Sameh ElFangary – Country President GCC & Pakistan, AstraZeneca

Sameh ElFangary, Country President for GCC and Pakistan at AstraZeneca, highlights AstraZeneca’s alignment with, and commitment to, Saudi Arabia’s Vision 2030 and the opportunities that the Vision is creating. ElFangary also explains the significance of a new memorandum of understanding to create a clinical research hub in Riyadh and how the COVID-19 experience has underlined the Anglo-Swedish drug maker’s commitment to patients.

 

The world around us is changing and the burden of disease is increasing. We are responding by increasing our focus on growth through innovation – being more patient-centric, doing more with technology, digital and data, and advancing more cutting-edge science

Can you begin by introducing yourself to our audience, your decades-long experience in the industry, and transition to AstraZeneca?

I have more than 22 years of experience in the biopharma sector, the majority of these in leadership positions across the region, mainly in Saudi Arabia, the United Arab Emirates (UAE), and Qatar. I also had the opportunity to work at the company’s headquarters in the UK. I am a pharmacist by training and have an MBA, but my real passion is to be a true partner that is helping to build a strong healthcare ecosystem in this region.

I joined AstraZeneca a year ago because the company’s ambitions and core values, as well as its ‘growth through innovation’ strategy, stood out for me. There is perhaps no other company whose product pipeline better fits the region’s needs; it was an unprecedented opportunity for me. The GCC and Pakistan cluster is of strategic importance to AstraZeneca as we work closely with our partners to build and improve healthcare ecosystems through patient disease awareness, HCP education and engagement, local manufacturing and research innovation. This, coupled with the importance of GCC as a region with huge growth potential as well as exciting progress being made on the patient-centricity front, helped me make my decision.

 

There is a trend in multinational companies of hiring executives with previous experience in the region to lead the MENA cluster and Saudi in particular. Can you comment on the importance of having local expertise in this market?

The world around us is changing and the burden of disease is increasing. We are responding by increasing our focus on growth through innovation – being more patient-centric, doing more with technology, digital and data, and advancing more cutting-edge science.

Within the GCC, this strategy is coming to life through a keen partnership focus – we are establishing the right partnerships in both the public and private sectors in order to create a holistic healthcare ecosystem, to bring innovative treatments to patients across our key therapy areas.

The stakes are high in the GCC since its growth is fundamental to the success of the entire International region; it is a cluster in which countries, and Saudi Arabia in particular, welcome innovation. For that reason, our focus is on all of AstraZeneca’s main Innovation therapy areas: Oncology; Cardiovascular, Renal and Metabolism (CVRM); Respiratory and Immunology; and Rare Diseases. We have recently also launched a new business unit – Vaccines & Immune Therapies – which will be integrated into our GCC portfolio in the coming months.

None of this would be possible without having the right local experience and understanding of the complexities of these markets. While there is a growth momentum occurring, there is a certain level of volatility that must be factored in. Success in this part of the world comes from a careful understanding of how local dynamics fit within the global picture. Working long-term within this region, you acquire a fair level of resilience, nothing can surprise you since every day comes with an interesting mix of opportunities and challenges. However, from a long-term perspective, if you look at the GCC region over the last 20 years, you will see a steady growth trajectory.

My biggest experience on that front came while being at global headquarters where I worked across the international region, from Asia to Latin America, which provided me with a broader perspective. However, when you come back to this region, you always need to combine the global perspective with the very specific external perspective and local knowledge.

 

As the largest market in the region, how relevant is Saudi Arabia for AstraZeneca and how is the company aligned with Vision 2030?

Saudi is the biggest economy in the region, making it a high priority market. Besides the size of the market, the country has been undergoing a transformation, something AstraZeneca can appreciate after being here for 40+ years. Saudi Arabia has always been an important market, but Vision 2030 has introduced more avenues for partnership and led our company to establish a stronger local presence with global support.

Vision 2030 has also brought more incentives for localization and research innovation, thereby creating opportunities to bring long-term investment. Since the Vision is endorsed by strong leadership, we see an alignment across the country – including across the various ministries, institutions, and healthcare authorities – that have a common set of KPIs, making it easier for companies to invest with a fair assessment of predictability of returns.

Specifically, we are investing in localization with local manufacturing; we began with secondary packaging but stepped up quickly with full manufacturing in partnership with local organizations. Aligned with Vision 2030, AstraZeneca invested around USD 80m in local manufacturing, serving around three million patients across Saudi Arabia, with high-quality medicines that are highly relevant to local medical needs in the cardiovascular, diabetes and gastrointestinal disease areas. Alongside the innovation being localized, this investment will be a significant generator of local, high-skilled employment.

In addition, we recently signed a memorandum of understanding with the Ministry of Investment, the Ministry of National Guard Health Affairs, and with the support of the Ministry of Health, to create a clinical research hub in Riyadh. With this investment, the country will contribute globally with early stages clinical trials in the priority disease areas relevant to the Kingdom’s future healthcare needs, in line with the Kingdom’s health sector transformation program.

Finally, we are transforming the structure of the organization to fit the mandate of the Kingdom’s human capability program and creating a more vibrant society, with 100 percent of our field force now being Saudi nationals, 50 percent of them women. The percentage of women within the full organization is 30 percent and we are aiming to achieve gender equality by 2025.

 

How has AstraZeneca been operating in this part of the world and what is its current approach vis á vis the Saudi healthcare market during this transformative period?

Our current focus is on having business units and franchises that can drive earlier access to innovation, which translates into more investment in the clinical research team, market access, key account management and digital. From this point of view, medical capabilities continue to be an area that can evolve further because AstraZeneca is one of the few companies that can help build an ecosystem around the patient. We look at the patient journey, understanding the pain points and finding solutions that are not just about delivering medicine, but helping with diagnosis and compliance, for example. We want to break down barriers for patients, going beyond providing access at affordable prices across the region.

