AstraZeneca's recently arrived Switzerland country president, Katrien de Vos, gives her first impressions of the Swiss market and how she hopes to build upon the affiliate's strong performance. de Vos also touches on access challenges (and how to surmount them) as well as AstraZeneca Switzerland's role in bringing the company's COVID-19 vaccine to the country once regulatory approval is granted.
Katrien, you took on your first country president position at AstraZeneca Switzerland in November 2020 after some time in the US. Given that this move occurred in the middle of the pandemic and with AstraZeneca as front-page news due to its COVID-19 vaccine, what mandate were you given and what priorities have you set?
It is true that this move occurred in special times, not only because of our vaccine but also because of a wider change in how we connect and are organised due to the pandemic. However, in terms of onboarding, you cannot miss the fundamentals or get distracted from your mandate. Getting to know our people – whether virtually or not – has been crucial. I have prioritised understanding their motivations, what drives them, and how I can help them achieve their objectives.
Quickly getting up to speed with the business and the specifics of the Swiss market has also been a priority. I have tried to meet as many stakeholders as possible and not be inhibited by the fact that many of these interactions are now occurring virtually.
AstraZeneca’s goal is to bring innovative medicines to the market; therefore, we must be excellent at creating access. The access environment is challenging everywhere in the world, including in Switzerland, and we, therefore, work to put in place the best regulatory and market access teams in the industry and ultimately bring innovative therapies to the market in a way that is sustainable for the system, as well as for us. On this front, AstraZeneca Switzerland has been performing quite well – we had the third-highest number of products of any company added to the Swiss reimbursement list last year – and we will continue to prioritise this, drawing on our excellent pipeline.
Beyond that, there is an increasing focus on the use of digital tools and data analytics that has been accelerated by COVID. Having a deep understanding of the ongoing trends in this field and how as a business we can evolve, work with, and be at the forefront of them is vital.
A final important area is evidence generation. As well as bringing innovative medicines to market, we are also driving continuous improvement in local evidence generation and understanding how our medicines can best be applied in a Swiss healthcare setting. AstraZeneca currently has 53 clinical studies and real world evidence initiatives running in Switzerland, 40 of which are in oncology, which we will continue to build on.
What have been your first impressions of your team and the ecosystem more broadly in Switzerland?
I have been extremely impressed by our team, which is made up of highly experienced, skilled and passionate people. They made me feel very welcome from day 1 and helped my onboarding in every way they could. The Swiss pharma labour market, in general, is extremely competitive, and we will continue to work hard to attract and retain top talent.
In terms of the Swiss healthcare system itself, I have been struck by its patient-centricity. In general, doctors here can choose what they consider to be the best treatment option for a particular patient. Quality of care is very high and usually also access, even though for innovative medicines, we do see that there are increasing delays when it comes to their inclusion in the reimbursement list. But overall, the Swiss healthcare ecosystem in my mind is a fabulous basis to build upon.
AstraZeneca Switzerland is operating in the home market of some oncology giants. Against this backdrop, how is the affiliate positioning itself and how is your oncology portfolio performing in Switzerland?
We have one of the most diverse portfolios and pipelines in the industry, spanning across six scientific platforms. We are striving to make cure a reality for the millions of people across the world living with cancer every day. Early detection is the goal, but unfortunately it isn’t always the reality. For many people, cancer goes undetected until it is in advanced stages, or returns after initial treatment. We also seek to create medicines and combinations aiming to combat metastatic and resistant disease, and achieve meaningful responses.
Also in Switzerland, our oncology portfolio with currently nine oncology drugs continues to grow. Our focus is on some of the most hostile and hard-to treat cancers including lung, breast, ovarian and certain blood cancers. We have a strong commitment to local clinical research and collaborate with key organisations and research groups in Switzerland to advance clinical and real world data. As well as institutional collaborations, we also work with patient organisations to advance early diagnosis and patient care.
What is the reason for locating clinical trials in Switzerland and what have been the challenges of maintaining these trials during the COVID-19 pandemic?
Increasingly, we are locating Phase III trials here based on the expertise in the Swiss centres. Although Switzerland is not the largest market, it continues to play a key role in AstraZeneca’s strategy in part due to this expertise.
There has been a huge focus from our clinical teams around the world on clinical trial continuity. Ensuring the continued safety of patients in all our ongoing clinical trials is our key objective, while activating continuity plans in order to minimise trial disruption from the pandemic. Our mitigation strategies include home-based treatment and monitoring options, moving patient recruitment to less-affected regions, and planning for accelerated recruitment once the pandemic has receded.
Market access seems to be getting more challenging in Switzerland, with greater emphasis on cost containment from the FOPH. What has been your experience of attempting to bring innovations to market so far?
Everywhere in the world, including Switzerland, healthcare budgets are under pressure. As an innovative biopharmaceutical company, it is a conversation we cannot avoid; we all benefit from a high quality and sustainable healthcare system.
