The future of health care - Part 2: Groundbreaking pharma

Thomas Mucha, Geopolitical Strategist
Rebecca Sykes, CFA, Global Industry Analyst
2022-08-03T12:00:00-04:00  | S1:E10  | 32:12

The views expressed are those of the speaker(s) and are subject to change. Other teams may hold different views and make different investment decisions. For professional/institutional investors only. Your capital may be at risk.

Episode notes

Global Industry Analyst Rebecca Sykes joins host Thomas Mucha to discuss the future of the pharmaceutical industry. They highlight the impacts of COVID-19 on the industry and explore today's newest pharma innovations, such as treatments for cancer, obesity, and more.

Key topics to listen for:

1:00 - Ongoing impacts of COVID-19

4:45 - Understanding regional differences

6:00 - Mental health and public health implications

9:15 - Intersection of biopharma and geopolitics

12:30 - Future of the health care industry

15:45 - Today's most exciting innovations

19:45 - Macro headwinds

22:30 - Rebecca's research process

26:15 - Career path and personal insights


THOMAS:   We’re still living through a historical moment, as the COVID-19 global pandemic rolls into a seemingly endless set of new variants, as well as ongoing social, economic, political, and geopolitical frictions. Of course, the global health care industry is at the center of these sweeping developments. What does it mean for the future, and what does COVID mean for countries around the world? To answer those questions and more, we’re joined today by Rebecca Sykes, a member of Wellington’s health care team, and a global industry analyst specializing in pharmaceuticals. Rebecca, welcome to WellSaid.

REBECCA SYKES:Thank you Thomas,.

THOMAS:   So let’s start with the big picture. What’s the current state of COVID globally? 

REBECCA:  Where we stand today is slowly the world emerging from the pandemic portion of this crisis and learning to live with the virus, and there’s still a lot of uncertainty ahead. You know, we’re learning with the help of the tools we have thanks to the pharmaceutical industry, to live with COVID. But, I’m optimistic from my vantage point as a research analyst today.

THOMAS:   How should we be thinking about these variants? 

REBECCA:  Yeah, sure. with each new variant or subvariant that emerges, we’re looking at the properties of the virus and understanding if it’s more transmissible as recent subvariants have been, and if there’s any change to the disease severity that results, and, of course, the populations that tend to get severe disease. And we’ll have to evaluate how effective the current vaccines are against of course with longer time against the existing variants we’re dealing with and against new variants. So it does seem that good chunks of the populations globally are going to need to be regularly boosted against COVID going forward, but to what extent, how frequently and to what sections of the population remains to be seen.

THOMAS:   Broadly speaking, how do you think COVID has changed health care in emerging markets?

REBECCA:  Of course, what comes to mind immediately is the delayed and differential access to vaccines and therapeutics that we’ve seen in less wealthy countries. It’s not all the fault of the manufacturers, for example. But I think we’ve learned that the industry can do something more to help promote equitable access to vaccines, particularly where governments or NGOs are not able to. And now especially the antivirals which, the oral ones have come about more recently. They are much less available in emerging markets. I think we’re taking lessons from the vaccines and applying them to these new oral treatments to hopefully enable better access to them going forward. As for the rest of health care, I mean, obviously the pandemic influenced regular health care, you know, the ability to visit the doctor on a regular basis or get chronic and even serious conditions diagnosed, or to get medical procedures, surgeries and other less invasive procedures done on time. And so, I think the disruption to normal health care, is something that we’re gonna see for a decade or more.

THOMAS:   That long?

REBECCA:  Yeah, it’s something we won’t fully know until the next several years where we see, potentially an increase in diagnoses of certain conditions. I think one area that I’m most focused on is cancer, where early detection can change therapeutic choices, right, and interventions, and potentially at a beneficial outcome to the patient. So, we could have more patients diagnosed at a later stage of disease, and in the case of cancer, later in the course could meant that the cancer has spread beyond the tissue of origin, and that can be, of course, harder to treat and maybe impossible to cure. And then, you know, in other chronic diseases, it may not make so much of a difference to start therapy later. But again, we’ll have to understand that better because even diabetes, cardiovascular disease, intervention is important, and does prevent adverse outcomes and certainly serious events that could cause death or disability.

THOMAS:   So, obviously we’ve seen a lot of regional variation in the spread of the disease, the treatment of the disease, the impacts. Which regions have done the best? Which regions have been more challenged? And do you think that’ll continue to be the case as the pandemic rolls forward?

