Fokion Sinis, Sanofi Vaccines’ General Manager for the Greater Gulf Multi Country Organisation, outlines some of the key impacts that the COVID-19 pandemic has had on the vaccine industry, the five ‘A’s of successful vaccination campaigns, and his ambitions for the future at a moment of great transformation for both Sanofi and the GCC region.
You have a very dynamic and international CV, having worked across several different functions and geographies. Could you begin by walking us through your journey up to this point?
My background is as a pharmacist and health economist. I was born in Canada, raised in Greece and then lived and worked in seven countries. I took a first career role in public affairs in Brussels, followed by a period with the European Medicines Agency in London. My journey in pharmaceuticals started with Novartis Oncology in Basel HQ in the function of Market Access & Pricing for emerging markets, followed by four roles with Novo Nordisk from Global Market Access to Africa commercial operations and BU Director in Spain. I joined Sanofi in 2018 with a commercial leadership role across portfolio for GCC and started my current role as General Manager for Vaccines for Saudi Arabia, UAE, Kuwait, Oman, Qatar and Bahrain last June.
What are Sanofi’s key vaccines within the GCC region today?
Sanofi is the market leader in the Greater Gulf (KSA, UAE, Kuwait, Qatar, Bahrain, Oman) in paediatric vaccines as well as vaccines for meningitis and influenza. For paediatric vaccines, our hexavalent six-in-one vaccine is now the standard of care in most of the GCC countries, and we also have a pentavalent vaccine for children of 18 months, as well as a tetravalent vaccine for children entering school. Additionally, Sanofi has vaccines for the adult population including, adolescents and pregnant women and is the only company that can bring a full acellular pertussis portfolio to the table.
We hold leadership in influenza vaccines in the GCC and 2021 was a record year for our quadrivalent influenza vaccine. 2022 will be the first year where all the countries in GCC will move from the trivalent to the quadrivalent vaccine.
We are also partnering with authorities to increase awareness and vaccination for mass gatherings like Hajj Prayer and the upcoming World Cup in Qatar.
The final part of our portfolio is our travel and endemic vaccines which protect from Rabies, Yellow Fever & Typhoid, also playing a part in our contribution to public health.
The COVID-19 pandemic has made vaccines into headline news; what do you see as the most important impacts of this period on the vaccine industry more broadly?
COVID-19 has dramatically changed public awareness of vaccines, which have become a topic of conversation for the entire population. We have also seen the biggest and most robust global vaccination effort in history, which triggered unprecedented levels of collaboration between public and private entities in healthcare, thereby setting new ways of working for the future.
While Sanofi is working on its own COVID-19 vaccine, expecting regulatory approval, I see several opportunities ahead of us in the vaccines market. The first one is that the growing public awareness of vaccines has led to a greater willingness on the part of the authorities to engage more with the industry on vaccination in general and how we can improve public health and national immunisation strategies. For example, the GCC countries were very successful in rolling out COVID-19 vaccinations, so we are now working with authorities to see how we can replicate this success in other areas, such as influenza.
Another opportunity, which is more global than local, is around mRNA technology, which COVID has catapulted into the limelight. Sanofi jumped into this opportunity and is now working on advancing mRNA technologies and adapting them for use in other settings outside of the pandemic. The company has created an mRNA Centre of Excellence and by 2025 we are aiming to have six mRNA projects in clinical development across our portfolio, with the intention to explore areas beyond vaccines.
Finally, Sanofi was the first to invest in evolutive vaccine manufacturing facilities. In the knowledge that vaccines are set to come to market more quickly than ever before, we were quick to invest in this new type of agile manufacturing facility, where three to four vaccines can be produced simultaneously. Greater flexibility in the manufacturing process will allow Sanofi to shift between vaccines and create better answers to the problems posed by future pandemics.
Part of the evolution in public discourse around vaccines has been in governments looking to achieve a level of vaccine independence for their populations. What is your take on the move towards localisation or regionalisation of vaccine manufacturing?
Obviously, Sanofi cannot put a manufacturing facility in every country in the world. However, here in the region we took bold action and are partnering with key countries in the region, such as the Kingdom of Saudi Arabia, where Sanofi considers itself a strategic partner in the Vision 2030 economic transformation plan.
In Saudi Arabia, we have partnered with local firm Arabio since 2019 and have already started localising the manufacturing of our vaccines, delivering three million doses of locally packaged vaccines in 2021. Sanofi continues to be committed to the Kingdom and as such we are exploring expanding our manufacturing footprint in the country.
Presumably, Saudi Arabia is by far Sanofi’s largest market in the GCC grouping?
Yes, it represents over 75 percent of turnover in the region. Beyond vaccines, Sanofi has a long-standing 50+ year presence in Saudi Arabia and also has a wholly owned manufacturing facility in King Abdullah economic city that produces more than 20 million packs of medicines every year.
