IDEA Collider | Deborah Waterhouse

Yeah, sure. So great to be here. Thank you for inviting me, Mark. I'm Deborah Waterhouse. I'm the Chief Executive Officer of ViiV Healthcare. ViiV is a company that is 100% dedicated to researching and developing medicines for people who are living with HIV or to prevent HIV. I've worked in the pharmaceutical industry for 24 years now, always the same company, GlaxoSmithKline. ViiV Healthcare is owned by GlaxoSmithKline, Shionogi, and Pfizer, so we have three significant shareholders. And I moved out of the mainstream GSK world about three and a half years ago to come and be the CEO of ViiV. So that's a little bit about me and my background.

Yeah, that's exactly how we think of the company, actually. So it's focused on a single disease area, which is obviously HIV. It's a small company in terms of the number of employees that we have in the organization. It's a very vibrant, dynamic, and somewhat activist organization, actually, because we're here to generate innovation from a scientific and medical perspective to support those who are living with HIV or those who are most at risk of becoming HIV positive. And in addition to that, we also have a very close relationship with the community and think of ourselves as standing side by side in this disease area where there is a huge amount of stigma and discrimination. And so we see ourselves a little more broadly than just providing the medicines and the innovation, though that is at the core of what we do. I would describe us as more than anything a purpose-driven company. So our purpose is to ensure that no person living with HIV anywhere in the world is left behind. And what that means is that we will find a way not just to develop great medicines but to make sure that at a global level there is access to those medicines. So if I think about today, if you're living in New York, you are likely to be on a dolutegravir-based regimen if that's what your physician has chosen for you. And actually, if you are living in Nairobi, you have also got access to that same dolutegravir-based regimen. And what we do in the developing world is we make sure that we are working through partners, we give up our intellectual property through voluntary licenses, and we allow generic manufacturers to make our medicines at prices that those countries can afford. We work with supranationals, the Bill and Melinda Gates Foundation, and PEPFAR, and all of those amazing organizations to again make sure that they're supporting access to our medicines. And then in middle-income countries, we do high-volume, lower-priced tenders. And then of course in markets like Western Europe, Australia, Japan, and of course the US and Canada, we negotiate with payers and governments to fix an appropriate price. So that's how we kind of run the company. We think of the company from our purpose, and then yes, we have to serve our shareholders obviously because we're not an NGO. We serve our shareholders, but we do it always guided by our purpose of leaving no person living with HIV behind. That creates this incredible energy and commitment in the minds of our workforce, and actually also makes us pretty easy, I think, to partner with if you are another pharma company or external supranationals or governments. We try our hardest to be the best partner that we can be. So that gives you a little flavor, I hope, of who we are and what our purpose is.

I think if you're running a large organization, and I've run some very large parts of GSK. I've worked in the US many years running vaccines and primary care and operations. I've worked in Australia, Asia, Europe. GSK is an incredible organization, and I've spent 24 years with the company, and it is a very purpose-driven organization and one which has innovation at its heart. But I think a big pharma company is very different to one where you've got 1,300 direct employees and probably another 5,000 external partners, and obviously GSK supports us with manufacturing and a lot of work. So there is an incredible difference between a 100,000-size company and one with about 6,000 people working together, 1,300 permanent employees. So I think there's a difference. It's not so much better or worse, it's what's possible. I can move so fast in ViiV, but I've got a much easier time of it with a single therapy area and a small workforce. I think it's much harder to do that with a larger group, and you have to work very hard to take people on the journey with you. But I do think GSK can do that very well, as actually Pfizer does too. I've had a lot of exposure to Pfizer. They are a great organization. And I think it's just a different way of working and being when you're huge.

