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Interview with J-P Garnier-Chief Executive Officer of GlaxoSmithKline
 
 
  The Lancet Infectious Diseases 2006; 6:477-482
 
Jean-Pierre Garnier is CEO of GlaxoSmithKline. He assumed this role in December, 2000, with the merger of SmithKline Beecham and Glaxo Wellcome. Before joining SmithKline, Garnier served in a number of management positions at Schering Plough for 14 years. Garnier holds a PhD in pharmacology and an MS in pharmaceutical science from the University of Louis Pasteur in France. As a Fulbright Scholar, he earned an MBA at Stanford University, California, in 1974. In March, 2002, he was honoured with the Fulbright Association's Lifetime Achievement Medal. Garnier serves on many boards and is the recipient of many notable awards both for his scientific achievements and duty to his country, France.
 
TLID: What drew you into the science arena?
 
J-PG: It really started when I did my PhD in pharmacology at the Pasteur Institute in Paris. I worked intensely trying to finish my PhD, and that included sleeping in the laboratory, which only other PhD students will understand. You become obsessed with your topic, and as you progress towards completion fewer and fewer people are able to even communicate with you, so you become very isolated. It was thrilling but I disliked the isolation aspect. So after that I decided I would like to do something completely different. I went from doing a PhD, where only half a dozen people in the world knew what I was working on, to studying economics and business in California. I have always moved around different subjects and have not ended up being a specialist-I am more a generalist by nature.
 
TLID: Did you ever imagine that you would be the CEO of a leading pharma company?
 
J-PG: No. When I was younger I wanted to be a student forever. I was a serious student; there was not much partying for me. I loved the process of learning and I still do today. I love to learn quickly about topics I know nothing about. It is always interesting to go from zero knowledge to becoming a rank amateur in a subject. When I turned 27 I did military service. I then started a family and it was time to start earning a pay cheque. I have to say that I toyed with the idea of going into academia but I was more excited about some of the offers I was receiving from the pharmaceutical industry. It seemed to me that working for a pharma company I could make a quicker impact on the world, which I was interested in doing, but I never translated that into a career plan. I do not think that career plans really exist. You just keep learning and then things happen.
 
TLID: Could you describe a typical day in your life; what drives you each day?
 
J-PG: There is no typical day, which is what I love about this job. It is more of a lifestyle than a job because you travel 70% of the time. You are constantly on the road and you do not have the stability of a routine, which is why every day is different. What gets me excited, and this will sound rather arrogant, is that GSK is changing the world. We are changing the lives of millions of people-that counts for something. We can change it for the better or for the worse, it is entirely up to us, which is why it is a tremendous thrill when you come up with a product like Cervarix [GSK's cervical cancer candidate vaccine] or something similar, or even a donation programme where you know that millions of people will have a chance to live a very different life from what they have. In fact, some people will have a life because of our medicines and our vaccines. I receive letters every day from patients who are so grateful because we have changed their lives or the life of a family member. All this is pretty exciting and, frankly, I would never consider a career outside of health care. I would not be a very good CEO in selling cars, and I have said this publicly because I really believe that health care is special. The intellectual challenge is formidable, because you have to behave impeccably.
 
We have 110 000 people working in 130 countries globally. I also have to meet many people in the political arena, so you do need tremendous stamina. If you do not have the stamina and the resilience, it is a problem because bad things happen to a company all the time. You also need to have a sense of humour and if you take everything personally each time something goes wrong, you will not survive this job. You need to have high levels of energy, be passionate, and love what you do. For me, the ideal job is the feeling you have when you cannot wait to get into the office. I was fortunate enough to find something that I enjoy on day one.
 
TLID: Pharma companies sometimes receive bad press despite the world depending on them for life-saving drugs. How difficult is it to strike the balance between running a business and serving the greater good?
 
J-PG: That is a very good question. The first point to make is that society does not trust big institutions, such as governments, the UN, and big businesses like GSK. This situation was not the case 25-30 years ago but it is a fact of life today and we cannot take it personally. Of course, when there is bad behaviour, or alleged bad behaviour, in the press, it reinforces this feeling of distrust. So first of all, we cannot shoot ourselves in the foot. We have to behave impeccably so that we avoid being in the press being accused of one thing or another. Second, we should not have to be defensive about our actions; we should try to do more positive things, and show society that we are doing something special. GSK has a tremendous track record in taking the high ground.
 
