Why Women’s Health Can Be a Good Investment

March 11, 2020 - 13 minutes

Since the Hormone Replacement Therapy market was destroyed almost overnight in 2002 after side effects were reported by researchers, there has been a lot of caution about investing in companies with a focus on women’s health. Mary Kerr, CEO of KaNDy Therapeutics and NeRRe Therapeutics, knows this only too well, but has not let it deter her in her quest to bring a treatment for symptoms of the menopause to the market. 

Kerr began her career in the UK big pharma company GSK. She held a range of different roles at the company with a focus on the links between research and commercial strategy in drug development. She was also a founding member of the GSK and Pfizer spin-out company ViiV Healthcare, which is working on a number of treatments for HIV, and she worked there for several years to build the business before returning to GSK. 

In 2015, an opportunity arose to spin out some research from GSK into a new company — NeRRe Therapeutics — and Kerr took the chance to move into the biotech space as its CEO. When NeRRe’s drug candidate NT-814 showed promise for treating symptoms of the menopause through a neurological pathway in 2017, a new spinout — KaNDy Therapeutics — was formed. 

With a recent successful phase II trial under its belt showing a reduction in hot flashes and improved sleep in menopausal women, the company is going from strength-to-strength proving that women’s health can be a good investment. 

What inspired you to move into biotech from big pharma?

In 2015, I made the decision to leave GSK after a long and rewarding career spanning more than 20 years. I truly enjoyed my time at GSK and would highly recommend anyone to work for GSK, or a big pharma with the same ethos to acquire a broad set of skills and experience. 

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I was at the point where I felt that I had achieved what I could. I had a great career at GSK and still had the energy to do something else. I had always wanted to be the CEO of a biotech from early on in my career and it seemed like the perfect time to achieve that goal. 

If you’ve always thought that you wanted to be the CEO of a biotech, why did you stay at GSK for so long? 

I stayed so long at GSK because it is a great company with people who really care about bringing medicines to patients and it offered me fantastic opportunities — I had 13 different jobs during my approximately 20 years there. 

There is another consideration that was important for me as a working mother of three sons, with a husband in an equally demanding job, and that was work-family balance.  As a working mother, I accepted certain elements of the job – long hours and travel frequently, but I felt I had to draw a line on other things like relocating my family to the other side of the world and leaving them there while I spent most of my time on a plane. 

It’s always a balance of finding an environment at work where you feel you’re productive, where you can have an impact, where you can make change, and at the same time, trying to balance stability for your family – it’s not easy. 

What attracted you to NeRRe Therapeutics, what was the impetus to found the company? 

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When I decided that I was going to leave GSK I started to look around and I met Raj Parekh and Kaasim Mahmood from Advent Life Sciences. We clicked and they offered me the role of Operating Partner at Advent and CEO of the portfolio company NeRRe Therapeutics. 

NeRRe had been founded by Mike Trower and another GSK colleague in 2013 and had a fabulous pipeline of gold-plated GSK neurokinin assets, which were ripe for development – we just needed to find the right indication for them. 

I felt that this was something that I could get my teeth into. At the time, I asked myself “Is this company worth me spending the next three or five years of my life on?” because that’s what it is: it’s basically a five-year commitment. When I look back now, four years later, we have found two medicines, which have potential to go all the way to the market and that is very rewarding and humbling.

Why did you decide to spin out KaNDy Therapeutics from NeRRe Therapeutics?

We had a pipeline of neurokinin antagonists in NeRRe. We are developing one of them, orvepitant, a neurokinin-1 antagonist, for chronic cough. We wanted to develop a second, NT-814, a unique dual mechanism neurokinin-1,3 antagonist to treat symptoms of the menopause. 

Back in 2016 when we were raising Series B funding for the company, it was hard to find venture firms who had interest to invest in both indications. Mike Trower and I decided at that time to demerge NT-814 and set up KaNDy Therapeutics in order to attract investors who were interested in women’s health. 

Basically, the NeRRe team and the KaNDy team are one and the same. One team of nine runs both the two companies as two separate legal entities and that gives us flexibility and optionality to raise money, to partner, to do the right thing for each company separately.

Has it been tricky to get funding for KaNDy? 

In 2016, the appetite to invest in the menopause was limited; it wasn’t very fashionable. Commercially, we needed to separate NT-814 into a separate entity to create focus and attract finance from interested, and enlightened, parties.

I think it’s somewhat easier now… In 2016, when we were raising a Series B round for NeRRe, there was very little appetite to do anything in menopause. VCs said things like, “there’s no market,” “there’s no unmet need,” or “I’d have to cut my hand off to get this past my partners.”  That’s why we made the decision to demerge NT-814. Since then, obviously, things have changed somewhat because there’s been a big exit in this space with Astellas acquiring Ogeda in 2017. 

When VCs see an exit and pharma interest, that provides the incentive to fund. There’s still a long way to go, but there’s a lot more momentum in women’s health now. Companies like AbbVie are there with elagolix and Bayer, ObsEva, Myovant Sciences and others are all active in the space, which is great to see. 

Why do you think there has been so little interest in investing in women’s health?

In my opinion, there are a few reasons. One is that the whole industry is rightly focused on a few key areas of unmet need like oncology, immuno-oncology, gene therapy, and rare diseases. In these diseases’ development it’s often quicker, the regulatory hurdles are perceived to be lower, the risk-to-benefit expectations are more tolerant, and pricing is often at a premium. 

In contrast, primary care and conditions which affect millions of people, but are not usually terminal, are not always as attractive because they are associated with heavier development and commercial commitments. 

Specifically with women’s health the industry was bitten badly in 2002 by the Women’s Health Initiative report, which crushed the Hormone Replacement Therapy (HRT) market almost overnight. After the publication that associated HRT with increased risk of breast cancer, cardiovascular disease and Alzheimer’s, despite having benefits, HRT became damaged goods. 

