All About ViiV: An Interview with CEO Deborah Waterhouse at CROI 2024

Well, what I can say is that myself and my team certainly stayed put, and we were discussing this morning how powerful and impactful that part of the opening ceremony was. As you've said, around the world, particularly in sub-Saharan Africa, we've seen some backward steps being taken on the ability for people who wish to be in same-sex relationships to have those relationships either recognized through marriage – there's been some steps back on that – or even at the most Draconian end of things, which we've seen happen in Uganda and other places where actually you've seen same-sex relationships outlawed. That is extremely disappointing. Part of what I spend my life at GSK doing is I'm the head of the LGBT+ Council, and we have a very dynamic spectrum chapter. We have a real core part of our culture both at ViiV and GSK which is about truly being you. We feel every day that we as a company need to make sure that we're standing up for what we believe in. We believe obviously that people should be allowed to live the life that they want to live, and we make that a core part of who we are and how we work. We attract incredible talent as a result of that. People stay a long time with the company because they feel, and I feel this way too, that it's a place where you can truly be yourself and do your best work and thrive. And if you look at the mission of ViiV, to be around when the virus goes, when you get rid of the virus, it must be really frustrating to see these retrograde steps when you know if you are criminalizing people most affected by the virus, it's going to make the end of that much tougher, isn't it? It is, and what we do is three things really. We focus on the science to make sure that we're listening to the community and bringing to them medicines both for the treatment of HIV and for the prevention that actually ensure that they can thrive and live the life that they want to live. So our pipeline and our products today are built on patient insight. The second thing we do is we work very closely with the community all over the world, many smaller community groups across sub-Saharan Africa, some in the US, some in Europe and other places, so that we're touching the community at the grassroots level and ensuring that our grants and our funding flows into those areas. It's been 30 years since our Positive Action group was set up, and we have distributed millions and millions of pounds to the places where at a local level it makes a phenomenal difference. The third thing we do is we tackle stigma. It's amazing to think that in 1988, if you were diagnosed with HIV, your life expectancy was about 18 months. Today, if you're diagnosed and you take your medication, you will live the same length of life as somebody that's not living with HIV. That's an incredible scientific journey we've been on, and yet for the many years I've been working in infectious diseases and HIV, I don't think stigma has changed as significantly as it should or could do. We spend an enormous amount of time tackling stigma through very public campaigns. We've done partnerships with Shutterstock to ensure there's a bank of images of people living with HIV that are vibrant and healthy and incredible instead of what people might have perceived. We've got an amazing partnership with Gareth Thomas, the rugby player. We take an enormous double-decker bus into rugby grounds. We were at the Rugby World Cup, we go all over the UK, and it's a way of educating people about HIV – how one could acquire it and what you could do to prevent it, but also the benefit of being tested. We're tackling and challenging stigma in places where you wouldn't normally find people talking about those topics, and people are incredibly open. There's a lot that we do to really challenge the perception of people living with HIV and to put the most positive perspective of them forward that we can.

We are presenting data on some of the products that are in the market today. We have oral two-drug regimens. We have developed oral two-drug regimens as an alternative to oral three-drug regimens because patients told us that over a lifetime they wanted to take less medicine. If you're diagnosed in your 20s, you will take medication until the end of your life, which is probably 30, 40, 50 years. On that basis, if you can take two drugs not three, you cut the number of medicines you take by about 36,000 to 40,000 doses, which is incredibly important. The second thing we are talking about is long-acting injectables for the treatment and prevention of HIV. This is really a way of reflecting patient insight particularly connected to stigma. Many people are happy to take a tablet every day to suppress their virus, but a significant proportion of people living with HIV are not out to their friends and family, so they haven't declared their status, or they struggle to take that tablet every day because it's just one of those things in life that happens – you forget a dose, you miss a dose. The pressure that puts on people's lives because if you miss a dose you could find yourself rebounding from viral suppression, which is not good for your health and could mean you become resistant to the medicine, but also you could pass the virus on to your sexual partner. That is very difficult for people. The third thing is self-stigma. Every single day taking that tablet reminds them of probably the worst day of their life, which was the day they were diagnosed with HIV. The question from the community was, can we have something that's long acting and really discreet? That's what we've been talking about: our current medicines for the treatment of HIV administered every two months, but also our pipeline, which offers the opportunity of a treatment every four months, maybe every six months. There is a glimmer, there is a dream that we could get to every 12 months, and that would revolutionize treatment, but it would also revolutionize PrEP because it means you're not having to take a tablet every day but you could go and have your injection and then you're covered for whatever eventuality happens in your life. That's what we're talking about at the Congress.

