Translating scientific breakthroughs into products that genuinely impact patients is more challenging than it has ever been. Only ten percent of drugs that enter clinical trials ever make it all the way to patients, meaning that much of the USD 250 billion spent on pharma R&D every year goes towards programmes that are eventually discarded.
At the heart of this conundrum is the chief scientific officer. CSOs must pinpoint and develop the best science, whether from internal programmes or, increasingly, through participation in in-licensing and M&A negotiations. In a world of high-stakes and high-complexity science, a good CSO must use their expertise to make tough decisions on which programmes to acquire, progress internally, out-license, or abandon. These decisions, shaped by science but always with patient impact and market potential in mind, can be the difference between a successful pharma and an also-ran.
I was delighted to be asked to dive into the key issues facing the modern CSO at the recent Asia Summit on Global Health in Hong Kong. Joining me on stage to discuss the evolution and future direction of the role were four CSOs, from four very different organisations – a Hong Kong-listed ophthalmology company, a Chinese pharma conglomerate, an Australian not-for-profit, and an ASX-listed regenerative medicine spin-out. Between them, these represent almost every model the industry has developed for getting science to patients.
Despite the various non-scientific tasks that CSOs must deal with, Dr Lau Lit Fui still sees himself as a “scientist at heart.” Lau, a neuroscientist by training, spent nearly two decades at Pfizer’s global R&D site in the US and since 2019 has led Zhaoke Ophthalmology, a Hong Kong-listed Lee’s Pharmaceutical spinout, as its president and CSO. “I am able to use my scientific perspective to ask questions about assets that others may not and to evaluate opportunities,” he said.
Even for the CSOs of much larger companies, such as major Chinese conglomerate Fosun Pharma, science is still king. However, Dr Li Xiang – who spent over two decades in R&D with Boehringer Ingelheim in the US – did admit that today, between 30 to 40 percent of his time is spent on business rather than science. Fosun has been extremely active on this front in recent years, out-licensing a GLP-1 programme to Pfizer for a deal potentially reaching USD two billion in December 2025 and in-licensing an Alzheimer’s programme from South Korean biotech AriBio for up to USD 4.7 billion earlier this month.
“Science is still at the foundation of all these business dealings,” said Li, who serves as the company’s SVP, co-president and CSO of Innovative Medicines as well as co-president of its Global R&D Center. “The fundamental driving philosophy is value creation. If you out-license a product to a big company like Pfizer, obviously you have income – that’s value creation right there. And it’s a shorter way of getting your return compared to developing it all the way to the end yourself.”
There is also the question of resource allocation. For example, Dr Li explained that, as Fosun’s core areas are oncology, immunology and CNS, out-licensing a cardiovascular/metabolic programme – as in the Pfizer deal – made sense “as more dominant and specialised players can help the product reach the global market better and faster.”
For Lau, a big chunk of his current role is choosing the right partners for Zhaoke’s international expansion efforts; the company currently has a presence in 18 countries across Asia-Pacific, the Middle East and Europe. “It’s very important to find the right partner – one that understands registration, sales and marketing. We look at their background and experience in ophthalmology, their regulatory capabilities, whether they have existing ophthalmology products and existing sales channels,” he explained.
Meanwhile, for CSOs of smaller companies and start-ups, especially those on whose research the company’s products are based, the role is different again. Unlike career scientists parachuted into existing organisations, these CSOs have an even closer relationship to the science and need a strong mix of skills to take their ideas from bench to bedside.
“You’ve got to be passionate, have an entrepreneurial spirit, understand the unmet need you’re trying to address, and have scientific judgement,” said Professor Zheng Minghao, a Chinese-born regenerative medicine specialist based out of the University of Western Australia in Perth. Zheng still serves as an advisory CSO at Australian Securities Exchange (ASX)-listed Orthocell, the company he co-founded in 2007 and which received a first FDA clearance for its nerve repair product almost 20 years later, in 2025.
Zheng was also keen to note that, although he has stayed the course with Orthocell, as CSO of a smaller company, “you are constantly looking for exit strategies.” He added, “As a CSO, you are always explaining to potential partners: what is our value, why is this better, where is our advantage? That is the CSO’s role as much as the CEO’s.”
Like Zheng, Professor David Thomas maintains an academic position alongside a CSO role, although his organisation – the Australian precision oncology clinical trials network Omico – sits in the non-profit rather than commercial space. Thomas – director of the Centre for Molecular Oncology at the University of New South Wales in Sydney and Omico’s chief science and strategy officer – has devoted his career to sarcoma and rare cancers and feels having a foot in the academic world is crucial to keeping patients front and centre.
“I chair the molecular tumour board and will review up to 40 pages of patient results in a normal week,” he said. “That is a very good way of becoming familiar with exactly what the consequences of your scientific strategy are and helps you understand where the unmet need is, which is critical to making good decisions for the next steps.”
This issue of keeping patients at the forefront is no mean feat for CSOs with so many plates to keep spinning, especially those, like Lau and Li, whose background is in discovery science rather than as practicing clinicians. “I have had to get out of my comfort zone and grow,” admitted Zhaoke’s Lau. “When you look at a drug, you don’t only look at the mechanism, you also look at the market size, how many patients are affected, what the medical need is, how it’s different from the current therapy, and how much value it will add. Patient compliance is also very important; that adds to the value of the product.”
For Zheng, patient-centricity in the CSO role means pursuing true, game-changing innovation and not just chasing incremental me-too products, especially given the eventual costs involved. “The number one rule is that patients must be able to afford what you develop. When you consider the technology, however sophisticated it is, if the clinical outcome is similar – even if it has a different mechanism – I would not develop it,” he said.
“In our business it’s very important to begin with the end in mind,” added Fosun’s Li. “Patient needs and market needs must be considered when you set up the discovery programme. In my earlier career, I spent most of my time in discovery where you can think you’ve done a wonderful job based on the mechanism – but when you think about the clinical setting, what disease can this mechanism actually work in?”
For all the complexity of the modern CSO role – the dealmaking, the partner selection, the resource allocation decisions – the panellists were united on what ultimately drives them. “Drug discovery is a very long process, very complicated, full of frustrations and dark moments,” reflected Li. “The patient’s need is really the light in the darkness you are aiming for.” Regardless of the model through which the science is commercialised, that, it seems, remains the constant.