Let me give you some examples. We were the first pharmaceutical company that gave a discount card for uninsured seniors in the USA. A 40% discount, no questions asked, was given to this group on purchasing GSK drugs. We were the first company to put all our clinical trials on our website for everybody to see. Our transparency means we cannot be accused of concealing data. We were the first company to sell not-for-profit HIV and malaria drugs in Africa, and have recently introduced the newer modern HIV drugs (Kivexa [abacavir and lamuvidine] and Telzir [fosamprenavir]) to our not-for-profit package as well as lowering the price of existing drugs in the package.
 
Everybody is talking about Cervarix in the developed world, but where it will have a huge impact is in the developing world. Here in the UK most women do Pap smears for detecting cervical cancer. We catch many early cases of cervical cancer and are able to save the person through surgery. Thus, the mortality from cervical cancer in the UK, for example, is a couple of thousand people-it is not zero but it is not huge. However, if you go to South America, which is a middle-income area, the number of people having Pap smears is very small. People there are dying of cervical cancer second to breast cancer and, therefore, we can save hundreds of thousands of lives if we can have campaigns to implement Cervarix in those countries.
 
We are the number one company in terms of philanthropic undertakings, and last year we spent ’380 million in product donations, cash donations, and community projects. As a percentage of profits, this is five times more than the average FTSE 100 company. We believe that we have to give back to society and are very proud of what we do. We are the most engaged pharmaceutical company when it comes to neglected diseases. We have a dedicated research centre-what we call the Centre of Excellence for Diseases of the Developing World-based in Madrid where we have been addressing malaria, HIV, and tuberculosis, the main killers in the developing world (figure 1). We have vaccines in clinical trials for all three diseases and continue to discover and develop new treatments. Crucially, as we find new drugs and vaccines for these diseases, we are committed to making them as widely available as possible at preferential prices.
 
To enable our ongoing commitment to this, we operate public-private partnerships (PPPs)-where we obtain funding from a variety of sources and we provide the scientific know-how to make the ideas a reality. Of course, I have to protect my shareholders so I get some of the funding from people like the Gates Foundation. It is a great system-everybody wins. The UK's Department of International Development, among others, gave us some money for the development of a combination malaria drug called Lapdap, one of the very first PPPs. Bill Gates funds a number of the PPPs we are currently involved in, including the malaria vaccine programme with the Malaria Vaccine Initiative. But we have found a number of other public and private institutions that want to give money to help tackle health problems in Africa and beyond. GSK has embraced this strategy more than anybody else-we are the only company that has a PPP in place on what WHO calls the "big threeh-and frankly we are recognised for it.
 
The economist Jeffery Sachs is a big admirer of GSK because he has seen our programmes in the field. When Bill Gates was voted as one of TIME magazine's people of the year he was asked: "Everybody admires you, you do fantastic things, but whom do you admire?h Guess what he answered-GSK! That's pretty awesome and it is because he has seen our work. In surveys of opinion leaders in the developing world, GSK is consistently up at the top while the rest of the industry is much lower down.
 
TLID: How do you reconcile the cost of your drugs in different parts of the world?
 
J-PG: The economics behind our products means that in return for our investment we price a little higher in the USA, Europe, and Japan. In middle-income countries we go way below that level and in poor countries we sell drugs on a not-for-profit basis. In Africa we sell antiretrovirals, anti-infectives, and antimalarials at incremental cost. By this I mean the lowest cost that accounts for the cost of the materials and manpower only and not for the costs incurred in manufacturing such as electricity and replacing machinery. In this way we beat the generics on price because they have to make a profit, and in Africa people are buying our drugs in preference to generics because we are cheaper than Cipla, for example, and others who claim to be selling their drugs at a lower price.
 
TLID: GSK won a business award this year for their work in lymphatic filariasis. Can you tell us more about this disease programme?
 
