A Global Vision for Access

Ester Banque

There are many aspects that contribute to being an effective leader in pharma today, but Ester Banque, senior vice president and head of Intercontinental Commercial at Bristol Myers Squibb (BMS), says one, in particular, prevails: You have to have a strong sense of purpose. Banque’s competitive spirit, fostered by her time playing top-tier soccer in Spain, propels her to want to win, but she says, “Without purpose, that drive can fall flat.”

With a heart and mind focused on those in need, she describes herself as being “driven by a purpose and with a purpose.” Throughout her career in pharma, she has noticed that if you place the right focus on helping patients, and consider decisions in light of how they might affect patients, the results will come. “Along my 25-plus years of professional career, it’s always been like that,” she says.

Delivering as a team

Playing on the Spanish national soccer team was a dream come true for Banque. “From the first time I touched a soccer ball at school almost 40 years ago, I was so passionate about soccer,” she says. “I was the only girl playing soccer in the entire school, so I learned a lot, but mostly I learned how to win as a team and how to lead.”

Although Banque was a forward, whose job was to score goals, she realized she couldn’t do that without the support of the entire team. “If the ball wouldn’t come to my feet or my head, there was no way I could score,” she says. “As much as I loved the adrenaline of seeing the ball touching the net, the highest satisfaction was when we hugged as a team, when we would celebrate that we accomplished something together.”

Banque learned many leadership lessons from her role as a team captain and says the most important principles were taught to her through soccer at a young age:

• Be compassionate when things don’t go well.
• Be there to pick somebody up when they fail.
• Stay calm when the whole team goes crazy when you’re losing.
• Keep working hard, even if you’re winning.

“You don’t even realize you are learning when you are a kid or a teenager,” she says. “I learned those basic traits in a very experiential way, and they have [remained] with me over the years.”

Expanding her horizons

Soccer wasn’t Banque’s only passion growing up—she also was fascinated by science and wanted to help people. After receiving her chemistry degree from Universitat Autònoma de Barcelona in 1990, she became a sales representative for Novartis. Intrigued by how a pharma company operates as a business, she enrolled at Universitat Pompeu Fabra, where she studied pharmaceutical marketing and received her MBA. “All of this combined led me to a pathway in pharma,” says Banque. “I’ve worked across the globe in a full range of therapeutic areas and living in multiple countries, and I have always kept the same sense of purpose, which is helping patients get access to transformational medicines.”

Her drive to achieve this was fueled by the experience of losing several family members to cancer and other severe conditions. She also witnessed how her grandmother was denied a valuable treatment because of cost and her condition subsequently deteriorated. “All these things, especially when they’re very early in your career, make a big difference,” she says. “They have a great impact and somehow shape the way you think and the way you see your role in the industry, which, in my case, is a role to lead organizations and work together with different stakeholders, to help patients get access to medicines that then changes their lives.”

Banque worked for two pharma companies most of her professional life: Novartis and BMS, which she joined two years ago. Following her work in sales at Novartis, she held different responsibilities in the commercial organization with progressive profit and loss (P&L) responsibility.

When she looks back on her time as a rep, she says, “I could have never imagined that we would ever see what I would have called the futuristic treatments that we have today. For example, immuno-oncology uses your own immune system to fight cancer, or cell therapy re-engineers your immune system to fight cancer. The pace of innovation of biomedicine is really incredible and fascinating. That, with my love for science and also passion to help patients, [makes me want to] leverage the platform of our company.”

When Banque was approached by BMS to join as senior vice president of Intercontinental, she thought it was an incredible opportunity. The region boasts a unique model with more than 70 countries across five continents under one umbrella; most top global companies have their countries fragmented in different regions. “I thought the opportunity not only to work in countries where access to patients is even more challenging than in more established and mature economies but also to have all of them under one roof was phenomenal,” she says.

As the commercial lead for Intercontinental, Banque is responsible for the group’s P&L and works in partnership with other functions to ensure the organization’s medicines reach patients in an agile and affordable way. The team currently includes about 3,000 people across five continents, has about 25 countries where there is an affiliate, and the rest operate through third-party distributors.

“When I joined Intercontinental, I was blown away not only by the talent that we have but also the resilience of our people that live in countries where sometimes there is a lot of risk and volatility and difficulties,” says Banque. “There is such an incredible energy of a can-do attitude, resourceful talent, and then all of them with the same passion really going the extra mile to help patients get access to our medicine. I love working with our team and making a difference every day.”

Banque begins her day early in the morning, starting with China, and travels virtually all around the globe, ending up in Australia by the end. Before quarantine, she admits she was on an airplane more than she was on the ground. “But it’s fun, because you see so many realities, so many perspectives,” she says. “It has helped me grow a lot, not only in my career but also as a person and as a leader.”

Managing global diversity

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Despite the diversity of her region, Banque says there is one common challenge throughout: access. But where challenges exist lies room for opportunity. BMS plans to launch more than nine medicines and 40 indications over the next five years across Intercontinental’s 70 countries, and has the potential to serve more than half a million patients in the region. By doing this, it positions itself to grow double digits over the next five years and become a strong global player.

Intercontinental has been affected by COVID in ways similar to the rest of the industry; many patients have been reluctant to go to the doctor, which has impacted new diagnoses. But it also has been impacted in ways specific to the countries it serves. At the start of the pandemic in some countries, BMS’s medicines were only distributed in top city hospitals, and because of lockdown, many rural residents couldn’t initially access the medicines they needed. Banque’s team worked in partnership with different stakeholders and helped provide access with special programs in rural areas. In one of the countries, COVID affected the distribution channel for one of the major wholesalers, so Banque’s team worked in partnership with the relevant stakeholders to provide solutions to help get BMS’s products distributed to the last point in the country, if needed.