I think what makes us agile is, you're right, everybody in that company has a deep understanding of the therapy area, and not just the fundamentals of the science but the way the community and each of the markets around the world works. So that's very helpful. I think purpose drives very strong alignment, and it's actually relatively straightforward to get alignment across a large group of people, even if it is only 1,300, because everybody is super clear on what the mission is. And then I think we don't have layers. We don't have the same number of layers and hierarchy, and that's in part because we're small, but actually in part it's how we choose to run the company. So I have a very close connection with as many employees as I possibly can personally, where possible, but through town halls and meetings and the like for the larger parts of the organization, particularly in the US. So for me, it's about not just the structure that you set up, but it's how you choose to lead, how you choose to connect to people, and how you stand alongside them in the good times and the times when it's tough. And that's basically how I, and I think my leadership team and all the leaders in ViiV, approach things. And we are one community with a mission to leave no person living with HIV behind. We try really hard.

Well, I think what I have always thought is that leading an organization with a strong purpose, whether it's a big, medium, or small team, has many, many advantages, both because it connects you to the very essence of why you come to work every day, it helps people understand why you do what you do, why the organization makes the decisions it makes, and actually it sets the tone for how leaders and all employees turn up every day. Actually, I think I've never really appreciated just how valuable that purpose and that commitment is until we've gone into the current crisis. Because actually it was very clear how we were going to make decisions, what the right decisions were, and we had the trust of the organization that whatever we did, we would always do it with the patient at the front of our mind for those people across the world that are living with HIV. So actually, the main concern that I think everybody across the organization had was: can we supply? Are we going to be able to supply the increased demand that we are seeing for our medicines? And the answer was yes, we have a very robust supply chain supported by GSK. They did an incredible job, and we had no outages of stock. Okay, so what about our clinical studies? Where are we with those? What disruptions can take place? How do we make sure that we put the most significant amount of effort possible to ensure that the people who have given their time to be part of our studies and have offered to support that journey of developing new medicines, how do we make sure that they get those medicines consistently and that the studies can continue? And once we answered those two questions, actually our workforce was pretty comfortable because we did what we needed to to really ensure that the first order of support was delivered against. And then what we've done was to say, well, how can we connect with the community? So we set up the ViiV COVID-19 Emergency Fund in response to feedback we got from the community and from our customers, and we put a grant in place which meant half of the money would go to do clinical research related to HIV and COVID-19, and half of the money would go to the community to give grants to community groups who were very close to patients at a global level, to make sure that during this time they were able to support those who really needed them the most, at a time when funding was being cut off from other places. So that's the kind of thing that we almost do as a reflex. And people come to us with ideas, and we can't do everything, but they know we're open to partnering. So it's been things like that that have really kept all of our employees committed to their day jobs, but also knowing that we're making the right decisions aligned to our purpose in everything that we're doing. And that's been incredibly powerful. And we have just immense amounts of hard work and focus and energy from all of our employees to make sure that everything that needs to be done is done in the way that it should be. And so I'm incredibly proud and thankful for everything that everybody's done. So COVID has obviously created some challenges in terms of commercially, and lots of things are on hold, and we can't see our physicians, but we've said: what can we do to support healthcare professionals? What can we do to support the community? What can we do to continue our clinical research? What can we do to make sure our supply is where it needs to be when it needs to be there? And we've managed to achieve that. So I'm feeling pretty happy with where we are against a backdrop of a very difficult situation where many people have been very personally affected by this.

So we have a philosophy that we price fairly wherever in the world we're operating. Our factories, in terms of our HIV producing factories, are based in the US, the UK, Spain, etc. So they're in countries where the cost of goods is going to be relatively high. And so we know that those cost of goods are absolutely perfect for supplying Western Europe, America, etc. And actually we can probably get the cost of goods for high-volume tenders to a level where in Brazil or Russia we can still serve those populations at a price that the government can afford. But actually, Mylan, Cipla, Aurobindo have masses of factories in lower-cost parts of the world, and their quality is incredibly high. So what they are able to do is then take our licenses and say, well, actually, in my factory in Karachi, for example, which is a big producing area, I can do 800 million tablets, and I can work in partnership with PEPFAR, and we will meet the quality standards that are required. Obviously that's a given. We'll take this intellectual property, and we'll marry it up with, in this case, lamivudine and tenofovir to create TLD. TLD is available across much of the developing world for about, I think, seventy-five dollars a year. I mean, that is incredible and means that access really is there for everyone. Sometimes underpinned by funding from PEPFAR or other groups, and on other occasions governments in those countries can afford to buy the medication that their population needs to keep them healthy, and in turn therefore economically contribute to the evolution of each of those countries. So I think that's an incredibly good model, and I think that is appreciated by everyone, whatever country you happen to be in.

