Welcome to the Woman of the Week podcast, a weekly discussion that illuminates the unique stories of women leaders who are catalyzing change throughout the life sciences industry. You can check out all our podcast episodes here.
It was a chance observation while sitting in traffic that changed Dr. Mary-Ann Etiebet’s life. She was accustomed to seeing inequities in her hometown of Lagos, Nigeria — but there was something about a teenage girl with a severe skeletal distortion of her legs walking down the side of the highway with a tray of fruit on her head, and holding the hand of a young boy wearing a school uniform, that shifted her view of the world.
“There was just something so inherently unfair about that picture. It planted the seed in me to think about the relationship between health, gender and economic opportunities,” she says.
Etiebet has cultivated that seed into a career-long journey as a healthcare provider, public health official and corporate leader to “change minds and hearts” and solve the many challenges related to health equity.
As associate vice president, health equity at Merck, Etiebet’s role not only involves working to embed health equity across all of the teams of the enterprise, she also oversees Merck for Mothers, now in its 10th year, which addresses the critical issue of material mortality.
“We have set a goal of reaching 25 million women by 2025 and ensuring all of them have access to high-quality, safe and respectful maternity care,” she says.
Since the program began, Etiebet says Merck has reached more than 18 million women in more than 60 countries.
The issue of maternal mortality is personal to Etiebet, who lost a sister-in-law during childbirth nearly 30 years ago, and she is quick to point out her daughter today has a higher risk and probability of dying during childbirth.
“Maternal mortality rates for Black women in the US is increasing. Now Black women are almost three times more likely to die during childbirth due to preventable causes,” she says. “This is not the inheritance that we should be leaving for our children and our grandchildren.”
In this episode, Etiebet shares her inspiring journey in public health, how she is changing hearts and minds around health equity and why she says don’t apologize for excellence.
Listen to the podcast or you can also read the transcript of the conversation below.
Welcome to WoW, the Woman of the Week podcast by PharmaVoice powered by Industry Dive.
Taren: Mary-Ann, welcome to the WoW podcast program.
Mary-Ann: Thank you so much, Taren, for having me.
Taren: It is such a pleasure to have you. You have two decades of experience of improving healthcare outcomes for underserved populations and transforming healthcare delivery at the front lines. Can you tell us about your journey to Merck?
Mary-Ann: Thank you so much, Taren, for the opportunity to share more. I really do feel like I’ve come full circle at Merck. I grew up in Lagos, Nigeria. For those of you who don’t know, it’s a bustling metropolitan known for its traffic jams, but it was also a place or is a place where wherever you go, you see inequities. I remember a specific “aha” moment growing up.
I was actually sitting in traffic, I saw a girl, she was probably about 13 or 14 years old, she was walking down the side of the highway. She had a tray of fruit on her head…she was selling that fruit. But what struck me was a physical abnormality she had. It was a skeletal distortion of her legs caused by rickets which is a nutritional deficiency. But she was holding the hand of a young boy who was probably her brother and he was wearing a school uniform. And I just felt that there was something so inherently unfair about that picture. It planted the seed in me for thinking about the relationship between health, gender, and economic opportunities. And I think at that point, the kind of the foundation of any of us being able to realize our full potential lying in our ability to live our healthiest lives that that seed was planted there.
You asked about coming full circle to Merck. We often say that 80% of health outcomes are the result of the social determinants of health – those social, economic, and environmental factors that we all live our lives in; and I’ve seen that in my own family. My aunts who never finished their schooling got married, lived quite hard lives in the village in Nigeria in which they were born, had limited availability to any healthcare services and they all died on average about 20 years younger than their brothers who were able to leave the village. And all of these things have informed my journey, my journey to medicine and becoming an HIV physician, the paths I’ve taken since then. You talked about working to improve the quality of healthcare at the front lines, ensuring that new healthcare innovations are reaching the last mile.
So now being able to work both for Merck for Mothers where we’re working to ensure that no woman has to die while giving birth and now helping to lead a team that’s working across our company to drive more equitable health outcomes for all of the communities that we serve, it’s both a privilege and an opportunity.
