The Perfect Enemy | Lessons from a pandemic – holistic strategy in the time of coronavirus
November 2, 2023


Even before COVID-19, in the days when we talked and worked together face to face, implementing a holistic strategy could be frustrating or impossible. COVID-19 delivered a scenario for which developing the strategy for any brand would have been a challenge.

The way healthcare strategy is developed in the wake of the pandemic does not have to be negative – there are clear opportunities to improve how we make strategic choices, by moving strategy into the digital age. I sat down with a group of peers and fellow industry leaders to examine how strategy needs to evolve.

The problem
Strategic planning takes a lot of time and resource. It is difficult to implement a holistic strategy when the chain of command is long and complex, with global, regional and national command centres often pulling in different directions, and when the component countries are as diverse and complicated as India and the USA, or Canada and Cameroon.

The drive towards smaller, orphan or niche products puts additional pressure on companies to find new ways of achieving commercial success, requiring a winning strategy that enables brands to reach enough patients to justify the development costs.

Right at the time when major companies are beginning to plan for the year after this one, organisations are adopting hybrid working, often forcing cross-functional teams into isolation and social distance because of the pandemic virus, making it even more difficult to design, test and communicate strategy.

Patients have been traumatised by COVID-19
We emptied our hospitals of all the elderly and the ambulatory, to clear beds. As a result, hospitals became places of contagion, ghost towns for all except the critical COVID-19 patients.

Our Primary Care offices imposed hurdles to protect their staff, removing the option of personal consultations for hundreds and thousands of patients, delaying thousands of operations, and to our perspective, delaying enrolment in clinical studies and delaying access to the patients who should be the target of our strategy.

Reimbursement hit the limelight, as countries struggled to resource personal protection equipment, with moves to bundle orders, simplifying ordering and increasing centralised purchasing power.

The design and implementation of global strategy was never easy, now it is even more difficult. Is there a ‘light at the end of the tunnel’, can we ‘seize the day’ and adapt to ‘a new normal’ with a new way of producing global strategy?

The solution
We need to make the patient the focus of our strategy, and align our operations selflessly to satisfying his or her needs and shape that patient journey, if we want to move our businesses forward. We must bring the outside in much earlier, we must be agile, iterative and experimental.

COVID-19 proves that patient need does not have a nationality. Clinical unmet need is almost identical around the world. Applying this to our business model for pharmaceuticals, we can see that although there are differences in the standard of care, these are shrinking. And in the case of rarer conditions, that standard of care difference is shrinking even faster.

Today’s world is more about patient access than market access. Beyond the consolidation we have witnessed, we can add the relentless drive towards rational prescribing and the adoption of health technology appraisal, whether NICE in the UK, or ICER in the US, placing the margins on pharmaceuticals under increasing pressure. With this, it is not difficult to see further consolidation of the payer structure in the US as other countries begin to look more attractive. The sharing of information between HTA countries reduces the variance even further.

We have seen a surge in telehealth in response to the barriers on face-to-face appointments, with patients prepared to engage openly with physicians over web-based consultation platforms, treating the camera as a trusted partner in the sharing of intimate details. In their living rooms, patients and consumers of health are more accessible – the question is whether healthcare practitioners (HCPs) are sufficiently equipped to work in this new and different way.

Reset the organisation to reflect the new world
When the organisation is driven by global, regional and local power plays, strategy is the first casualty.

A patient in one jurisdiction is experiencing much the same as a patient in another. Someone in Ontario with haemophilia does not really care where he or she are living, and may have more in common with someone in Edinburgh than they have with the general manager in Quebec.

If we start with the patient and the clinical need, these do not differ massively between countries. In rare diseases, these communities talk to each other across the world, and digital communication channels allow that type of connectivity to be amplified.

Take advantage of the similarities, not the differences
It is not a giant step to suggest that the technology can be leveraged to provide us with a different type of intimacy and allowing us to capture those local market insights to inform the development of strategy.