On the subject of innovation, do you apply a definition of innovation within the organization? So the way we look at innovation in our research and development space is we work very hard to understand what the unmet medical needs are in the therapy area in which we are fully immersed, so HIV first. And then what we do is we build our science back from the latest kind of scientific knowledge which is being discovered as science at a macro level progresses, such as genetics, genomics, etc. And then we say, well, we've got all of this new information and new innovation at a scientific level, and then we've got the insight from the patient and the physician in terms of what are the unmet medical needs. And then what we do is we have built a pipeline which is focused on unmet medical needs. So let me give you a few examples of that. We've got to a point where if you take your HIV medication, which is three drugs often in one tablet every single day, your life expectancy if you're HIV positive would be the same as if you hadn't been diagnosed, probably in your twenties, and you can live a very full and normal life with HIV. But as you get older, you start to have some additional comorbidities. So when you're 70, when you're 60, you probably have the issues you would have if you hadn't had HIV and weren't taking antiretrovirals. You have the issues you would have at 70 or 50, the ones that you would have at 60. So there's something about getting older having taken a lifetime of medication that causes a lot of comorbidities. What we then said is, okay, so how do we reduce the drug burden? And we discovered a medicine called an integrase inhibitor, which has become the world's gold standard integrase inhibitor. And then what we said is, well, actually, we've done that. Can you just take two medications a day versus three? Because that's something that we hear very strongly from people living with HIV, that as they get older they want to take the best medication every single day. And then every day, a lot of people really struggle to take their medication for a whole raft of reasons: self-stigma, how they feel about themselves, every time they take that tablet they find it difficult to adhere. There's a whole set of things. So we said, okay, well, how then can we help in that area? And we're bringing to market in the near future an injectable, long-acting dual regimen, which means that you could potentially have a shot, an injection, every two months, or six times a year, versus taking a tablet every single day. And so it's that insight-based innovation that we believe makes the biggest difference. And it has to serve the healthcare system as well, but also meets the unmet needs of the patient. And ultimately, we have a lot of money invested in cure, because we would like to see ourselves out of business. I mean, ultimately it's going to be many decades away, but a cure for HIV is the Holy Grail. It's something that so many of us long and hope for. But until the day that HIV is cured, we'll keep on developing medicines which meet that unmet medical need. Then we come back to purpose and innovation, because actually it would be easy therefore to decide, well, Western Europe and America, this will be an innovation that would bring a lot of commercial benefit. But if you've got the mission of leaving no person living with HIV behind, you cannot just look at the populations where you can make money. And so we have to look at it really broadly. So in my opinion, and I'm passionate about this, pediatrics is a highly underserved population. It's underserved because the medicines are very difficult for children to take. If you've ever tried to get a child to take a tablet, you know, be it paracetamol or whatever, it's very difficult. Well, HIV tablets are pretty big. So to get a baby or a small child to take a tablet is very difficult. The doses are wrong. And so we need to make sure that we can produce age-appropriate formulations for kids. There's no money in it. All of the kids live in the least developed countries of the world. This is where the issue is. 1.7 million children living with HIV, and a hundred thousand of them die every single year, most of whom are under five. Now, there is no money in that market. But if you live the mission as we do, you have to go after that. You have to go after that. And so what we've done is within the last ten years, developing versions of dolutegravir in baby formats. And I'm hoping that in the next couple of weeks we are going to get a dispersible 5 mg tablet which you can just drop into water and a child under five can easily take it, and then other doses where you will be able to have a full suite of dolutegravir-based regimens that children can take. And then what you do, which is what we've done, is you work with the generics manufacturers because we can't make it cheaply enough for the least developed countries to benefit in the way they really should have the opportunity to do so. We've got some amazing partners, Mylan, Cipla, who are already going through all of the tech transfer and the hard work to make sure that the minute we get the regulatory approval, we can hand to them the license. And then we'll work with the WHO and PEPFAR and others to make sure that the money is there and the access is there. And that is part of our mission: that we go after the populations that need us, not necessarily just the populations who need us but also offer us a commercial opportunity.