J-PG: The goal for any scientist working at GSK, myself included, is to be able to eradicate a disease. Lymphatic filariasis is a big win in that we have a chance to eliminate a crippling disease that currently affects 120 million people (figure 2). We have a chance to stop the disease by treating people in endemic areas preventively with albendazole. This drug stops the transmission of the parasite via mosquitoes. Eventually the disease disappears. This programme started 7 years ago, and we have the proof that the strategy works.
 
For instance, in Egypt where the programme has been completed, we find that the incidence of the disease has been reduced by up to 99%-not completely gone but pretty much eliminated. It is an amazing programme led by WHO and a number of non-governmental organisations (NGOs). We are producing the drug, helping with the distribution, and we even built a special manufacturing plant in Cape Town to make enough tablets. Our target is to treat around a billion people. Already we have reached over 100 million people-we still have a long way to go and what we need now is for more governments to buy into the programme and get it up and running. When I visit the Ministers of Health of those affected countries, they are so thankful for what has been done. It is a phenomenal achievement for us.
 
TLID: You talked about the philanthropic sector wanting to do business with you. But money from, say, the Gates Foundation, is not guaranteed in the long term. Are there dangers of not having a more sustainable form of finance?
 
J-PG: There is no doubt that we have to take a sustainable approach. NGOs will tell you that they do not like donation programmes unless there is a commitment to finish it. For lymphatic filariasis it is not an issue. We have committed to donate albendazole worth $1 billion over 20 years-we want to get the job done. We are going to do it-do or die. It is irrelevant whether the programme is doing well or not. This pot is protected-it is like the employees' pension-we do not touch it. Some people start a donation programme and then get tired of it. Interrupting a programme may result in a situation that is worse than before the programme was in place. With our HIV drugs in Africa, because we cover the costs we can build up more drug capacity. In fact we sold 40% more not-for-profit Combivir (lamivudine and zidovudine) in 2005 than 2004. We are able to expand this volume because we are covering our costs all the time. If we had started a donation programme instead, we would have been overwhelmed by the high demand because there are so many AIDS patients in Africa.
 
TLID: Do you have any power over governments?
 
J-PG: Pharmaceutical companies represent many good things but they do not represent votes and in politics that is what counts. However we can be the conduit-the catalyst that can bring the solutions to the table. In health care our expertise means our opinion counts. One thing that governments do understand is that health-care costs are relentless, they will keep growing in Europe, Japan, and the USA because of the ageing population, which is driving an exponential increase in consumption of medicines and health services. Governments know that the most effective way to stem this increase is to find new drugs that replace more costly interventions and vaccines that prevent illness in the first place. Pharmaceuticals are part of the solution of escalating health-care costs, they are not part of the problem.
 
TLID: Over the years the global movement for access to affordable AIDS treatments in Africa has put the pressure on drug companies forcing many of them to give up their patents. But despite the price drops, and even having free drugs, universal access to antiretrovirals remains a big challenge. How have GSK contributed to improving access, and what more should the global community be doing on this front?
 
J-PG: First of all, by selling our key drugs Combivir and Epivir (lamivudine) at incremental cost, demand has skyrocketed. We shipped last year 126 million tablets to the developing world. We are keeping hundreds of thousands of patients alive in Africa who 5 years ago would not have access to any medicines, so we have done our part. We have also issued voluntary licences to eight generic companies, enabling them to produce copies of our drugs for supply to the developing world. So it is not a question of patents. It is a question of political will and infrastructure. In some countries in Africa, you have governments who do want to take care of their population and Botswana comes to mind. In those countries, major progress has been made. We have seen the number of cases plateau and drop for the first time, so there is a definite positive effect.
 
However, in other countries like South Africa it is an absolute scandal to see the declarations of the Minister of Health, for example, when she says that to protect against AIDS you should use garlic and lemon juice. These highly placed political figures are not serving their people properly. Political obstacles and a lack of political will make it very difficult to make progress. To accelerate the success against the HIV epidemic you need the construction of a minimum health-care infrastructure in Africa. You need dispensary units in the middle of nowhere, otherwise people have nowhere to go, they do not have transportation, they barely have water.
 
