Eli Lilly is a global biopharmaceutical company with treatments in areas including oncology, cardiovascular, diabetes, critical care, and neuroscience. It has launched a number of global efforts including the Lilly MDR-TB Partnership in 2003 and the Lilly NCD Partnership in 2011.
The company is building on these previous efforts, and is currently working on a company-wide approach to addressing global health challenges to achieve an ambitious new goal.
Lilly is a longtime FSG partner and a sponsor of the Shared Value Initiative. FSG’s Laura Herman and Neeraja Bhavaraju recently interviewed Amy Israel, Global Health Thought Leadership & Policy Director at Lilly, to learn about Lilly’s progress and their journey ahead.
We have shared four key insights here and you can read the full conversation below.
“Our mission is to make medicines that help people live longer, healthier, more active lives. Interestingly, that mission also includes a commitment to make a significant contribution to improving health in the 21st century. To do that, we need to reach more people than we do today.”
— Amy Israel
Four Key Insights from Eli Lilly on Improving Health
- The entire company has an important role to play in shared value efforts. We have honed our skills to better target specific bottlenecks and challenges. As part of this shift, we have moved from having our global health efforts concentrated in the corporate responsibility and global health teams to engaging the whole company.
- Cross-department collaboration not only strengthens a shared value initiative, it can also increase employee excitement for the initiative. We’ve also established a steering committee with involvement across functions, including ethics and compliance, different business units, research labs, manufacturing, medical, etc. for guidance and oversight. It is really on all of us to figure out how to do this, which presents an opportunity to engage our whole employee base.
- No one department or company can undertake systems change alone. Partnerships are essential. We know we can’t do everything alone, so we are looking for collaborations to strengthen health systems that can expand access to care.
- Bringing care closer to the community is a significant, but exciting, health challenge to tackle. We are currently looking at how to address this issue [of healthcare access] by bringing care closer to the community level….We hope this will demonstrate how to treat diabetes at the primary care level in a way that is sustainable, reduces burden on the overall health system, and improves outcomes for patients.
In 2016, Lilly established the 30x30 goal to improve access to quality healthcare for 30 million people in resource-limited settings by 2030. What was the impetus for that goal?
As a leading pharmaceutical company, Lilly has an important role to play in improving global health. Our mission is to make medicines that help people live longer, healthier, more active lives. Interestingly, that mission also includes a commitment to make a significant contribution to improving health in the 21st century. To do that, we need to reach more people than we do today.
We defined this goal when the Sustainable Development Goals (SDGs) were being developed and we aligned it to the SDGs.
We aspire to improve access to quality healthcare in communities with limited resources for 30 million people annually by 2030. That is a 6-fold increase over the number of people that we reach today. We are trying to challenge ourselves as a company to reach this stretch goal.
How are you doing that?
We know this won’t be easy, but we have made progress — we’ve embraced the concept of shared value as a company, we’ve aligned our global health efforts more specifically with the company’s expertise in non-communicable diseases (NCDs), and we have honed our skills to better target specific bottlenecks and challenges.
As part of this shift, we have moved from having our global health efforts concentrated in the corporate responsibility and global health teams to engaging the whole company. We are working to achieve 30x30 in three main ways: pipeline, programs, and partnerships.
Pipeline: We are engaging our research colleagues to look at innovation in new medicines or new uses for existing medicines. We’re working on early drug discovery for neglected tropical diseases. On other diseases like TB, we’ve opened our compound library. We’ve started to look at drugs previously abandoned because they didn’t meet original development specifications, but may be useful for other conditions.
Programs: We’re also looking to expand access to our existing medicines. This includes product donations, especially in disaster relief settings, but we know that these efforts only reach a small number of people overall, so we are looking more at alternative pricing strategies and alternative business models.
Partnerships: We know we can’t do everything alone, so we are looking for collaborations to strengthen health systems that can expand access to care. This includes a number of efforts including the Lilly Global Health Partnership and contributing to broader coalitions such as Access Accelerated, a consortium of more than 20 pharmaceutical companies to tackle NCDs collectively.
How do you prioritize among different opportunities to achieve the 30x30 goal?
We use our portfolio and our expertise as our guide, and then we have an internal methodology that clearly defines efforts targeted at resource-limited populations and develops estimates of the impact of a potential intervention on health systems and on our 30x30 goal.
For example, we have a long history in diabetes. With NCDs growing, countries are challenged to manage the diabetes burden and that is an area where we can have a lot of impact.
We are also looking at cancer care as another key area. We know that women in Kenya, for example, are presenting with breast cancer at stage 3 or 4. There’s a significant opportunity to bring that diagnosis earlier. Together with our partners, we are testing different solutions of screening and linkage to care.
Achieving your goal goes far beyond what Lilly can do on its own. How do you catalyze additional resources for greater impact?
We know, for example, that only 1.7 percent of international donor financing is going to NCDs. We can’t tackle these diseases in the same way that we did for maternal and child health or infectious diseases. We need to look at different ways of partnering.
