Equity starts with listening: putting community voices at the centre of access
pharmafile | September 21, 2026 | Feature | |Â Â Gilead SciencesÂ
This article was developed and funded by Gilead Sciences Ltd.
By Peter Wickersham, Vice President and General Manager of Gilead Sciences, UK & Ireland
1. From your perspective, why is community engagement more critical now than ever in closing the gap between innovation and real-world access?
Peter Wickersham (PW): Community engagement has always been critical, because innovation only matters when it reaches people in ways that are trusted and practical. It matters now more than ever because science has moved at real pace but, too often, access depends on whether the system understands people’s lives, not just their clinical profile.
The gap between what’s clinically possible and what’s accessible isn’t a scientific problem – it’s a question of how well the system listens and flexes to provide care where people access services.
England’s hepatitis C elimination initiative is a good example of this. It was evident that the goal of elimination could only be tackled by working and partnering in fundamentally different ways, recognising we needed to bring the services to people, rather than wait for them to engage with care. This meant collaborating with all stakeholders involved, including drug treatment centres and prisons, at the very start and co-creating the programme with them.
Community-led approaches aren’t a nice-to-have alongside innovation, they’re what close the gap and achieve the public health outcomes we’re all striving for.
2. What are the most visible inequities you see across under-represented communities, and what do these lived experiences reveal about where the system is falling short?
PW: The most visible inequities I see are the ones that leave whole groups, particularly underrepresented communities, feeling invisible to a system meant to serve them.
For example, one in three people living with HIV in the UK are women, yet they are still more likely to be diagnosed later than men.1 Similarly, black women are disproportionately affected by triple-negative breast cancer than white women and people from ethnic minority communities, because they are more likely to receive a late-stage diagnosis.2,3
Taken together, these examples suggest a broader challenge within the system – one that does not always fully reflect the diversity of patient needs and experiences exacerbating the health inequalities we all want to tackle.
3. Can you share examples of where community-centred approaches have meaningfully improved access or outcomes, and what made those initiatives successful?
PW: The examples that stand out are those built with communities, rather than for them. Hepatitis C is perhaps the clearest example. By bringing together the NHS, drug treatment services, prison services, charities and peers with lived experiences, whose insight into the realities of accessing care was critical, a collaborative model was developed that meets people where they are and removes many of the barriers that previously prevented them from engaging with services. Through partnership working and more flexible care pathways, testing and treatment can now be delivered in trusted community and prison settings, making care more accessible and improving engagement. This model has helped at least 79 drug treatment centres treat over 17,500 people – putting England on track to eliminate hepatitis C by the global target of 2030.4,5,6
Another example is Martha’s Rule, which arose from one family’s fight to be heard about their daughter’s deteriorating condition. It now operates in every acute hospital in England, has recently been extended to all maternity services and has already prompted hundreds of potentially life-saving interventions.
Wherever it shows up, the pattern is the same: progress happens when the people closest to a problem help design the solution.
4. What are the biggest barriers preventing the system from embedding community insight into decision-making, service design and delivery today?
PW: The biggest barrier is timing. Community insight is often still gathered at the end of a process to validate decisions already made, rather than at the start to shape them.
There are signs the system is waking up to this. The NHS’s 10 Year Health Plan has emphasised the importance of putting the patient voice and neighbourhood-level care at the centre of its vision. However, the plan has not revealed detailed proposals on how communities can influence decisions beyond simple mechanisms such as digital feedback channels.
This is exactly where the gap between intent and implementation opens up. Recognising that gap is the easy part; closing it means giving people a real seat at the table early, not as an afterthought.
5. Looking ahead, what practical steps can each part of the health ecosystem take to better listen to and act on community insight?
PW: In my view, there are three practical steps that would make the biggest difference.
First, policymakers need to involve under-represented communities earlier in strategy development, and be transparent about how that input shapes the final decision.
Second, health systems should engage with community organisations as long-term partners, not a tick box during consultation.
Third, build pathways around how people actually live and access care outside of the traditional service settings of GPs and hospitals, rather than asking people to fit around the care system.
We’ve seen what’s possible when the whole system aligns around a shared goal in hepatitis C. We now need to apply our learnings of this people-led approach to HIV prevention: services delivered at a community level, where underserved groups are more easily reached and re-integrated into care, ultimately supporting our quest of ending new HIV transmissions by 2030.
6. Ultimately, what would a truly community-shaped access system look like, and what would it mean for the people who rely on it most?
PW: It would be a system where people and communities feel seen and heard much earlier – designed around real lives, not idealised patient pathways. A truly community-shaped system would then apply that same patient partnership principle everywhere. Critically, it would mean progress is judged not only by what the science makes possible, but also by who can actually benefit.
We have the knowledge to build that system. What it required now is the collective will to put communities at the centre to enable the system to evolve and adapt, as well as meaningfully address access issues and health inequalities.
UKI-COR-0192 | July 2026
References:
- UKHSA. 2024. New HIV diagnoses, AIDS, deaths and people in care by country and region tables.
- Plasilova ML, et al. Features of triple-negative breast cancer: Analysis of 38,813 cases from the national cancer database. Medicine (Baltimore). 2016. Last accessed: July 2026.
- Limb M. Black women in England are at greater risk of late cancer diagnosis than white women. 2023;380:p211. doi:10.1136/bmj.p211. Last access: July 2026.
- Gilead Data on File.
- Gilead Data on File.
- Gilead Data on File.
Peter Wickersham is Vice President and General Manager of Gilead Sciences, UK & Ireland
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