The biggest “a-ha!” moment during a recently held roundtable on advancing equality in biopharma may have come by way of the live polling.
Only 20% of the 10 or so drugmakers and CROs attending the roundtable said their corporate plans around diversity and inclusion were specific and intentional. Another 44% said they didn’t know if succession plans were in place for their top-performing leaders who are women of color.
On one hand, given longstanding issues of female underrepresentation among the industry’s upper echelons, these findings did not come as a surprise. On the other, the poll results were “astonishing,” as they demonstrated just how far industry has to go to achieve proper representation within its ranks, said Charlotte Jones-Burton, MD, founder of non-profit Women of Color in Pharma (WOCIP), which organized the event.
“It’s abysmal and inexcusable,” Jones-Burton said of the current racial and gender breakdown. Then again, she added, “We believe that it’s fixable and that’s where our opportunity lies.”
WOCIP convened the July 30 roundtable, dubbed the Think Tank, to get life science leaders to pursue not just racial and gender equality at the board and C-suite levels, but also to advance health equity in a wide range of areas. These include discovery, drug development and commercialization to the workforce, suppliers and patient communities.
It comes at a time when dialogue about these topics is flowing much more freely in the wake of 2020’s twin-demics – the COVID-19 health crisis and the social unrest ushered in by the wave of police brutality, which led to the tragic killings of George Floyd, Ahmaud Arbery and Breonna Taylor.
These happenings did not go unnoticed by drugmakers, as evinced by their healthy attendance at the Think Tank (each of the 10 firms paid a sponsorship fee and committed to bringing multiple C-level execs), and by what ensued.
Earlier this month, Bristol Myers Squibb announced a $300 million commitment to double executive representation of African American and Latino employees in the US and achieve gender parity at the executive level (women now comprise 53% of total employees) globally, both by 2022. The company will also boost its clinical trial diversity and work to strengthen health equity across its business.
Although it was among the Think Tank’s roster of participating organizations, BMS says the timing of its announcement was unrelated to WOCIP’s event. Rather, COVID-19 “revealed to us organizationally that, while we were focusing in on some spaces around improving health disparities, the situation was even worse than we imagined,” said Shamika Williams, full-time lead for BMS’ 1,300-strong employee resource group BOLD (Black Organization for Leadership & Development).
Thanks to BOLD, which has been around since 2016, the company already had benchmarks in place around diverse hiring and promotion, Williams said. The pandemic, she added, “showed the urgency of us accelerating what we need to do in this space.”
Other Think Tank participants echoed that thinking. “For a long time, we have focused on honoring diversity in all its facets – of thought, background and perspective – and on really ensuring that as a workplace, everyone can bring their true selves,” said Kabir Nath, president and CEO of Otsuka North America pharmaceutical business. “But clearly we recognize that in this moment, there is more that we need to do.”
Nath acknowledged that while the company collects statistics, Otsuka isn’t yet at the point of having truly intentional, explicit plans around succession for women of color or for ensuring that a certain number are brought forward at various levels of the organization.
Otsuka formed a company-wide D&I council, which he chairs, and has established a series of goals for the rest of this year focusing on making progress in the make-up of its workforce and, eventually, how the company works with vendors and recruits clinical trial participants. The firm has given itself until the end of 2022 to accomplish a series of short-term internal actions, including revising elements of its recruitment process.
In its sales force, for instance, Nath noted that Otsuka “actually incentivizes folks today for referring fellow employees. And of course, people refer people who look like them, so we need to change a whole bunch of practices.”
Among other elements of the plan, Jones-Burton is particularly optimistic about “The Playbook,” a 23-page PDF which WOCIP distributed to Think Tank participants. It’s designed to assist drugmakers in avoiding the kinds of practices that have served to perpetuate existing racial and gender imbalances.
“We know the old playbook is not going to work because it hasn’t worked – writing checks, having leaders within our company pose for pictures with community leaders as they’re writing these checks. But then those leaders move on, and so we haven’t seen any sustainable change,” said Jones-Burton, who also serves as VP of global clinical development at Otsuka.
Clearly, a different approach was needed, one which is more internal and deliberate.
“The Playbook was really designed for organizations to say, ‘I need to be intentional about this,’” explained Judith Greener, PhD, managing director at Inside Edge, a life sciences consultancy which had a hand in writing it. “You know, it’s nice that you’ve given this money to this organization, but you also need to take it inside and say, ‘These are the changes we need to make.’”
Action items spelled out include ways to overcome systemic barriers to driving workplace equity and how to scorecard progress. The handbook also goes in-depth in areas like building supplier diversity and making clinical trials more inclusive.
Therein lies the opportunity for industry. A survey by Johns Hopkins University and American Community revealed that African Americans contract COVID-19 at higher rates and have a higher death rate than white people. This problem is multifaceted in nature, but academic and medical communities agree that it is due in large part to social determinants, from housing density in Black communities to high crime rates and poor access to healthy foods.
Pharma cannot solve most of these problems by itself, but the sector plays a unique role in helping care for these communities through developing and marketing its medicines. Drugmakers should work to ensure awareness and access at the community level, Jones-Burton urged.
At the same time, some of the same misconceptions that have held companies back in these areas may be fueling COVID-related health inequity. In March, the oncologist and bioethicist Ezekiel Emanuel wrote that COVID-19 interventions should go first to front-line healthcare workers. This recommendation didn’t sit well with members of the Black community, many of whom are on the front lines, although perhaps not working in healthcare per se.