The final reason why women’s health is not fashionable is that often people making decisions do not have an understanding of just how devastating the menopause is for many women. 

The menopause is an enormous volume-based commercial opportunity – the HRT market was one of the original “blockbuster” markets and is still valued at many billions of dollars globally despite declining in volume dramatically since 2002. 

At peak, Premarin, the highest selling HRT had 25% market share and was valued at $2B [€1.8B] in 2002.  In today’s money – that is equivalent to a $10B [€8.8B] medicine. It was enormous at the time. It’s probably why the demise of HRT sent such a shockwave through the industry. To lose something of that magnitude, or to have a significant dent on sales is a seismic hit for any company.

What is it like to be on the board of a big, successful biotech like Galapagos?

It’s an amazing experience. The company is going from strength to strength. Onno van de Stolpe is a complete force of nature. He’s an incredible CEO whose drive, focus and commitment have been the backbone of the success. 

The whole management team works well together, and the board is a great board to be on, especially now with the two Gilead members. It’s been a fabulous experience to be on the board during this huge growth and transformative period. 

The Galapagos success is not a flash in the pan. Onno and his team have built that company over many years. I think that’s the real lesson for us in biotech. Sometimes people think you can go and flip a coin and things happen overnight. Well, no, the big successes take time, effort, persistence and money but are worth waiting for.

Are you trying to apply this experience at KaNDy and NeRRe?

Onno is an inspiration. Looking at him as a model for a CEO, someone who’s totally focused and committed and driven and has a vision for where the company is going, is hallmark of a great CEO. That’s very inspiring to see that up close.

What Onno did with Galapagos was engineer a situation, through the deal with Gilead, to ensure Galapagos will remain independent to grow over the next ten years. That was real strategic leadership. 

It would be a privilege for me to take NT-814 all the way to market and be part of something that could have such a positive impact on the lives of millions of women. If it makes it to the market to treat menopause, it will be treating millions and millions of women every day globally. Therefore, it ideally should be developed in partnership with a big pharma or large biotech who have a global footprint and the resources to really optimize the potential of such a special compound. 

We intend to take NT-814 into phase III and are actively exploring all funding options which include a trade partnership and an IPO.

What are the biggest management lessons that you’ve learned from your career and your biggest mistake?

I think the biggest management lesson is that it is all about teams. The team is everything. I have seen several examples of companies losing good compounds through poor decision-making. A team who makes quality decisions based on knowledge of the science, development, the intricacies of clinical design, bringing all of these different elements together is really key and certainly fundamental in biotech. 

Regarding mistakes, I spent several years driving a long daily commute, which in hindsight was a complete waste of time and energy. 

If I were to have that career time again, I would take full advantage of new technologies to worry less about ‘presentism’, commute less, and spend more time with my family. 

Certainly, in my current team we avoid wasting time and energy on commuting and only have one core office day per week, the remainder of the time we work virtually. That approach has been very beneficial for everyone and productive for the business. 

Why do you think there are so few women in senior management in biotech and pharma? 

There are probably a multitude of reasons, but in my opinion in a family situation it is still predominantly women who make the decision to pause their career, work part-time or not take on a new role due to family commitments. 

If you look at women who are operating at the highest level, they and their partner have often had to make tough choices, which often means one of them stepping back. All couples and partnerships need to make a decision, but finally, it’s usually the woman who’s the one who says, “I’ll stay at home.” 

I follow a high-profile female biotech journalist and broadcaster on Twitter. Around the JPM conference in January, she was saying, “Wow, when I’m travelling people keep asking me ‘who’s looking after the baby?’ How many of the guys out in San Francisco will be asked that question this week?” 

I can completely empathize with that. When I traveled when my kids were younger, everywhere I went, somebody always asked me, “Who’s looking after your children?” How many men ever get asked who’s looking after their children? I know really talented women who have had to step down because somebody has got to be at home. 

Do you think we need to do a bit more to normalize childcare being an equal thing?

Yes, I do and it is changing. I am recounting my personal experience and that of my generation of women in senior roles who are now in their 50s. 

I really do see hope for the future and attitudes are changing – the fact that people can work at home, they can work remotely, there are a lot more technologies now and more progressive corporate cultures that all support more balanced lifestyles. 

I also think that men don’t want the lives they’ve had. They want to share more, they want to be more involved with their children. I see that in young men I know. The attitude has definitely changed. 

How important is mentoring to you? Do you still have mentors yourself and are you mentoring anyone personally?

I think mentoring is important – to have a safe place to go, to bounce ideas around, to learn and to share in the wisdom of others. Over the years, I’ve had formal and informal mentors and still refer to these mentors. 

In biotech, the role of the chairman of the company is very much in that capacity. I work very closely with Andrew Kay, who is the chairman of NeRRe and KaNDy. He brings incredible wisdom and experience. I do make myself available as a mentor, not just to women. I get approached very often by people making the move from big pharma to biotech.

Mentoring is important, but sponsorship within and between organizations is as important for women. It is critical that an aspiring female scientist or leader has someone at the decision-making table who has her back and will actively advocate for her at those key moments when succession decisions are being made at the top of the organization. 

What advice would you give yourself if you could go back in time to when you started in biotech?

I would say to myself [or a young person like myself], “Do things that you are passionate about,” because that makes work sustainable. If you’re passionate about the science and making medicines, giving the energy that’s required, which is a lot, is easy. 

Move around, try new things, sample different cultures and find the culture with the best fit. Don’t make money your goal. Instead, seek out the impact science can have on patients and as yet undiscovered medicines. If you do that, success will follow.


Images via E. Resko

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