistic five years ago, but I see an enormous acceleration of that collaboration where we really can do breakthrough things not only in sustainable farming, but also in immunity-improving healthcare solutions.
Robin van Puyenbroeck 38:08
Very well said, Dimitri, about the role of business here. You did mention this triangle of partnership with the government so I’ll jump quickly back to you, Gabriela, on how as a policymaker in this scenario of the example that Dimitri was giving, how can you then impact global public health? Again, a lot of politics are still at the very local or national level. At best there is the more multilateral type of environment as well. How can you as a policymaker, as an elected official, make the greatest impact and also do your part from the public sector’s view in making these changes happen?
Gabriela Cuevas Barron 38:41
There are different levels of faction. If we learn the lessons at the multilateral level, there are a lot of things that we have to do. There is a very strong agreement that we need to strengthen the WTO. That’s clear. We see the first response of the countries of the pandemic — it was closing borders and people going to the supermarket for toilet paper. We need to change that dynamic and go back to collaboration, to more cooperation. It’s about, I think, basic things like exchanging data, having reliable data and having joint procedures in terms of research and development. Yes, the pharmaceutical industry and some governments had very trusting cooperation, but it was not enough. If we take a look at what’s happening, for example, in Africa or some developing countries that are just starting to receive some vaccines, we are failing. In the end, we’re failing because we are not acting as one single humanity. That goes for climate change, that goes for zero hunger. It’s about cooperation. It’s about understanding that there’s interdependence that we need to address and acknowledge. There’s also the national and local level. We do have a roadmap with the SDGs. We have a comprehensive idea of what UHC, Universal Health Coverage, mostly looks like. But when it comes to the national level, you have to design a tailor-made solution. That goes to how we are going to address health as a human right. In some countries, health is not recognized as a human right for all. Some countries were leaving immigrants or refugees or different ethnic groups aside from all health policies. That cannot be repeated. It’s about human rights. It’s about policymaking. It’s about recognizing all the different parts of a stronger health system that goes from the national level and highly specialized policies to the community-based health services. Of course, as Dimitri was pointing out, we need prevention. We need to understand that some of those causes are part of our food and agricultural systems. We need to do that part. The public sector, the government and the parliamentarians have a lot of things to do here because we need to set the rules. We need to decide the priorities that are going to be reflected in the budget. We need to understand that health is a priority. We need to close, but if we don’t do that, if we don’t understand that UHC must be a priority by the year 2030 half of the world’s population is going to be out of the health system. That is about 5 billion people without access to health. That cannot happen. If we imagine what would happen with 5 billion people outside of the health system and, for example, if we have another pandemic or something, that could be a disaster. We need to change how we are seeing health and that has to be translated to a real priority for the government and, of course, an inclusive policy with other stakeholders.
Robin van Puyenbroeck 42:13
Yes, it’s incredible if you look at the numbers. They’re staggering. We had better hope that Dimitri is right and that magic can still happen. I want to take this to you, Usama, coming off of your experience working in the sector, in the development. We’ve witnessed this huge role for the private sector in vaccine development and it was, you are right, an incredible exercise there to at record speed come up with this vaccine. Can you share some thoughts there on how that all came about? Also, to what Gabriela was talking about with prevention here, what can be done from your perspective in preventing a similar crisis like this and preventing a larger global health crisis, as Gabriela was referring to, in general that so many people would be outside of the healthcare system?