Taren: Well, I am so moved by your story and the impetus that set you on your journey of that girl holding her brother’s hand. And I think you touched on something so important there – health, gender, and economic inequities and how that affects women across the globe. So I think you are doing a yeoman’s job in trying to ride a ship that has long been tilted. There was a lot to unpack there, but let’s start by talking about some specifics regarding your role leading Merck for Mothers and maternal mortality.
Mary-Ann: So, Taren, today, actually, a new report came out from the CDC that showed that the maternal mortality rate in the US was not only increasing, but we’ve seen that the gap between the disparities in maternal health outcomes between Black women and white women in the US, that has also increased. So now Black women are almost three times, that’s 2.9 times more likely to die due to preventable causes. This year over year, this rate has increased, this gap has increased. One of the things that, again, just strike me about this work is how personal it is in my family as well. My brother-in-law’s wife died during childbirth. This was about 25-28 years ago in New York City where I live now, and her daughter now has a higher risk, higher probability, higher chance of dying during childbirth. And that’s not the inheritance that we should be leaving for our children and our grandchildren.
And so it is just so important to be able to work for Merck for Mothers. I think it’s so significant that our company, Merck, first committed 500 million dollars back in 2011 when the initiative was created. Last year, when we celebrated our 10th year anniversary, our company reaffirmed its commitment to this critical issue of maternal mortality and committed an additional 150 million dollars. We have set ourselves a goal of reaching 25 million women by 2025 and ensuring all of them have access to high quality, safe, and respectful maternity care. We’ve done this work in over 60 countries, and since we’ve started we’ve been able to reach over 18 million women. And that’s the result of so much team work and collaboration whether it’s the internal Merck for Mothers’ team or the teams of our over 150 partners and collaborators. But most importantly, and I think this is the lesson that we have learned and are still learning, is we are most impactful when we are able to fully include and integrate the experiences, perspectives, and the solutions that birthing people design and recommend for themselves. And that’s the journey we have been on as an initiative is making sure that we are really listening to mothers and we are helping to catalyze those solutions that are going to make a difference for them.
Taren: That’s an amazing story and I’m so thankful for you sharing that personal history with our audience. And when you think about that gap being three times more likely now that your niece could die versus your sister-in-law, that’s a terrible statistic. And thank you and thank you to Merck for really putting a lot of resources and money where your mouth is to address this challenge. Is it all attributable to social determinants of health or what else should we be looking at when we look at this gap between white women and Black women, and why is that rate increasing so much?
Mary-Ann: Thank you, Taren. You ask the hard questions that everybody asks – what is the thing that we should be doing to solve for this? And the answer is we have to be doing everything because the causes of maternal mortality are multifactorial. We see them manifest in different ways in different places and so it’s really important, one, to look at the data and to look at local data because a lot can be hidden averages. The other thing that’s important to understand is the combination of the clinical factors so what happens within that traditional four walls of the hospital system, but also what happens outside the hospital system in the community and making sure because so many deaths…actually over 40% of the deaths are happening after women leave the facilities. So unless we have strong systems for women to be able to recognize those warning signs and link to care quickly, we’re not going to be able to solve for maternal mortality.
The other thing I would like to emphasize is even when we correct for the other social determinants of health – poverty, education, as well as correct for clinical comorbidities, clinical factors, we still see this racial disparity in maternal health outcomes. And I think that just tells us one thing, that systemic racism is a major player in this. In fact, some studies have shown that about 50% of the disparities is due to the manifestations of systemic racism whether at an individual, institutional, or structural level. And so we need to, one, acknowledge and recognize that; and, two, work to dismantle those processes and systems. And I think it starts again with holding the mirror up to ourselves and making sure that our own internal processes and structures are inclusive and that we are practicing what we preach and hopefully changing norms in the way that we are all part of this healthcare ecosystem.
Taren: Absolutely. Well said. And when we talk about systemic racism and to your point at the community level when 40% of women are losing their lives after, it’s a trust factor and we have to start to rebuild that trust, dismantle as you said some of those outdated systems that are just set up for failure. What are some of the things that we, as women in healthcare, can do to even address this in our own jobs or in our own companies? Is there something that we can be doing better more of or at all if we’re not doing anything?