REBECCA:  Clearly in Asia, I’d have to say the zero-COVID policy, and purely objectively looking at numbers was quite successful early on, in terms of preventing deaths and infections and everything in between. Now, as we sort of look back, especially in the last year, you can’t make that case anymore, and countries that have opened up and resumed normal activity even in the face of surges have fared a little bit better. The other differentiating factor, of course, is the degree of adoption of vaccination, and probably availability of antivirals, although it’s still been recent with those. The vaccination rate varies pretty dramatically even in developed markets, perhaps for social or other reasons of perceived risk and biases and so forth, and also due to availability of different types of vaccines. Of course, the mRNA vaccines proved to be the most effective against COVID, and the US embraced those sooner than Europe, for example. So, that has impacted the experience over different periods of time.

THOMAS:   So, how do you think we should be thinking about the public health aspect of COVID, and specifically, what lessons are we learning from this that are likely to be applied to future pandemics?

REBECCA:  You know, with any highly transmissible respiratory virus, governments face tough tradeoffs for a better health outcome in the near term, but at obviously severe cost to the economy, and a questionable intermediate impact on the long-term health of the population where immunity does need to develop. So, I think there are a lot of lessons learned given that we haven’t had a global infectious disease pandemic in…

THOMAS:   A long time.

REBECCA:  …most of this century, right? We have to go back many decades. So, we had to brush off sort of policy thinking, and tools that hadn’t needed to be used, at least in large scale. I think that this experience is gonna make many countries better suited to the next major problematic infectious disease. Hopefully, governments will respond more quickly than they did. Hopefully, the pharmaceutical toolkits in the form of vaccines and therapeutics will be developed just as fast. You know, I’m not sure how they could improve upon the speed, that was remarkable, I would say, for COVID. But hopefully that would happen again, and on top of it, we could get better distribution and adoption of the vaccines, and availability of therapeutics in a better way than we have seen for COVID.

THOMAS: So Rebecca, there’s been some anecdotal evidence that COVID has led to more mental health issues. I don’t know if that’s accurate, but it’s certainly out there as a perception. How are you thinking about mental health in a post-COVID environment?

REBECCA:  Yeah, it’s a really important topic and I’m glad you brought it up, because I think from the industry side, there’s been an improvement in understanding of the biology of these diseases. And they’ve been challenging ones to understand. Of course, you know, disorders of the brain. And so that’s really encouraging, right, particularly given the context that you stated. And so, we’re seeing interesting new drugs in development for depression, for schizophrenia, bipolar disorder. And so, I’m very hopeful that some of these will come to market at a time that they’re of course greatly needed.


THOMAS:    That’s certainly a very important issue that has been amplified by the pandemic. Now, now much responsibility is on governments to better educate populations on public health issues such as these? Most notably, things like COVID-19?

REBECCA:  Well, the government plays a unique role in the time of a pandemic that it doesn’t usually in terms of making health decisions in patient’s lives. So, there’s only so much a government can do in terms of vaccine mandates, and, of course, paying for national immunization and having therapeutics available at no cost. And then, I think it’s a personal risk assessment, and social factors come into play. And so, I think that hasn’t changed, and, of course, those factors will lead to different outcomes in various parts of the world. 

THOMAS:   So, clearly governments have a role to play in managing COVID. We’ve also seen, as a result of this, governments dealing with vaccine nationalism, and how COVID is exacerbating some of the existing geopolitical strains, in the world that I pay close attention to. And I’m wondering how you think about geopolitics here, in terms of the broader health care industry. 

REBECCA:  Yeah, that’s really interesting, because I think the pandemic has reminded how important national interests are, right, and the strategic importance of the population’s health, and how vitally important it is for a country to take care of its population and have a domestic source, if they can, of these life-saving tools, such as vaccines and therapeutics. And so, it’s not surprising to see major world powers, the US as well as China, be very focused and spend a lot of resources at developing their own vaccines and therapeutics even when they perhaps could easily license or borrow the innovation that came from the other country. The world is still very global, and countries do respect IP in developed countries that can pay for it, but I think there’s an extra element of national security and pride, and of course, the supreme importance of health that’s playing a role here that’s probably different than sort of normal health care trade behavior.

THOMAS:   It’s clear to the policymakers that I speak with that health care is being seen in a more strategic light and COVID has clearly underscored that point. But the other side of the coin here is the dependencies that we see in some of the supply chain issues across the pharmaceutical industry. Like, this is a global industry, as you say. So how do you think that needs to be managed, balancing these global supply chains with the need to protect individual citizens, and, is that going to be an ongoing friction point from an investment perspective?

