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Emerging from Covid-19: What next for the pharmaceutical ?

June 2021 | A Grayling Global Report Introduction

As the world continues to tackle the Covid-19 To gain a comprehensive view, Grayling We also witness an acknowledgment that , now is the perfect time to assess surveyed 3,000 members of the public in six government budgets are likely to come under how people across the world perceive the role countries across the world and canvassed the renewed pressure once the virus is under and reputation of the . opinions of 14 senior decision-makers within control. Is public awareness of – and trust in – big pharmaceutical and life science companies pharma companies changing as the and healthcare charities. It is worth noting that Grayling conducted pandemic evolves? its survey and expert interviews before the What emerges is a world in which the debate surfaced around whether or not How is the relationship between perception of pharma companies has largely protections should be lifted temporarily pharmaceutical companies and governments been enhanced, especially in countries to increase the accessibility of in evolving and what does this mean for where Covid rollouts have been developing countries. the future of the industry? How can most successful. Are we seeing a politicisation pharmaceutical companies improve their of pharma and what does this mean for the This is just one of a number of important issues communication with stakeholders in the industry and its relationship with government that the industry will need to confront if it’s medical industry, government and the public over the long term? genuine in its desire to build on the goodwill at large? that has built up over the last 18 months. Our conversations with industry experts also provide valuable insights into the experience of those involved in the development of solutions, as well as those whose sectors struggled to Kathryn Ager get their message across while the world was Head of Health understandably focusing on Covid-19. Grayling

We observe an industry determined to emerge from the pandemic with more purpose, with hope that the closer public and private collaborations developed at pace during Covid can be sustained moving forward. Key themes

– Introducing the Grayling Global Pharma Survey – How the pharmaceutical sector is perceived

– The communications challenge for pharmaceutical companies – Other have been side-lined during Covid-19 – The threat of ‘vaccine nationalism’ – The future relationship between pharma and government – Finding a ‘higher purpose’ – Conclusion: Where does the pharmaceutical sector go from here? – About Grayling – About the research Introducing the Grayling Global Pharma Survey

The pharmaceutical sector will emerge from When people were asked how they heard in the UK (72%) are the most likely to report that the Covid-19 pandemic better understood and news of pharmaceutical companies, TV they know ‘nothing’ about pharma. more highly regarded than before the global emerged as the most dominant channel (67%). crisis, Grayling’s research finds. This figure does however vary widely from Perhaps unsurprisingly, people aged over 55 country to country, from a high of 76% in Russia (77%) are more likely to hear about pharma Nearly two-thirds (63%) of the 3,000 people to a low of 49% in China. companies via TV than younger demographics surveyed in the UK, US, France, , (57% of 18-34-year-olds). Meanwhile, those China and Russia say that the pharmaceutical When asked about their knowledge of the aged 18-34 are more likely to learn about a industry has a positive impact on society. pharmaceutical sector, the most-savvy publics pharmaceutical company via social media or appear to be in the US and China, while men word of mouth. Nearly half (49%) of people say they view the pharmaceutical industry in general more Factors influencing global views of pharmaceutical companies in general positively than before the pandemic.

How safe their treatments are 82% This was particularly evident in markets such as China, where nearly nine in ten (89%) people felt more positive towards the industry, while How honest and ethical they are 77% just a third (33%) of French people reported the same. How fairly they price their treatments 71%

Just 14% worldwide say they feel the pharma The amount of they conduct into new treatments 70% sector has a negative impact on society. Men are five percent more likely than women to say Whether they make a positive contribution to broader society 59% they think pharma has a ‘very positive’ impact (18% v 13%), while women are narrowly more Whether they also produce consumer healthcare I trust 57% likely to say pharma has a negative effect (16% v 11%). Whether they are based in my country 45% ­How the pharmaceutical sector is perceived “It is a rare moment that pharma is perceived well. And what’s unique is In all the six markets that Grayling surveyed, 10% of Brits. At the time of the survey, France we are using company names for the people are more likely than not to believe that was behind many other European Union (EU) vaccines, not the medical names. We the pharmaceutical industry has a positive countries in administering its vaccine rollout.1 impact on society. This positive affirmation need to tell the story of the pipeline ranges from 90% in China to just over half (51%) One of the common themes to emerge from and how academic research creates in Germany. the interviews that Grayling conducted with the pipeline for new and experts was that almost treatments. It is academic knowledge The pharma industry also faces something of a all of them agreed that pharma’s reputation that creates the pipeline. It is charities perception challenge in France, where nearly has improved during the pandemic. There has a quarter (24%) of people feel more negatively been a greater understanding of what the and early investors that create these towards the sector than before the crisis, which industry does. The challenge is how to make medicines.” compares to just two percent of Chinese and this goodwill last. - Charity representative