In Switzerland, the healthcare budget is increasing but the share of this budget dedicated to medicine has remained stable, despite the amount of innovation that we have brought to market. Switzerland already has some control mechanisms in place, with regular price reviews which control price levels and – as also stated by our Health Minister – generate savings of CHF one billion per year.
Additionally, when innovation is brought to Switzerland it is often benchmarked against existing therapies, which tend to be older and with lower prices. We are active engaging in debate to ensure that innovation is still sufficiently rewarded so that we can continue to increase quality of care.
AstraZeneca country managers in other geographies are often keen to position the company as at the forefront of innovative thinking in terms of value-based contracts and negotiations. Does this hold for Switzerland as well?
Yes. In many of our reimbursement interactions with our payer authority , we are proactive in proposing value-based concepts. We have been successful on a few occasions, but we have also been unsuccessful on others. Looking ahead, we are working on demonstrating and building understanding that value-based concepts can be a win-win in terms of risk sharing and providing innovation in a sustainable way.
On a positive note, the Swiss system allows for this relatively simply, although it is somewhat of an administrative burden. The infrastructure is in place to monitor individual patient outcomes and to adjust therapies based on this information; something we struggle with in many other countries.
However, the fact that Switzerland lacks a single centralised medical record system is an issue in this push. Both government and industry recognise that creating this system would be beneficial in terms of conducting good data analysis on a population basis, although there are barriers in place to its implementation.
Swissmedic is one of the few leading regulators not to grant early access approval to the AstraZeneca/Oxford Institute COVID-19 vaccine. Did this come as a surprise to you?
Swissmedic is an independent regulator that makes its own decisions. We respect the fact that they asked for additional evidence, specifically from a large randomized clinical trial. The company recently completed such a trial in the US, which will give Swissmedic a much larger data set to base their approval on.
As country lead, to what extent is delivery of these vaccines in Switzerland part of your responsibility?
It is our responsibility to obtain regulatory approval in Switzerland and that the product is quality controlled according to all applicable standards before we release it. However, Switzerland has a three-way contract with the EU and AstraZeneca through which the country is provided with the vaccine, upon approval. In that sense, we deliver the product to the Swiss government, which is then responsible for its distribution.
AstraZeneca has taken a huge reputational risk developing this vaccine. Is this something you reflect on with your team?
It has been good to remind ourselves of our common purpose. I am proud to work for a company that has the skills and motivation to be able to react to a pandemic and make a difference, developing this vaccine and distributing it at cost. It showed courage and entrepreneurialism, the same values that we are asked to display.
This vaccine is not only for high-income countries like Switzerland and the work does not stop when Switzerland becomes vaccinated. Until everybody in the world is safe, we will continue to work with this common goal front and centre.
How do you balance this mammoth vaccine effort with your existing product lines to ensure other areas do not get left behind?
This is an important point. COVID has taken up a lot of time and effort, but our other disease areas – from respiratory to immunology; cardiovascular, renal and metabolism; and oncology – remain equally important. Unmet needs in these areas remains high and in some even higher due to the pandemic. It is vital that we continue to set high standards in all our work.
What would you like to achieve during your tenure in this, your first country lead position?
Switzerland is a pharma hub and full of competitive workplaces, but we have the tools to make AstraZeneca Switzerland the most vibrant workplace in the industry. We have been awarded Great Place to Work certifications for four years in a row, something I want to maintain and even improve on. Of course, we do not have the same volume of employees as other companies but given our pipeline, collaboration, and spirit for innovation, we can be a truly exciting workplace.
Also important is further increasing our stakeholder outreach and establishing ourselves as a credible partner among the entire healthcare ecosystem, from physicians to patient organisations, insurers, scientific institutions, and even biotech start-ups.
Do you have a particular strategy in place for collaboration with biotech start-ups?
Globally, AstraZeneca has several innovation hubs where we give physical and financial support to start-ups. For our region, these hubs are in Sweden and Israel, but in Switzerland we still collaborate frequently with start-ups.
As an example, in respiratory care we are working with a start-up that has created a disease management platform; a tool for respiratory patients to monitor their disease outcomes in correlation with environmental and allergic factors as well as therapy adherence. This gives a more holistic view of a disease’s evolution and allows more accurate prediction of its future development.
Are there any projects you would like to push through at AstraZeneca Switzerland, drawing on your experience in the US and elsewhere?
To me it is important to understand how patients in Switzerland navigate through their healthcare and the challenges they and their physicians face, and then develop and where possible co-create solutions that are tailored to this market, rather than copying and pasting solutions from other geographies.
But of course, some of my experiences inspire ideas that we can implement in Switzerland. In the US, but also in countries like China, we worked with physicians and patients to deploy excellent digital tools for rapid diagnosis and patient interactivity. The uptake of these solutions by physicians and patients is very fast. We must ensure that we stay ahead of the curve in Switzerland too, and focus on creating resilient and sustainable health care systems, through and beyond the pandemic.