REBECCA:  Yeah, that’s a great point, particularly for a pharmaceutical supply chain that increasingly over the last 30 years has moved to Asia, at least, of course, the raw material, or the API portion of drugs in many different categories that starting material comes from Asia, for various reasons, many of them to do with cost. So, I think there will be some areas where we do see some movement of supply chain back west, for example, but to do that in a large way to a big part of the industry would be prohibitively expensive, and I don’t expect that to happen in a significant way, particularly for small-molecule drugs and particularly for, say, the services aspect of drug development, where, you know, there are a lot of incredibly great resources in China, well-trained chemists and biologists that are used all around the world by global multinational pharma companies in their discovery processes. I don’t think that that will go away, that global nature of the industry. However, I think there will be some areas that are a little more sensitive. The supply chains for new and important drugs could be preferentially located in the west, whereas before, they might have been more in Asia.

THOMAS:   So let’s talk about the state of the industry right now, post-COVID. I mean, what has COVID done to the industry, and how are you feeling about, you know, where the pharmaceutical industry is headed?

REBECCA:  Yeah, in some sense COVID should have put the industry in its best light, right? We got a vaccine developed, the first vaccine in under a year, and now have several vaccines approved and a therapeutic also in a very fast timeline. So, that’s great; it's great to see government encourage industry, and industry to work so fast to come up with a solution. However, the industry still has a mixed reputation. While people in this country, and around the world embrace innovation and solutions for disease, and health problems, they also are very sensitive to the cost of health care, right? And that’s a big problem around the world. Health care is expensive, and it’s expensive in developing economies, and it’s a very outsized part of our economy in the US. And that’s all not drug-related, of course. But the cost of medicines is a very visible and politically charged topic. And so I think that hasn’t gone away. What also hasn’t gone away is the brutal difficulty of the industry. The success rate in drug development is astonishingly low and the level of investment required to bring a new drug to market if you include all the failures, you’re looking at well over a billion dollars for bringing a drug to market, which means that you’re gonna have a lot of companies fail along the way, and a lot of ideas not work out. So, you know, the industry is doing well but many of the characteristics haven’t changed. That said, we’re at an actually, quite an interesting time point for the industry, and one of the most exciting since I’ve started following it 15 years ago. And I say that because we have a pretty, significant round of patent expiries coming ahead. And so, for industry, that accentuates this problem of needing to continue to innovate and come up with new medicines. And so, now we have a big test for the industry, because it’s a significant period of revenue erosion coming. But what keeps me optimistic, and what I’ve been impressed by is the industry’s ability to tap into all this innovation and identify the projects worth pursuing, et cetera. So, as I look at the group of, especially large pharmaceutical companies that I follow, while about 40 percent of their revenue is going away over the next 10 years on average the companies are at varying degrees of sort of addressing that, in terms of their own internal pipelines, as well as finding biotech companies or ideas of course from academia that could replace that business that they’re gonna lose. So, while some companies still have a lot of work to do, I’m very optimistic that, you know, the state of the pharmaceutical industry in terms of what is out there in the entire biotech industry is pretty interesting, and there’s a lot of exciting new drugs that will come to market in the next 20 years.

THOMAS:   So what has you most excited from an investment perspective, from a science perspective, or broader health perspective?

REBECCA:   I’d say a few areas, and I’ll try to summarize this to not go on too long. Of course, oncology has been a big area of drug development and a lot of investment over the last couple decades. You know, one of the biggest revolutions in the industry in biology in the last decade was the discovery of effective immuno-oncology agents. So, the ability to harness the immune system to go after cancer has really changed the course of treatment and the survival of many patients, depending on the tumor type. I’d also say auto-immune diseases, another area of a lot of advancement both in the biology understanding as well as the drug development will continue to see better solutions. Many autoimmune diseases we have much better solutions for than we did 20, 30 years ago, for example, conditions like psoriasis, even multiple sclerosis, although there’s more work to be done. But I’d say some autoimmune diseases remain still only modestly or poorly addressed, and those would include gastrointestinal autoimmune disease, so ulcerative colitis and Crohn’s disease, and we see some more effective therapies coming for those diseases. Other areas of really interesting innovation in broader populations would be in diabetes and metabolic disease, which of course is a huge problem in the west, and particularly the US with almost a third of Americans qualifying as obese. And so, the exciting area there is both better treatments for type-2 diabetes, for which of course obesity is a risk factor. So drugs that better control blood glucose and bad outcomes that come with diabetes. But as well, better drugs for obesity. And obesity is a condition that used to be considered more esthetic or lifestyle disease that while it was understood it increased risk factors for chronic diseases like diabetes, it wasn’t treated in and of itself besides advising diet and exercise, behavioral changes. And so recently we’ve seen the level of efficacy for obesity drugs raised significantly. A new drug launched last year that sort of set this new bar, and I think it’s been really encouraging how well patients, doctors, and payers, whether that’s governments or insurance companies, have embraced the notion of treating obesity for the disease it is in itself. And of course, understanding that that will have positive effects down the road. So that’s something I’m really excited about. And then, I think about the technology revolution we’ve had and the introduction of new modalities in drug development, that’s really exciting, and it applies across diseases. So of course, we talked about cancer therapies. Many of those have been in the area of large molecules, monoclonal antibodies, but we’ve got better biologics coming down the road, and something called antibody drug conjugates where you attach, basically a toxin or chemotherapy to an antibody, and deliver it in a more targeted way to the tumor. That’s really a breakthrough and raising both the efficacy and improving the tolerability of the way we treat cancer, which is really exciting. I’d also say small molecules, so drugs traditionally given as pills. We have better ways of building these drugs against targets, either we previously didn’t know to address, or targets that we knew about, but we couldn’t drug before because of the medicinal chemistry challenges. And then other modalities that you’ve heard about, like RNA therapy, of course the COVID vaccine would fit into that, but also RNA silencing, or RNA interference, gene therapy and gene editing, still very early days with all these modalities. And they all have relevance, both for rare and serious diseases, where they often are initially used, but also for more common diseases, and that could be really impactful down the road.