Mary-Ann: Yeah. Great question because I always do think change starts with you. It starts with the individual and to the extent that, one, we are speaking up where we see these biases unconscious or not to the extent that we are using our power to change these processes and systems to the extent that we are supporting each other when anyone of us gets out there in front and questions the status quo. I heard one collaborator from First Nations community in Canada saying “Creating this spider web of support, we all need that. And I think one of the most important things that we, as women, can be doing for each other is supporting and empowering ourselves.”
Taren: Absolutely. Well said. I couldn’t agree with you more. As part of the other hat that you wear is leading Merck’s Health Equity team and strategy development. So all this is part and parcel of some of the work you’re doing with Merck for Mothers obviously, but let’s talk about how Merck is advancing health equity. And can we talk about the difference between health equity and healthy quality?
Mary-Ann: Yes. So another great question. First, I would say that, one, health equity is not new to Merck. We’ve talked about how we’ve been committed to advancing health equity in maternal health through the Merck for Mothers program, but we have decades of commitments to advancing health equity whether it’s through our philanthropic efforts like the Merck Foundation or the Mectizan Donation Program and all of this work is just building on that legacy. I think what’s different now or what’s evolving now is ensuring that health equity is part of our day-to-day business strategy, how we think about the value that we are bringing to the communities that we serve. It’s part of thinking about how we reflect our values in our business and in the decisions that we are making around what products to bring to market, how to get them to market, how to ensure that they are having the broadest access possible.
And then what I think is really important is making sure that we are helping to drive towards more equitable outcomes. I think we’ve all seen during the COVID pandemic that it’s not enough to ensure that there is broad-based access…let’s have the example of vaccines. Without working within the healthcare system to make sure that you are helping to remove some of those barriers that different people face in order to get vaccinated because at the end of the day we need to be looking at impacts and outcomes as opposed to just inputs and processes.
You asked about the relationship of Merck for Mothers to the broader health equity work and I think, again, we’re always learning, we’re always trying to improve, we’re always trying to increase our impact for good. And I think one of the things that we’ve learned from Merck for Mothers is that you have to have a health ecosystem approach. You have to engage in collaborations and partnerships to think about the journey that patients take in order to live their fullest lives and you can’t do that alone. As a pharmaceutical company, we may not have the right expertise or we may not be the best placed organizations to lead on these solutions, but what we can do is bring people together who have a shared vision and have shared goals and bring the best of what we can offer to creating those solutions that, again, will need to be multifactorial and will need to address so many of the barriers that currently exist in our healthcare ecosystem.
Taren: Absolutely. Thank you so much again for sharing so many great insights. Obviously, as a physician, that has informed your view of health equity. Can you share some examples? I know we started off our conversation of what started your journey down this path, but I can imagine some of the things you’ve seen.
Mary-Ann: Yes. Actually, one of the things that so surprised me… I’ve worked in high-income settings here in the United States, I’ve worked in low-income settings in Sub-Saharan Africa, but I don’t think I was prepared to see what I saw when I walked into the emergency room of a public hospital here in Brooklyn during the first New York City surge of the COVID pandemic. It was frightening and you saw in front of you the breakdown of our health systems that was fully overwhelmed by the pandemic. But when you looked around and you looked at who the patients were that were in those emergency rooms, in those ICUs, they were the people who have been historically underserved, were disadvantaged, and were bearing the brunt of the COVID pandemic.
So I think to your question around what does my experience as a physician bring to this, first of all, as a physician, I try to treat every patient as I would want my mother to be treated and really think about that from that individual relationship, healing relationship that as you mentioned really depends on trust. I was an HIV physician, I’m not currently practicing right now but I remember saying to my patients, “Look, this is tough, but give me three months, trust me for three months, and let’s see how you’re feeling at the end of that three months.” And a lot of times, you have to help people envision what the future can look like if they’re in their optimal state of health, but they have to trust that you can help them get there. And when you break that trust, it’s really hard to get back.
And so in my role now, whether it’s as leader of the Merck for Mothers program or working to advance health equity and embed health equity across the teams of the enterprise, at the end of the day it comes back to what’s that patient thinking, feeling, experiencing, and how can we help them remove the barriers that they face in their journey to live their optimal lives and their healthiest lives.