“It was an incredible challenge,” she says. “But at that time, I could see how people went the extra mile. And that’s when you can really see the sense of purpose, that people go above and beyond the call of duty to help patients get access to our products.”

Managing a range of healthcare systems and maturities prohibits a one-size-fits-all approach to bringing medicines to each market. The annual healthcare spend per capita ranges from $5,000 a year in Australia, for example, which is one of the most mature and established economies, to $50 in low-middle-income countries. “When you have that range of spend, you need to work very closely with the different stakeholders, with governments, patient associations, and payers, to make sure that you find ways and bring programs that will help that access to patients.”

BMS relies on a variety of options:

• Risk- and cost-sharing models, which it has in place in some Eastern European countries.
• Patient assistance programs (PAPs) to support affordability for patients in countries like India and China.
• Contracting with governments, which could go from tendering in the Middle East or some Latin American countries to listing products in public reimbursement in multiple countries to private reimbursement in Brazil with private clinics and health insurances.

“This is a joint effort; it cannot be solved by one single party,” says Banque. “It is a journey, and we’re not there yet. But I’m optimistic, because when I see that a product like Opdivo is already commercialized and available in 50 countries in my region—and some of those countries have less mature healthcare systems—I can see that we can make it work; that there is a pathway, and we will always find a way to get patients access to our medicines.”

BMS’s commitment to bring medicines to every patient who needs them includes a thoughtful approach to pricing its medicines, considering their value to patients and society and their affordability. Banque believes the same needs to be done globally, looking to different stakeholders who make decisions and who can work together to facilitate access. “Intercontinental is a unique model, because the variety allows you to operate with more flexibility, speed to market, and a strong voice internally to get resources,” she says.

Banque describes Intercontinental as a “story of belief,” a belief that the group can harness the diversity of its talent, geographies, pipeline, and access, to bring medicines that are transformational to the many people that need them. To illustrate this, she shares that more than 50% of the company’s general managers are female—not an easy task when you consider that in some of the countries it serves, women are not yet benefiting from equal opportunities. “But we are a leading player changing that, placing talented female leaders in these positions,” she says. “I think we are changing the situation in certain countries and contributing to accelerate diversity there.”

Leading with heart and mind

Banque prides herself in being an inclusive leader. This is a personal initiative for her because she is gay and understands the challenges of being seen as an outsider. Though she has been married to her wife, Eva, for 25 years and has twin daughters who will turn 12 this month, being able to achieve that family life wasn’t easy.

“I’m Spanish and was raised in the Hispanic culture,” she says. “And I’m a woman. On so many occasions, I’ve been the only one in the forum that was either gay, or a woman, or Hispanic. I felt on so many occasions that I didn’t belong, and I grew up with a conviction that I will change that and I will make every environment an inclusive environment, where I have the opportunity to influence.”

Banque has realized that when you are inclusive, you also are able to create and build very strong teams. When you look for diversity in a natural way and inclusion in a proactive way, people feel valued that they can be themselves. “There is so much energy that is unleashed when people can just behave as they are and are valued,” she says.

Exposing her true self is something Banque has worked on over the years, including when it comes to being a leader. She says early in her career, she mimicked a leadership style that wasn’t hers, because in many cases her only role models were male. “I showed my brain mostly, and I would behave and be perceived as very rational,” she says. “But I discovered over the years that I’m at my best when I lead with my heart and execute with my brain. People mistake kindness for weakness, but I believe that you can be human, compassionate, kind, and at the same time, you can be firm, successful, driven, and make tough decisions. This combination of leveraging your heart and your brain is called blended leadership. So when I come to work, I just bring my whole self, and I’m a better leader since I’ve been doing that.”

After being in the closet in her professional life for 17 years because she was afraid of not being accepted, once she decided to come out and express herself freely and saw that she could be valued, she wanted to create the same opportunity for others. “It was transformational,” she says. “I realized that there is nothing that you can justify to cover yourself so that you are not yourself at work. And you don’t need to be gay to be in the closet, you can cover for so many reasons.”

Diversity may be personal for Banque, but she admires BMS’s public stance on the issue. A few months ago, the company expressed its formal commitment to diversity and health disparities in five areas: addressing health disparities, increasing clinical trial diversity, expanding its supplier diversity program, expanding its US Employee Giving Program, and increasing its workforce diversity. BMS is implementing strategies to attain these goals by 2025.

Diversity and inclusion councils, which were started at BMS a few years ago, are also part of this effort. Banque is a member of the Global Diversity and Inclusion Council and co-leads the Commercialization Diversity and Inclusion Council. “I’m very fortunate because I have those platforms that allow me to make an impact beyond my own organization or my own team,” she says.

Promoting health equity in diverse environments, from focusing on particular communities such as LGBTQIA+ within mature health systems to implementing innovative solutions quickly in developing markets, is another area where Banque is involved. Though present throughout the world for different reasons, inequity always comes down to one issue, she says: access. Last year, BMS showed its commitment to the LGBTQIA+ community by sponsoring a study to assess health inequities in the LGBTQIA+ population in the US. This first step will allow the company to elaborate plans and work on reducing those inequities moving forward.

Banque draws a parallel between her story and the Intercontinental story of belief. She believed that she could be herself, be successful, and make an impact in helping patients by putting them first. She believed she could create a family with her wife, despite the cultural stigma of the time, and not only be open about it but actively advocate for inclusion and diversity everywhere. Banque knows what it’s like to persevere and smiles in the joy of seeing those beliefs become reality.

Elaine Quilici is Pharm Exec’s Senior Editor. She can be reached at equilici@mjhlifesciences.com.