Yeah, it would. And also, just to give them credit, I have three incredibly supportive shareholders. So GSK owns 78% of ViiV. They are unbelievably supportive. The predecessor companies of GSK discovered AZT, the first-ever HIV medicine, 3TC, the first ever combination, Combivir. I mean, we've had a heritage in this area and a commitment scientifically since the very beginning. And so they're amazingly supportive. Shionogi are incredibly supportive. Pfizer are incredibly supportive. And so it's only with that supportive shareholder base that you really are able to balance the shareholder delivery with the investment in the purpose and the investment in our mission and how to really live our purpose. So I have to give huge credit to those shareholders who are unbelievably helpful and supportive.

We are quarterly results get rolled into GSK, so we do have the quarterly pressure because obviously GSK has the quarterly pressure. But what we are able to do with our single focus in this therapy area and the deep intimacy and knowledge we have in all the different geographical and customer and community areas is the ability to have a really long-term strategy that we're able to articulate clearly. And that is a very compelling proposition for our shareholders. So we spend a lot of time not talking about today and tomorrow, though that's very important, but actually 2028, 2030, like what does the next 20 to 25 years look like? And that is very clear in terms of what our strategy is, and it's very well understood and supported by our shareholders. So we have some short-term goals obviously that we must meet, but we do have a very supportive, long-term thinking set of shareholders.

So the first thing I would say is I love this industry. I am immensely proud to work in this industry. And I'm not just proud of what GSK or ViiV has achieved. I'm proud of what Pfizer has achieved, what Gilead has achieved, what Lilly has achieved, etc. We have as an industry made an incredible contribution to this world's economy and its health. And I think sometimes I feel very sad because I think our industry does not get the credit it deserves. And actually, unfortunately, some missteps of the past and some bad actors have probably damaged our reputation significantly over the past few years. And I am actually seeing a stepping forward in an amazing way during the COVID-19 pandemic crisis. And I see us on our best as an industry. I was hearing Bill Gates this morning ahead of the GAVI meeting in London talking on the BBC about his view of the industry, and he talks about us as an industry that is going to change the evolution of the COVID-19 pandemic. And my heart was so full of pride. So actually, I think as an industry we have done incredible things. You used to have an 18-month life expectancy once you were diagnosed with HIV. You will now live a normal life, same length of life as somebody without HIV. So I love what our industry has done. What I would like to now see us do is to continue the incredible innovation from a scientific perspective that we deliver, and then I would like to see us be very thoughtful about the role we play at a global societal level and take all that we've learned through COVID-19 and build on it, so that our industry is one that is admired, not one that is vilified because it seems to be gouging on price or whatever the things are that we've come under some criticism for over the last few years. But we are here fundamentally to deliver innovation in medicines, in devices, in science. And therefore I think we need to make sure that we continue to deliver value in that scientific space because that's the core of who we are, and then behave appropriately as an industry so that society doesn't just benefit from our science but appreciates everything that we have done to deliver it.

I believe culture is fundamental to the success of any organization. And so the purpose is the aligning thing that everybody can stand behind and put their heart into. So that's what we're trying to deliver. And then the culture is really important; that's the fabric of our culture. So we very much put the patient first. We are a very agile organization, non-hierarchical, very passionate about what we do, very supportive of our people. We're an organization where we truly believe you can be you regardless of your gender, your ethnicity, your sexual orientation. You can be you any day and any hour of the week, and we embrace and welcome that breadth. And I think that's what makes us successful and special, because we have such incredible people. But there is a very strong culture, a very strong belief in what we do, but also that flows into the how we do it as well. So I love that about the company. People write to me all the time and don't say, 'Deborah, you're a great CEO.' They say, 'Deborah, there is a gap here. I think we could do more,' or 'Have you thought of this?' or 'Could we have a forum to discuss whatever the topic?' It's very flat and very non-hierarchical. Nobody ever feels, 'I can't tell Deborah that because my manager wouldn't be happy.' It's much more of a community than a hierarchical organization. But our goals are clear. We're there to drive innovation, to drive performance, and to build trust with the outside community and our staff. We're very clear about what we're doing. It's not a soft and fluffy place, but it is a very agile and passionate and purpose-driven organization. And I think our culture is one of the things that will continue to allow us to be successful.