Taren: Wonderful. Can you share some examples of how you are strategizing and embedding health equity across the continuum at Merck?
Mary-Ann: Great, great, great question. One of the things I want to share is this has been such a bottoms-up phenomenon, the momentum for doing this is coming from individuals and teams across the enterprise. This is not kind of a top-down edict or strategy; it’s really teams taking it upon themselves to innovate and make sure that our solutions are having the broadest and most equitable impact that they can. One example I can share is if you just look recently at what we’ve been doing with molnupiravir, ensuring that it is accessible in low and middle income countries through collaborations around voluntary licensing. It’s also going into manufacturing collaborations, for example, with Johnson & Johnson over their vaccine again to ensure that these solutions can get to as many people as possible.
Most recently, again, another collaboration with UNICEF, which is the UN agency that supports child health, working with them again to make sure that the supply and distribution of molnupiravir gets to the places that it needs to get, gets to the last mile, because at the end of the day it’s about making sure that people wherever they are, are able to access the innovations.
Taren: Wonderful examples, thank you. Obviously, recognizing and working towards health equity is just the right thing to do, but it’s also good for business and it provides your employees with purpose and a drive to be better. Obviously, Merck has been at the forefront of this for a long, long time and you mentioned earlier 500 million dollars and looking to get to with Merck for Mothers 25 million by 2025 – that’s a lofty goal. How do you measure success in your initiatives? Is it by the sheer numbers or…
Mary-Ann: As I mentioned, we’re always trying to do better and hold ourselves accountable. One of the holy grail, I think, for health equity work is to really understand the outcomes across different populations. I will say as a health ecosystem, but more specifically for life science companies, we don’t always have the data and data capabilities to be able to understand that so within the team we are doing a lot of work both investing in data capabilities to understand the impact that our efforts are having across different populations, but also to understand what are the right metrics that we should be measuring or we should be supporting other people to measure because at the end of the day that’s what you want to look at, the health impact that you are having on lives.
I think the other thing to think about in terms of our journey and the capabilities that we’re building is making sure we continue to invest in diversity and inclusion because I do think that is also a big lever that we can use to advance health equity goals when we have people around the table who can share experiences from different vantage points, different perspectives; also, as you mentioned, have that drive to think about the health disparities that we see in the communities that we live in and we work in that we serve. That’s where the magic happens; that’s where we ask ourselves tough questions; that’s where we challenge ourselves; that’s where we innovate. And the innovations that are surfacing, they benefit everybody. They help to improve health outcomes for everybody.
Taren: I love that you called it “where the magic happens” and that it doesn’t happen in a vacuum, it happens through collaboration. It happens through having tough conversations and DE&I, however you want to call that, is top of mind for most companies now. Are you seeing that some of your maybe younger staff members are finding their voice and speaking up in ways that they hadn’t before?
Mary-Ann: You know, Taren, it’s almost like you read my mind. One example I was thinking about sharing happened with some of our marketing teams where I mentioned our work around health equity is embedding this in our day-to-day business. And so you for marketing teams, how they’re thinking about how they are reaching populations or communities that maybe they hadn’t previously reached before, or they had not been reaching in the right way. And so that’s the problem statement, how do you reach these communities where you may not have the expertise or the way that you’ve been doing it has not been effective or is not respectful.
It was actually some of the young members of the team, some of the members of our employee business resource groups that raised their hand and said, “Look, I think this marketing campaign actually could be perceived as offensive in the population that’s being targeted. I’m not comfortable with this.” This was a young person and I think it speaks to the ethos set at Merck that she felt comfortable saying that, and as a result of that there’s now systemic change. There are new processes that have been put in place. There have been comprehensive kind of analysis of internal capabilities as well as partner capabilities to be able to market effectively to different communities.
Taren: Look what a difference one voice can make. That’s amazing.
Mary-Ann: Yeah. And there are many, many, many, many other examples of that.
Taren: And it does speak to Merck’s ethos, as you’ve said, in terms of allowing that kind of breathing room, allowing somebody who has a different opinion to be able to raise that level of discourse in conversation. And kudos to the organization for recognizing that it was something that needed to be addressed. So that’s great. Let’s switch text just a little bit here. I know you serve on several boards as well as are the private sector representative on the World Health Organization or WHO; why are these engagements important to you? You have a full plate already so why give yourself to these other organizations as well?