Changes in feeling towards the pharmaceutical More positive industry in general during Covid-19, by market No change

More negative 89% 52% 49% 46% 44% 43% 41% 40% 38% 35% 35% 35% 33% 24% 20% 17% 15% 14% 10% 8% 2%

Total UK USA France Germany China Russia The communications challenge for Changes in perception of pharmaceutival pharmaceutical companies companies from Covid-19 coverage

More negative While the global response to Covid-19 However, while enjoys a healthy More positive has provided an opportunity for some approval rating (60% positive) among those pharmaceutical companies, it has also who have heard of the brand, AstraZeneca 58% Takeda turned the spotlight on them and how they is experiencing more negative perceptions, 12% 2 communicate. Some have seen their brand possibly due to its legal battles with the EU , 57% Sinopharm awareness rise significantly – especially the question marks over the accuracy of its data in 9% leading vaccine producers. One in five(21%) the US3 and reported links to rare blood clots4. Pfizer 57% 10% people say they have heard of AstraZeneca Sinovac 56% because of the pandemic, 15% say Pfizer More than a third (36%) of people said what 10% and more than one in ten say they now know they heard about AstraZeneca was negative, AbbVie 54% Johnson & Johnson (11%) and (10%) . compared to Johnson & Johnson (21%) and 13% 46% Sanofi(15%) . Negativity towards the Anglo- 11% Swedish firm AstraZeneca was highest in France 44% (46%) and Germany (42%) but lowest in the US 10% (9%). Merck/MSD 43% 11%

GlaxoSmithKline 43% 8%

Roche 42% 8%

Sanofi 42% 13%

AstraZeneca 41% 24%

Johnson & Johnson 41% 16%

Bayer 36% 8% AstraZeneca was also the brand people recall corporate communications lead at a major hearing most about (91%), narrowly ahead international pharmaceutical company, Awareness of pharmaceutical companies of Pfizer(89%) and Johnson & Johnson (88%). pharma firms need to be more transparent and Pfizer enjoyed the most positive perception honest about making a profit but also have (60%) of any pharma brand, with just 12% open conversations about how their business Before/during Covid-19 Before Covid-19 perceiving it negatively. The challenge for model fits with the non-profit business model to pharma companies is that if they face a achieve the same aims. “Treatments don’t exist reputation issue in one area of their portfolio, it without vision and investment,” he says. “The Johnson & Johnson 89% could damage their brand in other categories, [pharma] industry needs to stop shying away 78% even ones where they enjoy strong respect. from difficult conversations. Also, the industry Pfizer 86% 70% talks about ‘’ – we are all patients. We 84% Where people have been learning about need to talk about people instead.” 78% pharmaceutical companies during the AstraZeneca 80% pandemic is also revealing. Nearly six in The head of Policy and Public Affairs at 59% (59%) Roche 66% ten people in France have heard a leading UK health charity echoed this 59% journalists and commentators talking about viewpoint, arguing that the health sector needs Novartis 60% pharmaceutical companies, while just 38% say to engage with groups and invite them 50% they have seen a political leader discussing to be involved from the outset of Merck/MSD 59% pharma firms in France. In the UK, however, creation. “Bear in mind that patient groups are 51% Sanofi 58% the same percentage of the public (41%) an expert voice, connected, experienced and 48% has learned about pharma companies from can provide lots of insight in direction with the GlaxoSmithKline 58% the media and political leaders. Government appropriate framework,” she adds. 50% communication was key in the US, where Sinovac 51% 38% half the population (50%) said they learned The CEO of a major cancer charity emphasises Sinopharm 49% about pharma companies from government the need for the pharma industry to 38% (28%) (30%) spokespeople. China and Russia communicate authentically. She argues that Bristol Myers Squibb 49% were the places where people were least likely the general public can “see through window 39% Takeda 38% to learn about pharma companies from their dressing and ” and that, as purpose 29% political leaders. becomes a real focus for many organisations, Abbvie 38% pharmaceutical companies “need to think 29% How has the pandemic impacted how pharma about what they’re doing and get the balance firms should communicate? According to a right around commerciality.” Other diseases have been side-lined during Covid-19

