Partnering for health equity: ALJ Health’s Akram Bouchenaki

Healthcare is approaching an inflection point: both in the level of disparities and in the potential to address them. Disruptive technologies across disciplines (from new medicines and therapies to rapid advances in AI and machine learning) may offer tantalizing prospects for treating more people, more effectively, and more affordably than ever before. And yet, disparity gaps continue to widen.

ALJ Health, part of Abdul Latif Jameel—an independent, globally diversified family business with roots in Saudi Arabia focused in several sectors such as mobility, energy, financial services, and healthcare—seeks to bridge these gaps. ALJ Health combines science and business, regulatory expertise and patient centricity, and exploration of emerging trends with implementation across existing and emerging networks.

Dr. Akram Bouchenaki, the CEO of ALJ Health, sat down recently with McKinsey’s Ahmed Youssef and David Schwartz to discuss global trends in health equity—and new possibilities for solutions. An edited version of the conversation follows.

McKinsey: Are disparities in healthcare more severe than ever, or are healthcare disparities an evergreen challenge—and perhaps even the norm?

Akram Bouchenaki: The healthcare disparities we see today are acute. If this were a patient you were trying to treat, right now we’d be in a crisis phase. These disparities have always existed, but the pandemic has made them even more pronounced and visible. Look at a simple example: the world average of COVID-19 vaccination is above 60 percent; in Africa, it is about 15 percent.1

But disparities are also chronic. Looking at healthcare spend between the United States and an African market, for example, you see magnitudes of difference. You cannot expect to get similar access to care in a country that is spending $10,000 per person per year on healthcare as in a country or region that is spending $250 per person a year. And the truth is, you also see these differences within countries.

The COVID-19 pandemic has shown, starkly, that we are one world. We are a small planet, and we absolutely cannot think in silos. Combating disparities in access to care is the moral thing to do, and the good thing to do.

We are a small planet, and we absolutely cannot think in silos. Combating disparities in access to care is the moral thing to do, and the good thing to do.

Health equity is also a driver for growth. For instance, studies have shown that in countries with a high prevalence of HIV, such as South Africa, the economic impact of treating a population to control their HIV infection outweighs, by far, the cost of treatment. From a purely economic standpoint, it makes much more sense to have a healthy, productive population than to have a population that is suffering from disease.

McKinsey: What is your conception of “health equity”—and how do you advance it?

Akram Bouchenaki: The World Health Organization frames health equity primarily in terms of eliminating avoidable differences in healthcare among populations. We fully subscribe to that; we believe that healthcare is a basic human right. We strive to make this a reality by giving everyone the chance to access effective healthcare.

One aspect of that is capability building, which we strive to make an integral part of what we do. We try to address and understand the needs of healthcare professionals and the reality around healthcare infrastructure. As an example, we have introduced a Japanese heart valve treatment technology in Saudi Arabia. We not only brought the technology to Saudi Arabia, but we also partnered with the Saudi Arabian Ministry of Health to train heart surgeons to use the technology.

Another dimension in achieving health equity that is very important to us is affordability. As healthcare systems strengthen and develop and insurance schemes become more prevalent, we need to make sure that people are still able to afford the solutions that are made available to them.

At the end of the day, we are ultimately thinking about patients. When people are paying from their own pocket, they have to make difficult choices about what examinations they need to undergo in order to get to the next level of their treatment journey. These exams can be very expensive from the patient’s perspective. For us, patient centricity is absolutely fundamental.

McKinsey: How do you scale patient centricity and maintain decision-making discipline as you consider where, among a multitude of options, to focus and invest?

Akram Bouchenaki: We are fortunate to have a very strong network. The Jameel family has a long-standing approach to public health, including through Community Jameel, the independent global organization the family established to advance science to help communities thrive in a rapidly changing world. For example, in 2018, Community Jameel and the Massachusetts Institute of Technology cofounded the Jameel Clinic, which is a research center in the field of artificial intelligence and health sciences. Similarly, in 2019, Community Jameel and Imperial College London cofounded the Jameel Institute to look at novel data analytics to reduce global risks of preventable disease. So there is a flow of thinking, if you will, that underlies the creation of ALJ Health. We take our inspiration and vision from these initiatives.

It also helps us to focus. For one, we look at the macrotrends of the “big diseases”—the very fast growth of certain pathologies, particularly chronic disease in developing markets, such as cancer and metabolic disorders. We look at what is going on in the infectious-disease space. We look at mother-to-child transmissions and infant mortality, which are still issues in many of the countries we operate in. And we also look at what is going on in the innovation space and try to find or match solutions to the unmet medical needs that we assess.

Generally, what we see happen is that innovator companies want to go direct in their core or home market, whether it’s Europe or the United States. We can give them an expanded footprint. That is how we have designed our model so far, which is not to say that the model cannot evolve.

McKinsey: To what degree does the model depend upon other players in the healthcare ecosystem?

Akram Bouchenaki: Health disparities are absolutely addressable, but one organization cannot fix things alone. Everyone needs to build together. We’re trying to bring our brick to this building. And brick by brick, I think, together, we will be able to address disparities. But there is no question that it takes several groups working together, including investors.