It was one of a number of suggestions in the article that grated on Jones-Burton and Greener. In response, they decided to co-author their own piece, along with Kemi Olugemo, MD, offering solutions for improving health equity in Black communities in the face of the pandemic.
“In the fight against COVID-19, it may feel good to say we are all in this together,” they wrote, “But in reality, we are not. The Black community is experiencing a disproportional burden.”
It’s a state of affairs that will exist as long as the community’s needs continue to be overlooked. Consider one of Emanuel and colleagues’ other recommendations: that individuals who volunteer to participate in clinical trials should get a nod in terms of priority to receive care. Again, that’s insensitive to Black and Brown people, many of whose members face socioeconomic barriers to trial participation, owing to the way protocols are written or to the location of trial sites.
“It’s very difficult for them to participate in a clinical trial that requires them to perhaps leave work in the middle of the day or go to work a little bit later,” said Olugemo, who is WOCIP’s director of communications and executive medical director/head of neurology clinical development for Akcea Therapeutics.
Add to that the paucity of study participation by minorities due to a lack of trust, which has been eroded through historic ethical breaches. This distrust, Olugemo explained, dates back to the Tuskegee clinical trials of the 1930s. “Well, to the Tuskegee experiments,” she corrected herself. “Those weren’t really trials.” For this reason, trial sites need to be staffed by the right people, especially ones whom people of color are accustomed to seeing in their own communities.
BMS views this as low-hanging fruit. Over the next five years, Williams said, the drugmaker is planning to recruit 250 clinical investigators from diverse backgrounds to work in highly populated areas where potentially underserved trial subjects are located.
“We’re going to mentor them,” Williams said. “We’re going to put sensitivity training in place that they need in order to make sure that they are asking the right questions and are thinking holistically about what’s happening with this individual and in this community. That’s going to be critically important to enable the success of these programs.”
Only then can some of the psychological barriers and the systemic racism that exists in this part of the healthcare system be alleviated, allowing all patients to access clinical trials equally, she said. Perhaps most important, industry seems more willing to hold itself accountable for meeting said goals.
Starting next year, Williams said, BMS will start publishing results on the impact of the new trial standards. “We’re not going to put this out here and just assume it’s going to happen on its own. We are really going to continue to assess the progress and make adjustments accordingly in order to achieve it. I don’t think not achieving this is an option.”
WOCIP and Inside Edge are also working to quantify the return on investment of driving diverse enrollment into clinical trials. Their aim is to “definitively point to the kind of ROI you can expect by intentionally thinking about clinical trials in a different way and expanding your enrollment to include minorities,” Greener explained.
It’s logical that a company’s ability to produce trial results that better reflect the population could lead to an impact on the success of a drug and aid revenues overall. But other than a handful of examples, no one has done this research in a validated way, she added.
Nath agrees, adding, “If your clinical trial populations don’t reflect the real world, then you actually don’t know what your drug is going to do in practice. And second, to the extent that you’re under-serving minorities to whom your drug goes, you’re leaving money on the table. In the spirit of capitalism, there’s a good argument to be made there for why this is good business, too.”
Jones-Burton said WOCIP is looking to the industry’s two main trade associations, PhRMA and BIO, to standardize and lead these efforts. She also hopes to see the them inspire the industry to come together around these goals, shedding their propensity to act in siloes, and call on their member companies to release data, a requirement which will create accountability.
“Trade organizations only have so much power,” said Nath, who sits on PhRMA’s board. “But there’s a degree of naming and shaming that could take place. We’re all going to have to publish our clinical trials breakdown by gender and race, because it’s material.” Neither Otsuka nor BMS agreed to share how their executive ranks or clinical trials currently stack up racially.
Companies like Otsuka say change starts internally, with its own employees, before the external facets. “We’ll focus on the things we can do quickly around the supplier, provider and vendor base,” Nath added. “We’ll start to put in place the programs that will take us into the external area around clinical trials and actually serving underserved minorities.”
Achieving a more diverse pipeline of science-oriented, exec-ready applicants will take longer. This is not about a short journey, though, but an ongoing, long-term one.
There’s certainly a lot at stake. According to McKinsey’s Women in the Workplace 2020 study, among all healthcare stakeholders, pharma and medical products companies have the lowest female representation across all levels and the lowest share of women of color in line roles across the pipeline.
In addition, many women of color are choosing to leave these organizations when the path to senior management isn’t clear, the consultancy found. On the flip side, gender- and ethnicity-diverse companies are 24% and 33% more likely to outperform less diverse ones, respectively.
Olugemo says her company, which has two Black women in its C-suite, is an exception. But, she added, “Being the ‘only one’ can be really alienating. It can make you more susceptible to microaggressions. There’s much we can do to change this narrative. It’s critical for us to finally listen and take this seriously.”
The movement for social and racial change is indeed having its day. And this industry’s women of color are well-positioned to propel what had been a nascent, largely quiet diversity push in biopharma over the last three or four years to a major, headline-grabbing one.
“The industry is a microcosm of the world,” said Jones-Burton. “We see an opportunity to partner with our companies and with trade associations to really uncover where that is and, importantly, bring forth solutions about how to advance meaningful change.”