Nadine Schecker is global head of communications and external affairs, Novartis Social Business, a new unit that aims to enable access to healthcare for people living at the base of the pyramid in lower-income countries. Having served in several communications roles during her two-decade career with Novartis, Schecker is well placed to explore the shifts at play in the function. She recently talked to the Holmes Report about how the company's malaria initiative campaign reflects the changing role of communications, which is now directing overall business strategy rather than just supporting it, and how companies like hers are moving from stunts to "inside-out" initiatives.  The following transcript has been edited for length and clarity.

Arun Sudhaman (AS): You’ve been at Novartis in various communications roles for several years now including, of course, your work on the company’s malaria initiative. What are the changes you've seen in terms of how communications is part of business strategy rather than just a support function at Novartis?

Nadine Schecker (NS): For me it really comes down to the purpose of the company like ours, but also the pharma sector in general. Purpose drives reputation, reputation drives business, and if you do good business that enables you in return to deliver on your purpose and for us that would be to innovate in the area of access, for example.  Because it’s such a highly regulated sector, we have no end consumer contact except for some exceptions like the possibility of doing DTC marketing campaigns in countries like the US. So what drives our reputation is really broader topics such as science, innovation, value of medicine, but also global health and access. I would argue that global health and access is becoming more and more important for the industry and this is one of the big things which has changed over the past two decades where I have had the privilege to work for this industry.

So not only are the “what” we do now important, meaning developing transformative medicine, but also “how”, meaning getting them to as many people as possible. 
And this is an area where there is no easy solution, right? So this is an area where the sector needs to engage with stakeholders and partners to try to find solutions jointly and in my opinion this is the big shift in comms also because not only do we need to adjust to that new reality but I do actually believe we need to help drive it. That means if we need to drive it we need to be at the centre of the business strategy and not at the periphery and have a seat at the table up to the highest level. So if you come back to malaria, that means that not only do we deliver communication around strategies that are pre-developed that we really helped think through, what would be the right strategy and any human part of developing it. 

In terms of communication, that needs a radical shift to becoming a partner. That means that when you communicate you need to shift from things like we lead to we can learn, from we supply to we co-create, or we know to we learn and adapt. And that’s a big, big change I think. It also means that we have no other choice — and I’m deeply convinced of that — to move away from big campaigns, which I might call stunt campaigns, that very often do not involve the countries where the issues are actually acute, to a new way of communicating which is really driven by dialogue, transparency. Also, at a communications level, you need to think about alliance building and to have joint communications with partners. And as I said, this inherent challenge of covering not only global but also local needs in terms of reputation at the same time.

AS: So do you find, given those changing realities, that the role of the chief communications officer has changed, and how challenging is that, perhaps, given that maybe ten or 15 years ago it was more of a support function?

NS: I think we are on the right path but I think we are not there yet. I think that the changing reality will accelerate this movement but it would be too bold of me to claim that this is already a reality everywhere.

AS: In terms of the malaria campaign that you ran across Asia and Africa, what would you say were the key challenges from a communications perspective?

NS: The joint Malaria Futures report — I think it’s actually an excellent example of this new style of communication I was mentioning in terms of also building alliances and doing joint partner communications. Progress is building in this area but there is emerging resistance in South East Asia so there is a risk for the current generation not only of treatments but also insecticides. At the same time it is a topic the world is getting very complacent towards, it’s not a media-sexy topic. So the challenge is how do you bring malaria back to the centre of the attention, also with the aim to raise funding that will be needed. So what we figured is, we joined forces with a couple of key stakeholders in the space such as Roll Back Malaria, Malaria No More US and UK, the Asia Pacific Malaria Alliance, and we said that as part of this dialogue that needs to take place now to really devise novel approaches and potential solutions to reach the SDGs we needed also to bring to the table the voices from the ground, because this had not been done before.

So we engaged in that two years ago, first focusing on sub-Saharan Africa and this year we also launched an Asian version on this MalaFA study and it was really about interviewing key stakeholders at government level, NGO, academia, to get an understanding from their perspective where they see the biggest challenges and opportunities in malaria elimination. And this is I think a very good example of how to join forces with partners to advance and make advocacy on basically global topics that are of interest to everybody. We cannot stand at the side as the private sector, we have to engage actively. 

AS: This does sound like an example of how communications shapes the business strategy because you are learning from the key stakeholders. I wonder how does that change the skills required of communications professionals, if at all?

NS: I think that the challenge, but also what really motivates me, in my role is this need to bring a multitude of levels of expertise to such a role. We have to move away from the big, global stunt-like campaigns to do something much more different and authentic and inside-driven. I think someone working in communication in such a space needs to be conscious that he or she will need to cover communication needs and devise strategies at a local, regional and global level with different objectives. That means, in terms of expertise, you need to have a really good understanding of the audiences you are working towards. You also need to thoroughly think through the support network you are building around yourself to really implement a different level of communication strategy. There are rarely campaigns which are actually built to meet objectives not only at global, but also at a local level, for example in Asia and Africa, because that requires a multitude of specific pieces of expertise that is sometimes difficult to combine. So it’s this multilevel approach in terms of audiences, in terms of content so that the content is really targeted and therefore becomes relevant to the audiences you serve, and then also in terms of objectives at each level. 

