Science shows the way

Bergström has not been given the job just to act as the CEO's designated pit bull in tough economic battles. He brings to the job an independent, almost missionary zeal about the promise of new scientific discoveries. "Industry needs to be very vocal on what this new science can deliver. If we do not change the terms of the debate, the vaulting promise of molecular biology will not result in new products that reach patients. Then we will all have failed in our mission to society," he says.

Characteristically, within months of taking office, he booked one of the most prestigious conference centers in Brussels and delivered a public lecture entitled "Is society ready for the new science?" Speaking without notes (and without necktie), he held court with an audience of senior officials, industry leaders, academics, and the media for over an hour, with a presentation novel in substance and style that tried to move the debate about pharmaceuticals into a strategic discussion of the future. While he is fully aware that scientific progress is difficult to predict, with many unanswered questions posed by personalized medicine and advanced therapies, he depicts the regulatory and financial obstacles as challenges—ones that the industry and governments have a moral duty to overcome. And he is insistent on finding new incentives for innovation.

Talk to me

Bergström's enthusiasm for collaborative research is matched by his attachment to dialogue and trust with the external community. From the day he got the EFPIA job, he presented himself as someone who has "learned to listen to governments and other stakeholders to make sure that my industry meets the expectations of society."

His interest in good governance goes back a long way. When he was running LIF, he had no hesitation in describing an alleged bribery case in Sweden involving Merck-Serono as "totally unacceptable," and publicly distancing the association from the actions of the company. He used to serve on the board of IMM, the Swedish Institute against Corruption, and since 2006 he has been an advisor to the World Health Organization on good governance in medicine.

A key priority for him is to oversee work within EFPIA on trust development, in a bid to overcome persistent allegations of dubious marketing practices and undue industry influence on regulatory decisions. "We have to develop better trust, so EFPIA now has a trust agenda," he says emphatically. "We've established a baseline for perception monitoring—so that we're not down there with the tobacco industry."

The internal barriers to meeting this challenge are no easier in Europe than in the United States, and high-profile lapses on the promotion and corrupt pricing side continue to be documented eagerly by health campaigners as evidence that no one in the medicines game can be trusted. Just as he took office, major scandals broke involving safety and promotional lapses around an anti-diabetic product marketed by an EFPIA member company, Servier of France. "Mediator was a big setback for France," he accepts, and there is still work to do to respond when companies get out of line, or where past behavior is now resulting in public sanction and fines. But, he underlines, these scandals merely pave the way for remedial and preventive action that reformers like him can initiate, designed to clean house.

Bergström chairs a new EFPIA committee which develops the public policy line to be taken on trust, reputation, and compliance, and he has been leading a drive to build a sector-wide platform on corporate social responsibility, through the conclusion of an agreement with patient associations, doctors, and pharmacists on ethical conduct that he hopes will win EFPIA a greater degree of public and political goodwill. He recognizes that there is more than simple public relations at stake: "It is critically important that decision-makers listen to the industry and take advice on matters affecting innovation and access to medicines. This will only happen if there is trust," he wrote in this year's EFPIA annual report. Actions he has driven through since he took up his new post include an initiative to limit the provision of free medical samples, as well as implementation of new amendments to put more teeth behind EFPIA codes of conduct on promotion of medicines and on sponsorship of scientific conferences.

Bergström is also a vigorous advocate for greater transparency and accountability, and has pushed hard to open up clinical trials information, to assess public attitudes to the industry, and to actively seek out critics and opponents in discussions on sensitive subjects such as access to medicines in poorer countries or wider use of generics. "We used to avoid groups who don't like us, but now I go out and talk to them," he says.

His constant refrain is that "we need to sit around the table with others and figure out a sustainable way forward." One of his most evident frustrations is with the lack of dialogue and communication within the pharma industry itself. "Getting people inside the sector to talk to one another is not easy. Getting common understanding or consensus is even harder. Coordination within companies doesn't happen automatically. You get some agreement in one room, and expect it to permeate—but it doesn't. Research people don't talk to colleagues in marketing, government affairs don't talk to regulatory departments...or the French subsidiary doesn't know what's going on in the Germany subsidiary. I still come across pockets of people in this industry who will go on a rant against generics on the basis of quality—and I say 'Where have you been?' There's no longer any argument in Europe about the quality of generics!"

Start from the top, aim for the bottom

In his view, the industry CEOs are ready to take on these challenges. "It is at the lower levels that there is resistance. Better communications and coordination within the industry is vital. And here there is an obvious role for the associations, in helping local CEOs in their own mission to represent their companies and the industry in setting an example." Even within EFPIA, better communication is needed, he admits. "We need to update ourselves all the time," he insists, listing initiatives he has pioneered such as featuring CEOs in short video messages to allow people working in the industry to hear their leaders spelling out the new realities, and ramping up EFPIA's digital presence with YouTube clips "to get more of a buzz."

The desire to change extends to his own management style, which has been challenged at times for the constant travel and abruptness around decisions that can be seen as quick on the fly. Looking around his headquarters in Brussels, he adds: "I'd like to knock down the walls in this office and make it open plan, to replace the silo mentality with a better spirit of collaboration. I'm not happy yet, and I'm still working on internal communications and flow."

That said, Bergström has had some success in alliance building over the last year. He skillfully exploited new legislation requiring an upgrade of anti-counterfeit measures on medicines to create a broad coalition across the sector, engaging his member companies and associations with pharmacists, wholesalers, and—most remarkably—parallel traders in the design of a product verification system that can also serve the community's long-term interests in sophisticated acquisition and processing of product delivery and usage data. However, despite building new bridges to the generic sector on many matters, ranging from pricing to ethics, he has still not been able to persuade the European generic industry association to join the anti-counterfeit campaign, but he remains optimistic that he can do so.

His job would be easier—and the industry's destiny clearer—if there was more coherence among the authorities he has to deal with in the complex patchwork of the European Union. One of the many contortions in the EU policy context is that responsibility for pharmaceuticals is split across different departments—notably health, industry, and research—within the European Commission, the EU's central civil service.

Reluctantly, in light of his past enthusiasm for all those Commission industry reform panels, Bergström acknowledges this is a brake on policy progress. "The unfortunate consequence of having economics and health in different places is that it legitimizes silo thinking on health policy and industry policy for Europe," he says. "The people responsible for health can't talk about industry, and the ones responsible for industry can't talk about drug pricing."