Mary-Ann: I think that they’re so important because often the private sector and especially the life sciences industry, we’re often painted with a negative brush. We’re often perceived as the bad guy in the situation. And I think that you need to be at these tables in order to share what you are doing from a very detailed and specific perspective, not from a stereotypical or perceived perspective. I know because folks have asked me why did Merck invest in maternal mortality, you don’t have any products in this space; 500 million dollars is a lot of money for PR or window dressing. And so I’m able to answer those questions face-to-face and change perceptions that other stakeholders in the healthcare ecosystem have about the life science industries and how we can contribute and work together to solve for these global challenges.
And I think the other thing I would say is that again oftentimes or historically our contributions may just be again considered as writing a check. I don’t want to say it’s the least important contribution that we make, but it’s definitely not all of it. I think in Merck for Mothers we have dozens of colleagues across the enterprise that are providing their technical expertise to our partners. We co-design, co-implement, co-evaluate these programs with our collaborators and so they see us there at the beginning, they see us there in the middle, they see us there working to solve for the challenges, and they see us there at the end. And I think it’s that longevity of collaboration staying the course, that’s what builds the trust and that’s why it’s important to be part of these groups and platforms that are doing this work.
Taren: Absolutely. And thank you for sharing that. And I have to ask, nobody had the nerve to say to you directly that this is PR or a window dressing, did they?
Mary-Ann: Yes, many people. But it’s good because, one, I’m glad they asked the question because obviously they were thinking about it; and, two, we were able to have a discussion and for the most part people came out of that discussion thinking something different.
Taren: I’m sorry, but does it not still surprise you the ignorance that you hear sometimes? I’m very impressed that I would’ve lost my cool to be quite honest.
Mary-Ann: I think that also the fact that I have had so many different experiences or types of role in the health system – I’ve been a provider, I’ve been a public health official, I’ve worked for the public sector, so I also understand some of those cultural dynamics and some of the ideology and where that’s coming from. What I will say is people may be thinking about what happened 20 or 30 years ago may be again painting the whole industry with one brush. And what we have to do to change minds and hearts is to actually be out there in a proactive and in an offense position as opposed to a defensive position because it’s when you are collaborating that’s when you change the hearts and minds.
Taren: Well, I think you’re a perfect ambassador for changing minds and hearts. So, again, thank you for all the good work you’re doing on the ground floor, as you said, at the beginning, in the middle, and at the end because you’re touching it across the entire enterprise and at all these different levels and having that voice of reason and having that voice that is backed by the chops that you’ve got, the bonafides, you come at it from a place of knowledge and passion, so thank you. Obviously, you’ve reached a very senior level at Merck. Can you share some advice with other women who may want to progress their careers to get to that senior level? What are some things that worked for you?
Mary-Ann: Do you remember the Sesame Street song “One of these things is not like the other”?
Taren: Yes, Ma’am.
Mary-Ann: So I think that has served me well – be the IT guru in a room of physicians. Be the physician in a room of consultants. Be someone who has done the work at the front lines in a room of funders. I think that when you are able to bring unique and different perspectives and experiences to the table, your contributions have more weight, have more value. It’s an advice I give my sisters, I’m like go outside your comfort zone, go cross geographies or cross industries and you’ll really understand how that totality of experiences can catapult your career.
But the other thing I also say is listen to your gut. There are more neurons in there than in your brain. And don’t do something because you think it’s what you should do, it’s what the expected next wrong of the ladder is or what the expected path is. Do think about what’s going to be meaningful and fulfilling to you and I do think that the rest will come because when you are fully committed to the work, you do your best work and people see that and people recognize it.
Taren: That’s great advice. And I have never heard it put that way “Your guts have more neurons than your brains, so listen to your instincts” – that’s wonderful. So, conversely, what is some of the best leadership advice you’ve ever received?
Mary-Ann: So many or so much. I think there are two things: one, come prepared, be ready, don’t apologize for excellence; and I think the other thing is focus on your team; build, take care, empower your team. If you get that right then everything else will take care of itself, and I think it’s about investing in people so whether it’s investing in the people on your team, whether it’s investing in the people that we serve through our, our different programs, human capital is a renewable resource and so that’s what’s going to give the dividends and I love being able to see people grow and see people do things that they didn’t necessarily think that they could do.