THOMAS:   So a lot of exciting things in the pipeline, that will likely produce all sorts of tailwinds for the industry in the future. But what about the current headwind and what I’m talking about here is the macro uncertainties that are hitting the economy, much of which start with the COVID pandemic itself, which led to all sorts of erratic behavior in economies around the world. So how were you thinking about the impact of macro uncertainty on the sector?

REBECCA:  Yeah, it’s a really great question, right, because budgets are not unlimited. And so, strains on budgets for reasons of dealings with pandemics and tax revenue shortfalls and so forth are really important, because the pharmaceutical industry can sometimes be a solution or a source of those funds. So, one of the things that I’m paying attention to a lot right now is the potential acceleration, perhaps, of drug-pricing pressure, because of the impact that COVID has had on economies and government budgets. And so, we saw this in the great recession in Europe, where the government funds health care, and took a more aggressive stance to spending on health care and pricing of drugs in the years after the great recession. Of course, we haven’t felt this before in the US because we technically have free pricing here, even though the government purchases about 50 percent of drugs in terms of total spending in the US, drug companies are mostly free to set the price they wish on drugs. Now, it’s possible that there becomes more political pressure to change that system in the US, to allow the government to directly negotiate, and it’s been a lot of talk, in Congress about that, particularly since the end of last year. And it's possible even more the midterm elections, we could see something happen along those lines in the US here. I also, of course, think about interest rates and the impact that rising rates, higher inflation, economic slowdown is having on capital markets, and the ability of the smaller companies with the industry to fund themselves. And so we’re seeing that right now, of course, the stock-price performance of smaller companies in the pharmaceutical industry, or traditionally what we’d call biotech, has suffered a lot. And a lot of that is because of a more difficult financing environment now, and perhaps, coming off the back of what had been too easy of a financing environment. But that’s something that I play close attention to, the direction of our economy, inflation, interest rates, because I think it has a significant impact on the ability of innovation to be funded at the smallest and most far-reaching parts of the industry.

THOMAS:   I want to switch gears a little bit as we wind down the conversation a bit, and talk a little bit about your research process, and your philosophy, and how you learn, and stay abreast of everything that’s going on in such a complex industry. What is you process? How do you do it? And related, has COVID changed any of that?