I think my leadership philosophy is, and I think back to what I've said before, if you all know why you turn up to work, that makes it easy. Because actually, no matter what your role, whether you're in the finance team, whether you're in HR, whether you're a scientist, whether you're a sales professional on the front line, everybody knows what they're there to do. That's the start point for us. And communication, in every decision we make, everybody can align it back to the purpose. So yes, there are challenges and there are pressures, but a lot of the pressure that we have actually is something that juices us. Because if you imagine, let me go back to the pediatric medicine which I am waiting, in the next hopefully 12 days, to see an approval on. We've been working on that medicine for 10 years. 10 years. And yet every year we have a detailed plan, week by week, day by day, particularly as we get closer to the approval, which sets out where we could cut out time. Every day that we can cut out, every week that we can cut out, all of the speed that we can deliver means that kids in Malawi and Botswana and Uganda get that medication a week, two weeks, three weeks, one month, six months earlier. And so when we're putting both support and challenge into the system, people know it comes from a place that we're not trying to do it for some financial gain tomorrow or the day after, although that is important, but that we're doing it because we are trying to get our medicines to people that need them as soon as is humanly possible. And so yes, there is tension and challenge. We're a very challenging organization. We're quite outspoken, and feedback is very direct. But it is taken in the spirit of we're all here trying to do something really, really important. I get super direct feedback from my team, and sometimes it can be a little bit confronting, and I'm like, 'Yeah, they're right. Okay, we're going to take this on,' or 'Actually no, I disagree.' We have quite fierce debates, but we do it in the spirit of knowing why we're here, why we come to work every day. And actually, I think if I had a compliant organization, I wouldn't quite know what to do with them. I love challenge, and I want us to be the best we can be and to continuously improve every single day. And so that is how I think we come together, and that we can have the direct and challenging conversations and give each other feedback and say, 'Well, that's not good enough. Actually, you could cut three weeks out there. What if we got a different supplier? What if we didn't use that particular API?' And I think that's how we find harmony, with challenge sitting quite nicely side by side.

I think you can only do it if you know that through doing that, taking that approach, you are going to deliver the shareholder value, because ultimately people own you and you've got to deliver against a set of targets. But you can either say that the target is the purpose, or the patient is the purpose, and believe that in serving the patient, actually you will deliver for the shareholder anyway. And that's what we have found. The alignment, the strength, the culture, the passion, the innovation that we've been able to create because of that has absolutely served people living with HIV across the world, and soon we hope will serve in the prevention space as well, because we just had some incredible clinical data on one of our medicines in terms of prevention. So that delivers the best work from everybody, and the best work from everybody is the best way to create shareholder value. So that is my leadership philosophy. I think lots of companies do approach things like that, and I think the more customer-centric the company is, the better they perform. And I think that's a great thing. But different companies have to choose the right path for them. And I do understand that the external world of analysts and institutional shareholders who need to deliver their goals, and it doesn't matter whether the money to do that comes from pharmaceuticals, oil, gas, retail, that is a different world to be in. So for me, it would be naive to say everybody could be like us. I think it's possible, but maybe not quite so intense, because my shareholders are three pharmaceutical companies, and I contribute significantly to the shareholder value of one of them, but two of them actually. But it's not the same as having the outside world owning stock and making demands of you which might not be in the best long-term value. So I think it's different. But all I can say is that's how I want to lead. That is who I am. That is how I lead authentically, with humility, I hope. I would not ask people to do anything that I wouldn't do myself. I've carried the bag. I've been a leader in sales. I worked in marketing and R&D. I've worked in so many different areas of the world. I am so privileged to be part of this incredible industry. And I hope my team feel my care and connection to them in this incredible journey that we are on together. And nobody is more important than anybody else on that journey. So that's basically how I approach leadership, and so far it seems to be working.