The Lilly Global Health Partnership is one way that we are making the most of the resources we have by contributing not just money, but also energy, time, and employee skills. We are also contributing corporate skills to build capacity for NGOs and government agencies.
How does the Lilly Global Health Partnership program work?
Our operating principle for the Lilly Global Health Partnership is to develop effective patient-centered models for chronic care to expand access and improve health outcomes at the primary level for people in resource-limited settings. We work predominantly on diabetes and cancer in five countries and we are looking at the lowest level of care that could be provided, specifically primary and community care.
Health systems are often set-up for acute or episodic needs, but with NCDs, people need regular access to treatment and it is really hard to keep people on treatment and associated diets, exercise regimens, etc. That’s why we are looking at the primary and community care level as that is often the first and easiest point of contact.
For each Partnership country, we develop hypotheses about the key issues based on desk research and we then bring those to the National Ministry of Health and test them with other experts. Together we refine the hypotheses and then find NGO partners to work alongside the government to implement solutions to address those areas.
For example, we have been working in South Africa on diabetes and hypertension since 2012. The South Africa National Department of Health (NDOH) policy is that insulin has to be initiated by a doctor. Since many primary health facilities don’t have a doctor on staff, insulin is often initiated at the district level. So what we’ve seen in South Africa over the past few years is that people who do not need insulin are keeping their HbA1c levels under control, but those who do need insulin just aren’t getting better. When we looked into this, a major driver was people not wanting to or not being able to go to the district health facility because it required traveling long distances, taking time from work, finding childcare, or waiting for a long time because district hospitals are overburdened. And because people weren’t experiencing major complications, they were making decisions to not go.
We are currently looking at how to address this issue by bringing care closer to the community level. We are working with University of Pretoria and the local government health systems to ensure that people can get the treatment they need at the primary level or through community health workers or nurses. We hope this will demonstrate how to treat diabetes at the primary care level in a way that is sustainable, reduces burden on the overall health system, and improves outcomes for patients.
As part of our Research-Report-Advocate framework across the Partnership, all programs have key research questions they are trying to answer, and they are publishing the data to help others learn from this work and building the evidence base for scale and policy change.
How do you manage all of this work across the company?
Our CEO has really gotten behind our 30x30 goal, and he has challenged our Executive Committee to think creatively about how to reach it. We’ve also established a steering committee with involvement across functions, including ethics and compliance, different business units, research labs, manufacturing, medical, etc. for guidance and oversight.
It is really on all of us to figure out how to do this, which presents an opportunity to engage our whole employee base. As a company, we make medicines to save lives and everyone knows that their work contributes to the broader good. But when we have something like this that is so tangible, it creates a lot of momentum as well as deeper employee satisfaction.
To what extent is achieving this goal a core business priority? How will progress towards this goal help create long-term financial value for Lilly?
For the Lilly Global Health Partnership, we are not looking at direct financial value — we want to support building strong and resilient health systems and improving health outcomes. What this does, however, is that it helps us understand the local context and environment for country-specific needs. It also helps improve access to insulin, including our products, so it is a shared value approach.
For us, our aim is to make the 30x30 goal sustainable so that we are seeing impact as a business while contributing to societal value. For some of the other components of 30x30, we do hope to see a return on investment, even if it is small. Lilly will not stop our philanthropic and corporate responsibility efforts — those are our DNA. But, in order to try some of these creative solutions to reach more people, we do need to see that being financially viable, or at least to not be in the red on those efforts.
We’re learning along the way too. One of the great benefits of this work is that people are getting together who don’t normally work together and looking at problem-solving together. This is stretching people and we are truly acting as “One Lilly.” That’s been an unintended consequence, but a great learning.
Has anything been easier than you expected?
People love the 30x30 goal. It’s amazing — people are really getting behind the goal, even when they don’t know exactly how they can contribute. Lilly has about 38,000 employees around the world and we’re hearing lots of people talk about it at all levels and all geographies throughout the company. That’s been really exciting.
How are you working with the regional markets?
This is not just coming from headquarters. That’s one of the real values of our Steering Committee is that it has representation across the business. We are working top-down and bottom-up, and we’re working to engage our regional leaders, our country general managers, and people who have specific expertise on specific topics like finance or market access. We have not had any challenges in generating creative ideas, that’s for sure. Our challenge is in prioritizing those ideas based on feasibility and their potential to improve health for more people. We need to problem-solve together to address barriers and put the best ideas into action.
How are you tracking progress towards the 30x30 goal?
We will track progress. For the Lilly Global Health Partnership, we are tracking a standard set of outputs and outcomes across countries, for example number of individuals screened and diagnosed. While those are output indicators, it also helps us understand loss to follow-up care and the cascade of care. For outcomes, we will be looking at the number of people changing behavior, number of people achieving diabetes control, etc. We will be tracking on a regular basis and making those public.
For 30x30, measurement is key. It’s challenging because we’ve never tried to count across this wide swath of different programs and approaches. Our plan is to gather data every quarter and publish that data frequently.
We think it’s important to show not only our progress and impact, but also what isn’t working. That can be much more valuable for the field than only what is working. So we hope to be able to publish some of those findings and lessons along the way.