Take Egypt, which had one of the highest prevalence rates of hepatitis C. I was involved in discussions that came all the way from the top of the political infrastructure. The country launched a huge campaign to address the challenge of hepatitis C infection in Egypt. Fifty million people were tested for hepatitis C, and four million people received treatment—a massive effort and absolutely unheard of. Today, Egypt is on its way to completely eliminating the disease.

Another example, again in the field of infectious disease: Rwanda has implemented policies to address the HIV epidemic. They were able to reach a point where more than 75 percent of the adult infected population has undetectable disease, which means they will not transmit to more people, and therefore there is a path to eliminating the disease. This is to the credit of the country.

The name of the game is partnerships—establishing as many partnerships as possible at different levels for training purposes, for funding, for screening campaigns, for awareness campaigns, for media support, and more. We have been fortunate in our year and a half of existence to have already secured a number of great partnerships with innovative people and companies.

We have worked, for instance, with a cutting-edge handheld ultrasound device company that can basically turn your phone into an ultrasound machine. For just a few thousand dollars, a healthcare provider gets an ultrasound device with an AI-powered app that helps guide them and that can be used as a training tool for medical students—remarkable. We absolutely love this opportunity that will democratize access to ultrasound imaging. Just imagine the benefits for people in remote locations and in different clinical settings.

Another example is a partnership we have formed with a company that is developing oncology-specific products. It is aiming to make oncology treatments highly affordable, at a fraction of the cost of what one would expect from innovative products. That was very appealing to us. We are planning to introduce their products across Africa, the Middle East, and potentially more markets.

McKinsey: Given that maintaining human safety is paramount, are there changes to regulations that could help?

Akram Bouchenaki: Our industry is a highly regulated one—and for the right reasons. However, if I look at our territories, countries would benefit from more harmonization and speedier reviews.

Right now, unfortunately, lengthy administrative processes are affecting patient access to therapies in many cases.

That said, we have also seen a lot of countries make tremendous progress to speed things up. We have seen it in Europe with the European Medicines Agency; you file only once, and you have access to all these markets at the same time. In Egypt, products can get authorization in record time to address the urgency of the situation. In the United States, the FDA authorized a new vaccine in a few weeks. All of this indicates what is possible. We are seeing regulatory efficiencies in more and more countries.

McKinsey: Are there demographic trends you pay particular attention to?

Akram Bouchenaki: We are fortunate to operate across a very broad territory, which is interesting and challenging at the same time. So we see very different demographic trends between countries; we pay close attention to all these trends and try to tailor our portfolio accordingly.

We have countries with an aging population and with the corollary diseases that follow, including cancer and other chronic conditions. We also have countries in our territories where the population is very young and where birth rates are still very high. In Niger, for instance, birth rates are above seven per woman. In countries like this, issues of infant and maternal mortality are very important. So, for example, we are introducing a great Japanese technology that allows for fetal monitoring remotely. It is a doppler-based technology that allows a pregnant mother to monitor heart rate and contractions in utero, and then to transmit, with only a 3G signal, the information to a healthcare provider or midwife, who will tell them if everything is all right or if they need immediate health attention.

In some areas, metabolic disorders are a huge issue. There is also an increased prevalence of certain rare genetic disorders in some countries. For instance, in the Middle East, there are higher prevalence rates of certain muscular dystrophies, such as Duchenne muscular dystrophy. Not every genetic disorder has a treatment, but when there is one, we try to find it and see if we can help.

These are not universal demographic trends, but this is how we look at the world and adapt our pipeline.

McKinsey: How do you measure the impact of your work?

Akram Bouchenaki: We look at classic metrics. We look at what the epidemiology looks like as we bring in a product, technology, or drug. We want to make sure to touch as many people who need the service or the drug as possible. We work with healthcare authorities and healthcare providers to get their feedback and understand their needs, as well. And we also pay attention to patient groups, which are getting stronger and more empowered from information.

Of course, with time, we will continue to refine our approaches. And doing so will help us work with our partners upstream, meaning the companies that entrust us with their technologies, to provide them with that feedback and assessment.

McKinsey: What excites you about the future?

Akram Bouchenaki: It’s all very exciting. We are in a unique time in the history of medical science. Right now, there is an incredible conjunction of chemistry, biology, cellular therapy, and artificial intelligence. The work that has been done over the past two decades in understanding the human genome is now yielding results, and the understanding of new cellular pathways to disease is a reality. Small companies and small research labs are hugely productive these days.

We are seeing immense strides, and we are fortunate to have access, through our place in the ecosystem, to identify incredible opportunities. Look, for example, at the development of robotics, telemedicine, and the incredible advances that are taking place in diagnostics, such as liquid biopsies and other screening tools. We want to be the bridge to make incredible advances available and affordable to the “majority world,” as we call it. We see markets that have not yet met their massive potential—where there are still large, unmet medical needs. One can think of India, certainly, and many African markets, which would greatly benefit from us having a strong and sustained presence.

I also hope to replicate the success that ALJ has had, more broadly, in other industries. The company has developed a remarkable recipe. My objective is to leverage what has been done by ALJ and to deliver equivalent success. The sky is the limit when businesses, governments, technologies, and people converge.

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