Taren: I love that. And I think that every woman should have “Don’t apologize for excellence” printed on a t-shirt and wear it everywhere they go.
Taren: That is awesome. In terms of your own career, did you have a mentor or a sponsor or a champion?
Mary-Ann: As I mentioned, I think so many throughout the years. What I will say though is it’s only recently that I’ve actually felt comfortable reaching out to mentors or being very specific about seeking or asking for sponsorship. And I wish I didn’t have that hang-up, I wish I’d come to that realization earlier. And what I would say is that for the most part people want to help people, but they can’t read your mind and so it really is your responsibility to reach out and share what it is that you hope to achieve.
Taren: Absolutely. That is, again, great advice. Well, I could speak with you for another hour; we are nearing the end of our time and so I have to finally ask you about an accomplishment or a WoW moment that either shaped your career or changed the trajectory of your career.
Mary-Ann: So, Taren, I’m going to answer like both if that’s okay because it was hard for me to think through this, but I actually appreciate the opportunity to kind of dig deep into the question. And so I would say a WoW moment was the 1999 AIDS conference, first international AIDS conference. It happened in Durban, South Africa. I was a med student at the time and I had done some research in a township called Khayelitsha outside Cape Town in South Africa. And if you remember during this time, this was the time where people were saying that antiretroviral therapy would not be feasible in Sub-Saharan Africa because people either wouldn’t be able to take it appropriately because they didn’t have watches or clocks or that they wouldn’t want to take it because it may further stigmatize them. And I thought who are we to speak for people and was able to interview pregnant women who were receiving…this was the first program of anti-retrovirals in Sub-Saharan Africa who were receiving at the time AZT for the prevention of mother-to-child transmission.
And I just did a simple knowledge attitude practice survey and I was presenting those results at the conference. The conference was opened by Justice Cameron, the first openly gay public figure in South Africa. And in his opening remarks, he shared some of the findings from my research, no one listening would have known but I recognized some of the data points that he was referencing and I thought, “Wow, this work is making a difference, making sure that women’s voices are surfaced.” And we create platforms to amplify what they are thinking, what they are experiencing, what they want – that is important work and it’s having an impact, it’s affecting policy, it’s affecting norms. So that helped me on my journey. It gave me a lot of fuel to do the work. In terms of something that shaped my trajectory, it was actually again another research opportunity that this time was only enabled because I was able to get an independent research grant from a pharmaceutical company and this was while I was a fellow. And without that funding support, I would not have been able to do my own independent research which obviously helped with the next part of my career and getting an academic faculty position.
And so, again, coming back full circle, we as a life science industry, we need to invest in supporting a diverse pipeline of healthcare workers – whether they be physicians, nurses, clinical scientists, researchers, clinical trial support staff; those investments that companies make in supporting young talent make a difference. I can categorically say if I hadn’t had that funding support to do that research, I wouldn’t be sitting here right now. And it comes back to that full circle of now being in a privileged position to work with colleagues across Merck to further advance efforts that our company is doing to support a more diverse pipeline of clinical scientists and healthcare workers.
Taren: Well, thank you so much for sharing both of those extraordinary stories and I’m so glad you got the funding. When you referenced back to 1999 and that first HIV conference, I immediately went back in time and I remember those conversations. I remember reading all of that same data and I think to now where we are in 2022, look at how far we’ve come because of efforts of women like you, of doctors like you. So thank you for doing all you do to raise the discourse and raise the EQ of our industry to address these really tough challenges. As I said, I could have spoken to you for another hour, but I want to thank you so much for sharing so much of your personal stories and so many great insights. You are like a sound clip machine; I have pages of notes here. It’s been marvelous; thank you very, very much.
Mary-Ann: Thank you so much, Taren, for the opportunity and, again, an honor to be part of the family of WoW podcasters.
Taren: I love that. Thank you.
Mary-Ann: Thank you.
Thanks for listening to this episode of WoW, the Woman of the Week podcast. For more WoW episodes, visit pharmaVOICE.com.