Since early 2020, the healthcare agenda Others commented that the public is more worldwide has been dominated by Covid-19, knowledgeable now around medicine trials often at the expense of other diseases, and the regulation process than ever before. treatments and patient needs. Important Even pharma brands who have not been procedures were postponed across the world directly involved in the development of Covid to free up beds. vaccines have had to demonstrate leadership at this time. “Treatment of patients with chronic illness – such as or heart - was “We need to reach a general frequently overlooked. But it should not be so,” one communications official at the Russian arm understanding that the system of a multinational explains. “Thus, the market, authorities, patient organisations, should show should be sustainable despite that healthcare is about people. We need to any health crises.” reach a general understanding that the system should be sustainable despite any health Covid-19 has increased the relevance of crises.” health and in our daily lives and, as a result, the public’s appetite for this The communications lead at a major cancer information. Meanwhile, prolonged disruptions charity explains that it had been a struggle to to healthcare during the pandemic have had get any traction in the media with healthcare severe implications for other disease areas. As stories as the health pages are dominated by the virus is suppressed more opportunities will Covid-19. Another said that cancer patients open up for non-Covid-related stories in the have been forgotten, with treatments delayed media. This will provide a crucial opportunity and trials stopped, potentially putting lives at for organisations to communicate effectively risk. about solutions to address these other emerging health crises. The threat of ‘vaccine nationalism’

It has been impossible to extrapolate the Grayling found that people in the UK were pandemic from global political events. In far less attached to the idea that a vaccine Europe, disputes over vaccine supplies have had to be produced in their country to be led the EU to sue AstraZeneca, arguing the trustworthy than other countries. Just under half pharma company breached its contract over (49%) said it was important that a vaccine was supply rates5. developed in their country for them to trust it, compared to China (88%), Germany (68%) The pandemic overlapped with changing and France (65%). In the US, the White House’s response to the trading relationships with the UK, which has led pandemic became an election issue. One to tension on both sides. Important elections - Meanwhile, in Russia, one Russian-based biopharma expert commented: “There’s more whether in the US, UK or the Netherlands - have government affairs expert at a multinational confusion than ever. I struggle to know what been influenced by the perceived handling of pharma company warns that the main to trust, it’s so politicised. There’s a need for the crisis by Government. threat to healthcare in relation to Covid-19 credible scientific information.” is politicisation. “There are a lot of politically- “Vaccine nationalism is inevitable. It is a coloured talks about vaccines, foreign pharma The expert highlighted the rise of misinformation political imperative to vaccinate your own companies etc.,” he warns. “Russia is not the during the pandemic and the friction between population,” one former British minister says, only one in this respect – for example, India those willing to wear masks and those who do which he warns can lead to bad and irrational banned the import of substances for political not. behaviour. “The [UK] Government is not alone reasons. This approach is risky and should be in this. The attitude of the EU has not been avoided.” great. Pharma will need to be smart and Would you be more or less likely to trust a responsible in their deals with governments,” A government affairs and comms lead at Covid-19 vaccine if it was invented by a he continues. “While the UK funded the another Russian subsidiary of an international company based in your country? [AstraZeneca] vaccine, there could be a case pharma explained that Russian pharma for UK prioritisation, but pitting contracts and companies are “always welcome and countries against each other is not great.” supported” while it is harder for foreign companies to break into the market without China Germany France USA Russia UK direct investments. 86% 66% 63% 60% 49% 45% The future relationship between pharma and government

If healthcare has become politicised, how does “Pharma has enjoyed this impact the future relationship between the pharmaceutical industry and governments unprecedented access to Prime worldwide? Ministers and Presidents, with “Pharma has enjoyed unprecedented unprecedented opportunities to access to Prime Ministers and Presidents, with unprecedented opportunities to engage governments.” engage governments,” comments a government affairs specialist at a multinational A corporate communications lead at a major pharmaceutical firm.“But is the goodwill still pharmaceutical company believes that the there? The EU Pharma Strategy would imply it is speed of decision-making and collaboration not, with its focus on fair pricing and inequality between pharma and government has of access. The concerns around AstraZeneca shifted massively, especially during 2020. The have accelerated the issues around equitable question now is how to make sure this “game- access and of vaccines and changing” relationship continues in a non- pharma products.” pandemic setting. “How can we maintain the same sense of urgency, decision-making and One EU government affairs lead at a collaboration? Trust has been very positive,” multinational firm believes the pharma industry he adds. “Pharma needs to show it’s a key should be worried about upcoming legislation. element at the heart of healthcare solutions.” “Just about every pharma company had a record year last year in terms of profits. Soon, Several interviewees agree that more government will want to cut healthcare international cooperation is required going spending as part of their recovery plans and forward. discussions will begin again about medicine pricing and access.” Finding pharma a higher purpose