There is a lot of data on monoclonal antibodies, or broadly neutralizing antibodies, as a potential for long-acting treatment, and they may also have a role in cure. I'm very interested in the bNAbs. I'm also always very interested in pediatrics. Our company's mission is to leave no person living with HIV behind, and actually the most underserved population globally is children. There's a lot of data on kids in terms of the new regimens and presentations that have been developed that are easy to take for even the youngest children. I'm very excited about the progress we're making there. Then obviously I go and sit in the cure sessions – that's the holy grail. Will we ever cure HIV? Probably not in the sense of a true cure; it's probably more a remission, a period over however many years where you could be treated and then you would just forget about your HIV, and then a number of years later you may come back for another treatment. That's the stuff that really excites me. Those are the areas I've been jumping in and out of all day today. I've got my little book with the sessions all marked down, and I'll be seeing the posters later and I'll be in all the sessions tomorrow. There is a study, and you mentioned the US particularly – there's a session on Wednesday which is a new study by the ACTG group, and they have studied in the hardest-to-treat population what impact long-acting would have. I think that is going to be a real game changer because in the US at the moment about 70% of people living with HIV are virally suppressed, but 30% are not; they fall in and out of care. That is really tough for them, but it's also challenging from a public health perspective. This study is talking about the utilization of long-acting to help us reach those people who really struggle to adhere for a whole set of different reasons. I'm very excited about the latitude data. And indeed, don't be fooled by my British accent because one of my other hats is as chair of the San Francisco Community Health Center. It's the premier health delivery service for people living in the Tenderloin, homeless, mentally ill, a lot of HIV. For both prevention and treatment, long-acting has been an incredible lifesaver because you come to get the injection, you're not carrying your medication around. I agree there's something very interesting about long-acting technology for those populations that one of my colleagues says are hardly reached. But yet, last year at CROI, one of the most exciting presentations I attended was Monica Gandhi presenting data on the population from San Francisco she had gathered together and had studied in terms of the impact of long-acting. She started that journey, and latitude builds on that knowledge. I think this is going to be a very important evolution of where we see long-acting being used and making a contribution to ending the epidemic in the US, which is a bipartisan objective that's been set for the US where viral suppression rates are a lot lower than in other wealthy countries.

No, I am a commercial leader by background. That's how I came to join the pharmaceutical industry. But for me, I wanted a career that was focused on making an impact on humanity, and healthcare seemed like a good place to start. I've worked in many different parts of the world – US, Australia, New Zealand, Central and Eastern Europe, the UK, other parts of Europe. Wherever I go, the question I ask is, what's the maximum impact that we can make on the health of others? That's why I work for GSK, because at the heart of that company is prevention with our vaccines, prevention when treatment is prevention, and we're an infectious disease company. So for me the fit was very good. I came into the HIV space in the late '90s when we just started to have highly active antiretroviral treatment, which was a very exciting moment to come in, but there was still a lot to do. For me it was a true opportunity to impact human health at a time when this virus had presented so many challenges to us. It is one of the trickiest if not the trickiest virus humanity has ever faced.

No, I think it's a pathfinder for other diseases. In HIV, the reason I love working in this area so much is because it is a community coming together to deliver a common goal, and that is to end an epidemic. The partnership, the collaboration, the connectivity between global funders, pharmaceutical companies, our industry, healthcare professionals, and of course community – because without community we can't move forward at all. I think it is a brilliant example that a lot of the ways in which we operate as a collaborative and connected community were really fundamental to the way we at a global level faced into COVID. But I also see that same collaborative approach being taken with TB. I'm the CEO of ViiV Healthcare, but I also wear the hat of President of Global Health for GSK, so I work in the TB space and the malaria space. I think HIV has really set up a model where collaboration shows and has the best possible impact on the outcomes for human health. I think it has been critical.

Yes, we have three shareholders. The majority shareholder is GSK, but we also have Pfizer and Shionogi as our other shareholders. We have a board, we have a chairman, and we operate separately, if you like, from GSK. But at the same time we have a wonderful relationship with them because what we do is we're 100% focused on delivering medicines to prevent and treat HIV – that's all we do. We live and breathe every single day to do that. We have a mighty set of employees, incredibly talented, passionate people. But what we're able to do is pull on the infrastructure of GSK for our manufacturing; they execute our clinical trials, they register all of our intellectual property. They, if you like, hold a massive orange umbrella above our head so that we can get on with what we're here for: to make sure that no person living with HIV is left behind, and that one day we are able to end this epidemic. Pfizer and Shionogi are okay with GSK providing the orange umbrella because we pay them for their services, so it works out financially very well. What I have to do is make sure that we deliver against the needs of our shareholders from a financial perspective, and in return we run ViiV in the way that we have chosen to do from day one. In high-income countries we strike agreements with governments and payers to give access to our medicines. In middle-income countries we have high-volume, low-unit value tenders so that Brazil and countries like that have access. In low-income countries we actually give our intellectual property to the Medicines Patent Pool, and they give licenses to generic manufacturers. That means today 24 million people are on a dolutegravir-based regimen. That means if you're in Kinshasa or in Denver, in London or in Sacramento, you're probably on the same medicine. That was all done extremely quickly so that there is equality of equity. That's how the company runs, and our shareholders are very happy with it because it's the heart of who we are. The incredible talent we are able to attract becomes a virtuous cycle of talent delivery and financials, but the do well and the do good come together, which I think is a really magical situation to be in.

