Could Covid-19 give pharma the chance for the ultimate image makeover?

It's not hard to understand why people dislike Big Pharma. The industry has been hampered with reputational issues for years and the absurdly high prices of cheap-to-manufacture drugs, sky-high executive salaries and apparent tendency to put profit before the greater good have done little to help the problem.

In Gallup’s 2019 industry favourability poll, pharma ranked below all other public and private sectors in the US, with a positive perception of only 27%. This marked the lowest favourability it had had since Gallup began polling in 2001, a situation that was hardly surprising given the performance of Big Pharma that year. 

Allergan had just sold the patent for its Restasis prescription eyedrops to the Native American Akwesasne tribe in exchange for the sole and exclusive rights to manufacture and market the drug in the US, blatantly abusing both the patent system and capitalising upon the tribe’s financial hardship. Johnson & Johnson was fined $572m for its role in the opioid crisis, a sum that sounds staggering but only makes up around 4% of the company’s annual profits. 

Moreover, organisations such as Novartis, AstraZeneca and Sanofi began to back away from antibiotic research due to a lack of profit in the area, despite the growing threat posed by antimicrobial resistance. Consequently, as 2019 came to an end, pharma had not painted a picture of itself as an industry with humanity’s best interests at its heart.

Then, the Covid-19 pandemic happened. This forced the public to sit with an uncomfortable truth: only the pharmaceutical industry has the capacity to manufacture and distribute a vaccine that will help pull us out of it once and for all.

“I think this really is an opportunity for the pharma industry,” says Practio CEO Mads Mikkelsen. “The pharma industry has been working very closely with policymakers in communicating how they’re working with the development, progression and distribution of the vaccine. I think that can all contribute to increasing the public trust in pharma companies.”

Covid-19 has provided an opportunity for pharmaceutical firms to save the world – but can they salvage their reputation at the same time?

The Gallup poll from 2020 does indicate something of a renewed trust in the industry – its overall positive perception rose to 34% overall, a seven-point percentage increase over the year before. This was the third greatest increase among all of the industries the survey covered, although pharma still sat second-to-last in the favourability poll overall.

The Harris poll, which has tracked perceptions of pharma in ongoing surveys since March, has also noticed an uptick in pharma’s favourability, with 40% of consumers reporting a better view of the industry than they had before the pandemic began.

“The spirit of collaboration that has been displayed across rivals in the industry coupled with the urgent need for a global vaccine has led to a positive perception in the view of the public already,” says Acumentice founder and managing director Karina Malhotra. “Previous views regarding greedy big pharma are dispelled whilst they work with healthcare professionals, rivals and patients together to tackle this universal problem."  

The very origins of the Covid-19 vaccines that pharmaceutical companies are beginning to distribute may well have also played a part in this. Currently, two messenger RNA vaccines from Pfizer/BioNTech and Moderna have emerged as the most promising candidates, demonstrating efficacies of 90+% in clinical trials.

These discoveries have ultimately been spearheaded not by pharmaceutical conglomerates, but smaller, research-centric biotech companies. This could potentially signal a new frontier for pharma. Research indicates that smaller companies are generally perceived as more responsible, something which could be especially important in trying to build up trust going forward.

Even Pfizer’s involvement with the vaccine it is now rolling out has ultimately been a logistical one, facilitating clinical trials and sales rather than laboratory research. Pharma companies increasingly appear to be streamlining their in-house R&D and turning towards academic research and partnerships with other organisations instead.

“People are being educated on a new form of science from new companies that don’t represent old pharma,” says healthcare branding consultancy Interbrand Health executive director Barry Silverstein. “It’ll be really interesting to see how they develop, but I believe it is time for pharmaceutical companies to use this as an opportunity to reset their dialogue.”

If pharma companies want this reset, Silverstein says, it has to go beyond a simple PR exercise.

“It means how they speak, how they do clinical trials, how they tackle socioeconomic disparities in drug access. In order for pharmaceutical companies to reset in today’s world, where information is much more widely available and they have to be much more transparent, they’ve got to change their behaviours,” he says.

A behaviour change on this scale would constitute a fairly significant shift for the industry, but this disruption could ultimately serve to benefit in the long run. It could potentially allow larger pharmaceutical companies to attract better employees, for example, as scientists may no longer be put off working for big names with bad reputations. 

More favourability could also allow pharma companies to move into new areas of discovery that are currently more likely to fall into the remit of smaller companies, such as behavioural health or digital health.

“I wonder if a better reputation and more trust would allow pharma companies to move out of this box that they’re in, of trying to come up with new drugs that will make them enough money for the next years’ shareholder report,” says Silverstein. “There’s so many ways that they can be a positive impact on society.”

A better reputation for the pharma industry could also equal better public health in the long run. Many vaccine-hesitant people feel the way they do due to a lack of trust in the sector at large and working towards a more trustworthy image could potentially boost their uptake.

Mikkelsen says: “There’s a relatively large percentage of the population that is still adamantly against, or at least has reservations about, getting certain vaccines. An increased trust in pharma companies would mean we see more people open to actually getting these vaccines, as it would lead to an increased trust in the efficiency and safety of the products that they bring to market.”

However, there’s no guarantee that the potential reputational benefits associated with the rollout of Covid-19 vaccines could continue in the long term. The collaboration, transparency and clear public benefit involved with vaccine research could all aid in the industry’s reputational rehabilitation, but this is for nothing if pharma returns to business as usual in a post-Covid-19 world.

“Pharma has seen this as an opportunity to go that final step from blockbuster to megabuster,” says PharmaFlow managing consultant and author of Taming the Big Pharma Monster Hedley Rees. “Maintaining that everyone’s got to be vaccinated throughout the whole globe means we can initially price it fairly economically, but we could have a ten to 20% increase in price every year and before you know it the pharma executives behind distributing the vaccines are multi-billionaires.”

The People’s Vaccine Alliance has also revealed that rich countries are hoarding doses of Covid-19 vaccines, meaning people living in the developing world are set to miss out. Its analysis has found that rich counties have bought enough vaccine doses to inoculate their populations three times over, buying up 53% of the most promising vaccine candidates so far despite making up just 14% of the world’s population.

The Alliance is now calling on pharma corporations to share their technology and intellectual property (IP) through the World Health Organization Covid-19 technology access pool, so that more doses can be manufactured by suppliers in resource-limited settings. Should pharma companies leave the developing behind by failing to share their IP or make arrangements to distribute their vaccines internationally, they may find their reputation even worse than it was before the crisis.

There are numerous areas where pharma needs to improve, and if it wants to salvage its reputation then Covid-19 vaccine rollouts will not be enough. Big Pharma needs top-down reform of its everyday business practices and the way it engages with consumers – otherwise, a year from now, it may find itself inching back down to the very bottom of the opinion polls.