In South Africa I visited a dispensary, one small unit with a few beds and absolutely heroic personnel, people who have abandoned a good life in Johannesburg to serve this population. The progress made with this one small unit is enormous. From the day it was created 12 years ago, we have sponsored this clinic and provided drugs to the local community. Initially the government stopped us from providing drugs and were effectively murdering their own people.
 
It saddened me to see people living in bare huts and wasting away. Today, however, many of them survive. They are very disciplined in taking their medicines. People used to say patients in the developing world would not follow their treatment but that is not true; they are very focused on their disease and on getting better. Many of them have tuberculosis as well, an added complication which has become the norm. This one small dispensary costs really very little because all the workers are volunteers, they work for minimum wages, and the results are extraordinary.
 
If we start to increase the network of these kinds of dispensaries across Africa, we will see some tremendous progress. If we do not, the epidemic will continue to rage on.
 
TLID: Over the years the existence of drug patents has been an area of much controversy, particularly in the developing world. How much do we really need them?
 
J-PG: The World Trade Organisation's "Trade related aspects of intellectual property rightsh (TRIPS) was established to bypass patents to enable the acquisition of medicines for public-health crises. This treaty is a great warranty to prevent needless deaths that would otherwise occur if patents were not removed.
 
However, you cannot eliminate all patents. Nobody in his or her right mind will invest in the risky business of drug discovery if there is not a financial return. It would kill innovation. We need patents, but they need to be regulated so that they do not obstruct the needs of public-health emergencies. That is why Brazil, a country that is serious about dealing with HIV/AIDS, have bypassed patents to make their own generics, and as a result have rolled out a successful and widely respected AIDS treatment programme.
 
Generic companies are in the business of copying our discovery and innovation and want to kill off patents. There is an economic war going on here and sometimes there is a certain naivet from the media towards the generic industry, who view them as some sort of Robin Hood of the pharmaceutical industry. In fact "generich is misleading-while it refers to the drug it often does not refer to the price, so while they sell drugs at low prices in the developing world; the real prize for them is in more lucrative markets in Europe and the USA-it's here that patents are needed to protect our innovation, discovery, and investment.
 
TLID: Those who work in hospital-acquired infections are concerned about the gradual depletion of effective antibiotics. The perception is that big pharma have been pulling out of drug development in this area. What do you think about this predicament and how are we going to get round this problem?
 
J-PG: I do not believe that anybody has pulled out. We are driven by the progress of science, so if there is some discovery that can be exploited, that is where resources and researchers go. In the case of drug discovery in anti-infectives, we have exhausted the classic approach and have not been able to produce a new category of drug for 20 years. It is not just a problem for big pharma but the smaller biotechnology companies as well.
 
GSK is addressing the problem in a very active way. We have three new prototype antibiotics in early clinical development, all of which are entirely new approaches in terms of new classes of anti-infectives. They are chemically distinct and attack the bacteria in a different way from today's antibiotics. It is a bit early to know whether they will be successful in the end but a long pregnant pause in drug discovery does not mean that there is nothing going on; it means that we are working on it. I should add that we have several new classes of antibiotics in preclinical studies too. We were working on atherosclerosis for 15 years before we discovered a new risk factor, so things take time. I know there is a need for new antibiotics and we are certainly not giving up. We are simply doing what we need to do to be successful.
 
TLID: Do you think that recent toxicity scares and tougher regulatory conditions have put pharma off from drug discovery and development?
 
J-PG: Over the past 20 years, drug development has become very costly, partly because of the increasing additional requirements from the regulatory authorities. There is a balance between efficacy and safety in that no drug is completely safe. No drug is without side-effects, but drugs present a huge benefit and sometimes a small risk. The regulators have tried to regulate us in a way that we absolutely control the minimum risk that is attached to our drugs, and the intent is good but there must be a balance between the benefit we provide and the risk that goes with it. However, lately the pendulum has swung a little too much towards the safety side. The US Food and Drug Administration (FDA), in particular, is constantly being criticised by politicians every time a drug scare hits the headlines. However, I have to say that when you come up with a life-saving drug, or a major advance in therapy, the FDA does a good job. They listen and they look at the science. If we are truly innovative, we will get our drugs approved.
 
