COVID-19 (Corona Virus Disease) is a good example of how the environment can be VUCA or Volatile, Uncertain, Complex and Ambiguous. In future it will be a business case for management classes and any business forecast or future cast will need to include a section for whether one has proactively prepared for a COVID-19 like situation. Though however well we may prepare for such an eventuality, when it hits us, we will always be unprepared, as it is so unpredictable. The pharmaceutical industry was initially caught unawares but being resilient it was able to bounce back to some extent. De-growth has happened more with the acute care segment, but the chronic care segment is not de-growing to the same extent.

In fact, if companies invested in ensuring that the supply chain was not interrupted by the lockdown (that was done to break the chain of viral transmission) and medicines for patients with chronic disorders (diabetes, hypertension) were delivered to the patient’s doorstep, then one could even expect growth of the business. Imagine if even glucometer strips were delivered to the patient’s home, they could also check their glycemic control, and accordingly the doctor could tailor their treatment. On March 25, Medical Council of India (MCI) released the telemedicine guidelines, and the industry scaled up online webinars to try and fill the gap of their field force (FF) not being able to visit doctors face to face (F2F). Reality became virtual. Even conferences started going digital (e.g., American Diabetes Association called it RAVE – Really A Virtual Experience) including the presence of stalls.

Initially doctors did not appreciate this barrage of Go To Market activities but then slowly started embracing the new normal. E-advisory board meetings, webinars, virtual round table meetings (RTMs), e-investigator meetings, multi-specialty meetings around COVID-19 as it affected so many fields, but subsequently doctors settled down to topics in their own therapeutic area. One important topic was how to disinfect clinics, maintain physical distancing, and prepare to go back to clinical practice once the lockdown was going to be lifted. Companies did distribute PPE kits, N95 masks, sanitizers, fumigants, etc., and even set up social media accounts for doctors so that they could interact with their patients online.

Tele-medicine picked up and now even virtual physical examinations are being attempted. Incidentally doctors are also daily wage earners, and this lockdown affected their income as well. But they had nowhere to go but wait, till this too passes. Some intrepid souls even worked during the lockdown. Clinical trials have been impacted because of patients not willing to come to trial sites (clinics, hospitals) and some changes in rules have been issued by the regulator, but going forward one will need to Go To Patients through digital CTs, where the patient need not come to the sites, but the sites go to patients. Technology as a platform will need to be used more often. Devices and wearables may become the norm, instead of an exception. Just as one has thermometers, peak flow meters, glucometers and even pulse oximeters at home (low oxygen saturation in these times of COVID-19), one needs to purchase BP meters and keep them at home, but only the ones that have been clinically validated and found to be as accurate as the gold standard.

As Yogi Berra has said, the most difficult thing to predict about is the future. Work from home has already become a reality. Managing virtual teams via zoom calls, Whatsapp video, Skype, etc., is the new normal. Does one really need to come to office every day and sit from 9 to 5 pm? One can save on real estate space and also on time that one loses every day commuting from home to office and back, in endless traffic jams predisposing to traffic thromboses. Instead one can accomplish more when one is working from home, flexibly, 24/7. Even when doctors attend meetings, using Blue Jeans or other applications, one has proof of the doctor’s presence and involvement and the fee for service honorarium is more justifiable. One does not need to spend on liquor (though in some premium advisory board meetings, liquor may be delivered to the doctors’ home) and the meeting gets over on time. And everyone has to participate and share inputs. Even for employees the appraisal is more objective, not based on activities, but on outcomes.

Since China is creating problems for us at the border, finally the Government of India (GOI) has taken cognisance of the fact that we can’t be too dependent on China for active pharmaceutical ingredients (API) and Indian API manufacturers will need to be encouraged to be quality conscious and cost-competitive. The regulator is moving at warp speed to approve CTs (pilot studies on 25 patients) of new drugs for COVID-19 or even drugs approved for other indications, but now being repurposed for COVID-19. Sometimes as for remdesivir the Drugs Controller General of India (DCGI) too has issued an Emergency Use Authorisation (EUA) like the US FDA did. Companies are being innovative in exploring the personal hygiene space, building immunity as a guard, and focused on investing in technology as a platform so that they become less person dependent and more system dependent. Doctors too are realizing the value of being digital. The younger doctors were already technology savvy but now even the older doctors are beginning to learn that they need to adapt to the changing times.

People are realizing the criticality of being fit and healthy because if their chronic disorder is not well controlled they are at risk of developing severe COVID-19 infections and may incur heavy cost or die without even their dead bodies being given to their families for the last rites. This virus has unmasked many hard realities of life. Physical distancing may need to continue for a very long time as we cannot afford another such impact to the already fragile economy. The big players in the industry will survive. The smaller ones will disappear or reinvent themselves and find new avenues (blue oceans). Services beyond the pill will become the norm (though not from a margin perspective) as all try to “touch” (digit = finger) the customer’s emotional retina for enhanced brand recall. Co-marketing and co-promotion alliances will continue. Mergers and acquisitions too. The end objective would be to cut the flab, be lean and mean business. Artificial intelligence, machine/deep learning, big data will not replace doctors but re-place them higher up in the value chain. Data is the new oil and companies will try to leverage on real world data to complement data from RCCTs to justify the value proposition of premium priced patent protected products, but the same can apply to branded generics as well. There may be me-too products but there are no me-too brands. Companies will fiercely compete to be distinct rather than just differentiated.

This positive sense RNA strand virus has brought about some positives too in this negative scenario. No longer can we take things for granted. We need to expect the unexpected. We need to know how to adapt and manage every crisis (Amazon’s valuation has hit the roof; Mukesh Ambani is the 9th richest man in the world) and still grow. Circumstances will make us change but we need to lead change, anticipate the next COVID-19 (not another wave or a new virus), which has become a euphemism for all things that one cannot possibly prepare for, and still forge ahead, instead of whining and complaining and wishing that things would go back to the old normal. They will not. It is not the strongest of the species that will survive but the ones who know how to best adapt to the situation. The fittest will survive (those who are fit for the test). COVIDITY could be a new word born out of the devastation wrecked in our lives. Like co-morbidity, we will have to learn how to deal with covidity, the ability to confront, organize, (be) virtual, intelligent, decisive, iterative, trained and (to learn from) yesterday, to be present to the present and future proof.