I want to cure HIV. I probably won't be working by the time that happens in 2040, 2045, but ultimately I want HIV to be cured. That's what I want. So if I think about okay, well I won't be working at that point, so what are the things I can do today to take us towards that goal? And that is better medicines for everybody that needs them. That means prevention. That means supporting the community. That means being the best leader that I can be for my people every day. Those are the things that keep me motivated. And I honestly believe I have one of the best jobs in the whole world, so that is incredibly energizing and important to me. But obviously everybody needs an underside to their lives, so I have a very supportive husband. He's an NHS consultant, so he's actually been on the frontline of COVID much more than I have over the past few months, so that's been really interesting to get that perspective on life. I've got two kids, teenagers, who are supposedly doing their equivalent of GCSEs and A-levels, but that's all been thrown up in the air. So one will see how they go, but they're phenomenally supportive and they give me huge amounts of energy. And the two parts of my life seem to work quite nicely together. They mesh quite a lot, particularly at the moment where the blurring of the lines between home and work is probably more than it's ever been. But I consider myself one of the luckiest people alive.

Yeah, so three thoughts. Number one, and it depends where you are in your career. Number one, one of the books I first found really important to me in the way I operated was Stephen Covey's 'Seven Habits of Highly Effective People.' That helped me bring efficiency and effectiveness to, as I became more senior, a massive work which could overwhelm you. So I think that's a great book for everybody to read. And I did it actually because at the time I had my first child, I was really struggling to be the mum that I wanted to be and get my work done, and that book really helped me juggle both sides of my life. And the second one, which I probably read first in about 2008 or 2009 when I just moved to Australia and became the General Manager of Australia and New Zealand, was Marshall Goldsmith's 'What Got You Here Won't Get You There.' And I realized that the way I'd worked previously had got me to the place I was, but I had to change the way I approach things, my style of leadership, the way I work with people, empowerment. That was a fabulous book. And another one that made a big difference. And then recently I have read a book by Erica Fox, and I think it's called 'Winning from Within.' That's what it's called. And that's been something I've been reading over the last 18 months, and it talks about the different elements that you have within you as a person: warrior, thinker, lover, dreamer. And it talks about how you bring all of those together to be the most effective person that you can be at work from a leader perspective, and it also helps quite a bit with your home life as well, because all of us have things that are more dominant in our personality, and it's how we flex those to be the most effective at connecting with others. So that's what I've just read recently.

Wow, I think we covered just about everything today. We've had a very broad-reaching conversation. We've done COVID and science and HIV stigma and purpose. So I think we covered just about everything.

Yes, so we haven't talked today about technological advances which are part of your customer connections and the model that you have. In our industry, it's a face-to-face human selling model actually. Now we've got from a patient and a doctor perspective, digital and virtual as a really key part of what we do. We haven't talked about that today because we were focusing more on the innovation from a science perspective. In the commercial space, from a digital perspective, we have a clear strategy, but a lot of the stuff that comes up that ends up populating the thought of how we execute that strategy comes up from grassroots, and then we fiercely share best practices and get adoption across other markets where relevant. And a lot of the stuff that comes out of markets never ceases to amaze me. I'm like, 'Oh my gosh, that's so smart, and actually we should be doing that in so many other places.' And so we do have this kind of bottom-up, top-down. And I love that. I love that the new ideas constantly come through that can make a massive difference to how we connect with our customers. I'm also a great believer that what works in one place may not work in others, and making everything for everyone is not a good thing. So if you can push decision-making and creativity down into the markets and the places that are closest to the customer, that's often what creates the magic. I'm not a fan at all of top-down, everybody must do it the same way, because that never works as well as stuff that is tailored. I mean, some of the wiring and the systems have to be standard because that's just the way work, but the actual customer magic is often created at the coalface rather than in a big office building somewhere in London or New York or Philadelphia or wherever.

Thanks, Mark. Thank you for inviting me. It was great to talk to you.