Jean-Luc Belingard, president of FEFIS (Fédération Française des Industries de Santé – French Federation of the Health Industry), explains his role following up on the implementation of the CSIS (Conseil stratégique des industries de santé – Strategic council of the healthcare industry) and speaks out about the competitiveness of the French healthcare sector on a global scale.
The best investment is in healthcare and the Macron administration has been made aware of this
What is your assessment of the current state of healthcare in France?
There are actually very few fully-fledged, high-performance healthcare industries around the world with the most important ones being the USA, Japan, Switzerland and Germany, while France remains a very significant player in this race. Healthcare is at the centre of the economic life of each and every one of these countries. It delivers both a social and economic dividend to the nation on top of the obvious medical benefits for patients. Indeed, countries that possess a well-functioning healthcare system gain a significant competitive advantage. It has been documented that when the life expectancy of the population of a country is raised by one year, the GDP of the country will rebound by as much as 0.6%. Hence, there is a clear correlation between economic success and social welfare as defined by the health scenario in a country. The best investment is clearly therefore in healthcare and the Macron administration has been made aware of this, which is actually one of the reasons why I have been appointed to oversee the implementation of the actions that have been agreed upon at the 8th strategic council of the healthcare industry (CSIS) earlier this year.
How significant is France’s strong legacy in clinical research and medical scientific discovery in contributing to this dynamic ecosystem?
It is absolutely true that France has historically enjoyed a very robust clinical culture and the standards of clinicians in this country still surpass those of heavyweight markets like the US and China. If you analyze the prevailing trends in medical science, however, there has been a noticeable shift of emphasis towards predictive technology and digital software to the point where you could even argue that, in certain instances, clinical culture is becoming supplanted and substituted. There is a real danger of becoming too reliant on some of these technologies, but it is certainly having the effect of altering the balance of power.
The characterization of a doctor’s diagnosis has two main sources, which determine its quality: the clinical one and the technical one. My assessment is that France has found a good compromise in this area and still lays claim to one of the world’s best healthcare systems, underpinned by an excellent educational system. The time has, therefore, come to leverage these assets in assembling a world-class life sciences industry
The downside to France’s healthcare scenario is the bloated state bureaucracy, which risks inhibiting the performance of our national life sciences industry. The French administration remains highly present in domains like scientific research and while this can sometimes be very constructive it can also have its drawbacks. One of the primary reasons for holding the CSIS is precisely to remove some of these shortcomings and ensure that policy-making and execution help foster an operating environment whereby life sciences enterprises can easily flourish and realize their full potential.
You mentioned that you have been tasked by Prime Minister Édouard Philippe to supervise the implementation of the 8th CSIS. How important is it to actually have someone representing the industry in this position tracking this progress made?
This is a hugely significant and symbolic step, which demonstrates that the authorities are serious about delivering upon their promises and converting action into words. The previous editions of the CSIS have been one-off meetings that have been running every two years. This year’s CSIS has been different in the sense of having established a series of follow-up meetings every two weeks. We witnessed Presidents in the past that have promised to invigorate industry, liberalize the economy and unleash entrepreneurialism but have ultimately failed to implement the necessary reforms. This time around, however, as far as the life sciences industry is concerned there is now a roadmap and clear vision in place for going forwards. This time the authorities will not be allowed to take their eye of the ball and will be held to account in the delivery of their promises.
The life sciences and healthcare industry, not only in France but also more generally, tends to work in cycles of eight to ten years, while governments, in contrast, usually have a one-year cycle involving the passing of an annual budget. This divergence of interests and timeframes is often the root cause of a lot of friction between the pharmaceutical developers and the state. Our job is to bring innovative products to the market that promise to improve the situation in five to six years, while the government is more concerned with balancing the budgets for this year. This year’s CSIS has been very unique as it comes up with a very pragmatic, logical and sequential approach to solving these discrepancies.
The initial industry reception of this year’s July CSIS was overwhelmingly positive. It was hailed as offering a potential turning point for the future attractiveness of the French life science’s industry. What would you say were the main takeaways?
