The ethical dilemma of salespersons in times of COVID-19

I found this post in my drafts. I had written it on March 16, 2020, but for some reason not posted it. It was the beginning of the lockdown in Turkey to slow the spread of the novel coronavirus in this country. My thoughts from then are resonating with the situation we are facing now; in the second lockdown (light version). Only the case numbers are different. Higher of course. And the pandemic has meanwhile reached virtually every corner of the planet. I chose to leave the text as it was when I first wrote it, only making some additions for context in italics from today’s perspective, 9 months later.

Istanbul, March 16, 2020:

As I am spending my first day in my Istanbul home office – along with wife working from home and my three kids who are switching to online schooling – my thoughts turn to our colleagues whose work cannot be so easily done from their home: I am referring to the pharmaceutical industry’s field force of medical sales representatives and their detailing visits to doctors to promote our medicines.

Here in Turkey most of these promotional interactions of the field force still take place face to face with doctors. Even though we can safely assume that every doctor has a smartphone, doing all promotion digitally is a change that just doesn’t appear feasible in Turkey within a matter of days. Neither the medical representatives nor the doctors are used to it. In the majority of hospitals, which is public, we cannot expect the physicians to have adequate computers with webcams and video conferencing software that would be required to promote medicinal products remotely. In addition, as opposed to a face to face visit, we cannot know if the physician is by himself or seeing patients or having nurses, secretaries or other people nearby who shouldn’t be present, because the Turkish Promotional Regulation for Medicinal Products for Human Use prohibits promoting medicines to anyone except doctors, dentists and pharmacists.

But now that Covid-19 has reached most countries on earth (as of today, 16 March; 148 countries or according to the WHO Situation dashboard), now that European countries are putting in place curfews and even Turkey with currently „only“ 47 positively tested Covid-19 patients is closing almost everything except supermarkets, pharmacies and gas stations as of today at midnight; against this backdrop I am seriously asking myself if it is actually ethical – in terms of the pharmaceutical industry’s responsibility to society as well as our responsibility for the well-being of our employees – to still have any face to face promotional interactions with HCPs at all.

But each pharmaceutical sales representative visiting physicians in different hospitals or family practitioners centers – the clear virus hotspots – is at risk to infect herself and to possibly act as a super-spreader by getting infected with Coronavirus in one place and then transmit it – for days before any symptoms become apparent – to other people, their family members, other physicians or patients. In times of social distancing and home confinement the pharmaceutical industry’s field force is highly mobile between infection hotspots…

Isn’t is the ethical imperative of this hour to proactively suspend any face to face field-based activities in all countries where there are Covid-19 cases, or at least in all countries where governments have put measures of social distancing in place (like school closures, closure of most restaurants etc.)?It’s not only about protecting the wellbeing of our field force employees; it’s about the responsibility of the industry to protect society (and ultimately humanity) at large.

Today I read that Pfizer is restricting all field promotion to digital communication channels – in the U.S. But what about other countries? What if the pharmaceutical industry’s field-based associates become one of the reasons that a country that is not yet heavily affected by Covid-19 turns into a country that is? I think it’s time for the industry to be proactive and self-restrict face to face engagement with physicians out of a sense of responsibility for our employees, society and the wellbeing of all people – even before governments impose restrictions on in-person promotional interactions.

December 12, 2020

We meanwhile have over 1 million 800 thousand people infected with COVID and over 16 thousand deaths, if you believe the official numbers. (Which you might choose not to do, because of the semantic games and lack of transparency in reporting we have experienced since July this year. )

As I wrote above, at that time in March, face to face interaction with healthcare professionals had not yet been restricted. It was in fact stopped by decree from the ministry of health, soon after and only allowed to begin again in the middle of June with restrictions.

We didn’t know it at the time, but a few months later, after face to face visits had been forbidden and all promotion was done remotely via phone or over the internet, Turkish doctors were surveyed for their preference – digital or face to face promotion – and a clear majority expressed an unambiguous preference for traditional face to face interaction.

Throughout the lockdown period in the first half of the year, we learned to work and communicate over Zoom, MS Teams and FaceTime. We gathered experience and got better and better over time. The shift to working more via digital channels got an unexpected boost through the COVID situation and out of the necessity to adopt and carry on we were forced to go through changes in a matter of weeks that would otherwise have taken months if not years.

When direct personal visits to doctors were again allowed in late June, we permitted our field force to go back to the field- with precautions and severe restrictions of course, but kept a mix of digital and traditional face to face interactions.

Currently in-person visits to doctors are still allowed even as the COVID-19 numbers have dramatically increased and the country is going into a second lockdown. Our field colleagues have the choice to work from home and interact with the doctors remotely; but very few of them do because they know the doctors‘ preference for the direct interaction and deem their work to be much less effective when done remotely. Less effective meaning they will earn less money. Which makes them put themselves under pressure to don their face-masks and go out and visit the doctors personally in those hospitals and family practitioners centers where it is allowed.

I still stand behind all that I wrote in March about the ethical obligation of my industry to pull our people from the field well before the government forces us to do so. However today I would stress even more our ethical obligation to take away the dilemma we are putting our field force in every day to decide themselves if they want to risk their health (and in some cases their lives) in order to do their job. Now that the vaccines are here and it is only a matter of months (definitely not years) until we get everyone vaccinated, shouldn’t we have the solidarity with our employees to take the economic pressure off their shoulders and make them work from home, even if it means business results will go somewhat down further? It won’t put us out of business, not this industry. And the engagement and commitment of our employees is likely going to help our business „hit the ground running“ when we emerge from the crisis some time in 2021.

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