Usama Malik 42:57
Let me structure this in a few ways. If we take the example and Dimitri set this up perfectly, it was under duress last year that we made such a breakthrough change. Ultimately, the incentives were aligned. If you take capitalism at its purest form, it is ultimately about incentives and constraints. While there’s a lot of optimism in this conversation about the partnership between the public sector and the private sector, it is a loose partnership. These bonds need to be strengthened further and there needs to be more accountability between the public sector and the private sector. If governments can create stronger frameworks and clear outcomes that they want to achieve and thereby incentivize the private sector to try and solve those problems, the private sector always steps up to the plate. What happened last year was under duress. We knew that economies were collapsing, people were dying and something needed to be done. Governments came together individually or as collectives and they started to put frameworks together in terms of incentivizing from an economic perspective, from a distribution perspective, from a speed perspective — the companies were then held accountable within that framework to deliver. Whether we’re talking about climate change, whether we’re talking about health access, whether we’re talking about the dignity of labor, whatever issues and topics that we deem important for the productivity of societies, we have to start getting more clear and accountable at a public policy level and then enable the private sector to play that role. Looking forward to future potential health catastrophes, I think Gabriela, to a large extent, covered this. Collaboration, information sharing and lowering the boundaries for institutions to be able to exchange and stay ahead of these things is incredibly important. In our last administration here in the US, we took an entire institutional infrastructure that was focused on looking at epidemics and pandemic — forecasting, looking at it and trying to solve those problems — and we disintegrated that entire institutional infrastructure. When COVID hit us, we were entirely unprepared. We were unprepared within the country and we were unprepared to link and share with other countries. When we think about future pandemics, we have to create institutional infrastructures both at the public and the private sector level. There is an enormous amount of collaboration and information sharing that needs to happen. Data is everything today. We’re generating data at a breakneck pace that we’ve never seen. Each day that pace is quadrupled from the day before. The ability to share and understand this data and then make decisions within institutional frameworks is incredibly important. We’re not there today. I think it’s a patchwork of local institutions. It’s a patchwork of either private sector groups, civil society groups or public groups that are incrementally looking at these things but we really haven’t come together as a collective, as a society or civilization and said, what are the big things that we want to accomplish? What are the risks that are ahead of us? How do we manage and incentivize the public sector, the private sector and civil society to address the biggest goals that create productivity and happiness in society on the one hand? What are the critical risks for every step that we take that will occur? And how do we manage those risks and then create the institutional frameworks around those to share information and then make progress in those things? I know these are generalized statements and we can get into the specifics of it. From a framework perspective that’s how I would think about it.
Robin van Puyenbroeck 46:56
I think you’re right. Data is critical. We just mentioned earlier about measuring and the key to measuring to make decisions is having the right data. This is extremely interesting. We have only a few minutes left, unfortunately. I have a question for each of you, a one minute answer if you can. Usama, I’ll stay with you. It’s a more personal question. How has the pandemic affected you personally? What was your experience with the work that you do? What do you think has permanently, if anything, changed because of the pandemic?
Usama Malik 47:30
Well, I actually had COVID last year. Not only was it the isolation of the pandemic, but having gone through the disease — I don’t have anything magical to say here. I think it was an incredibly tough year for all of us. Isolation, social distancing in its ultimate form where you’re disconnected from friends, family and society are things that are antithetical to human nature. It creates a lot of anxiety within oneself. We’re seeing rates of depression go up, we’re seeing rates of productivity decline, we’re seeing families fall apart, relationships have been tough, raising children at home when they’re schooling on Zoom and you’re a working mom or working father and having to deal with that. It really, in many ways, showed and exposed how weak societies and communities can be when you’re hit with such a catastrophic event on the one hand. On the other hand, for every underbelly there’s a lot of optimism and opportunity. For example, the role of digital catapulted over the last year. The fact that we’re doing this conference that was once done in person and we could have shaken hands, and we’re doing it from the comfort of our homes. As a CEO now, how I thought about this five years ago is very different from how I think about it now. The integration of people’s personal lives, their families, their livelihoods and how they want to operate is much more front and center for me. To be able to think about that and have more empathy for how people want to work and not impose structural top-down rules in terms of how work should happen. Ultimately, we’re trying to achieve outcomes and if we can achieve them in the best way, in the happiest way, in the most productive ways that work for each one of us individually, I think that’s a big leap. You’re seeing this in large institutions — from Goldman Sachs to JP Morgan to Pfizer — everyone has shifted their thinking on what work means and how you can be productive.
Robin van Puyenbroeck 49:37
I couldn’t agree more that the work-life balance has shifted. People have redefined their pursuit of happiness. Gabriela, same question. How has this pandemic impacted you and what do you think has permanently, if anything, shifted?
