After more than 25 years in healthcare, Sanofi's Liz Selby is tired of the long-term focus on incrementalism.
From an early career in frontline nursing to leading portfolios spanning mass market medicines and rare diseases at Sanofi, she has seen the health system from many angles. Now she argues the industry is facing a moment it cannot afford to miss.
“As an industry, we’ve been circling the same problems, slow access, HTA [health technology assessment] reform, PBS sustainability, for years. And we’re still circling.”
While Mark Butler used his address to last week's AFR Healthcare Summit to emphasise careful, consultative progress on HTA reform, Selby cautions that the pace of change is now as critical as its design. The concern is not about the direction of reform, but whether it is moving with sufficient urgency to keep Australia competitive, she says.
Selby argues that the debate needs to shift from process to outcomes.
A sustainable Pharmaceutical Benefits Scheme depends on timely access, predictability and a clear pathway for innovation, says Selby. She frames medicines as a productivity driver rather than a cost centre, enabling faster recovery, workforce participation and reduced hospital burden. In that context, delays carry economic and patient consequences and reinforce the need for a system that actively supports innovation rather than unintentionally deferring it.
What has changed, Selby argues, is the external environment. Global competition in life sciences has sharpened, with governments treating the sector as a strategic economic priority rather than a purely health policy concern.
“The geopolitical environment is shifting fast,” she says. “If Australia doesn’t move with confidence and clarity right now, we won’t just fall behind, we’ll be actively passed over.”
The challenge, in her view, is not diagnosing the problem but breaking a cycle of inaction.
“It won’t be different if we keep applying yesterday’s thinking to today’s problems.”
Selby argues for a reframing of the debate away from system repair and towards productivity and growth.
“This isn’t just a repair job. There are genuine productivity gains on the table,” she says, arguing that a better-aligned system can “unlock value for patients, for industry and for the broader economy.”
Her perspective is shaped by what she describes as a dual lens, working across both high-volume chronic disease and highly specialised rare conditions.
“The policy settings that work for diabetes or cardiovascular disease don’t automatically work for a rare condition affecting 300 Australians. And yet we often design systems as if they do.”
That breadth, she argues, is critical for the industry's leadership, where decisions can inadvertently favour one part of the system over another.
If there is a single idea she returns to, it is the need for alignment across the sector.
“We don’t lack ideas, we lack alignment.”
She points to a broad consensus on priorities such as HTA reform, faster regulatory pathways, sovereign manufacturing, and stronger clinical trial infrastructure, but argues that progress has stalled at the point of collective commitment.
“The ideas exist. What’s missing is the courage to commit to them collectively and the urgency to stop waiting for perfect conditions.”
That alignment, she says, needs to extend beyond industry to government, research institutions and the wider innovation ecosystem.
It also requires a shift in how the sector is framed nationally.
“Life sciences isn’t a health cost centre, it’s an economic asset,” she says, positioning medicines policy as part of a broader agenda that includes skills, research competitiveness and investment attraction.
She is particularly blunt about the geopolitical dimension, arguing it remains underappreciated in domestic debates.
“These are now national security and economic competitiveness issues, not just health policy ones.”
Australia, she says, still has a window to act, but it is narrowing.
“Windows close. We need to act with the confidence that matches the moment.”
Selby frames her focus on execution, pointing to experience from clinical care through to global pharmaceutical leadership, and a track record of building cross-sector partnerships.
“I know how to get people to the table and keep them there,” she says, adding that she will “champion policy that makes a more productive life sciences sector the explicit goal, not a happy accident.”
Her benchmark for success is a system that moves beyond constraints.
“A system that doesn’t just manage scarcity but actively invites innovation. Faster access for patients. And an Australia that other countries look to as a model, not a cautionary tale.”
“The ideas are there,” she says. “Now it’s about alignment and action.”