In general, Sanofi offers what no other company can through its vast portfolio and broad range of vaccines, diabetes, cardiovascular, speciality and self-care products. We have a unique value proposition to the Saudi government as a strategic partner.
Our commitment goes beyond delivering innovation as we continue to help improve outcomes for patients through HCP education. In fact, from January 2020 to date, we have invested more than 12M SAR in activities related to HCP education. We are also reshaping medical research with Real World Evidence, initiating landmark clinical research projects in the Kingdom.
The pace of change in Saudi Arabia is monumental; how would you assess the level of readiness of local partners there for the future? Are there efforts that need to be made in terms of capacity building or knowledge sharing to bring everyone up to speed?
Stakeholders from the various authorities in Saudi Arabia are convinced and willing to move the dial. Every time I visit Riyadh, I am struck by the pace of change, showing that Vision 2030 is not just being written on paper, but enacted in reality. Moreover, in terms of technologically complex processes such as vaccine production, Sanofi is firmly committed to supporting local actors in Saudi Arabia to transform the country.
The rollout of vaccines is one thing, but uptake is another. You mentioned that the COVID-19 vaccine campaign has been quite successful in the Gulf so far, but are there any barriers inhibiting even greater vaccine uptake in your region?
Until a vaccination rate of 100 percent is reached, the work will never be complete. The Gulf countries have done amazing work on COVID-19 vaccination, but there’s always space for improvement.
We define success in vaccination rates across five “A’s” and they are: accountability of Health Authorities, access to vaccination, accountability of healthcare professionals, awareness of the public and appreciation of the value of vaccines.
Accountability for health authorities is very high in the region, authorities really take action and in countries like Saudi Arabia we can see one of the most modern vaccination schedules in the world.
On access, there are two main areas where we can work on making vaccination more accessible. One example, which is not as developed yet here in the region, but is in Europe, is pharmacy-based immunization. When implemented in Europe, vaccination rates rose because people could take a vaccine from a nearby pharmacist rather than having to go to the hospital.
The other one would be reimbursement of vaccines. COVID-19 vaccines were free, meaning that all barriers of out-of-pocket payment were removed, perhaps this could be an idea for other areas where vaccines are still being paid for out-of-pocket or where a financial contribution for vaccines are required. Removing any price tag for the vaccines could also be an element to improving access.
Additionally, another way of improving access could be to utilise or replicate the infrastructure created for COVID for other areas, such as influenza vaccines. We are already rolling out such a program in Saudi Arabia very successfully. Increasing the number of points at which patients can receive a vaccine will lead to greater access and this higher vaccination rates.
The third ‘A’, accountability of healthcare professionals, is at a very good level in the GCC, but we need to partner with authorities and key private hospitals to keep educating all healthcare professionals about vaccines; this should never stop.
The same goes for the awareness of the public, which rose during the pandemic, yet should not relent post-pandemic. We need to engage in continuous dialogue and education with the public beyond COVID about the value about vaccines and disease awareness. For example, people sometimes take influenza lightly, but this is a disease that causes a significant amount of mortality annually. Increased awareness will also allow the public and the payers to appreciate the value of vaccines, the final ‘A’.
At a moment of transformation within both Sanofi and within the GCC region, what are you most looking forward to achieving in the short- to medium-term?
I always tell my team to take a step back, think about why we wake up every morning, and why we should be proud of it. In 2021, almost 10 million people in the GCC were protected by Sanofi vaccines, a source of great pride which drives us forward. Our job here is to work with public health authorities and private players to increase vaccination rates so that we can improve public health and keep chasing the miracles of science to improve people’s lives.
This is for the current portfolio, but also looking into the future we have a very broad pipeline of innovative vaccines. Ten candidates are going to the clinic by 2025, six of which will use mRNA technology. Additionally, we are looking into getting flu to the next level with innovative flu vaccines and working on respiratory syncytial virus (RSV), the leading cause of hospitalisation for infants globally, with the aim of protecting all infants.
We are also looking into a pentavalent meningitis vaccine and into entering new areas like Pneumococcal or even unexplored fronts like acne and chlamydia.
Sanofi made a bold announcement at its last investor day of its aim to more than double sales by the end of the decade and this will reflect in our business in the region as well.
As someone that has risen through the ranks within the industry relatively quickly, what advice would you give to other young people starting out in pharma?
We should always be looking to stretch out of our comfort zones. What brought me here today are new experiences and a can-do, solution-oriented attitude; I always wanted to learn more about new geographies and functions. Agility and adaptability are so important in the world today and the traditional career pathway from sales rep to marketing to GM is no longer quite so relevant. The world is changing and people that go from one function to another, stretching themselves, learning new skills, and adapting to new realities in different geographies will be highly valued.
