“If you could see inside my head, you would see my thoughts flip between innovation, performance and trust pretty frequently,” says Deborah Waterhouse, CEO of specialist HIV company, ViiV Healthcare.

It’s a juggling act many CEOs will recognise - driving a strategy for long-term growth that creates value and builds trust for all stakeholders.

ViiV Healthcare develops medicines to treat and prevent the spread of HIV. Its singular purpose is to ensure no person living with HIV gets left behind. In pursuit of that mission, the company collaborates with a comprehensive list of governments, NGOs and businesses to make those drugs available and accessible worldwide. It also invests heavily in innovation.

But as with all businesses, that innovation pipeline must be economically viable.

“So my second priority is performance,” says Waterhouse. “We're not running a charity, we're running a commercial business and we have to make sure we perform extremely well and deliver profit to our shareholders so they will keep investing in us and the work we do.”

The commercial nature of pharmaceutical firms has often been a source of public criticism and media negativity. But Waterhouse says the global response to the COVID-19 pandemic has helped reframe the debate and demonstrate the value and importance of a successful pharmaceutical industry. However, she doesn’t take for granted that such positive sentiment will endure without effort to maintain trust.

“You have to have the trust of external stakeholders, from patients, charities and communities to other global organisations focused on ending the epidemic or ensuring innovation is available across the world.”

But there remains a careful balance to be struck in protecting both access to affordable healthcare and intellectual property and commercial interests. For some stakeholders, the question of trust depends upon that balancing act.

For parts of the world such as sub-Saharan Africa, ViiV works with external partners and generic drug manufacturers to establish strong agreements that ensure medicines are accessible and affordable for those countries that need them most. These agreements help to ensure ViiV’s business model, which is based on flexible pricing and sustainable access, works. This allows ViiV to continue to be profitable and invest in further research and development.

“We have to be bold, try new things and accept some risk,” says Waterhouse. “Because if all you do is think about risk then you wouldn't do anything. You wouldn't be audacious, you wouldn't think big, and you wouldn’t believe you can end the HIV epidemic.”

ViiV’s efforts are not only focused on innovation in medicine but also on addressing human behaviour and its impact on the effectiveness of those innovations. 

“If you become HIV positive today, your life expectancy is the same as somebody that's not living with HIV,” says Waterhouse. “In the 1980s, it used to be that life expectancy from diagnosis to death was about 18 months. But if you are taking effective medication, you can expect to live a long life.”

Waterhouse says ViiV works closely with patients, communities and charities such as The Elton John AIDS Foundation and Terrence Higgins Trust to tackle the persistent societal stigma that can prevent people from being tested and exploring their treatment options or sticking to their drug regimen.

ViiV is also working in creative ways to reshape the narrative around HIV. Waterhouse notes that imagery we see today of people living with HIV can still be quite bleak and negative. So ViiV worked with stock photography agency Shutterstock to create a bank of authentic stock images showing real people living happily and thriving with HIV.

The importance of collaboration is a point Waterhouse emphasises.

“Anybody that thinks they can deliver an amazing outcome alone, certainly in the world of healthcare, is kidding themselves. We've got all the right partners to make sure that together we can be successful, from academic partnerships to charities and communities.”

Drawing upon the skills and expertise of those partners is critical to success. But so is developing in-house talent. Waterhouse says a lot of recruits are attracted to ViiV because they want to be part of a purpose-led organisation. However, she says ViiV still encounters competition for talent in areas such as technology and data science.

Technology is an area Waterhouse is taking a greater personal interest in.

“As a CEO you've got to make enough time to step back, think, reflect, consider and learn,” she says. “You can't just be in the day job.”

Off the back of such reflection comes an admission that Waterhouse feels lucky to do the role she does.

“I get to do something I love. I get to make a difference, working side-by-side with incredible people to change the trajectory of a terrible disease.”