AS: I read that Novartis is linking bonuses to ethics which I thought was an interesting initiative. How do you think that plays into helping build and improve the company’s reputation?

NS: It’s all interlinked. I mean Novartis in general is revising its incentive system and one important element is also that we are considering looking at incentivising against patient reach, which is slightly different than sales only. I think this comes back to what I was mentioning — this shift of companies now who are not only focusing on what they do but also how. “How” meaning getting these medicines, these transformative medicines they develop and then market to as many patients as possible. And the fact that there are no easy solutions and you need to think out of the box to enable your own organisation to live up to this aspiration and to the purpose of the company.

AS: What role do you think reputation management — whether it is in terms of incentivising ethical behaviour or in terms of the kind of stakeholder management work and advocacy that you’ve described — plays when it comes to finding and retaining people in the company? Especially when we are talking about younger talent.

NS: I think that the younger generation want to feel that they are part of something when they work for a company. The topic of global health and access is something that is of interest, at least, for a very big part of this target population. Because of what we do we have a very strong purpose, but still we are competing not only within our industry but with global leaders in many other industries. We have two big locations, one being in Boston and one in Hyderabad — I mean here we are directly competing with biotech, tech services and others and that’s a fierce competition. So, that’s why it becomes so important to then also convey to these audiences the work we do. And that’s also why it is so important that communications changes from these bigger stunt campaigns to something much more authentic because the generations have different expectations. They also communicate differently. Social media plays a key role obviously, so that means we need to engage differently and through different channels. 

AS: Novartis Social Business is, if I’m correct, essentially a vehicle by which the company can blend profit and purpose. Is that an accurate characterisation?

NS: I would describe it as an incubator. I mean the aim was to combine the purpose side which is this transformative medicine, development and marketing and on the other side the profit which is to get it to as many people as possible and to test different approaches. The work we’ve done in malaria is one type of approach — we’ve chosen to test and then to scale, where we basically launched a novel treatment 20 years ago. We had this innovation at hand but we had no way of getting it to patients because this was a patient population, mostly in sub-Saharan Africa, that had no means to pay. So we came up with the first ever memorandum of understanding with the WHO, we committed to make this treatment available in a without profit business model. So no profit, no loss. And at that time we were told we would never be expected to deliver more than 20 million treatments and today we have delivered 920 million treatments through that model. So luckily enough we built it with exactly that mindset because otherwise it’s not sustainable for a private company to do so.

That’s one example. The other one is what we’ve done through another programme called Healthy Family which was born in India called Arogya Parivar, where we tried something completely different. We built an approach that had two arms — one was the traditional salesforce, [but] what was novel was that the product they were detailing was really tailored, the portfolio, to the needs of the rural populations we were targeting, which was a first at that time. Then we couple that with a second arm which was a social arm where the focus was really to work in the communities to help raise awareness of diseases, of healthcare behaviours. We basically work through health camps and the profit on one side serves to finance the work on the other side and that model in India in particular broke even within 30 months. So today we have expanded into Kenya and Vietnam and over the past ten years we have basically provided health education this way to more than 40 million people.

Yet again we were basically challenged by external stakeholders saying 'yes you are focusing and you are doing not too bad a job in infectious diseases' but, looking at chronic diseases, what can you do there? So we came up with yet another model, which is still small, we launched in 2015, called Novartis Access where there we decided to bundle 15 treatments we had out of our generic arm as well as original products. These treatments were selected based on the four disease areas that generated the highest level of death within chronic diseases and in low income countries. These were diabetes, cardiovascular diseases, breast cancer and respiratory illnesses. We made calculations and projections and we came up with an average price for this package of $1 per treatment per month. And when we launched we thought we’ll be in so many countries in such a short period of time, we will actually face production issues and we will not be able to hide because we have such high demand. This did not happen. So that was a really interesting learning because whilst the portfolio offering made commercial sense, countries are not set up in the way that they can procure portfolios, they procure single treatments, one at a time. 

So over the past three years we learned a lot. We found out that some partners like NGOs and aid organisations could very well work with such an offer while the public sector we might need to adjust. And when we launched what we did is actually what we discussed earlier, we engaged in transparent dialogue. We put our approach out on the table, we said look guys if you are interested come, help us, challenge us, be conscious that we will also say we will need to adapt, and this is exactly what has happened. And while today we are in five countries and we have delivered over three million treatments, obviously the initial expectations were much, much higher. But I would argue that the learnings we have had through this effort and the dialogue we have been able to initiate with a multitude of stakeholders was definitely worth the effort and we will continue and we will adjust because it really is allowing us to learn on how to best propose solutions which are co-created at a country level with the respective key partners – be it government, be it NGOs etc.