The main achievement has been the recognition of the healthcare sector as a strategic element of this country’s economic fabric by the government. This is a big practical step, as we have not been considered as a strategic asset in the past, but as a cost burden. This re-conceptualizes the way that policymakers view public health: namely repositioning it as an area that is worthy of sustained investment.
Secondly, we have worked for the last six months to recognize all the issues related to governance and regulation, which may hinder the competitiveness of the life sciences industry. Together, with the authorities, we have flagged up and identified 60 problem areas or bottlenecks encompassing market access, clinical research, approval timeframes and much more besides. Then, at the CSIS, we started working on concrete initiatives to unblock these bottlenecks and we are now meeting every two weeks with the requisite government officials to implement each measure in turn. Additionally, we scheduled meetings with Prime Minister Édouard Phillippe every two months, to verify that progress has been made, and to ensure that we have sustained backing right from the top.
Everything is mapped out in a very transparent and systematic way. We have created a table where we have listed the 60 issues and the mitigating actions to be taken. Noted down also is the responsible authority and the person in charge of following up on the changes made on behalf of the industry. Ultimately it is a very simple process and in two years time, we will begin to see tangible results. Meanwhile, we continue to monitor the individual steps on a two-week basis. The intention is to have resolved each and every one of these 60 points within a period as short as possible. There are even performance indicators attached to each of the measures to demonstrate to the authorities the benefits to be derived from enacting the changes. This is to ensure that there will be no backtracking.
Presumably, there are other additional adjustments or reforms that you feel are still needed and remain outside the scope of the CSIS. What is still missing beyond the 60 measures agreed upon in July 2018?
There are quite a few issues that we haven’t yet managed to secure agreement on and the measures agreed during this year’s CSIS are by no means meant to represent a closed box. If we discover that, along the way, additional measures are going to be required, then there are alternative mechanisms in place so as to still be able to implement them. Already we are engaging in a process that we call horizon scanning, which includes the long-term perspective of our industry. We possess many tools for forecasting, as we understand the industry’s pipeline and the unmet medical needs. Therefore, we are trying to think beyond the one-year budget perspective and contemplate budget needs for five years ahead taking into account how we believe drug development pipelines will evolve.
Is the French research apparatus fit-for-purpose when it comes to being at the forefront of future advancement in medical science and then commercializing those discoveries?
We do possess a lot of early-stage science institutes within the CNRS (Centre national de la recherche scientifique – National Center for Scientific Research) or the INSERM (Institut national de la santé et de la recherche médicale – National Institute of Health and Medical Research), but the connection with the industry is not as harmonious or seamless as it should be. The difference is stark when you compare it with the relationship between academia and industry enjoyed in the US for example. While the CSIS is aiming to improve this interface much more needs to be done to incentivize and promote the translational aspect of scientific research.
There is also a cultural dimension to surmount as institutes in France do not have the same entrepreneurial mindset or instinct as do their counterparts in the US, which, in itself, produces a lack of fluidity. In the US, scientists tend to work in the industry and then go into research and vice versa. There is no rigid contractual frame. In France, however, industry and research seem to inhabit very different worlds. We see many lifelong positions in research in France, which can be good on the one hand as it allows researchers to undertake more risks. On the other hand, not everyone ending up in a lifelong research position might be the perfect fit for consciously driving through progress. Rethinking career management in the research community is a very important issue here, as it is not facilitating interactions between the academic and business spheres.
In the new world of big data and digital healthcare, in which areas can France become a true leader and pioneer?
France’s centralized infrastructure and universal healthcare system lend themselves to being at the forefront of the genomics revolution and the concept of personalized medicine. Artificial Intelligence (AI) is another area where we are striving to become a first-mover and leader. Already a national strategy has been drawn up to this effect. Applying AI to healthcare is a fundamental development, especially in the imaging space.
Do you have any concluding remarks for our international readers?
I am highly optimistic about the value of this year’s CSIS and the readiness of the Macron administration to enact meaningful reform in the life sciences sector. We now have a clear vision that crucially entails a mechanism of action that is functional. We will undoubtedly encounter hurdles and obstacles along the way, and it is of utmost importance that economic policy and budgetary decisions are coherent with the measures unveiled during the CSIS, but I am confident that we have the right mechanisms and processes in place to be able to prevail.