We got the US license, and the next seven countries that secured licenses were all in sub-Saharan Africa which we were supporting. We actually licensed Australia slightly before those sub-Saharan African licenses because Australia was a reference country, so the licensure was very quick. We gave licenses to the three generic manufacturers through the Medicines Patent Pool faster than any licenses have ever been issued before. That part of the process was very quick. But we always knew, because of the complicated manufacturing process, that it was going to take a while for the generics to come on board. So we then said we would provide our long-acting prevention at a not-for-profit price. Global Fund and PEPFAR worked in partnership with us, and they are currently purchasing at a not-for-profit price everything that we can manufacture. The first 23 vials left the factory in October on a big lorry headed towards sub-Saharan Africa, and many hundreds of thousands of doses will be provided this year, increasing next year. We'll keep supplying that not-for-profit price until the generic manufacturers are able to step in. I suppose that will limit to some degree the penetration of the long-acting – that's an unfortunate phrase – but getting that into people in sub-Saharan Africa will slow things down. I wonder actually if what you're doing is laying the groundwork for the Gilead long-acting that's coming up behind you, or do you feel that what you're learning in terms of tech transfer, helping your generic partners learn how to manufacture long-acting at scale, is something that will be beneficial to you in the longer term? I think at the moment we are introducing a brand new therapy into sub-Saharan Africa, and that takes quite a long time. At the moment we're doing implementation studies, which is what many governments have asked for. After those have read out, the volume demand will come. So at the moment we're supplying large volumes both for the studies and for some programmatic implementation, but the supply and the demand are not significantly mismatched. We're just waiting to see how that demand evolves over time. I think it is very important that generic manufacturers know how to make, and we're doing the tech transfer for long-acting medicines. The key thing I would say is we have a medicine, a long-acting medicine to prevent HIV, in our hands today. Our competitors are coming, but they don't have their phase three studies out yet, so we've got no idea how that may play out. What I have is something in our hand which we work very hard to get into low-income countries. If something else comes along, another choice and another option, that's fantastic because the more choices people have the better. Oral PrEP is still there, the dapivirine ring is available, the long-acting injectables that we manufacture are available. Let's see what our competitors decide to do in the future, but we've always had our commitment to leaving no person with HIV behind, and now we're stretching that into the PrEP world as well.

I felt that there was definitely not equity, and that we need to do better in the future. I think that's why now you're seeing more of a movement towards ensuring that manufacturing is set up in sub-Saharan Africa so that you have the opportunity to produce vaccines and medicines in the continent itself rather than having it imported from other places. I think we've learned some very important lessons. I think we've also learned a lot about humanity because in places where the vaccine was available, there were all sorts of myths and concerns, and in fact the uptake wasn't as good as it could or should have been either. There was something about supply but there was something about demand as well that we've learned a lot about during COVID. I believe that next time we will be better prepared to ensure there is a greater level of global equity, but I hope that we will also communicate more effectively about the benefits.

I mean, human beings are perverse in many senses. We spend all that time desperately wanting to protect ourselves and our children, and vaccines are, after clean water, the best public health intervention that we have at a global level. So it's disappointing that some misinformation and distrust has evolved over time. People need to be able to make their own choice when it comes to how they manage the health of their body and their family. I would never be in favor of compulsory vaccination or anything like that. But I do think that having a consistent objective of building confidence in vaccines so that people make a choice with the right information in their hands, rather than believing some of the misinformation which leads them to make a choice that could damage the health of themselves or their family – for example, in the UK we've had big measles outbreaks, whooping cough, diseases that vaccination prevents, and that is very damaging to the health of kids and adults. So for me, it's a case of continuing to communicate, continuing to push back against the misinformation, but also there's a peer-to-peer piece which is all about having friends and family talk about this stuff, making sure that we're sticking up for the right for the health of ourselves and our families.

That is a great question. I think I'd start with the fact that I joined a company that really has never put any barriers in the way of my success. I could be me, I could be the authentic individual I wanted to be. I've had every opportunity to work all over the world, to take on many different breadth and depth assignments, and as a result I've been able to grow as a leader and grow in terms of my experience and knowledge. If I were starting my career again, I'd make sure that I chose a company that had the culture that connected to me, the purpose and mission that connected to me. Also, it would be important to know that there were lots of senior female role models and that the company had the culture that allowed me to be myself and allowed me to thrive. That's the advice I would give to people starting their career today. The second thing I would say is I mentor a lot of younger women, and what I see is still a little less confidence maybe than some of their male peers. I would say shut that voice in your head up that tells you you're not good enough, or maybe you're not quite ready, or that promotion may not be the right thing for you. Just go for it, be the authentic amazing leader you aspire to be, and have that confidence to be the best version of yourself. If you can shut that voice in your head that tells you that's not the right pathway for you, that would be a massive step forward.

Yes, I'm feeling slight trepidation at this, but go for it.

Oh, that's easy – West End Girls.

I have seen them in concert actually, yeah, me too. Terrific, terrific. I'm more of an R&B girl generally, but there was a moment in time – probably when I was at university – where New Order and Pet Shop Boys and all that amazing electronic pop music was the thing, and I fully immersed myself in it. I hope you did too.

Thank you, Ben.