Gabriela Cuevas Barron 49:51
A lot of issues are going to change in our lives, in our communities, in our countries and perhaps at the international level. I had to change from a different job. I used to be President of the Interparliamentary Union. I used to be a very active president. I was traveling a lot because I do believe in national implementation. The only way to dream about changing the world is how you convince governments, how you convince parliaments to do their part regardless of their political circumstances or budgetary restrictions. You have to go up to them and tell them that they need to do their part to change the world. With the pandemic, everything changed. We are more isolated, but not only in terms of the confinement or restrictions personally, but also in terms of the way that we can communicate. We can interact with other different cultures or even traveling seems a part of that interaction of getting to know each other. In terms of how we can have empathy through estimating, for example, that’s very challenging — how we can build different understandings among people that are speaking different languages and are coming from different backgrounds. How did you bring all that plurality to a common ground? I think that was part of the challenge. I am Mexican — we love hugging each other, we are kissing people, we love our families. Even though my country didn’t have a lot of restrictions, the consequences were awful. We have lost a lot of people. We are not sure about the magnitude of the pandemic here. The lessons are still there. The real challenge is going to be if we’re going to be able to learn from the pandemic personally and as humanity, or if we are going back to business as usual and we lose a very important and perhaps tragic lesson, the opportunity to improve our lives.
Robin van Puyenbroeck 52:03
Very well said. Let’s see whether we go back to the old normal or if we’ve learned a lesson here. Dimitri, to you to end this great session here, same question to you. What was the impact on you and what, if anything, has permanently changed do you think?
Dimitri de Vreeze 52:20
I have to be honest. For me, it was a difficult time. Gabriela is Mexican. Although I’m Dutch, I’ve lived for a long, long time in Italy. The Italians communicate via hands and hugging and talking and making noise and disagreeing with them. I tried it on Microsoft Teams (Teams), but it didn’t work. It doesn’t come across right. Although I have to say I think the whole community learned how to communicate via Teams. If we would have done this a year ago, we wouldn’t have had this passionate interaction. We’ve also learned to adapt. It is very good to see that we can have this intense conversation even via Teams. I’m a strong promoter of connecting, getting-close intensity, getting there. I found it very difficult but I tried to adapt. In all fairness to the other extreme as being CEO, I sometimes did weird things in the past by having a New York breakfast meeting. Flying from Amsterdam to New York, having a breakfast meeting and then flying back. I think in today’s world if you look at that, you think, “are you nuts?” That’s not going to happen. That’s not going to work anymore. I think rightfully so. Last but not least, within our company, we are a company who produces things — bioscience, bio base, fermentations — safety is key. We want to create a safe working place for all of our employees. We have added, after the COVID pandemic, the health part. Not that it was not important, but it was more important during COVID and it will remain important after COVID. We have what we call life-saving rules and we are also going to create health-improving rules. It has to do with hybrid working, it has to do with working off-site, off-screen, being safe and healthy going forward. You can expect that if you are in the health business you need to take care of not only your partners and your consumers, but also your employees. That has changed and will change quite a bit. In all fairness, I’m happy that hopefully it opens up a little bit because my biggest concern, if this continues, is that many of the companies will lose the soul of the company. The soul of the company is built via human interaction, partly via Teams, but predominantly also because they meet, they interact. I’m worried that if it takes longer than this 1 to 1.5 years, that the soul of the company will be eroded. I’m optimistic that we can create some magic and that we can build on the soul of the company and the soul of partnerships in the private-public space as well. With that, Robin, that is basically what I take home from the COVID pandemic.
Robin van Puyenbroeck 55:07
I think all four of us here are eternal optimists and that is a good thing. Sadly, our time is up. Thank you so much, Usama, Dimitri and Gabriela for sharing so generously here. There’s a lot of work ahead of us, but I think it’s very important for people in the audience and the world to hear and see and understand the expertise and dedication that you all bring to the table in addressing these issues of global health. I want to recognize the role of partnerships between business and government and also your commitment to making the world a better and healthier place for everyone. We said the word magic, so let’s make more magic happen to deliver universal health coverage and true accountability for all actors. Thank you again and I look forward to continuing this conversation and meeting in person as soon as we have a chance. Thank you so much.
Usama Malik 55:57
Absolutely. Honor and pleasure. Thank you, Robin.
Robin van Puyenbroeck 56:01
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