REBECCA:  So, my research process of course has evolved over my career, but having spent all of my career in health care and most of it looking at the biopharmaceutical industry, one thing hasn’t changed, which is that understanding that innovation drives value in the industry, and being able to identify that innovation at an early time point is important, right? And that can be a way to invest successfully for our clients. So that’s the crux of how I spend my time, is really trying to understand how well understood the biology of disease is in various areas as well as understanding how effective or not different approaches the industry’s is trying to address those diseases. And then I’d say the other point besides innovation is really understanding human capital. So, the differential ability of scientists and management teams to come up with good ideas and bring them through the drug development process. And while I still feel like my career is young, I’ve seen a big range in abilities and success rates in doing this, and we’ve talked about how difficult the industry is. So, I do spend a fair amount of time really trying to get to know the people in the industry, and studying their track records and history because I think while the science and the data speak for itself, there are good decisions and bad decisions to be made along the way, so I try to really learn from the people that have had a greater-than-average success rate in that effort. So, as to the question about whether this has changed during COVID, I’d hope not, right? I think there’s still the creation of value in the industry is the same. Of course, we need to understand, are there going to be different costs of doing certain projects or rewards in the form of financial value of different types of drugs going forward, and, to that end, I’m thinking perhaps more about infectious diseases. I think there’s been a disproportionate effort in industry away from infectious diseases in the last decade. They’ve chased oncology, both because the biology enabled it, right? We had a better understanding of how to harness the immune system, or which are the genetic drivers of certain cancer types, and that’s really important, but cancer drug pricing is also very high, and so that has probably incentivized behavior. And so, I think, you know, with the spotlight on COVID, right, and other infectious diseases, I’m hopeful there will be more investment behind problematic other infectious diseases, and a couple that I’m watching right now are respiratory syncytial virus, RSV, a big problem in the elderly and to a lesser extent in babies, as well as flu. You know, flu is widespread, we deal with it every year, but our current vaccines aren’t that useful. And so, COVID of course has accelerated new technologies, like mRNA vaccines that potentially could be more successful at addressing these problems. So the crux of my process hasn’t changed, but I’m gonna be mindful of how COVID has changed the world, and perhaps could change incentives and areas of investment going forward.

THOMAS:    I’m wondering, Wellington has an incredibly deep and talented health care team, of which you’re a part of. So what’s your story? I mean, how did you get into this position? What was your path?

REBECCA:  Yeah, so I have had an interest in biology for a long time, certainly since high school, and even before that, I have some family members in the industry. But I kind of figured out, self-discovery that I didn’t want to be in academia, or be a bench scientist. And so, I decided to pursue the business of health care, and my first job was to go to Wall Street, and I was an analyst in a health care investment banking group of a large investment bank, and that was eye-opening. I learned a lot about capital markets, of course, you know, and say a little bit about the industry, but I realized I could learn a lot more about the industry if I either entered it directly, or if I came to an investment firm. And so, I did that after a couple of years. And as I said, I’ve been here at Wellington for 15 years, and what’s kept me here is the amount of learning, and I love health care and medicine, and the ability to focus my day job on research and think long term, and work with a bunch of people who are collaborative, but also diverse in backgrounds and experiences has been, you know, incredibly enjoyable, and I still feel like I have so much to learn. And, so I’m excited for what’s to come.

THOMAS:   I’m learning a ton from you today, so thank you. So, another question I like to ask in these conversations has to do with reading. You know, we all read a lot. But do you have any book recommendations that have helped you understand the industry better? I mean what advice would you have for laypeople to learn more through reading?

REBECCA:  Yeah, sure. Gosh, there are so many, especially with all that’s transpired in the health care industry, and in biology in the last 20 years. But you know, I was actually thinking about, you know, books that shaped me as an investor, and I guess what came to mind was the last book I read, which was Red Notice by Bill Browder, who’s of course the hedge fund manager, turned political and human rights activist after his experience in Russia. And you know, spending myself a lot of time on emerging markets, of course specifically health care companies, I find it really interesting to learn about other people’s experiences in understanding political regimes and countries undergoing significant change, so of course, his story is about investing in Russia and Eastern Europe in the post-Soviet era, and uncovering corruption and so forth. It sort of reminds me of kind of lessons learned as an emerging markets investor, and the importance of being skeptical, and understanding that there are a lot of dishonest people in the world, and really trying to understand, a company and an industry when you research it. And the whole context matters, right? So that geopolitical backdrop that I try to learn from you and our teammates here at Wellington but also the history of the company and the founders and what might drive behavior that doesn’t seem rational at first glance. 

THOMAS:   And then another question we like to ask here is if you weren’t a health care investor at Wellington what would you be doing?

REBECCA:  I think if I weren’t here as an investor, I’d probably be within a company somewhere, a health care company, perhaps in operations, or in finance, and yeah, I think that would be really fulfilling to work at a company whose mission is to improve the health and lives of patients.

THOMAS:   Well for selfish reasons, I hope that does not come true, and you stay with us, but that’s a good answer. So Rebecca, thank you so much, really, for your time, your expertise, for staying on top of all of these issues, not only during the time of COVID, I know a lot of us at Wellington have listened to you very carefully over the past couple of years, but even beyond that, so thank you.

REBECCA:  Thank you, Thomas. 


Views expressed are those of the speaker(s) and are subject to change. Other teams may hold different views and make different investment decisions. For  professional/institutional investors only. Your capital may be at risk. Podcast produced August 2022.


Views expressed are those of the speaker(s) and are subject to change. Other teams may hold different views and make different investment decisions. For  professional/institutional investors only. Your capital may be at risk. Podcast produced July 2022.

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