Across the world, the pandemic has [the pandemic], but it’s an opportunity to accelerated progress towards a more communicate the ethos of what it means to be Would you be more likely to trust a Covid-19 compassionate business model, where a R&D-based pharma company,” she says. vaccine if the company had promised it businesses are finding a purpose beyond wouldn’t make a profit on the vaccine? purely prioritising profits. This ‘New Collectivism’ This platform will enable the industry to elicit engrains greater environmental, social and more varied opinions on the big questions that governance (ESG) responsibility into company people have around pharma, such as pricing China Germany France USA Russia UK . Some for-profit companies that commit and access, she adds. The theme of inequality 84% 53% 52% 48% 48% 46% to fulfilling rigorous social and environmental of distribution was one that a few of our performance can qualify for ‘B-Corp’ interviewees raised. (Benefit Corporation) certification. This is reflected in the findings of our global One former UK politician believes that, survey. More than half (55%) said they would looking to the future, there is a case for be more likely to trust a Covid-19 vaccine if moral capitalism in the pharmaceutical the manufacturer had promised not to seek to sector. “The B-Corp concept is great. The time make a profit from it. Women(58%) are more has come for companies to have a social likely than men (52%) to trust a not-for-profit purpose and reform in corporate governance vaccine. is overdue,” he says. “Governments need a trusted partner that they know will behave Also, just over half (51%) would trust a vaccine ethically.” more if the company provided doses to poorer countries at a reduced price. However, According to a policy and public affairs neither of these trust drivers were as strong as specialist at a leading UK health charity, the the vaccine being developed in their country pharma sector has an opportunity to take (64%). advantage of public interest to educate it on the medicine development process. “People didn’t pay much attention before Conclusion: Where does the pharmaceutical sector go from here?

There is a general consensus among the can be translated into other areas. However, “There is an opportunity to leverage people Grayling interviewed that the she warns that the perception of pharma is the goodwill and the fact that both the pharmaceutical sector is enjoying goodwill different in Western countries compared to public and government stakeholders among the public for now but must hard developing countries, so the narrative must be are – slightly – more knowledgeable to build on it going forward. culturally nuanced. about the R&D process. The ‘’ reputation has always been “We’ve never been good at telling stories, One agency-side public affairs expert voiced about high prices. Sometimes it’s we never move beyond pricing,” one concern that the pharma sector was so justified, but it’s often because the government affairs specialist at a multinational successful in developing and distributing media and/or the public doesn’t pharmaceutical says. “We’re too risk averse, vaccines that it will set high expectations for understand the complexities of R&D so flown under the radar. This is an opportunity future emergencies. The key, and different healthcare systems.” to be front and centre on discussions around she adds, is to demonstrate that work is always and talk about the value of ongoing. - Healthcare industry representative medicines.” A number of experts that Grayling interviewed For the communications lead at a leading raised the steps the health sector has taken health charity, the story that “science has to digitalise during lockdown. The pandemic saved the world” is a compelling narrative. has proven that remote healthcare with direct “What’s been done for Covid could be done patient engagement via digital channels is A public affairs director at a global medicines for other diseases, especially the power of possible. company says that the bounce in reputation vaccines,” she argues. “We can see that in for pharma creates opportunities, especially terms of cancer, and we are investing in some There is now a greater public appetite around supply chain resilience and the vaccine programmes. The role of pharma is for services such as consultations via potential to grow the biotech sector. really important.” videoconferencing. One interviewee told us “The sector needs to take advantage that his company had run some successful of this bounce,” he concludes. She adds that the value of international sessions on invitation-only audio platform, cooperation has been demonstrated and Clubhouse. “The question is how?” About Grayling Health

Grayling offers full- communications We are grateful to the following organisations To find out more or discuss how Grayling for healthcare organisations across the for their support with this report: could help you with your organisation’s world. Our teams help build, grow, sustain AbbVie, Anthony Nolan, Bayer, Bristol Myers communications, please contact and repair health and health-related brands Squibb, Chiesi, Edwards Lifesciences, Gilead, [email protected]. and organisations worldwide. Whether it’s Janssen, , Ovarian Cancer Action, supporting clients to navigate a challenging Roche, Servier, Worldwide Cancer Research. regulatory environment or creating award- winning campaigns that drive awareness, About the research provoke thought or change behaviours, the The research of 3,000 adults from six countries work we do, inspired by our clients, creates was carried out by Opinium Research. Five advantage. ​ hundred people each from UK, USA, France, Germany, China and Russia were canvassed Grayling has worked with some of the leading between 28 April – 10 May 2021. names in pharmaceuticals and healthcare, including public health bodies and health service providers across the world. We have also worked with regulators, research bodies, trade unions, government departments, health boards and regulators, research bodies, trade unions, health boards and Patient Advocacy Groups (PAGs). References

1. www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html (retrieved 11/05/21)

2. www.bbc.co.uk/news/world-europe-56891326 (retrieved 11/05/21)

3. www.news.sky.com/story/covid-19-astrazeneca-defends-vaccine-trial-data-against-us-claims-of-possible-outdated-information-12254874 (retrieved 11/05/21)

4. www.bbc.co.uk/news/health-56620646 (retrieved 11/05/21)

5. www.uk.news.yahoo.com/eu-sues-astrazeneca-over-delayed-114532394.html? (retrieved 04/05/21)