Treatment for all: the key steps to better representation in pharma

As people have become more conscious and vocal about diversity and inclusion, Page & Page’s Lisa Lishman says pharma should reassess how it conducts clinical trials.

The pharmaceutical industry is one of the most important industries in the world, providing lifesaving drugs and treatment to people who need it the most. This already significant industry is growing – it is estimated to be worth $1.27 trillion by end of 2020. But despite reaching billions of people around the world, it has not necessarily met the needs of every patient from every background.

The issue of better diversity and inclusion has been a focus for organisations, businesses, policy makers and people from all walks of life in recent years. As people have become more conscious – and vocal – about the lack of representation in so many aspects of our lives, the pharmaceutical industry has had to recognise its short fallings. And then the COVID-19 pandemic really brought it into sharp relief.

As the vaccines were developed and rolled out, the disparity in their take up among different sections of the community highlighted how excluded some minority communities felt from areas of healthcare. In the UK, research found that even among people working within the healthcare sector, there was greater vaccine hesitancy among every minority of healthcare workers (HCW) than among white HCWs.

Vaccine hesitancy was the most recent and highest profile example of distrust among minority groups towards the pharmaceutical industry. To address this problem, businesses operating in this sector should go back to the beginning of the process and look at how they conduct clinical trials.

Clinical trials are the cornerstone of the industry, but they often fail to recruit female and BAME volunteers. Without clinical trial diversity, the industry will never fully appreciate the unmet medical needs of patients in underrepresented groups. And as COVID demonstrated, if people don’t feel they are represented they are less likely to participate in public health initiatives.

In 2020, 53 novel medicines were approved by the FDA and of the patients who took part in trials, just 8% were black and 6% were Asian. An analysis of FDA data into trials of cancer drugs approved since 2015 found that 24 out of 31 cancer drug trials had fewer than 5% black trial participants – and this is despite black women being disproportionately affected.

This is not a box-ticking exercise and in some ways it’s as much about cultural intelligence as cultural diversity. If people don’t see people who look like them, who are from their socio-economic group, from their demographic, from where they live – there will inevitably be less trust.

In addition, uncertainty is higher because historically some communities have shied away from using pharmaceutical products to treat their ailments – they have had their own cultural views on treatments and manufactured drugs have not necessarily been part of their lives.

Better representation must extend to all areas of the industry, not least in the workforce. In 2016, the pharmaceutical industry was found to have less gender and ethnic diversity than other industries in the Fortune 500. One-third of the top 50 companies have no women on their boards, and just 8% of board seats are held by ethnically diverse directors. Diversity and inclusion has often been stuck with human resources (HR) and focused too much on ticking a box.

In addition, companies should invest in sensitive, multi-layered communications that reach different people, cultures and ethnicities. There is a need for parallel comms: internally to educate teams – be they working in drug development or sales; and externally in all outward facing campaigns.

So, pharma needs to adopt comms strategies that are culturally intelligent – communications that talk to people in a way they listen, in a language they understand, with people that they relate to and provides knowledge and challenges false data. There isn’t a one-size-fits-all approach. While convincing an old man living in a Tier 3 city in China who has lived his life through Chinese medicine to travel 100 miles to get an injection may be a tall order, there are smaller steps that can be made that reassure people, give them comfort that this is a good thing that will make their lives and their communities’ lives better; that it’s not necessarily about the action itself but what it means for the wider population of their friends and family.

This might involve changing the conversation, that it’s for the greater good and that pharma can work in parallel with traditional medicine or techniques people more happily rely on. It doesn’t have to be an either/or – instead focussing on how it helps a person live longer and complements what they’re already doing.

The recent support of the Black Lives Matter (BLM) movement by some CEOs of leading pharma companies has also been an important step in these companies being viewed as allies and promoting safety for different communities. For example, Pfizer’s Albert Bourla sent a letter to all employees supporting speaking out against racial injustice in line with BLM.

There is a risk that diversity and inclusion can feel like something that is stamped onto a job title or initiative to make it appear as if companies care. The same goes for filling quotas versus purposeful hiring. But for this industry – with much to be done to improve inclusion – clinical trials are clearly a first port of call. When drug development is conducted with all people included, and workforces better represent the population, we really will get closer to achieving treatment for all.

About the author

Lisa Lishman is partner and commercial director at Page & Page and Partners