We have learnt a lot during the pandemic; enriching our digital capabilities will be a priority, both internally to enhance system efficiency and simplification, and externally for our interactions with stakeholders and healthcare practitioners. For example, if we used to provide around 20,000 education touchpoints annually, we are able to increase that number to close to 100,000 this year. We also encourage two-way conversation via our social media platforms, ensuring that patients are integrated into the decision-making process.

Internally, we are leveraging the interesting generational mix among our staff since Gen Z and millennials are 60 percent of our organization, people that are educated differently and are more digitally savvy. For them, we have different programs like reverse mentoring so they can receive training but also themselves train us as leaders to accelerate the organization’s digital journey.

Our learning digital journey is incredible and reflects our culture and core values, including putting patients first, following the science, playing to win, being entrepreneurial and doing the right thing.

The entrepreneurial mindset that exists at AstraZeneca – which means taking calculated risks, pushing the boundaries of science and not shying away from taking decisions that have a big impact on patients’ lives – is also a crucial part of what attracted me to the firm initially.

 

Can you elaborate on AstraZeneca’s presence in terms of portfolio?

Our therapy areas, Oncology; Cardiovascular, Renal and Metabolism (CVRM); Respiratory and Immunology; and Rare Diseases, are well represented in the market. We have adapted to Saudi Arabia’s fragmented healthcare structure, dealing with the MoH, the private sector and insurance companies, to achieve fair access across the fragmented healthcare system. That fragmentation has implications on the overall strategy since we must seek cooperation with all healthcare providers, the unified procurement body NUPCO, policymakers, and payors at different ministries.

As part of the patient journey, we identify access barriers and implement a partnership model, including subsidized access in some cases through patient support programs for critical medicines in areas like oncology. Also, we recently started working with the MoH on innovative value-based strategies, with outcome-based agreements.

Since we follow a science-based approach, we do not believe that we have too much competition but rather complement the offering of other companies, and we are all collaborating to provide the best outcomes for patients. Decision-makers understand the value that AstraZeneca brings to different therapeutic areas which we are leading.

 

What is the objective behind the recently signed memorandum of understanding and how will it improve Saudi Arabia’s R&D ecosystem?

Today we have 13 clinical trials in oncology, diabetes, cardiovascular and respiratory, but we want to bring in more early-stage trials for oncology, biologics, and rare diseases.

We agreed to assemble a task force with members of our company and governmental authorities to define specific KPIs for the investment and to expose the team to other R&D hubs around the world. Hopefully, the task force will get exposure to best practices and a deeper understanding of processes such as ethics committee approvals, international standards, and regulations. It is a holistic approach to create a local hub in Saudi Arabia. The ambition goes beyond the current number of trials that we are looking to triple in the next few years, to put the Kingdom on the global map of innovation and discovery of new medicines that best suit the local health priorities and future needs.

 

One of the most important developments for the company in the last year and a half has been that of its COVID-19 vaccine. Can you comment on the journey and how this has been reflected in Saudi operations?

Collaboration is central to our success. Our purpose is to push the boundaries of science to deliver life-changing medicines. Our way of working is inclusive, open and collaborative. We aim to create mutually beneficial partnerships founded on trust and partnerships. AstraZeneca is responding to the global pandemic in a manner consistent with its values, and our obligation globally to be part of the solution.

Recognising the urgent need for a safe and effective COVID-19 vaccine we partnered with the University of Oxford in April 2020. This landmark partnership brought Oxford University’s world-class expertise together with our global development and manufacturing capabilities. Together we committed to providing the vaccine broadly and equitably across the globe, at no profit for AstraZeneca.

AstraZeneca partnered with capable and established organisations across the globe, to ensure that the vaccine could be manufactured at pace and scaled to reach people in need as quickly as possible.

AstraZeneca was also the first global pharmaceutical company to join COVAX in June 2020. This global mechanism is working to accelerate the development, production and equitable access to new COVID-19 tools across the world for all participating countries, regardless of income level.

In the time that it took to develop and manufacture the vaccine, AstraZeneca continued working to ensure that there was uninterrupted access to medicines, which was not easy due to the changing dynamics of the industry during the pandemic.

Today, we have produced and released for supply more than 2 billion doses to more than 170 countries, including all GCC nations. Internally, we are proud to be a major supplier for low- and middle-income countries; approximately two-thirds of these doses have gone to low- and lower-middle-income countries, and around two-thirds of the COVAX supply has been from AstraZeneca.

In the GCC, we have supplied over 20 million doses, of which more than 14 million were supplied to Saudi Arabia. On that front, I would like to thank the Saudi FDA and other authorities in GCC that granted the vaccine an emergency approval. The Kingdom has achieved a vaccination rate of 70 percent and we are happy to be part of that milestone. We are also proud of our collaboration with King Salman Humanitarian Aid and Relief Centre to facilitate the donation of the AstraZeneca vaccine to countries that needed it the most.

 

Do you have a final message about Saudi Arabia and the future role of AstraZeneca in the market?

Saudi Arabia is a unique country to invest in and one that carries great leadership influence within the region. AstraZeneca is proud to be part of the future of Saudi and we have been inspired by Vision 2030 because it will help the entire GCC remain on the right path. I would like to keep the momentum of the country going in the coming years, getting closer to the resilience and sustainability of the broader healthcare ecosystem.

In terms of regulations and pricing, we need to strike the correct balance to continue attracting long-term foreign investment calling for more predictability and sustainability of the business cases. A move towards a value-based system and predictable incentives to investments is a better fit to the Kingdom’s vision than traditional pricing and procurement measures.


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