Setting a series of guide rails which structures thinking and offers the opportunity for individual countries to share their knowledge of the patient and other stakeholders impacted by, or involved in, the management of disease may be a better way of getting to those all important insights. We need to speed up the whole process, making it more agile, more collaborative and co-creative.

New challenges create common focus
In the rush to accelerate clinical trials that test existing or new therapies and vaccines, there has been remarkable cooperation between public regulators and private researchers, probably because of the realisation that they were fighting a common enemy. We need to galvanise cross-functional global, regional and national teams into seeing the value of a holistic strategy (one that is informed, coherent and to which all are aligned) as the way to fight the disease which is seen as ‘the brand’s enemy’.

One of the reasons why holistic strategy is important, particularly with rare diseases, is that the key secondary or tertiary care physicians know each other. It is not unusual for a physician in France to have spent time in California being trained, or vice versa. Or for the physician in China to have had a sabbatical in Paris. The connections they have are deep and are maintained when they meet at conventions or, increasingly, virtual meetings.

We have all been on the receiving end of global strategies and have written global strategies and, on both sides, no-one was really satisfied.

Of course, our product has core truths and certain things are fundamental and we must work on them together and then make sure that we are aligned.

Collaboration does not mean slavish alignment.

Unfortunately, it is not practical to leave strategy to each individual country and hope that the country’s circumstances will lead to similar choices. The financial commitment from this organisational inefficiency would kill any business. Instead, perhaps it would be better to identify some immutable truths and offer the possibility of weighting elements of the strategy according to where the country is in its evolution – viewing the different countries as travellers on different stages of progression towards the long-term vision for the brand.


Seek out the best, wherever they are
Turning to how the various routes are built, and how the immutable truths are agreed, there is always a risk that senior managers will apply knowledge from previous situations, engineer their own perceptions and their own experience into that strategy and, in so doing, obstruct the pursuit of clarity. When this happens, the clean and exciting aspects of strategy can be smoothed off, leaving a strategy that looks like any other.

There is a growing appetite to devolve the ability to test and learn and experiment throughout the organisation. It requires input from the smartest thinkers in the organisation. It also requires transparency, so that the route to a strategy is understood and challenged appropriately.

If you think about the key elements of any strategy, you should start with the idea of ‘what does winning look like’. This should be clearly grounded in the experience of the patient. When we do this, we work out the unmet need and work around which stakeholders we are going to engage, and which behaviours we are going to drive. We win by getting our positioning right, with clear imperatives and objectives that may change along the way.

The strategic imperatives should be identical globally and the issue/starting point and options for change should reflect that different countries are at different places on the arc of development. No more straight-line thinking!

Through technology, which is already available, there is no requirement for anything to be linear. We can shape anything in any way. People can share stimulus material and contribute and collaborate around the different contributions.

All of which encourages national, regional and global contributors to share their knowledge, achieve insight and move towards alignment on the strategic choices they need to make. Allowing contributors to enter the process at an infinite number of points frees people to dip in at several different places, wherever they feel comfortable, and to build on the thinking.

At the facilitation level you want to track the progress of that strategic development, you could want to facilitate Q & As around the stimulus and, if there’s anything that is slightly unclear, invite people to the conversation who can engage to resolve misalignments on any aspect of that strategy.

COVID-19 has forced us to focus more on where we want to be, on ‘what winning looks like’. It has forced us to look more closely at the patients we want to serve and at the optimum resource allocation for this purpose. It has speeded up the implementation of innovative communication technologies and it has forced us to see each other as more similar than different.

We have presented an approach to strategy which is more inclusive, less directed, less confrontational and more likely to engage and motivate.

The White Paper produced in conjunction with a group of peers and fellow industry leaders that examines how strategy needs to evolve can be found at

Janice MacLennan is founder of the NMBLR app and CEO at St Clair Consultancy

24th November 2022