TLID: I understand GSK are producing a bird flu vaccine, and expects to mass produce the vaccine by the end of the year. Will there be sufficient capacity to produce enough vaccine for the developing world?
 
J-PG: Yes. It is an H5N1 vaccine and the hope is that governments will stockpile enough before the pandemic starts. Of course, we do not know when the pandemic will start, but we need to be ready. If we have enough time, we can make hundreds of millions of doses very quickly within a few months. Therefore, if the pandemic does not start for, say, a year or a year and a half, we shall have stockpiled substantial quantities of H5N1 vaccines. By the way, we are not alone, as a couple of other companies are also developing vaccines. If our vaccine works very well, we are ready to share it in a way that would maximise its availability.
 
The tricky part is if the current virus mutates. If it mutates a little, our vaccine will probably work anyway. However, if it mutates completely to a different viral strain, we shall have to redo the work and there will be a lot of pressure to deliver a vaccine very quickly. That is why we have invested close to $2 billion in the past 2 years to increase our capacity for tackling flu and a pandemic. During influenza seasons generally we believe the flu vaccine should be used more widely, and not just targeted towards specific groups such as elderly people. Universal vaccination would also prime the body against a possible pandemic. By having a different flu vaccine jab every year, the body will become stronger. Usually when a pandemic strikes, it is young people who are the most vulnerable, but an annual vaccination would mean they are more effectively protected.
 
As for global vaccine capacity we are working with the Gates Foundation to see if we can find some money for the developing world. Let us face it though, if you are a Minister of Health in a very poor country there are much more urgent health problems to deal with. Pandemic influenza is a risk for the future and thus, understandably in developing world countries, comes low on the political agenda. We shall try to stockpile on their behalf but right now it is a little early to give any idea as to how that will happen.
 
TLID: GSK has been the target of animal rights activists and you have publicly stood up to them. How much of an effect do you think these organisations are having on research, and what kind of personal issues has this raised for you and your shareholders?
 
J-PG: As you know the economy needs an influx of research and development innovation, new labs, and so forth. Those facilities are provided by companies like GSK but also by many other non-British companies. The UK faces a particular problem with animal rights extremists, one which is not experienced elswhere in the same way. Companies that cannot afford the sort of security they need to protect their employees and facilities switch their investment somewhere else and go to Spain, France, or Germany. It is wrong that a small number of extremists are depriving the UK of the substance that drives a modern economy, which is why we have to stop them.
 
TLID: Personally and professionally, what have been your greatest achievements?
 
J-PG: Personally it is easy. I never started my life by saying I wanted to be successful in one thing. I want to be a success in everything that is important to me: my family, my marriage, my children, my job, and my Sunday tennis game! I am a competitive person, but given how overwhelming my job can be I think I have managed to keep a good balance and retain my sanity in the process. That in itself is an achievement since all too often I have seen many CEOs where the job has been their life and when they retire their lives become meaningless.
 
Professionally, it is up to others to judge what I have done right but I will say this: I see the role of CEO of GSK as the custodian of a large organisation that includes 110 000 people plus all the other constituents such as shareholders and the local communities we work in. With this huge burden I think the key issue is to hand the company over to your successor in a better shape than it was given to you. There is no doubt that GSK is a completely different and much improved company from the day I received it.
 
TLID: What new directions is GSK planning to take in the infectious diseases area, and are there any personal challenges you have set you heart on tackling?
 
J-PG: What we need to finish is our work towards the malaria vaccine. The availability of a reasonably priced, cost-effective malaria vaccine would change the world. It would give us a chance to stop around 2-6 million needless deaths every year. We need to concentrate on completing the difficult problems we have set out to tackle before we can look at other challenges.
 
TLID: How do you disengage from being the CEO? How do you relax and unwind?
 
J-PG: I live a very normal life outside my job. I like to play squash and tennis. I am an outdoor sports-oriented person and like hiking up mountains. I like to spend time with my three daughters and grand-daughter, who keep me busy. A good work-life balance is absolutely essential in this job.
 
 
 
 
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